Defining interval cancer, also called missed or post-endoscopy cancer-for both gastric and colorectal cancers-presents a complex challenge. Consequently, the Interval Colorectal Cancer Expert Working Group from the World Endoscopy Organization’s (WEO) Colorectal Cancer Screening Committee^1,2 defines it as a cancer diagnosed after a colorectal screening exam where no cancer was found, and before the next recommended screening. This term is broadly used to denote cancers of the gastrointestinal tract identified in the interval between an endoscopically reported normal study and the next scheduled follow-up examination. For gastric cancer, the interval cancer rate stands at 9.4% (95% confidence interval [CI]: 5.7-13.1%)³, aiming for an ideal rate below 5% as per WEO standards; whereas, for colorectal cancer, the incidence rate of interval cancer is a matter of debate, ranging between 5.25% and 9.3%^4,5. The importance of understanding interval cancer spans diagnostic, therapeutic, ethical, legal, and public health concerns, especially considering these represent the two most prevalent digestive neoplasms in our society.

Dr. Castaño and colleagues⁶ offer a compelling analysis aimed at determining the rate of interval cancer in both gastric and colorectal cancers by comparing the two. They delve into the local tumor incidence rates, addressing the lack of data on this phenomenon in our context, with the goal of sparking interest in acquiring specific local data among the journal’s readership.

The etiology of these neoplasms is multifactorial, with the highest risk stemming from overlooked or incompletely excised lesions. There is no consensus in the literature regarding whether interval colorectal cancers are inherently more aggressive due to molecular composition changes⁷. Colorectal cancer itself is recognized as a heterogeneous disease, with different molecular entities involved in oncogenesis, potentially contributing to the development of interval colorectal cancer. Evidence suggests the sessile serrated neoplasia pathway might accelerate carcinoma development post-screening colonoscopy. Nonetheless, the overall survival rates for interval colorectal cancers are comparable to those detected within the screening process⁷. Flat neoplastic lesions pose a significant challenge for both endoscopists and pathologists⁷. In our context, factors such as schedule overloads, preparation difficulties (refer to Aponte and colleagues)⁸, endoscopist haste, and the lack of appropriate technology in various settings are among the numerous determinants of the quality in diagnostic and screening endoscopy^9,10.

Enhancements in the quality of endoscopic procedures, through endoscopist education, procedure quality surveillance systems, risk-stratified screening, and the integration of technologies such as chromoendoscopy and artificial intelligence, could significantly influence this situation⁷.

Referencias

Rutter MD, Beintaris I, Valori R, Chiu HM, Corley DA, Cuatrecasas M, et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology. 2018;155(3):909-925.e3. https://doi.org/10.1053/j.gastro.2018.05.038

Sanduleanu S, le Clercq CM, Dekker E, Meijer GA, Rabeneck L, Rutter MD, et al. Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature. Gut. 2015;64(8):1257-67. https://doi.org/10.1136/gutjnl-2014-307992

Pimenta-Melo AR, Monteiro-Soares M, Libânio D, Dinis-Ribeiro M. Missing rate for gastric cancer during upper gastrointestinal endoscopy: A systematic review and meta-Analysis. Eur J Gastroenterol Hepatol. 2016;28(9):1041-9. https://doi.org/10.1097/MEG.0000000000000657

Ertem FU, Ladabaum U, Mehrotra A, Tehranian S, Shi Z, Saul M, et al. Incidence of interval colorectal cancer attributable to an endoscopist in clinical practice. Gastrointest Endosc. 2018;88(4):705-711.e1. https://doi.org/10.1016/j.gie.2018.05.012

Shanahan JJ, LeBlanc DM, Courage ER, Benesch MGK, Hickey KE, Hartwig KA, et al. Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador. Curr Oncol. 2022;29(12):9150-9162. https://doi.org/10.3390/curroncol29120716

Castaño R, Puerta-Díaz JD, Jaramillo R, Palacio-Fuenmayor LJ, Rodríguez-Molina M, Molina-Meneses SP, et al. Cáncer gástrico y cáncer colorrectal posendoscopia: vidas paralelas. Revista. colomb. Gastroenterol. 2024;39(1):3-13. https://doi.org/10.22516/25007440.1145

Ibáñez-Sanz G, Sanz-Pamplona R, Garcia M, On Behalf Of The Msic-Sc Research Group. Future Prospects of Colorectal Cancer Screening: Characterizing Interval Cancers. Cancers (Basel). 2021;13(6):1328. https://doi.org/10.3390/cancers13061328

Aponte-Martín DM, Corso-Bernal CL, Aponte-Aparicio MV, Sabbagh-Sanvicente LC. Mejoría de la preparación de colonoscopia usando tecnologías de la información y comunicación (TIC), ensayo clínico aleatorizado. Revista. colomb. Gastroenterol. 2024;39(1):51-58. https://doi.org/10.22516/25007440.1092

Deding U, Kobaek-Larsen M, Bøggild H, Kaalby L, Thygesen MK, Baatrup G. Socioeconomic inequalities in interval colorectal cancer are explained by differences in faecal haemoglobin concentration and age: a register-based cohort study. BMJ Open Gastroenterol. 2023;10(1):e001113. https://doi.org/10.1136/bmjgast-2023-001113

Castaño-Llano R, Piñeres A, Jaramillo R, Molina S, Aristizábal F, Puerta JE. Interval gastric cancer: A call to attentiveness and action. Rev Gastroenterol Mex (Engl Ed). 2023;88(2):91-99. https://doi.org/10.1016/j.rgmxen.2022.05.015

Notes

Author notes

*Correspondence: David B. Páramo-Hernández. paramo.david@gmail.com