Unacceptable variation in screening colonoscopy

Heisser and colleagues’ (doi:10.1136/bmj.l6109) linked meta-analysis of colorectal cancer and adenoma prevalence in the years following a negative colonoscopy shows that while neoplasms (including adenomas) were observed in more than 20% of participants within five years, advanced neoplasms were rare even after 10 years (2.1% in men, 1.8% in women).1 The authors concluded that a 10 year screening interval after negative colonoscopy, as currently recommended,2 could be adequate.1

In a second paper, Burr and colleagues (doi:10.1136/bmj.l6090) quantify rates of colorectal cancer up to three years after a negative colonoscopy in England.3 They report a decreasing incidence of post-colonoscopy cancers over the period of investigation (from 9.0% in 2005 to 6.5% in 2013), but highlight statistically significant variation between colonoscopy providers. Specifically, they find higher rates of post colonoscopy cancers following privately provided colonoscopy, after controlling for certain confounding factors (adjusted odds ratio 1.63 (95% confidence interval 1.39 to 1.91), P<0.01). Rates were also higher among women, older …