Population-based screening colonoscopy in Korea: balancing benefits and limitations

Population-based colonoscopy screening is considered one of the most effective strategies for reducing the incidence and mortality of colorectal cancer. Its major strength lies in its dual benefits: early detection of colorectal cancer and prevention via the removal of precancerous lesions. Colonoscopy has a high sensitivity and provides a full colonic evaluation in a single session, thereby reducing the need for frequent testing. However, this approach has notable limitations. Colonoscopy is an invasive procedure associated with rare but serious complications such as perforation and bleeding. Participation rates tend to be lower than those of noninvasive methods like fecal immunochemical tests. Additionally, implementing colonoscopy as a populationbased tool requires significant resources, including trained endoscopists, endoscopy facilities, and financial investments. The quality of colonoscopy may also vary depending on the operator's skill and adherence to guidelines. Given these trade-offs, population-based colonoscopy screening must be carefully evaluated in terms of cost-effectiveness, feasibility, and public acceptance within each country's healthcare system. Therefore, population-based colonoscopy screening should be approached with a balanced understanding of its benefits and limitations to ensure cost-effectiveness, feasibility, alignment with each country's healthcare infrastructure, and integration with existing screening programs.