Masterclass: Colorectal Screening Plus (On-Demand) | September 2025-Shaukat Quality indicators screening tests

Shaukat Quality indicators screening tests

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This presentation by Dr. Aasma Shaukat from NYU Langone Health emphasizes the critical importance of quality in colorectal cancer (CRC) screening programs, focusing on stool-based tests and colonoscopy quality indicators.<br /><br />For stool-based screening, especially fecal immunochemical tests (FIT), establishing clear protocols for sample handling and patient education is vital. Key quality indicators include high completion rates (>60%), low rates (<5%) of unprocessable tests, and colonoscopy completion (>80%) following positive FIT results. The US Multi-Society Task Force (USMSTF) recommends single-sample FIT over guaiac-based tests due to better adherence and stresses repeated annual testing and timely colonoscopy follow-up to prevent CRC.<br /><br />Colonoscopy quality indicators are well-defined and evolving. Important metrics include cecal intubation rates (≥90%), adequate bowel prep (≥85-90%), adenoma detection rate (ADR) benchmarks (35-45% depending on indication and age), sessile serrated lesion detection rate (~6%), withdrawal time (8-9 minutes), polyp resection documentation (≥98%), and adherence to surveillance guidelines (≥90%). Higher ADR is linked to reduced risk of post-colonoscopy CRC and death.<br /><br />Challenges include poor follow-up after abnormal stool tests (24-55% completion rates) and incomplete polyp resection, which increases future neoplasia risk. Techniques such as rigorous withdrawal inspection, proper resection methods (cold snare for 4-9mm polyps), and advanced technologies like computer-aided detection (CADe) can improve outcomes. Multifaceted interventions combining education, technique, and technology are recommended.<br /><br />Quality programs should involve continuous monitoring, report cards for endoscopists, and public transparency. The evolving landscape requires GI physicians to engage in patient education, ensure high-quality exams, advocate for access, and collaborate with PCPs and payors.<br /><br />In summary, quality in CRC screening is a continuum demanding rigorous, systematic measurement and improvement of stool-based tests and colonoscopy practices to reduce CRC incidence and mortality effectively.

Keywords

colorectal cancer screening

fecal immunochemical test (FIT)

colonoscopy quality indicators

adenoma detection rate (ADR)

cecal intubation rate

bowel preparation quality

polyp resection techniques

computer-aided detection (CADe)

screening follow-up adherence

quality improvement in CRC screening