Colon cancer is the second-leading cause of cancer death in the United States, after lung cancer, with about 154,000 new cases detected and 52,000 deaths a year. This is tragic because most of these deaths could be avoided if screening colonoscopies were performed more often.

In the US, gastroenterology graduates are woefully in short supply. This is why many enterprising surgeons and general practitioners have discovered the lucrative potential in performing colonoscopies even if many of them were inadequately trained to look for flat lesions that the Japanese doctors had been telling us all along, were dangerously precancerous or outright malignant.

In a study of 1,819 military veterans, it was found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to become malignant. Poorly trained physicians know only about stalked or what we refer to as sessile polyps. We can only guess how many of these flat lesions escape detection.

The study underscores the importance of determining the level of training and guided experience of the colonoscopist. In the institution where I trained, our program director would remind us that even a monkey could be trained to guide a tube through the colon. The real skill lay in the recognition of risky lesions.