Colorectal Cancer (CRC) Screening

To overcome non-neoplastic polyp (NNP) resections, computer-aided diagnosis (CADx) systems have been developed. In a meta-analysis, the performance of CADx systems was superior to endoscopists. The proportion of incorrect predictions could be significantly reduced with CADx assistance. It was reported that autonomous AI prediction could achieve an agreement with the standard pathology-based surveillance intervals. In a prospective study targeting diminutive rectosigmoid polyps, CADx achieved a negative predictive value compared to the histology as gold standard. Lesions were amendable for a leave-in-situ strategy, suggesting a potential to reduce the burden of unnecessary polypectomies. It was estimated that the average colonoscopy cost and annual reimbursement could be reduced under the 'diagnose-and-leave' strategy. Nevertheless, almost all existing literature reporting the efficacy of CADx were simulated studies and focused on the diagnostic accuracy (i.e. all polyps were ultimately resected for histopathology). There is a lack of real-world data with hard clinical endpoints to support its implementation. A recent RCT compared leave-in-situ and resect-all strategy with real-time CADx in both arms. Using ADR as the surrogate marker, it was shown that the leave-in-situ strategy with CADx support was non-inferior. The major limitations of this RCT were that: i) CADx were activated in both arms - the pure CADx effect could not be demonstrated; ii) 'resect-all' strategy was not a real-world practice especially for diminutive rectosigmoid polyps; iii) the interaction and decision making between AI and human was not documented and uncertain. A well-designed RCT is warranted to evaluate the pure CADx effect on reducing NNP resections (enhance treatment efficacy) while maintaining the benchmark of ADR (safe implementation). In addition, AI-measured metrics may objectively validate the procedural quality for performance tracking and auditing purposes. If the above points are proven, AI-assisted colonoscopy would become the 'mainstream' in CRC prevention.

This is a mixed-methods implementation pilot combining an educational intervention with a mailed stool-based testing outreach feasibility study within a resident primary care clinic. Participants will be assigned by clinic team to education, mailed FIT, mailed Cologuard, or usual care comparison groups.

The goal of this prospective implementation study is to understand the impact of a blood-based screening test (BBST) for colorectal cancer (CRC) on patient acceptability of and adherence to CRC screening as well as the rate of follow-up BBST in those with negative BBST at a 1-year interval. Additional aims include assessing the impact of digital patient navigation intervention on the rate of follow-up colonoscopy in individuals with positive BBST. Patients will be randomized into the non-intervention arm or the intervention with an app arm.

In the United States, colorectal cancer ranks second to lung cancer as a cause of cancer death and is the third most commonly occurring cancer in both men and women. Colorectal cancer in most cases develops slowly over a period of years, starting with the growth of precancerous polyps on the colon or rectum wall. The slow development of colorectal cancer makes it possible to detect and prevent it entirely by the removal of the precancerous polyps with colonoscopy. To date, there is no screening test, other than colonoscopy, able to detect the precancerous polyps. Gixam is a camera that takes multiple pictures of your tongue and uses artificial intelligence software to predict the presence of precancerous polyps within your colon or rectum that may eventually become cancerous. The device creates the prediction by comparing the images taken of your tongue with many other images of tongues from healthy patients and patients with a history of precancerous polyps. Patients who have been predicted by Gixam to have precancerous polyps may be more likely to complete colonoscopy at the interval recommended by their physician, potentially reducing the likelihood of developing colorectal cancer. The purpose of this research study is to test the accuracy of the Gixam device in persons that have received a negative outcome on a Fecal Immunochemical Test (FIT). This study will compare this prediction to the actual findings of your scheduled standard care colonoscopy and allow researchers to evaluate and improve the Gixam system.