{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:24:13Z","timestamp":1792239853853,"version":"4.4.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Although the adenoma detection rate is a key colonoscopy quality metric, benchmarks for serrated polyp removal, specifically the sessile serrated lesion detection rate (SSLDR), are currently lacking.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the physician SSLDR and the risk of postcolonoscopy colorectal cancer (PCCRC) and related mortality.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was conducted between January 1, 2000, and December 31, 2021, within a large integrated health care system in Northern California and included colonoscopies performed for patients aged 18 years or older, without a diagnosis of colorectal cancer within 6 months of colonoscopy, history of colorectal cancer, or history of inflammatory bowel disease by 50 gastroenterologists. Statistical analysis was performed from January 1, 2000, to December 31, 2021.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n The primary exposure was the SSLDR, defined as the proportion of screening colonoscopies with at least 1 histologically confirmed sessile serrated adenoma or traditional serrated adenoma, categorized into quartiles.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was PCCRC diagnosed more than 6 months after negative colonoscopy results. Secondary outcomes included proximal or distal PCCRC, advanced stage colorectal cancer, all-cause mortality, and colorectal cancer\u2013related mortality. Outcomes were ascertained through linked state and institutional cancer registries and vital records.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 328\u202f416 colonoscopies performed for 226\u202f695 unique patients (mean [SD] age, 58.6 [10.7] years; 51.7% women), 562 PCCRC cases were identified over 2\u202f038\u202f816 person-years of follow-up. The absolute PCCRC incidence rate decreased with higher SSLDR quartiles, from 3.9 cases per 10\u202f000 person-years in the lowest quartile to 2.4 cases per 10\u202f000 person-years in the highest quartile. Compared with patients in the lowest SSLDR quartile, those in the highest SSLDR quartile had a significantly lower risk of PCCRC (multivariate hazard ratio, 0.69; 95% CI, 0.50-0.94;\n P<\/jats:italic>\n \u2009=\u2009.01 for trend), primarily associated with lower risk of proximal PCCRC. A higher SSLDR was associated with lower all-cause mortality (second quartile, 57.7 deaths per 10\u202f000 person-years; third quartile, 58.0 deaths per 10\u202f000 person-years) and colorectal cancer\u2013related mortality (second quartile, 0.2 deaths per 10\u202f000 person-years; third quartile, 0.2 deaths per 10\u202f000 person-years) in the second and third SSLDR quartiles, but the association was not significant in the highest quartile compared with the lowest quartile.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this large community-based cohort study, a higher physician SSLDR was associated with a significantly lower risk of PCCRC in a dose-dependent manner. These findings support using the SSLDR as a crucial quality metric for colonoscopy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.56964","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T16:30:22Z","timestamp":1771345822000},"page":"e2556964","source":"Crossref","is-referenced-by-count":7,"title":["Sessile Serrated Lesion Detection Rate and Colorectal Cancer Risk and Mortality"],"prefix":"10.1001","volume":"9","author":[{"given":"Edward S.","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Palo Alto Medical Foundation, Sutter Health, San Jose, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiwen","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Health Systems Research, Sutter Health, Palo Alto, 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