Clarification on editorial

We were pleased to see our article on detection of colorectal cancer (CRC) during surveillance [1] referred to in the editorial by Rodrigo Jover [2]. Although we completely agree with the key points on the importance of colonoscopy quality, we need to highlight certain misunderstandings.

It is stated that we only included type B post-colonoscopy CRCs (PCCRCs). This is not correct, as we state: “Participants were followed from their FIT-screen-derived colonoscopy until detection of PCCRC, surveillance colonoscopy, or end of the timely surveillance interval, whichever came first.” Thus, the cancers detected were interval PCCRC or type A PCCRCs (detected before or at surveillance). Unfortunately, we were unable to distinguish between interval and type A PCCRCs as indication for follow-up (surveillance or not) were not reported consistently.

Furthermore, the editorial stated that the detected incidence of PCCRC in Denmark was much higher than what has been found in other studies. As we stated in the article, our incidences were 0.58% and 0.37% in the intermediate and high risk groups, respectively (at 3 years and 1 year of follow-up, respectively) if we include all those eligible for surveillance as the denominator instead of all those who had follow-up examinations during the surveillance period. These numbers are similar (and calculated similarly) to the 0.63% CRC incidence at 3 years’ follow-up reported in the meta-analysis by Zhang et al. [3]. Zorzi et al. reported lower rates (0.22% after 3 years) from an Italian fecal immunochemical test-based screening program, but their younger population and lack of information on surveillance adherence make direct comparison difficult [4].

We believe that these points are important to clarify to avoid inaccurate interpretations of our data and results.

Enhancing the quality of colonoscopies is crucial, and we are pleased to confirm that both adenoma detection rate and sessile serrated lesion detection rate have significantly improved in recent years within the Danish CRC Screening Program.

Publikationsverlauf

Artikel online veröffentlicht:
22. April 2025

• References

• 1 Larsen PT, Jørgensen SF, Hagemann-Madsen R. et al. Detection of colorectal cancer and advanced neoplasia during first surveillance interval after detection of adenomas in fecal immunochemical test cancer screening: a nationwide study. Endoscopy 2024; 56: 853-861
• 2 Jover R. Surveillance after polyp removal: quality really matters. Endoscopy 2024; 56: 862-863
• 3 Zhang Y, Wang X, Zhang W. et al. Incidence of colorectal cancer at different screening intervals after index colonoscopy and post-polypectomy: a meta-analysis of 811,181 participants. Expert Rev Gastroenterol Hepatol 2022; 16: 1101-1114
• 4 Zorzi M, Battagello J, Amidei CB. et al. Low colorectal cancer risk after resection of high-risk pedunculated polyps. Clin Gastroenterol Hepatol 2024; 22: 1518-1527.e7