Purpose The incidence of post-colonoscopy colorectal cancer (a cancer diagnosed within 6 months to 3 years of a “normal” colonoscopy, or PCCRC) is a critical performance measure of colonoscopy screening programs. In 2018, the World Endoscopy Organization (WEO) standardised the method for calculation to facilitate comparison and use as a quality indicator1. We wished to assess published world-wide trends in incidence of PCCRC and identify risk-factors via systematic review of the literature. Methodology We performed a systematic review by searching Ovid MEDLINE, EMBASE, CINAHL and Cochrane databases from inception to 1st December 2025 to identify population-based or multicentre studies adherent to WEO methodology that reported pooled and/or yearly PCCRC 3-year data. Results Eight studies from Europe and North America met criteria for inclusion. 13 studies published in 2025 alone did not use the WEO’s definition of PCCRC incidence. A total of 20,638 PCCRC cases and 266,638 detected colorectal cancers gave a pooled PCCRC 3-year prevalence of 7.7%. From 2004 until 2017 there was no statistical improvement in incidence of PCCRC. Female patient gender, diverticular disease, inflammatory bowel disease and proximal lesions (all P < 0.001) were all significantly associated with higher risk of PCCRC Conclusion When using the WEO methodology the pooled Western PCCRC 3-year rate is 7.7% but concerningly there has been no significant improvement in incidence from 2004 to 2017. Improvements may be possible in identifying PCCRC cases within colonoscopy programs, reporting of data and risk-stratification of patients with contributing factors. With the ultimate aim to minimise this significant source of morbidity and mortality. References: 1.Rutter MD, Neintaris I, Valori E, et al. World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology 2018; 155:909-925