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In Reply Dr Crockett highlights the serrated polyp pathway to colorectal cancer. The pathway accounts for more than 20% of sporadic colorectal cancer cases, and the precursor lesion—the sessile serrated polyp—is difficult to detect with any screening modality, as Crockett points out. These lesions tend to be flat, have few surface blood vessels, and tend to be located in the proximal colon. The natural history of these lesions has been uncertain because of poor detection at colonoscopy and interobserver variability among pathologists.
Lieberman D. Sessile Serrated Polyps and Colorectal Cancer—Reply. JAMA. 2017;317(9):976. doi:10.1001/jama.2017.0544
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