We report three keynote lecture presentations from the Endoscopic Forum Japan 2009 at Otaru, Hokkaido, on 1-2 August 2009. We will discuss herein: (i) colorectal cancer screening focusing on a comparison between the National Polyp Study and the Japan Polyp Study; (ii) how to deal with small polyps <5 mm in diameter; (iii) the natural history of colorectal tumor development; (iv) the importance of follow up for local recurrence after endoscopic resection for colorectal polyps; and (v) screening for colorectal cancer using two new modalities, narrow-band imaging and autofluorescence imaging. A questionnaire was completed by everyone involved in the conference and the most important results were reported and then discussed by the participants.