• Manuel Zorzi, Giulio Antonelli, Claudio Barbiellini Amidei, Jessica Battagello, Bastianello Germanà, Flavio Valiante, Stefano Benvenuti, Alberto Tringali, Francesco Bortoluzzi, Erica Cervellin, Davide Giacomin, Tamara Meggiato, Erik Rosa-Rizzotto, Diego Fregonese, Manuela Dinca, Gianluca Baldassarre, Paola Scalon, Maurizio Pantalena, Luisa Milan, Gianmarco Bulighin, Daniele Di Piramo, Maurizio Azzurro, Armando Gabbrielli, Alessandro Repici, Douglas K Rex, Massimo Rugge, Cesare Hassan, Veneto Screening Endoscopists Working Group, Anna Giacomin, Andrea Buda, Deborah Costa, Davide Checchin, Renato Marin, Elisabetta Patarnello, Aldo Ceriani, Ennio Guido, Perla Bertomoro, Nicoletta Merlini, Francesca Murer, Ephrem Ntakirutimana, Luca Benazzato, and BellocchiMaria Cristina ContiMCC.
• Veneto Tumor Registry, Azienda Zero, Padova, Italy (M.Z., C.B.A., J.B.).
• Ann. Intern. Med. 2023 Mar 1; 176 (3): 303310303-310.

BackgroundColorectal cancer (CRC) screening programs based on fecal immunochemical tests (FITs) represent the standard of care for population-based interventions. Their benefit depends on the identification of neoplasia at colonoscopy after FIT positivity. Colonoscopy quality measured by adenoma detection rate (ADR) may affect screening program effectiveness.ObjectiveTo examine the association between ADR and postcolonoscopy CRC (PCCRC) risk in a FIT-based screening program.DesignRetrospective population-based cohort study.SettingFecal immunochemical test-based CRC screening program between 2003 and 2021 in northeastern Italy.PatientsAll patients with a positive FIT result who had a colonoscopy were included.MeasurementsThe regional cancer registry supplied information on any PCCRC diagnosed between 6 months and 10 years after colonoscopy. Endoscopists' ADR was categorized into 5 groups (20% to 39.9%, 40% to 44.9%, 45% to 49.9%, 50% to 54.9%, and 55% to 70%). To examine the association of ADR with PCCRC incidence risk, Cox regression models were fitted to estimate hazard ratios (HRs) and 95% CIs.ResultsOf the 110 109 initial colonoscopies, 49 626 colonoscopies done by 113 endoscopists between 2012 and 2017 were included. After 328 778 person-years follow-up, 277 cases of PCCRC were diagnosed. Mean ADR was 48.3% (range, 23% and 70%). Incidence rates of PCCRC from lowest to highest ADR group were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10 000 person-years. There was a significant inverse association between ADR and PCCRC incidence risk, with a 2.35-fold risk increase (95% CI, 1.63 to 3.38) in the lowest group compared with the highest. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (CI, 0.95 to 0.98).LimitationAdenoma detection rate is partly determined by FIT positivity cutoff; exact values may vary in different settings.ConclusionIn a FIT-based screening program, ADR is inversely associated with PCCRC incidence risk, mandating appropriate colonoscopy quality monitoring in this setting. Increasing endoscopists' ADR may significantly reduce PCCRC risk.Primary Funding SourceNone.

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