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after a negative colonoscopy, so-called post-colonoscopy colorectal cancer (PCCRC) [1], can represent a missed opportunity for earlier diagnosis and presumably better prognosis. PCCRC has therefore become an important, perhaps the most important, quality marker for colonoscopy. The World Endoscopy Organisation (WEO) has recently published a consensus paper on the taxonomy, investigation and reporting of PCCRC [2] aimed at both colonoscopy services and investigators. In the linked paper, Macken et al report national level data of PCCRC in Belgium, exploring characteristics of PCCRCs and factors associated with their development [3]. The Belgian investigators should be applauded for resisting the temptation to invent a new method of analyzing PCCRC rates. Instead they have followed previously published methodology for calculating rates [4] incorporating all false-negative colonoscopies and included an analysis of the method recommended by the WEO [2]. This means that we can now, for the first time, compare rates between nations and other jurisdictions as the WEO consensus guideline intended [2]. Publishing and comparing national rates of PCCRC draws attention to a problem that is otherwise “off the radar” for most endoscopists and endoscopy services. There is limited awareness of PCCRC in everyday practice because it is a relatively rare event. Furthermore, it is not easy to link cancer to previous colonoscopy because the two events are separated by months and years. It is likely that most of the time colonoscopists are unaware of a CRC that occurs several years after the index colonoscopy. There is also, perhaps, complacency that a PCCRC is a fast-growing tumor rather than a missed or incompletely resected lesion, or that missing lesions is something that happens to other people, or it is too rare to be concerned about. On the other hand, from the patient perspective, it is very important because it can mean the difference between having cancer or not, having treatment for later stage tumor or not, or having a worse prognosis through delayed diagnosis. Finally, there are additional costs to the health system of delayed diagnosis. The Belgian study has shown significant variation in PCCRC rates between individuals and units. This variation supports previously published data, that to a large extent interval cancer and PCCRCs are preventable [5]. There was a greater than 10fold difference in PCCRC rates between colonoscopists. Individual physicians with low rates of colonoscopy, polyp detection and polyp resection were more likely to have PCCRCs. Unfortunately, there is limited information about characteristics of hospitals, therefore, there is no such analysis of unit-level factors that affect the rate of PCCRC, despite 30% of hospitals falling outside the 95% credible intervals on the funnel plot. The study identified various patientand procedure-related factors that increase the chance of PCCRC which are mostly in line with other studies, with the exception of the finding that deep sedation is associated with a lower rate of PCCRC. These consistent associations indicate that colonoscopists should be especially vigilant when performing colonoscopy for higherrisk patients and when inspecting the right colon. When views are suboptimal, or when the procedure has not achieved deep cecal intubation, there should be a definite and documented decision to repeat the test, perform another procedure or to not investigate further. This latter option may be wholly approNational post-colonoscopy colorectal cancer data challenge services to improve quality of colonoscopy