Search Results (71)

Background/Objectives: The incidence of early-onset colorectal cancer is increasing worldwide. The fecal immunochemical test (FIT) is widely used for screening adults aged 50 and older, but its performance in younger individuals is less understood. Methods: We retrospectively analyzed 202,676 FITs from asymptomatic adults aged 18–49 between 2011 and 2025. FIT results, age categories, and follow-up colonoscopy findings were evaluated. Results: The FIT positivity rate was 4.7%. Among 1973 FIT-positive individuals who underwent colonoscopy, 5.9% had advanced adenoma or sessile serrated lesion and 1.3% had invasive cancer. A total of 143 advanced neoplasms (ANs) were detected, with prevalence increasing with age. Most ANs (79.1%) occurred in those aged 40–49. The prevalence of ANs was higher in the 45–49 than in the 40–44 age group (49.0% vs. 30.1%; OR 1.55, 95% CI 1.04–2.32) and higher in the 40–44 than in the 35–39 age group (30.1% vs. 10.5%; OR 2.20, 95% CI 1.20–4.02). Conclusions: The diagnostic performance of FIT in individuals under 50 years is comparable to that observed in the older population. Given the age-related rise in the prevalence of ANs in young adults, several countries have lowered the screening age to 45 years, and extending screening to individuals aged 40 years may be warranted. Full article

Colorectal cancer (CRC) is responsible for a high cancer burden and a high number of deaths all over the world, although effective screening can make it preventable to a significant extent. Stool-based tests, such as the fecal immunochemical test (FIT) and multitarget stool DNA (mt-sDNA) testing, are gaining considerable popularity as non-invasive procedures that can be a replacement for colonoscopies for people at an average risk for colon cancer. Despite evidence from several randomized controlled trials supporting the use of these tests for colorectal cancer screening, their external validity in a real-world setting is influenced by many factors such as adherence, timely follow-up post testing, the healthcare cost burden, accessibility and the capacity of the health system. In this article, we have performed an extensive narrative literature review of research published between 2020 and 2025 comparing FIT and the mt-sDNA test with reference to diagnostic accuracy, cost-effectiveness, adherence and outcomes of implementation. We discuss the issues of sensitivity and specificity, look at post-test requirements for colonoscopy and check if there is any discrimination in healthcare. These findings suggest that FIT and mt-sDNA tests should not be considered competing technologies but rather complementary screening methods, with their overall effectiveness contingent upon appropriate patient selection and widespread system-level implementation. It is crucial to combine strategic test selection with a robust follow-up infrastructure to ensure that the entire population benefits from the CRC prevention program. Full article

Background/Objectives: Colorectal cancer (CRC) represents a major cause of cancer-related morbidity and mortality worldwide, particularly in regions with delayed or incomplete implementation of population-based screening programs. Evidence describing the burden and characteristics of colorectal lesions detected through organized screening initiatives in Eastern Europe is still limited. Methods: This retrospective study analyzed data from a regional CRC screening program conducted between November 2020 and December 2023 in South-West Oltenia, Romania. A total of 1550 individuals aged 50–74 years underwent colonoscopic evaluation following fecal immunochemical testing or direct referral based on risk assessment. Lesion characteristics, including size, anatomical distribution, histopathological subtype, dysplasia grade, tumor differentiation, and resection margin status, were systematically analyzed. Associations between demographic variables and lesion characteristics were evaluated using appropriate statistical methods. Results: At least one colorectal lesion was identified in 63.7% of colonoscopies, with a total of 5001 lesions detected. Most lesions measured <10 mm. Serrated lesions (51.4%) and conventional adenomas (42.2%) predominated, while invasive adenocarcinoma was identified in 6.2% of cases. Increasing lesion size was significantly associated with higher-grade dysplasia, incomplete resection margins and advanced histopathological features (p < 0.05). Age showed significant associations with histopathological subtype and resection margin status, whereas male sex was linked to higher-grade dysplasia and adenocarcinoma (p < 0.05). Conclusions: This study revealed a relatively high prevalence of precancerous and malignant colorectal lesions in a previously unscreened population. The strong associations between lesion size, dysplasia severity, and resection completeness underscore the importance of early detection and quality-controlled colonoscopy. These findings support the expansion of organized CRC screening programs and the integration of quality indicators to enhance diagnostic accuracy. Full article

Acute diverticulitis (AD) is a common gastrointestinal condition that has seen a significant rise in incidence and prevalence, largely due to the aging population and the increasing prevalence of obesity. Historically, routine colonoscopy was recommended after every episode of AD, but recent studies and meta-analyses have questioned this practice. Evidence now supports a more selective approach, suggesting that colonoscopy should only be performed in patients with complicated AD, persistent alarm symptoms (abdominal pain, weight loss, altered bowel habits, blood in stool, or iron-deficiency anemia), or imaging findings suggestive of neoplasia. For uncomplicated AD without alarm symptoms, routine colonoscopy is not justified, as it may lead to unnecessary complications and overuse of healthcare resources. Current guidelines reflect this shift, recommending individualized decision-making based on the patient’s clinical history and risk factors. Emerging non-invasive diagnostic tools, such as fecal immunochemical tests (FIT) and artificial intelligence (AI)-based models, hold promise for improving risk stratification and potentially reducing the need for invasive procedures. This narrative review, based on a structured literature search, synthesizes the evolution of post-AD colonoscopy recommendations, presents current evidence, and highlights future research directions on alternative diagnostic methods and their potential to optimize patient care and clinical decision-making. Full article

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer deaths worldwide, despite existing effective prevention strategies. Pharmacists are increasingly involved in various colorectal cancer prevention programs and are well-positioned to support these prevention efforts. In this systematic review, we investigate evidence regarding pharmacist-led interventions for colorectal cancer prevention by conducting a comprehensive search across the following electronic databases: MEDLINE, Embase, Web of Science, CINAHL, PubMed, and ClinicalTrials.gov. Studies were included only if they examined the role of pharmacists in early colorectal cancer detection and screening, lifestyle counseling to support prevention, and risk awareness and education. Risk of bias was assessed using the Pre–Post Quality Assessment developed by the National Institutes of Health. A total of 1405 studies were identified, of which four were included in the review. The included studies were quasi-experimental studies that mainly addressed screening awareness with fecal immunochemical test distribution, referrals, and counseling. The results of these studies showed an increase in screening participation, an improvement in knowledge of colorectal cancer risk factors and screening, and enhanced colorectal cancer referral rates. This systematic review highlights the potential of pharmacist-led interventions in enhancing colorectal cancer prevention efforts, but further well-designed studies are needed. Full article

Background: Flanders (Belgium) offers a fecal immunochemical test (FIT) biennially to citizens aged 50–74 years, but uptake is suboptimal (~50%). This study evaluated the impact of a second e-reminder on FIT uptake. Methods: We conducted a quasi-experimental study comparing FIT uptake in individuals who received a first e-reminder during June 2023–May 2024 and a second e-reminder five weeks later (intervention cohort) with those who received a first e-reminder in June 2021–May 2022 without a second reminder (historical control). The study outcome was FIT uptake within one year after the first e-reminder. Analyses were stratified by screening history (regular vs. irregular participants). Results: The study population consisted of 54,734 regular (27,522 control and 27,212 intervention); and 18,492 irregular participants (8565 control and 9927 intervention). Median age was slightly lower in the intervention group (regular: 57 vs. 59 years; irregular: 62 vs. 64 years). Gender distribution was balanced (≈50% men). Regular participants receiving a second e-reminder had 80% higher probability of participation than controls (OR 1.80; 95% CI 1.73–1.86; p < 0.0001); with uptake increasing from 29.5% to 43.7%. Irregular participants with a second e-reminder had a 91% higher probability of participation compared with no second e-reminder (OR 1.91; 95% CI 1.74–2.09; p < 0.0001), with uptake increasing from 9.4% to 18.4%. Conclusions: A second e-reminder significantly increased FIT uptake among both regular and irregular participants in the Flemish colorectal cancer screening program. These findings support its use as a low-cost strategy to improve population-level screening participation. Full article

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide, accounting for approximately 10% of all cancer cases. Despite the proven effectiveness of conventional screening modalities such as colonoscopy and fecal immunochemical testing (FIT), their invasive nature, high cost, and limited patient compliance hinder widespread adoption. Recent advancements in artificial intelligence (AI) and bowel sound-based signal processing have enabled non-invasive approaches for gastrointestinal diagnostics. Among these, bowel sound analysis—historically considered subjective—has reemerged as a promising biomarker using digital auscultation and machine learning. Objective: This review explores the potential of AI-powered bowel sound analytics for early detection, screening, and characterization of colorectal cancer. It aims to assess current methodologies, summarize reported performance metrics, and highlight translational opportunities and challenges in clinical implementation. Methods: A narrative review was conducted across PubMed, Scopus, Embase, and Cochrane databases using the terms colorectal cancer, bowel sounds, phonoenterography, artificial intelligence, and non-invasive diagnosis. Eligible studies involving human bowel sound-based recordings, AI-based sound analysis, or machine learning applications in gastrointestinal pathology were reviewed for study design, signal acquisition methods, AI model architecture, and diagnostic accuracy. Results: Across studies using convolutional neural networks (CNNs), gradient boosting, and transformer-based models, reported diagnostic accuracies ranged from 88% to 96%. Area under the curve (AUC) values were ≥0.83, with F1 scores between 0.71 and 0.85 for bowel sound classification. In CRC-specific frameworks such as BowelRCNN, AI models successfully differentiate abnormal bowel sound intervals and spectral patterns associated with tumor-related motility disturbances and partial obstruction. Distinct bowel sound-based signatures—such as prolonged sound-to-sound intervals and high-pitched “tinkling” proximal to lesions—demonstrate the physiological basis for CRC detection through bowel sound-based biomarkers. Conclusions: AI-driven bowel sound analysis represents an emerging, exploratory research direction rather than a validated colorectal cancer screening modality. While early studies demonstrate physiological plausibility and technical feasibility, no large-scale, CRC-specific validation studies currently establish sensitivity, specificity, PPV, or NPV for cancer detection. Accordingly, bowel sound analytics should be viewed as hypothesis-generating and potentially complementary to established screening tools, rather than a near-term alternative to validated modalities such as FIT, multitarget stool DNA testing, or colonoscopy. Full article

Background/Objectives: Colorectal cancer is the most frequently diagnosed cancer and second by mortality among all cancers in Croatia. The Organized National Colorectal Cancer Screening Program was introduced by the government in 2007. It targets individuals aged 50–74 years with a biennial screening with a guaiac fecal occult blood test (gFOBT). The aim of this study is to analyze the costs associated with colorectal cancer in Croatia and to compare the cost-effectiveness of three screening strategies: no screening, biennial gFOBT, and biennial fecal immunochemical testing (FIT). Patients and methods: A model was developed to compare the three screening scenarios. The model simulated a cohort of 10,000 patients aged 50 years without colorectal cancer. Health outcomes and associated costs were projected over a five-year time horizon. The model outcomes include the number of newly diagnosed colorectal cancer cases, number of colorectal cancer-related deaths, life-years gained, and costs per life-year gained. Results: The average five-year costs per patient for the treatment of advanced cancer are EUR 39,802, which is substantially higher than the average costs of EUR 16,897 per patient across all stages. The implemented model indicates that both screening options yielded improved health outcomes at lower costs compared with no screening. FIT is considered the preferred screening option due to its higher sensitivity, greater health outcomes, and lower costs relative to gFOBT. Conclusions: The introduction of FIT screening instead of gFOBT could increase screening uptake for colorectal cancer, improve health outcomes, and reduce healthcare expenditures and the economic burden associated with colorectal cancer in Croatia. Full article

Background: Less than 1% of all colorectal cancers (CRCs) are primary colorectal signet-ring cell carcinomas (SRCCs), which represent an uncommon and aggressive histological subtype. Given their subtle onset and rapid progression, these are often diagnosed in an advanced stage, and can be distinguished by the presence of mucin-producing signet-ring cells. Synchronous colonic metastases at initial diagnosis are rather uncommon. Case presentation: We report the case of a 65-year-old male patient who underwent a routine colonoscopy following a positive fecal immunochemical test (FIT). The patient had no remarkable medical history and was asymptomatic. A 3 cm semi-pedunculated polyp and several smaller depressed lesions, 2 cm maximum in diameter, were observed in the descending colon during the colonoscopy. Multiple biopsies were obtained. The lesions were found to be SRCC according to histopathological examination. There was no sign of extra-colonic metastases on the computed tomography (CT). The patient was referred for extensive hemicolectomy, regional lymphadenectomy, and adjuvant chemotherapy. Conclusions: This article provides a thorough literature review on this uncommon presentation and discussion regarding the current understanding of the pathogenesis, clinical manifestations, and management strategies of SRCC. This case highlights the importance of routine screening in detecting aggressive malignancies like SRCC in asymptomatic individuals. Early identification through colonoscopy can lead to timely intervention, potentially improving prognosis. Full article

Background/Objectives: Modeling analyses for colorectal cancer (CRC) screening focusing solely on the costs of screening do not fully capture the value of screening programs. We evaluated the clinical and economic effects of CRC stool-based screening tests, including impacts on cancer-related outcomes. Methods: A cohort-based decision-analytic cost-estimator model estimated outcomes for a single round of screening with next-generation multi-target stool DNA (ng mt-sDNA) test or fecal immunochemical test (FIT) from a US payer perspective. Undiagnosed cancers were assumed to become symptomatic (and detected) within 10 years. Clinical assumptions, advanced precancerous lesion and CRC prevalence, and test performance inputs were from clinical trial data. Adherence rates for initial screening and follow-up colonoscopy after a positive result were from real-world data. Input costs included the screening tests, follow-up colonoscopy (with and without polypectomy), and CRC treatment. Results: Compared with FIT, more individuals completed ng mt-sDNA (321,000 vs. 713,000, respectively), leading to the detection of more CRC cases (436 with FIT vs. 2235 with ng mt-sDNA), more advanced precancerous lesions, and more CRC at earlier stages. The cost of screening per patient screened was USD 801 for ng mt-sDNA and USD 124 for FIT. Follow-up colonoscopy cost was USD 149 million with ng mt-sDNA versus USD 22 million with FIT, whereas CRC treatment costs were lower for ng mt-sDNA (USD 1423 million versus USD 1474 million, respectively). When accounting for both direct and CRC averted costs, the total cost of screening and treatment was USD 1383 million with ng mt-sDNA versus USD 1427 million with FIT. Conclusions: Higher screening costs with ng mt-sDNA versus FIT are counterbalanced by savings realized from enhanced CRC prevention and earlier detection due to the superior test performance and better adherence with ng mt-sDNA. Full article

Background: Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, obesity, and cancer are the leading cause of mortality globally and in Saudi Arabia, accounting for more than 70% of all deaths. Despite national initiatives offering free preventive services, screening uptake remains low. This study aimed to describe the demographic and clinical characteristics of individuals participating in community-based NCD screening campaigns in the Eastern Province of Saudi Arabia and to evaluate screening uptake, compliance, and diagnostic outcomes. Methods: A retrospective cross-sectional analysis was conducted among 3106 adults screened at volunteer-driven community campaigns held between January 2023 and December 2024. Screening included anthropometric measurements, blood pressure assessment, and glucose testing, followed by eligibility evaluation for osteoporosis and cancer screening. Uptake and compliance were verified using electronic health records. Descriptive and inferential statistical analyses were applied. Results: Participants were 64% male and 36% female, with a mean age of 41.4 ± SD years. Obesity, hypertension, and diabetes were identified in 32%, 31%, and 12% of participants overall. Gender-stratified prevalence showed higher obesity among females at 36% (95% CI 32.3 to 38.1) and higher hypertension and diabetes among males at 36% (95% CI 34.0 to 38.2) and 14% (95% CI 12.1 to 15.2), respectively. Uptake among eligible individuals was 51% for dual-energy X-ray absorptiometry (DEXA), 47% for fecal immunochemical testing (FIT), 43% for Pap smear, and 39% for mammography. Diagnostic findings demonstrated substantial undetected disease burden, including osteoporosis in 41% (95% CI 26.0 to 56.8) of DEXA scans, a FIT positivity rate of 5% (95% CI 1.5 to 10.3), abnormal Pap cytology in 3% (95% CI 1.1 to 7.5), and BI-RADS 0 mammograms in 19% (95% CI 11.9 to 29.5), reflecting incomplete assessments requiring further evaluation. Conclusions: Community-based campaigns can effectively resolve limited engagement in health promotional activities and detect substantial burdens of undiagnosed NCDs. However, improvements in referral tracking, follow-up systems, and culturally tailored health education are essential to enhance screening compliance and early detection outcomes. These results can be utilized to inform public policies by extending screening services to additional areas, increasing investment in preventive health campaigns, and enhancing the capacity of the health system. Full article

Background and aim: The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined. Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings. Methods: This retrospective study included 38,392 adults (≥18 years) who tested positive for FIT between 2016 and 2022 across eight medical centers in Israel. Of them, 1560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included the detection of neoplastic and precancerous lesions, with the rates of adenoma and polyp detection calculated. Gastroscopy findings, including gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy, were analyzed and compared between patients with normal and abnormal colonoscopy results. Results: Among 38,392 FIT-positive adults, 1560 underwent bidirectional endoscopy; of these, 632 (40.5%) had normal and 928 (59.5%) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.5% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 15% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Gastric ulcers were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group. Conclusions: Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare. Full article

Background/Objectives: Computer-aided detection (CADe) systems are increasingly used in endoscopy to enhance lesion recognition. PolyDeep is a CADe/x tool previously assessed in an observational study. The aim of our study is to determine if PolyDeep-assisted colonoscopy reduces the adenoma miss rate (AMR) compared with conventional colonoscopy. Methods: We carried out a multicenter randomized controlled trial with a tandem colonoscopy design in participants from a colorectal cancer screening program (positive fecal immunochemical test-FIT or surveillance). Expert endoscopists performed all colonoscopies, and patients were allocated to groups by a computer-generated sequence. The primary endpoint was AMR; secondary endpoints included polyp miss rate (PMR), serrated lesion miss rate (SLMR) and advanced polyp miss rate (APMR). Results: From May to November 2023, we recruited 260 patients and excluded 20, leaving 240 for analysis. Baseline characteristics were balanced between groups (62.1% male; mean age 62.3 ± 6.5 years; 65.8% FIT-positive; mean first withdrawal time 13:38 ± 08:07 min; mean second withdrawal time 07:50 ± 03:38 min; lesion detection rate 76.6%; mean polyps per patient 3.4 ± 3.1). We did not find statistically significant differences between PolyDeep-assisted and conventional colonoscopy groups in AMR (21.3% vs. 18.1%, p = 0.5), PMR (21.8% vs. 20.3%, p = 0.7), SLMR (23.4% vs. 25.6%, p = 0.9) or APMR (7.3% vs. 11.3%, p = 0.5). In the subgroup analysis according to indication, we did not find any statistically significant differences. Conclusions: In the context of a CRC screening program, PolyDeep-assisted colonoscopy did not reduce AMR. Full article

Background/Objectives: Colorectal cancer (CRC) is the leading cancer-related death in Puerto Rico (PR). Yet CRC screening (CRCS) rates remain low. We developed ¡Salud!, por la Vida, an educational intervention aiming to increase CRCS among age-eligible adults living in PR. Methods: We conducted a cluster randomized controlled trial among adults 50–75 years old at Federally Qualified Health Clinics in PR. Participants could not have a history of CRC nor be currently adherent to CRCS guidelines for a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (within last year) or colonoscopy (within last 5–10 years). Out of 445 randomized participants, 355 completed the study procedures (Control: 277; Intervention: 78) and were included in the main analysis. Participants in the intervention arm completed baseline and follow-up questionnaires alongside the educational intervention (at baseline) and two reminder calls (before follow-up) within a four-month period. Control arm participants only completed baseline and follow-up questionnaires within the same period. All participants were followed up to assess CRCS completion. Results: Post-trial screening rates were significantly higher in the intervention group: FOBT/FIT (55% vs. 39%, p = 0.02), colonoscopy (10% vs. 3%, p = 0.02), and any CRCS (60% vs. 41%, p < 0.01). Compared to controls, those in the intervention group showed a 48% higher probability of undergoing any CRCS (RR = 1.48, 95%CI: 1.17, 1.86), were 1.4 times more likely to complete a FOBT/FIT (RR = 1.40, 95%CI: 1.09, 1.80), and were over 3 times more likely to undergo a colonoscopy (RR = 3.16, 95%CI: 1.26, 7.91). Conclusions: The findings underscore the efficacy of the intervention in increasing CRCS uptake, potentially preventing late-stage detection and reducing CRC mortality in PR. Full article

Background: Colorectal cancer (CRC) represents one of the leading causes of cancer-related morbidity and mortality globally. Although national screening programs in Europe and the United States have demonstrated success in reducing incidence and death rates among populations aged 50 and above, a concerning increase in early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, has emerged. Methods: This paper is a narrative literature review comparing American and European CRC screening guidelines. A comprehensive search was conducted using the PubMed database with emphasis on publications from the past ten years. Results: The United States has adapted more swiftly to EOCRC trends by lowering the recommended screening age to 45, supported by modeling studies showing life-years gained and improved cost-effectiveness. In contrast, European programs remain largely organized and cost-efficient but predominantly initiate screening at age 50, potentially missing high-risk younger adults. EOCRC appears to demonstrate unique molecular and pathological features compared to late-onset CRC. Participation and adherence to screening also vary significantly between regions and modalities, with colonoscopy remaining the gold standard but less scalable than fecal immunochemical tests. Conclusions: The rising incidence of EOCRC calls for a reassessment of CRC screening policies. While the European model emphasizes equity and structure, its slower responsiveness to epidemiological changes may lead to late detection in younger cohorts. The American model’s earlier screening age addresses emerging trends but faces challenges in implementation equity. A hybrid approach may provide the optimal management, balancing public health benefit with system sustainability. Full article