Postcolonoscopy Colorectal Cancer 3-year Rates Decline
Following its introduction of a standardized methodology for calculating postcolonoscopy colorectal cancer-3yr (PCCRC-3yr) rates in 2018, the World Endoscopy Organization (WEO) conducted a systematic review to determine the global PCCRC-3yr rate according to its methodology, assess changes over time, and evaluate risk factors associated with PCCRC occurrence.
A comprehensive literature search of 5 databases was conducted from inception through January 2024, identifying studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated, and subgroup analyses were performed to assess trends over time and risk factors influencing PCCRC-3yr rates.
Despite numerous studies failing to meet WEO criteria, 8 studies from 4 Western European and 2 North American countries were included in the analysis, encompassing 220,106 detected colorectal cancers (CRCs) and 18,148 PCCRC cases between 2002 and 2017. The pooled PCCRC-3yr rate in these regions was 7.5% (95% CI, 6.4%–8.7%). A statistically significant decline in PCCRC-3yr was observed over time, decreasing from 7.9% (95% CI, 6.6%–9.4%) in 2006 to 6.7% (95% CI, 6.1%–7.3%) in 2012 (OR, 0.79; 95% CI, 0.72–0.87; P < .05).
Several risk factors were associated with higher PCCRC-3yr rates. Patients with inflammatory bowel disease had the highest risk, with a PCCRC-3yr rate of 29.3% (OR, 6.17; 95% CI, 4.73–8.06). Those with a history of prior CRC also exhibited an elevated PCCRC-3yr rate of 29.8% (OR, 3.03; 95% CI, 1.34–4.72). Additional risk factors included proximal CRC (PCCRC-3yr, 8.6%; OR, 1.51; 95% CI, 1.41–1.61), diverticular disease (PCCRC-3yr, 11.6%; OR, 1.74; 95% CI, 1.37–2.10), and female sex (PCCRC-3yr, 7.9%; OR, 1.15; 95% CI, 1.11–1.20).
This study underscores a reassuring decline in PCCRC-3yr rates over time; however, further research is needed to understand the underlying causes, particularly among high-risk populations. To facilitate greater adoption of the WEO methodology and ensure consistency in future PCCRC-3yr studies, a standardized WEO methodology checklist was developed.
Reference:
Kader R, Hadjinicolaou AV, Burr NE, et al. Systematic review and meta-analysis: the three-year post-colonoscopy colorectal cancer rate as per the World Endoscopy Organization methodology. Clin Gastroenterol Hepatol. 2025;23(4):519-530
