Adenoma detection and subsequent colorectal cancer risk: is the race really over?

A high adenoma detection rate (ADR) is vital for effective colorectal cancer (CRC) screening, but evidence suggests limited additional benefit beyond a certain threshold. In a pooled analysis of five large colonoscopy studies, we confirmed an inverse relationship between ADR and postcolonoscopy CRC risk. In primary screening, an ADR of at least 27% is essential. While higher ADRs further reduce risk, the benefit plateaus beyond 34%, offering minimal added value. Efforts should focus on supporting low-performing endoscopists to meet quality standards. ADR benchmarks in faecal immunochemical test (FIT)-based programmes warrant further investigation.