We aimed to evaluate the association between colonoscopy and colorectal cancer (CRC) occurrence and related mortality in an older population.This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding colonoscopy within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between colonoscopy and non-colonoscopy groups using a time-dependent Cox proportional hazard model. Subgroup analysis was conducted among four age groups: young, middle-aged, old, and very old.Among 748986 individuals followed for 9.64 (SD 0.99) years, the colonoscopy group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa] 0.35, 95%CI 0.32-0.38) and 76% lower CRC-related mortality (HRa 0.24, 95%CI 0.18-0.31) after 5 years compared with the non-colonoscopy group. Colonoscopy was associated with the most significant reduction in CRC occurrence in the middle-aged group (HRa 0.32, 95%CI 0.29-0.35) and in CRC-related mortality in the young group (HRa 0.04, 95%CI 0.01-0.33); the very old group had the least reduction in both CRC occurrence and CRC-related mortality (HRa 0.44, 95%CI 0.33-0.59 and HRa 0.28, 95%CI 0.15-0.53, respectively).We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥40 years after 5 years of follow-up; however, these associations were weaker in the very old group. More research is needed on the association between colonoscopy and older age.

Surveillance endoscopy is recommended after endoscopic resection of esophageal squamous cell carcinomas (ESCCs). However, surveillance endoscopy sometimes detects advanced subsequent ESCCs with invasion of the muscularis mucosa (MM) or deeper. We aimed to clarify the clinicopathological features of these advanced subsequent ESCCs.

This single-center retrospective study identified subsequent ESCCs detected during surveillance endoscopy. ESCCs that invaded the MM or deeper and were detected within 24 months after the previous endoscopy were defined as post-endoscopy esophageal advanced lesions (PEEALs), while the first ESCC detected in the patient was defined as the primary lesion. Study 1 compared the clinicopathological characteristics of PEEALs versus non-advanced lesions. Study 2 compared the endoscopic features of pT1a-MM PEEALs versus pT1a-MM primary lesions.

A total of 307 subsequent ESCCs were analyzed in Study 1. Of these, 20 were PEEALs and 287 were non-advanced lesions (pT1a-EP/LPM). The median intervals from the previous endoscopy for PEEALs and non-advanced lesions were 6.1 months and 6.7 months, respectively (P = 0.283). The morphological feature of marginal elevation was seen in 60% of PEEALs. In Study 2, 15 pT1a-MM PEEALs were compared with 149 pT1a-MM primary lesions. Compared with primary lesions, pT1a-MM PEEALs were smaller (median 10 mm vs. 30 mm, P < 0.001) and had a higher prevalence of marginal elevation morphology (53.3% vs. 10.1%, P < 0.001).

The specific feature of PEEALs was marginal elevation. Surveillance endoscopy with careful observation for these lesions is recommended after endoscopic resection of ESCCs.

The adenoma detection rate is higher among endoscopists who spend more time observing screen edges during colonoscopies. Nonetheless, eye movement parameters related to lesion detection remain unknown. This study aimed to determine the specific eye movement parameters related to colorectal adenoma detection, including the gaze rate in a particular area and eye movement speed.

This study was a post hoc analysis of a randomized controlled trial investigating the effect of modifying eye movements of endoscopists on colorectal adenoma detection. Gaze rate at a specific area and eye movement speed were calculated based on endoscopist gaze coordinates in each examination. Time required for observation and treatment of polyps was excluded. The lower peripheral area was defined as the bottom row when the screen was divided into 6×6 sections. These parameters were compared between patients with and without adenomas.

Five physicians performed 158 colonoscopies. The adenoma detection group exhibited a lower peripheral gaze rate (13.7% vs. 9.5%, P = 0.004) and smaller average eye movement distance (29.9 pixels/30 ms vs. 33.3 pixels/30 ms, P = 0.022). Logistic regression analysis showed that a lower peripheral gaze rate > 13.0% and an average eye movement distance <30 pixels/30 ms were increased independent predictors of adenoma detection ( P = 0.024, odds ratio [OR] 2.53, 95% confidence interval [CI] 1.71-3.28; P = 0.045, OR 4.57, 95% CI 1.03-20.2), whereas age, sex, and withdrawal time were not.

Lower peripheral gaze rate and slow eye movement are associated with colorectal adenoma detection.

Although accurate assessment of polyp morphology helps endoscopists select the appropriate management for colorectal polyps, some studies have reported unsatisfactory accuracy in such assessment. This study aimed to clarify the usefulness of a short educational video available on the Internet for accurate polyp morphology assessment.

This was a multicenter randomized controlled trial. Participants were randomly assigned to the pre- or post-education groups after a pre-test comprising images of 42 polyps, including 12 laterally spreading tumors. Participants who scored ≥ 80% on the pre-test were excluded. Only the post-education group completed the diagnostic test after watching an online educational video. The primary outcome was the difference in diagnostic accuracy between the pre-test and diagnostic tests for each group.

Of the 296 endoscopists enrolled from 48 institutions, 34 missed the test deadline, and 29 who scored ≥ 80% in the pre-test were excluded. The primary outcome analysis sets were 117 and 116 in the pre- and post-education groups, respectively. The mean pre-test accuracies in the pre-education and post-education groups were 60.6% and 60.7%, respectively. The difference in diagnostic accuracy between the pre-test and diagnostic test was significantly higher in the post-education than the pre-education group (12.0 points, 95% confidence interval [CI] 9.9-14.1 and 2.3 points, 95% CI 0.9-3.6; p < 0.001).

This multicenter randomized controlled trial demonstrated the usefulness of a short educational video for accurate polyp morphology assessment.

Around 1.9 million new cases and 1 million deaths worldwide were attributed to colorectal cancer (CRC) in 2020.

The aims of this study are to assess the cost-effectiveness of a multi-target stool DNA-based screening strategy, COLOTECT, compared to faecal immunochemical tests (FIT), colonoscopy, and no screening in the Asian population to inform more choices for policymakers in colorectal cancer screening.

We assume that 100,000 persons aged 50 undergo annual FIT, annual COLOTECT multi-target testing, or colonoscopies every 10 years until age 75. The data used in this study was retrieved from different sources including the Hong Kong Cancer Registry and previously published studies on the population aged 50 to 75 years old between 2010 and 2023. This study accessed the most cost-effective screening strategy available. If a positive result of FIT or COLOTECT were observed, the participants would undergo a colonoscopy. The participants who used the colonoscopy as the main screening method conducted colonoscopies every 3 years. The Markov models were utilized to compare the outcomes from different strategies including life-years saved, years of life lost, and incremental cost-effectiveness ratio (primary outcome). The highest ICER was observed in colonoscopy (USD 160808), followed by FIT (USD 108952), and COLOTECT (USD 82206). A higher detection rate of CRC (COLOTECT: 39.3% vs. FIT: 4.5%), more CRC cases prevented (1272 vs. 146), and life-years saved (2295 vs. 337) were observed in the COLOTECT strategy than in FIT. Additionally, a lower total cost per life-year saved of COLOTECT (USD 180097) was observed than colonoscopy (USD 238356), which identified the more affordable and cost-saving COLOTECT strategy.

This study highlighted the better performance of COLOTECT than FIT in detecting CRC. Additionally, given its lower cost and higher acceptance, the COLOTECT strategy might be more cost-effective than colonoscopy for massive CRC screening.

Gastrointestinal cancers, especially colorectal cancer, represent a major health care issue. According to the data, the incidence of these cancers exceeds 50/100,000, mainly in high-income countries. Risk factors for the disease include genetic factors (i.e., Lynch syndrome) and lifestyle factors, e.g., overweight and obesity, smoking tobacco products, low-fiber diet, and low physical activity. When diagnosed early, gastrointestinal cancers can, in most cases, be effectively treated. This review focuses on the presentation of research in the area of screening and its results. It provides insights into current trends in research on methods of early cancer detection and improving screening reporting. Differing levels of screening reporting are one of the main challenges faced by researchers in this field. Research on this issue should be conducted in parallel with research on methods of early diagnosis. Finally, the development of diagnostic methods and communication with patients are important elements of public health.

Aggressive colorectal cancer (CRC) frequently originates from serrated lesions (SLs), particularly in the proximal colon, which are challenging to detect using standard screening colonoscopy. Although duplicate examinations or chromocolonoscopies are recommended for detecting proximal SLs, evidence from randomized trials is limited. We evaluated the effectiveness of tandem colonoscopy with an acetic acid-indigo carmine mixture (AIM) for detecting SLs in the proximal colon compared with white-light imaging (WLI) and indigo carmine (IC).

This 3-arm, multicenter, randomized controlled trial involving 9 institutions enrolled patients undergoing colonoscopy and assigned them randomly to the WLI, IC, or AIM group. The primary outcomes were the SL-detection rate (SDR) of proximal lesions during the second examination (SDR 2nd ) and SL additional rate (SAR). Secondary outcomes included the detection and additional rates of other polyps, factors contributing to SAR, and complications.

Between 2021 and 2024, 1,319 participants with 1,267 polyps were included in the analysis. With AIM, the SDR 2nd and SAR were significantly higher compared with WLI or IC (WLI vs AIM: 2.7% vs 14.0%, P < 0.001; IC vs AIM: 7.9% vs 14.0%, P = 0.002, and WLI vs AIM: 22.4% vs 69.3%, P < 0.001; IC vs AIM: 45.8% vs 69.3%, P = 0.001). AIM conferred a higher adenoma detection rate 2nd than with WLI (10.5% vs 24.7%; P < 0.001) and was an independent factor for SAR (odds ratio [95% confidence interval]: 7.79 [3.76-17.08]). No major adverse events were observed.

AIM significantly improved proximal colon SDRs and outperformed WLI and IC. The relationship between SDR and CRC incidence warrants further investigation.

This study aimed to compare the bowel cleansing efficacy, adverse reactions, and patient compliance of two low-volume bowel preparation regimens, sodium picosulfate (PICO) and 2 L polyethylene glycol electrolyte lavage solution (2 L PEG-ELS).

This single-center, prospective observational trial was conducted at the Gastrointestinal Endoscopy Center of The Third People's Hospital of Chengdu between May and October 2023. Patients undergoing colonoscopy were enrolled, with the primary outcome being the rate of adequate bowel cleansing, as assessed by the Boston Bowel Preparation Scale (BBPS) with three segments scoring ≥ 2. Secondary outcomes included polyp detection rate, adverse reactions, patient compliance, and the BBPS total and segment scores.

A total of 5423 patients were included, divided into the PICO group (n = 739) and the 2 L PEG-ELS group (n = 4684) based on the bowel preparation regimen they chose. There were no statistically significant differences between the PICO and 2 L PEG-ELS groups in adequate bowel cleansing rate (92.2% vs. 91.3%, P = 0.437) and polyp detection rate (42.2% vs. 45.5%, P = 0.096). However, the PICO group achieved a better performance in the BBPS scores of the total [(6.90 ± 1.19) vs. (6.81 ± 1.14), P = 0.016] and the right colon [(2.15 ± 0.53) vs. (2.11 ± 0.51), P = 0.005] compared to the 2 L PEG-ELS group. In terms of adverse reactions, the 2 L PEG-ELS group reported more nausea (11.7% vs. 5.7%, P < 0.001) and the PICO group reported more sleep disturbances (24.5% vs. 14.6%, P < 0.001), but the willingness to repeat the procedure with the same regimen was similar high in the 2 L PEG-ELS and PICO groups (99% vs. 99.2%, P = 0.588).

In this prospective observational study, both PICO and 2 L PEG-ELS are safe and effective options for bowel cleansing in the Chinese population.

Genomic analyses of cell-free DNA (cfDNA) in plasma are enabling noninvasive blood-based biomarker approaches to cancer detection and disease monitoring. Current approaches for identification of circulating tumour DNA typically use targeted tumour-specific mutations or methylation analyses. An emerging approach is based on the recognition of altered genome-wide cfDNA fragmentation in patients with cancer. Recent studies have revealed a multitude of characteristics that can affect the compendium of cfDNA fragments across the genome, collectively called the 'cfDNA fragmentome'. These changes result from genomic, epigenomic, transcriptomic and chromatin states of an individual and affect the size, position, coverage, mutation, structural and methylation characteristics of cfDNA. Identifying and monitoring these changes has the potential to improve early detection of cancer, especially using highly sensitive multi-feature machine learning approaches that would be amenable to broad use in populations at increased risk. This Review highlights the rapidly evolving field of genome-wide analyses of cfDNA characteristics, their comparison to existing cfDNA methods, and recent related innovations at the intersection of large-scale sequencing and artificial intelligence. As the breadth of clinical applications of cfDNA fragmentome methods have enormous public health implications for cancer screening and personalized approaches for clinical management of patients with cancer, we outline the challenges and opportunities ahead.

Rates of colorectal cancer (CRC) screening in the United States continue to fall short of guideline-recommended benchmarks. Challenges to increasing CRC screening include racial disparities, barriers at multiple levels of the health care system, and inadequate completion of 2-step screening. With new options for CRC screening and employment of programmatic strategies for screening by physicians, patients will have more opportunities to initiate and complete testing, which can ultimately improve CRC detection and prevention. This article highlights the current state of and optimal approach to CRC screening.

Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.

Visual gaze pattern (VGP) analysis quantifies endoscopists' specific eye movements. VGP during colonoscopy may be associated with polyp detection. However, the optimal VGP to maximize detection performance remains unclear. This study evaluated the optimal endoscopic VGP that enabled the highest colorectal adenoma detection rate.

This randomized controlled trial was conducted between July and December 2023. We developed an eye-tracking and feedback (ETF) system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. Patients who underwent colonoscopy were randomly assigned to 4 groups: 3 intervention groups, in which the endoscopist's gaze was instructed to a different level of the peripheral screen area using the ETF system (the periphery of 4 × 4, 5 × 5, and 6 × 6 divisions of the screen), and a control group in which the endoscopist did not receive instructions. The primary outcome was the number of adenomas detected per colonoscopy (APC).

In total, 189 patients were enrolled. The APC and adenoma detection rate were significantly higher in the 6 × 6 group than in the control group (1.82 ± 2.41 vs 0.59 ± 1.17, P = .002; 68.9% vs 30.8%, P = .002). The APC and the number of screen divisions were positively correlated (R = 0.985, P = .0152). The rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (R = 0.964, P = .0363).

Colorectal adenoma detection was improved by correcting the endoscopist's gaze to the periphery of the screen, especially by dividing the screen into 6 × 6 segments.

The aim of this study is to compare the results of repeat colonoscopies performed on the same day and by appointment in patients with inadequate bowel cleansing.

The study was designed as a prospective randomized controlled study. Eighty patients with inadequate bowel cleansing detected in elective colonoscopies were included in the study. Patients were randomly divided into 2 groups: Group I: Same day group and Group II: Appointment day group. Same day colonoscopy group was given day hospitalization, sennoside A+B calcium was given and colonoscopy procedure was repeated. Patients in Group II were rescheduled and standard colonoscopy preparation protocol was applied. Boston bowel preparation scale (BBPS) was used for bowel preparation quality. Cecal intubation time, cecal intubation rate, procedure time, BBPS score and polyp detection rate were compared between the groups.

In the same-day group, 52.5% of the patients were female while 45.9% were female in the appointment group. There was no significant difference between the two groups in terms of age or gender (p>0.05). The rate of cecum intubation was higher in the same-day group than it was in the appointment group (p=0.022). The total BBPS score was 7.9±1.79 in the same-day group and 6.89±2.23 in the appointment group, and the difference was statistically significant (p=0.03). When the two groups were compared in terms of tolerability of the procedure, no difference was detected (p>0.05).

Same-day colonoscopy is an effective method and can be performed safely in patients with inadequate bowel cleansing.

Early detection of cancer can help patients with more effective treatments and result in better prognosis. Unfortunately, established cancer screening technologies are limited for use, especially for multi-cancer early detection. In this study, we described a serum-based platform integrating surface-enhanced Raman spectroscopy (SERS) technology with resampling strategy, feature dimensionality enhancement, deep learning and interpretability analysis methods for sensitive and accurate pan-cancer screening.

Totally, 1655 early-stage patients with breast cancer (BC, n = 569), lung cancer (LC, n = 513), thyroid cancer (TC, n = 220), colorectal cancer (CC, n = 215), gastric cancer (GC, n = 100), esophageal cancer (EC, n = 38), and 1896 healthy controls (HC) were enrolled. The serum SERS spectra were obtained from each participant. Data dimension enhancement was conducted by heatmap transformation and continuous wavelet transform (CWT). The dimensionalization SERS spectral data were subsequently analyzed by residual neural network (ResNet) as convolutional neural network (CNN) algorithm. Class activation mapping (CAM) method was performed to elucidate the potential biological significance of spectral data classification.

All participants were divided into a training set and a test set with a ratio of 7:3. The BorderlineSMOTE method was selected as the most appropriate resampling strategy and the deep neural network (DNN) model achieved desirable performance among all groups (accuracy rate: 93.15%, precision rate: 88:46%, recall rate: 85.68%, and F1-score: 86.98%), with the generated AUC values of 0.991 for HC, 0.995 for BC, 0.979 for LC, 0.996 for TC, 0.994 for CC, 0.982 for GC, and 0.941 for EC, respectively. Furthermore, the combination use of SERS spectra data and ResNet (form of heatmap) were also capable of effectively distinguishing different categories and making accurate predictions (accuracy rate: 94.75%, precision rate: 89.02, recall rate: 86.97, and F1-score: 87.88), with the AUC values of 0.996 for HC, 0.995 for BC, 0.988 for LC, 0.999 for TC, 0.993 for CC, 0.985 for GC, and 0.940 for EC, respectively. Additionally, strong wave number range of the spectral data was observed in the CAM analysis.

Our study has offered a highly effective serum SERS-based approach for multi-cancer early detection, which might shed new light on cancer screening in clinical practice.

To evaluate the accuracy of Chat Generative Pre-trained Transformer (ChatGPT) powered by GPT-4 in histopathological image detection and classification of colorectal adenomas using the diagnostic consensus provided by pathologists as a reference standard.

A study was conducted with 100 colorectal polyp photomicrographs, comprising an equal number of adenomas and non-adenomas, classified by two pathologists. These images were analysed by classic GPT-4 for 1 time in October 2023 and custom GPT-4 for 20 times in December 2023. GPT-4's responses were compared against the reference standard through statistical measures to evaluate its proficiency in histopathological diagnosis, with the pathologists further assessing the model's descriptive accuracy.

GPT-4 demonstrated a median sensitivity of 74% and specificity of 36% for adenoma detection. The median accuracy of polyp classification varied, ranging from 16% for non-specific changes to 36% for tubular adenomas. Its diagnostic consistency, indicated by low kappa values ranging from 0.06 to 0.11, suggested only poor to slight agreement. All of the microscopic descriptions corresponded with their diagnoses. GPT-4 also commented about the limitations in its diagnoses (eg, slide diagnosis best done by pathologists, the inadequacy of single-image diagnostic conclusions, the need for clinical data and a higher magnification view).

GPT-4 showed high sensitivity but low specificity in detecting adenomas and varied accuracy for polyp classification. However, its diagnostic consistency was low. This artificial intelligence tool acknowledged its diagnostic limitations, emphasising the need for a pathologist's expertise and additional clinical context.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide. The leading risk factors for CRC include male gender, age over 50, family history, obesity, tobacco smoking, alcohol consumption, and unhealthy diet. CRC screening methods vary considerably between countries and depend on incidence, economic resources and healthcare structure. Important aspects of screening include adherence, which can vary significantly across ethnic and socioeconomic groups. Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colonoscopy or radiologic imaging techniques. Technological capabilities for CRC screening are rapidly evolving and include stool DNA test, liquid biopsy, virtual colonography, and the use of artificial intelligence. A CRC prevention strategy should be comprehensive and include active patient education along with targeted implementation of screening.

Adequate bowel preparation is indispensable for high-quality colonoscopy. We have developed an ultralow-volume (500 mL) polyethylene glycol (PEG) combined with other laxatives (sennoside, sodium picosulfate, and lactulose) and applied this regimen clinically to all patients with colonoscopy for 3 decades. This study aimed to assess the effectiveness of this ultralow-volume bowel preparation regimen.

This single-center, retrospective study analyzed data from consecutive outpatients who underwent colonoscopy between January 2022 and December 2022. All the patients took sennoside (24 mg) two nights before, sodium picosulfate (75 mg) one night before, and 500 mL of PEG with lactulose (58.5 g) on the day of examination. Cleaning efficacy was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a total BBPS score ≥6, with all colon segments scoring ≥2.

Out of 862 patients with colonoscopy, 773 were eligible for this study, and the median age was 66 years. The adequate bowel preparation rate was 91.8% (710/773). Notably, the BBPS full score "9" was observed in 50.5% (390/773). The median cecal intubation time and examination time were 8 and 20 min, respectively. Only 3 patients vomited as a side effect. In the multivariate analysis, age ≥70 years, diabetes mellitus, and diverticula were significantly independent risk factors for inadequate bowel preparation.

Our established ultralow-volume (500 mL) PEG is safe and useful as a bowel preparation method.

Although U.S. Preventive Services Task Force (USPSTF) recommended CRC screenings are effective; patient reluctance reduces adherence. Most cost-effectiveness models assume perfect adherence, yet one-third of eligible individuals aren't current with CRC screening. Our study assesses the cost-effectiveness of Shield, an FDA-approved blood-based CRC screening test, using real-world adherence.

The CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model, a validated discrete-event simulation, evaluated clinical and economic outcomes of CRC screening under real-world adherence scenarios. We compared the Shield blood-based test administered every 3 years to no screening, considering it cost-effective if the incremental cost-effectiveness ratio (ICER) was under $100,000 per quality-adjusted life-year (QALY) gained.

Shield increased QALYs by 154 and raised costs by $7.5 million per 1,000 individuals, with an ICER of $48,662 per QALY, meeting the $100,000/QALY threshold. Shield remained cost-effective up to a unit cost of $3,241 (at $100,000/QALY) and $4,942 (at $150,000/QALY). Sensitivity analyses confirmed cost-effectiveness with lower adherence to diagnostic colonoscopy (56.1%) and annual screenings.

The CAN-SCREEN model shows that Shield is cost-effective compared to no screening. Including real-world adherence improves accuracy in assessing screening strategies. Shield's noninvasive approach offers a promising, cost-effective way to increase adherence and reduce CRC mortality.

Genomic screening to identify individuals with Lynch Syndrome (LS) and those with a high polygenic risk score (PRS) promises to personalize colorectal cancer (CRC) screening. Understanding its clinical and economic impact is needed to inform screening guidelines and reimbursement policies.

We developed a Markov model to simulate individuals over a lifetime. We compared LS+PRS genomic screening with standard of care (SOC) for a cohort of US adults at age 30. The Markov model included health states of no CRC, CRC stages (A-D), and death. We estimated incidence, mortality, and discounted economic outcomes of the population under different interventions.

Screening 1000 individuals for LS+PRS resulted in 1.36 fewer CRC cases and 0.65 fewer deaths compared with SOC. The incremental cost-effectiveness ratio was $124,415 per quality-adjusted life year; screening had a 69% probability of being cost-effective using a willingness-to-pay threshold of $150,000/quality-adjusted life year . Setting the PRS threshold at the 90th percentile of the LS+PRS screening program to define individuals at high risk was most likely to be cost-effective compared with 95th, 85th, and 80th percentiles.

Population-level LS+PRS screening is marginally cost-effective, and a threshold of 90th percentile is more likely to be cost-effective than other thresholds.

Growing evidence supports the importance of characterizing the organizational patterns of various cellular constituents in the tumor microenvironment in precision oncology. Most existing data on immune cell infiltrates in tumors, which are based on immune cell counts or nearest neighbor-type analyses, have failed to fully capture the cellular organization and heterogeneity.

We introduce a computational algorithm, termed Tumor-Immune Partitioning and Clustering (TIPC), that jointly measures immune cell partitioning between tumor epithelial and stromal areas and immune cell clustering versus dispersion. As proof-of-principle, we applied TIPC to a prospective cohort incident tumor biobank containing 931 colorectal carcinoma cases. TIPC identified tumor subtypes with unique spatial patterns between tumor cells and T lymphocytes linked to certain molecular pathologic and prognostic features. T lymphocyte identification and phenotyping were achieved using multiplexed (multispectral) immunofluorescence. In a separate hepatocellular carcinoma cohort, we replaced the stromal component with specific immune cell types-CXCR3+CD68+ or CD8+-to profile their spatial relationships with CXCL9+CD68+ cells.

Six unsupervised TIPC subtypes based on T lymphocyte distribution patterns were identified, comprising two cold and four hot subtypes. Three of the four hot subtypes were associated with significantly longer colorectal cancer (CRC)-specific survival compared to a reference cold subtype. Our analysis showed that variations in T-cell densities among the TIPC subtypes did not strictly correlate with prognostic benefits, underscoring the prognostic significance of immune cell spatial patterns. Additionally, TIPC revealed two spatially distinct and cell density-specific subtypes among microsatellite instability-high colorectal cancers, indicating its potential to upgrade tumor subtyping. TIPC was also applied to additional immune cell types, eosinophils and neutrophils, identified using morphology and supervised machine learning; here two tumor subtypes with similarly low densities, namely 'cold, tumor-rich' and 'cold, stroma-rich', exhibited differential prognostic associations. Lastly, we validated our methods and results using The Cancer Genome Atlas colon and rectal adenocarcinoma data (n = 570). Moreover, applying TIPC to hepatocellular carcinoma cases (n = 27) highlighted critical cell interactions like CXCL9-CXCR3 and CXCL9-CD8.

Unsupervised discoveries of microgeometric tissue organizational patterns and novel tumor subtypes using the TIPC algorithm can deepen our understanding of the tumor immune microenvironment and likely inform precision cancer immunotherapy.

Guideline-recommended screening programs exist for only a few single-cancer types, and these cancers represent less than one-half of all new cancer cases diagnosed each year in the U.S. In addition, these "single-cancer" standard of care (SoC) screening tests vary in accuracy, adherence, and effectiveness, though all are generally understood to lead to reductions in cancer-related mortality. Recent advances in high-throughput technologies and machine learning have facilitated the development of blood-based multi-cancer early detection (MCED) tests. The opportunity for early detection of multiple cancers with a single blood test holds promise in addressing the current unmet need in cancer screening. By complementing existing SoC screening, MCED tests have the potential to detect a wide range of cancers at earlier stages when patients are asymptomatic, enabling more effective treatment options and improved cancer outcomes. MCED tests are positioned to be utilized as a complementary screening tool to improve screening adherence at the population level, to broaden screening availability for individuals who are not adherent with SoC screening programs, as well as for those who may harbor cancers that do not have SoC testing available. Published work to date has primarily focused on test performance relating to sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). MCED tests will require approval through the pre-market approval pathway from the United States Food and Drug Administration. Additional studies will be needed to demonstrate clinical utility (i.e., improvements in health outcomes) and establish optimal implementation strategies, (i.e., testing intervals), follow-up and logistics of shared decision making. Here, we propose core attributes of MCED testing for which clinical data are needed to ideally position MCED testing for widespread use in clinical practice.

Delayed post-polypectomy bleeding (DPPB) can occur up to a month following the procedure but is typically seen within the first week. Tranexamic acid (TXA) is a member of a class of drugs called antifibrinolytic agents. It reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin, which may prevent bleeding. The goal of this pilot study is to assess the feasibility of using tranexamic acid after endoscopic mucosal resection (EMR) of large (≥2 cm) non-pedunculated colorectal polyps (LNPCPs) to prevent DPPB.

This was a single centre feasibility study conducted at the Kingston Health Sciences Centre in 2021. After the polypectomy was completed, IV tranexamic acid was given [1 gram of TXA in 100 mL of normal saline] and infused over a 10-min interval. The participants received tranexamic acid 1 gram PO TID to be taken for 5 days.

A total of 25 patients were enrolled with a mean polyp size of 3 cm. Intraprocedural bleeding occurred in 7 patients (28%) and all of these were treated with soft coagulation. Two patients had clipping for suspected muscle injury. All 25 patients received IV TXA post-procedure. Sixteen patients (64%) took every dose of the prescribed pills. One patient presented with post-polypectomy bleeding. All patients completed the day 30 follow-up phone call. There were no major adverse events.

TXA to prevent delayed post-polypectomy bleeding (DPPB) was feasible to use with no major adverse events reported. A randomized controlled study will be needed to see if TXA can significantly reduce DPPB.

Colorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID.

To compare disparities in CRC screening before and after the onset of the COVID pandemic among privately insured individuals.

Retrospective cohort study using deidentified claims data from the USA between January 1, 2017, and December 31, 2022.

Blue Cross Blue Shield beneficiaries aged 50-75 years with average risk of CRC.

Mean screening use was compared by demographic and area-level socioeconomic factors between the periods preceding (January 1, 2017 to February 28, 2020) and following (July 1, 2020 to December 31, 2022) the onset of the COVID pandemic. Difference-in-differences analysis was used to evaluate changes in screening differences.

Our study included 21,724,223 beneficiaries. Compared to males, females had higher screening in both periods (p < 0.05), and this sex difference in screening increased 1.63% (95% confidence interval [CI]: 1.32%, 1.94%) following the onset of the pandemic. Compared to residents in areas with high socioeconomic status (SES), low SES area residents had lower screening (p < 0.001) during both periods. Furthermore, this difference grew 4.32% (95% CI, 3.76%, 4.88%) during the post-onset period. Metropolitan area residents had higher screening than non-metropolitan area residents during both periods (p < 0.001); however, this difference decreased 0.77% (95% CI, 0.34%, 1.20%) during the post-onset period. Among beneficiaries with high risk of CRC, the difference in screening based on social deprivation index and metropolitan area status increased 6.99% (95% CI, 5.77%, 8.20%) and 1.82% (95% CI, 0.88%, 2.74%), respectively.

Among privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.

Controversy remains regarding transparent cap-assisted technique improves adenoma detection rate (ADR) in colonoscopy. We aimed to investigate the effect of transparent cap-assisted colonoscopy (CAC) on ADR and other colonoscopy performance.

We performed subanalysis of an international, multicenter, open-label database containing colonoscopy data from 11 centers in 4 Asian countries/regions on patients who underwent colonoscopy. The patient characteristics, procedure-related characteristics, and pathological findings of all detected lesions were prospectively recorded. The patients were divided into 2 groups as receiving colonoscopy with or without transparent cap attachment. The ADR and procedure time were compared between the 2 groups. Other procedural factors related to ADR were also investigated.

Between November 2020 and January 2022, 3,029 who underwent colonoscopy (transparent CAC, n = 1,796; standard colonoscopy, n = 1,233) were enrolled in this study. The transparent CAC group ADR was significantly higher than the conventional colonoscopy (55.1% vs. 50.0%, p < 0.01). Transparent CAC detected a higher proportion of patients with adenoma (odd ratio [OR]: 1.59, 95% CI: 1.13-2.24, p < 0.01) and any polypoid lesion (OR: 1.49, 95% CI: 1.04-2.16, p = 0.03). Transparent CAC also reduced cecal intubation time (mean difference: -0.35 min) and total colonoscopy time (mean difference -3.4 min). In the other procedural factors, using linked-color imaging (OR: 1.75, 95% CI: 1.49-2.06, p < 0.01), patient body rotation (OR: 1.54, 95% CI: 1.12-2.13, p < 0.01), longer withdrawal time (OR: 1.12, 95% CI: 1.09-1.15, p < 0.01) were also significantly associated to adenoma detection.

In real-world practice, transparent CAC is a safe and inexpensive technology that could improve adenoma and polyp detection.

Background and aims Endoscopic mucosal resection (EMR) is a standard preventive method for colorectal cancer. Managing patients on anticoagulants during EMR is challenging because of balancing bleeding and thrombotic risks. Updated guidelines recommend continuing anticoagulants over heparin bridging; however, data on bleeding risks with continuing anticoagulants remain limited. This multicenter prospective study evaluated bleeding rates in patients who continued oral anticoagulants during EMR. Methods Patients on warfarin or direct oral anticoagulants (DOACs) undergoing EMR were enrolled from 12 tertiary hospitals. Warfarin was maintained on the day of EMR, while DOACs were paused on the day of EMR and resumed afterward. Post-EMR mucosal defects were closed with clips per protocol. Adverse events were monitored for 30 days. The primary endpoint was the major bleeding rate, defined as immediate bleeding requiring difficult hemostasis or delayed bleeding necessitating endoscopic intervention. The secondary endpoints were minor bleeding, other adverse events, and differences in bleeding rates between warfarin and DOACs. Results Among 107 patients (341 polyps; mean size = 6.7 mm), major bleeding occurred in five (4.7%) patients (95% confidence interval: 2.0%-10.5%), and all cases were managed endoscopically. Minor bleeding and thromboembolism events occurred in eight (7.5%) patients and one (0.9%) patient, respectively. No significant differences in bleeding rates were observed between warfarin and DOACs. Major bleeding rates were lower than those reported for heparin bridging. Conclusions Continuing anticoagulant therapy during EMR was associated with a low major bleeding rate (4.7%) and minimal thrombotic events, supporting its safety as an alternative to heparin bridging.

The current recommendation for a 10-year rescreening interval after a negative colonoscopy screening (NCS) result has been questioned, with some studies showing a persistently lower risk of colorectal cancer (CRC) after NCS results.

To examine long-term CRC incidence and mortality after NCS results (ie, no presence of CRC or polyps) and according to a risk score based on major demographic and lifestyle risk factors.

In this cohort study, 3 prospective US population-based cohorts from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study were followed up from 1988 and 1991 to 2020. Data from the National Health and Nutrition Examination Survey (NHANES) from the January 1, 2017, to December 31, 2018, cycle were used to compare the risk profile distribution with that of the general US population. Data analysis was performed from October 2023 to August 2024.

Time-varying status of NCS results and risk score.

Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs for incidence and mortality of CRC.

A total of 195 453 participants (median [IQR] age, 44 [37-56] years at baseline; 81% female) were followed up for a median (IQR) of 12 (6-20) years. Among 81 151 individuals with NCS results and 114 302 without endoscopy, 394 and 2229 CRC cases and 167 and 637 CRC deaths, respectively, were documented. Negative colonoscopy screening results were consistently associated with lower CRC incidence (HR, 0.51; 95% CI, 0.44-0.58) and mortality (HR, 0.56; 95% CI, 0.46-0.70) for 20 years. Among individuals with NCS results, those with an intermediate risk (scores, 6-7) and low risk (scores, 0-5) did not reach the 10-year cumulative incidence of CRC (0.78%) of the high-risk individuals (scores, 8-12) until 16 and 25 years after initial screening, respectively.

These findings provide evidence for shared decision-making between patients and physicians to consider extending the rescreening intervals after an NCS result beyond the currently recommended 10 years, particularly for individuals with a low-risk profile. These results showed, as a proof of concepts, the importance of considering known CRC risk factors when making decisions for colonoscopy rescreening.

Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this.

This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines.

The UP-PGH CRC KAP (University of the Philippines - Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire's validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively). Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense.

The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.

Colonoscopy remains the most commonly used colorectal cancer screening test in the United States. A substantial portion of the screening population value the high sensitivity of colonoscopy for precancerous colorectal lesions of all sizes, which allows it to be performed at 10 year intervals in average-risk persons with negative examinations. Emerging evidence supports the eventual endorsement of 15 year intervals for patients with normal examinations. Considerable evidence supports an impact of colonoscopy on colorectal cancer incidence and mortality, including a randomized controlled trial of colonoscopy vs. no screening, numerous case-control and cohort studies, an impact of fecal blood testing on cancer incidence, and the impact of one randomized controlled trial of flexible sigmoidoscopy on proximal colon cancer incidence. Colonoscopy is the gold standard for detection of colorectal precancerous lesions, and continues to evolve with regard to sensitivity for precancerous lesions and the effectiveness and safety of precancerous lesion resection. Gains in detection of precancerous lesions have followed from a robust movement to improve colonoscopy quality, and development of non-device techniques such as patient rotation during withdrawal, water exchange colonoscopy, and double examination of one or more colonic segments. Further, development of devices to improve mucosal exposure during withdrawal (e.g. Endocuff Vision, distal cap attachment, and Computer-Aided Quality), and devices that highlight flat lesions (e.g. chromoendoscopy, electronic chromoendoscopy, and Computer-Aided Detection) have created opportunities to achieve very high levels of detection and thereby increase the protective benefits of colonoscopy. Further, colonoscopy resection safety has improved via the widespread use of cold resection for lesions < 10 mm in size, as well as sessile serrated lesions of all sizes. Colonoscopy can be offered to patients as one of multiple options for screening, or as the test of choice for patients with the highest pre-screening probability of cancer and precancerous lesions, or as the first test offered followed by offers of other screening tests if colonoscopy is declined (sequential offers of screening). Sequential offers of screening result in overall adherence to screening similar to offering multiple options, but with a higher fraction of patients undergoing colonoscopy. Given the long-lasting protective effects of colonoscopy and its improving effectiveness and safety, colonoscopy remains a useful option for primary average-risk colorectal cancer screening.

Colonoscopy has been widely regarded as the gold standard for its high diagnostic accuracy and preventive potential. However, its invasive nature, high cost, and suboptimal participation rates limit its utility at the population level. Non-invasive screening tests, notably the fecal immunochemical test (FIT) and multitarget stool DNA tests, present promising alternatives that may improve screening participation and reduce barriers to participation. Among these, FIT has demonstrated a consistent advantage in enhancing participation, which subsequently contributes to better long-term outcomes in CRC prevention. FIT-based two-step screening offers several practical advantages, including cost-effectiveness, non-invasiveness, and greater flexibility. Moreover, the quantitative nature of FIT allows for adjustable sensitivity thresholds and the ability of risk stratification, making it adaptable across diverse populations and scenarios. Through serial testing, FIT can increase cumulative detection rates over time. This approach facilitates the identification of high-risk individuals, allowing for more judicious use of colonoscopy resources and reducing unnecessary invasive procedures, especially among low-risk populations. Notably, evidence indicates that participation to FIT-based screening is consistently higher than to colonoscopy, which enhances the detection of early-stage cancers and advanced adenomas in the long run. Given the constraints of limited endoscopic capacity, the aging population, and the recent lowering of the recommended screening age due to the rising incidence of early-onset CRC, FIT emerges as a practical, flexible solution. The role of two-step FIT screening in improving participation and enabling risk-stratified, personalized approaches to CRC prevention is pivotal, advocating for its expanded integration into future screening paradigms.

Introduction Endoscopic mucosal resection (EMR) is a common intervention for large colorectal polyps, but its long-term success depends heavily on post-procedure surveillance to detect recurrence. Despite the critical importance of follow-up appointments, some patients fail to attend these crucial visits. This study aims to identify demographic, clinical, and socioeconomic factors that predict missed follow-up appointments after EMR. By understanding which patients are at the highest risk for non-compliance, we can develop targeted strategies to improve follow-up adherence and optimize long-term outcomes in this population. Methods We conducted a single-center retrospective study at the Saint Louis Veterans Affairs Healthcare System of patients presenting for colon polyp EMR between January 2019 and December 2022. The primary outcome was the no-show rates for the scheduled patient endoscopic follow-up among patients who underwent EMR. A predictive model was then constructed to yield adjusted odds ratios and their prospective 95% confidence intervals. Results A total of 69 patients met the inclusion criteria. Fifty-nine patients followed up within the recommended interval. Ten patients failed to attend their follow-up appointments and were labeled as no-shows. The predictors of no-shows with their adjusted odds ratios and 95% confidence intervals in descending order included previous history of one or more no-shows (3.8, 1.7-8.5, p = 0.002), recommended follow-up interval greater than six months (3.5, 1.1-12.5, p = 0.04), psychiatric comorbidities (2.8, 1.7-4.6, p = 0.002), and history of substance use (2.7, 1.8-6, p = 0.03). Conclusions In patients undergoing EMR, our study identified several risk factors for follow-up non-compliance, including previous no-show history, substance use disorder, and psychiatric comorbidities. These findings suggest that targeted interventions for high-risk patients may improve follow-up adherence. While longer follow-up intervals (>6 months) were associated with increased no-show rates, modifying established surveillance guidelines would require dedicated studies evaluating the safety and efficacy of alternative follow-up schedules.

Colorectal cancer (CRC) incidence and mortality of China account for nearly 30% of the global attributable fraction. We aimed to estimate the yield and effectiveness of a 2-sample fecal immunochemical test (FIT)-based screening program in China.

Eligible individuals were invited for 2-sample FIT between 2007 and 2021, with positive ones (cutoff 40 μg/g before 2013 and 20 μg/g thereafter) referred for colonoscopy. Participation rates, detection rates, and positive predictive values were calculated. Participants were classified into: FIT+/colonoscopy compliers, FIT+/colonoscopy noncompliers, and FIT- as control subjects. We compared CRC incidence and mortality and calculated the age reaching comparable risk.

Among 246,349 invitees, 150,524 (61.10%) participated in 2-sample FIT, with 16,994 (11.29%) identified as FIT+; 12,816 (75.41%) underwent colonoscopy, yielding a detection rate and positive predictive value of 0.57% and 6.70% for advanced neoplasia, respectively. Median follow-up was 10.58 years. Compared with FIT- participants, CRC incidence and mortality were relatively similar among FIT+/colonoscopy compliers with hazard ratios of 0.94 (95% confidence interval [CI], 0.75-1.19) and 1.62 (95% CI, 1.09 to 2.41) but higher among noncompliers, with hazard ratios of 3.52 (95% CI, 2.85-4.34) and 4.41 (95% CI, 2.96-6.55). Taking CRC incidence and mortality risk of FIT- participants at 50.0 years of age as the benchmark, FIT+/colonoscopy compliers reached same risk at 50.6 and 46.1 years of age, while noncompliers reached the same risk at 38.0 and 37.9 years of age, respectively.

Two-sample FIT could effectively identify high-risk populations, and colonoscopy compliance is associated with a lower risk of CRC incidence and mortality. This strategy might facilitate CRC screening practice in countries with large populations.

Background and study aims Among colorectal serrated polyps (SPs), sessile serrated lesions (SSLs) and hyperplastic polyps (HPs) have a similar endoscopic appearance. However, the endoscopic distinctions between those two categories, microvesicular HPs (MVHPs) and goblet cell-rich HPs (GCHPs), are not well understood. Therefore, we compared the endoscopic features of SSLs, MVHPs, and GCHPs. Methods This retrospective, cross-sectional study was conducted at the Toyoshima Endoscopy Clinic. We examined polyp size, location, Paris classification type, mucus cap, indistinct border, expanded crypt opening, varicose microvascular vessels, and JNET classification type. Multivariable analysis of each endoscopic finding using a binomial logistic regression model determined the factors that predicted SP histology. Results A total of 670 SPs were enrolled in this study, comprising 159 SSLs, 361 MVHPs, and 150 GCHPs. On comparing the SSL + MVHP group and the GCHP group, a mucus cap (partial regression coefficient 1.705), expanded crypt opening (1.828), and varicose microvascular vessels (1.270) were more often observed in the SSL + MVHP group compared with the GCHP group. In the comparison between MVHPs and GCHPs, a mucus cap (1.564), expanded crypt opening (1.802), and varicose microvascular vessels (1.288) were more often found in MVHPs in contrast to GCHPs. When comparing SSLs and MVHPs, SSLs were more likely to be in the proximal colon (0.662) and were larger (0.198) than the MVHPs. No significant differences were observed in other endoscopic findings. Conclusions SSLs and MVHPs have endoscopic appearances that differ from those of GCHPs. Considering MVHPs and GCHPs as distinct entities may aid in endoscopic diagnosis of SPs.

The use of computer-aided detection (CADe) has increased the adenoma detection rates (ADRs) during colorectal cancer (CRC) screening/surveillance in randomized controlled trials (RCTs) but has not shown benefit in real-world implementation studies. We performed a single-center pragmatic RCT to evaluate the impact of real-time CADe on ADRs in colonoscopy performed by community gastroenterologists.

We enrolled 1100 patients undergoing colonoscopy for CRC screening, surveillance, positive fecal-immunohistochemical tests, and diagnostic indications at one community-based center from September 2022 to March 2023. Patients were randomly assigned (1:1) to traditional colonoscopy or real-time CADe. Blinded pathologists analyzed histopathologic findings. The primary outcome was ADR (the percentage of patients with at least 1 histologically proven adenoma or carcinoma). Secondary outcomes were adenomas detected per colonoscopy (APC), sessile-serrated lesion detection rate, and non-neoplastic resection rate.

The median age was 55.5 years (interquartile range, 50-62 years), 61% were female, 72.7% were of Hispanic ethnicity, and 9.1% had inadequate bowel preparation. The ADR for the CADe group was significantly higher than the traditional colonoscopy group (42.5% vs 34.4%; P = .005). The mean APC was significantly higher in the CADe group compared with the traditional colonoscopy group (0.89 ± 1.46 vs 0.60 ± 1.12; P < .001). The improvement in adenoma detection was driven by increased detection of <5 mm adenomas. CADe had a higher sessile-serrated lesion detection rate than traditional colonoscopy (4.7% vs 2.0%; P = .01). The improvement in ADR with CADe was significantly higher in the first half of the study (47.2% vs 33.7%; P = .002) compared with the second half (38.7% vs 34.9%; P = .33).

In a single-center pragmatic RCT, real-time CADe modestly improved ADR and APC in average-detector community endoscopists. (ClinicalTrials.gov number, NCT05963724).

Disparity in overall survival (OS) and differences in the frequency of driver gene variants by race and ethnicity have been separately observed in patients with colorectal cancer; however, how these differences contribute to survival disparity is unknown.

To quantify the association of molecular, socioeconomic, and clinical covariates with racial and ethnic disparities in overall survival among patients with colorectal cancer.

This single-center cohort study was conducted at a tertiary-level cancer center using relevant data on all patients diagnosed with colorectal cancer from January 1, 1973, to March 1, 2023. The relative contribution of variables to the disparity was determined using mediation analysis with sequential multivariate Cox regression models.

OS, from diagnosis date and from start of first-line chemotherapy.

The study population of 47 178 patients (median [IQR] age, 57.0 [49-66] years; 20 465 [43.4%] females and 26 713 [56.6%] males; 3.0% Asian, 8.7% Black, 8.8% Hispanic, and 79.4% White individuals) had a median (IQR) follow-up from initial diagnosis of 124 (174) months and OS of 55 (145) months. Compared with White patients, Black patients had worse OS (hazard ratio [HR], 1.16; 95% CI, 1.09-1.24; P <.001), whereas Asian and Hispanic patients had better OS (HR, 0.66; 95% CI, 0.59-0.74; P <.001; and 0.86; 95% CI, 0.81-0.92; P <.001, respectively). When restricted to patients with metastatic disease, the greatest disparity was between Black patients compared with White patients (HR, 1.2; 95% CI, 1.06-1.37; P <.001). Evaluating changes in OS disparity over 20 years showed disparity decreasing among Asian, Hispanic, and White patients, but increasing between Black patients and White patients (HRs, 1.18; 95% CI, 1.07-1.31 for 2008-2012; 1.24, 95% CI, 1.08-1.42 for 2013-2017; and 1.50; 95% CI, 1.20-1.87 for 2018-2023). Survival outcomes for first-line chemotherapy were worse for Black patients compared with White patients (median OS, 18 vs 26 months; HR, 1.30; 95% CI, 1.01-1.70). Among 7628 patients who had clinical molecular testing, APC, KRAS, and PIK3CA showed higher variant frequency in Black patients (false discovery rate [FDR], 0.01; < 0.001; and 0.01, respectively), whereas BRAF and KIT were higher among White patients (FDR, 0.001 and 0.01). Mediation analysis identified neighborhood socioeconomic status as the greatest contributor to OS disparity (29%), followed by molecular characteristics (microsatellite instability status, KRAS variation and BRAF variation, 10%), and tumor sidedness (9%).

This single-center cohort study identified substantial OS disparity and differing frequencies of driver gene variations by race and ethnicity. Socioeconomic status had the largest contribution but accounted for less than one-third of the disparity, with substantial contribution from tumor molecular features. Further study of the associations of genetic ancestry and the molecular pathogenesis of colorectal cancer with chemotherapy response is needed.