BACKGROUND Risk of post colonoscopy colorectal cancer is related to adenoma miss rate (AMR) during colonoscopy. Artificial intelligence (AI) and Endocuff Vision are tools both used to increase adenoma detection rate (ADR). AIM To assess whether the combination of AI and Endocuff vision, compared to using AI alone, increases the ADR. METHODS This is a single-center randomized, tandem colonoscopy trial. Patients with a Boston Bowel Preparation score ≥ 6 with an indication of colorectal cancer screening (78, 91.8%) or polyp surveillance (7, 8.2%) were included from the study. RESULTS Eighty-five patients were included in total (male: 51; mean age: 63 ± 8 years old). In 39 patients, the initial colonoscopy was performed using AI alone, while in 45 patients, it was carried out with a combination of AI and Endocuff. Colonoscopies without Endocuff were associated with a numerically higher ADR (19/39, 48.7% vs 14/45, 31.1%, P = 0.107) and an increased number of polyps detected per procedure (1.7 ± 2.5 vs 1.2 ± 1.4, P = 0.272). During tandem colonoscopy, an additional 0.4 ± 0.8 polyps per examination (polyp miss rate = 0.08 ± 0.15), along with 0.3 ± 0.7 adenomas (AMR = 0.10 ± 0.25), were identified. Adding Endocuff to AI during tandem colonoscopy did not provide any benefit in AMR or polyp miss rate when compared to initial AI combined with Endocuff-assisted endoscopy followed by tandem AI-only procedures (0.11 ± 0.24 vs 0.92 ± 0.27, P = 0.727; and 0.10 ± 0.15 vs 0.07 ± 0.14, P = 0.415, respectively). CONCLUSION Adding Endocuff to AI-assisted colonoscopy, according to our results, does not lead to increased adenoma detection.

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.

Anxiety before a first-time screening colonoscopy is a commonly reported patient-level barrier to completing colorectal cancer (CRC) screening. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of "For peace of mind. Get Screened," a brief online mindfulness-based intervention (MBI) to reduce anxiety before a first-time screening colonoscopy. Participants (n = 100) were randomized (October 2023-July 2024) to usual care or the MBI (daily CRC screening infographics guided by the Protection Motivation Theory, mindfulness infographics, and brief mindfulness meditations based on Monitor and Acceptance Theory) starting five days before their scheduled colonoscopy. Anxiety was assessed using the State-Trait Anxiety Inventory-State Subscale (STAI-S) in the endoscopy suite's waiting room. Participant retention was 83% due to patient and health system issues. Participant satisfaction with the MBI was high (mean: 6.40 out of 7). The MBI group had an average STAI-S score 2.54 points lower than the usual care group, though this difference was not statistically significant (32.24 vs. 34.78; p = 0.21). However, among participants not lost to follow up (n = 83), the MBI group had significantly lower waiting room STAI-S scores compared to the usual care group (31.52 vs. 35.21; p = 0.02). Clinical outcomes did not differ between groups. Feasibility of the MBI was partially limited due to logistical issues. Findings support MBI acceptability and suggest that a brief MBI has the potential to decrease anxiety prior to a first-time colonoscopy. A larger randomized controlled trial is needed to further examine the efficacy of this intervention. ClinicalTrials.gov NCT06233253.

A spatially-programmed DNA nanoplatform for multiplexed and orthogonal miRNA profiling enables robust diagnosis of colorectal cancer.

Interventions to improve cancer screening adherence in migrants and ethnic minorities in the European Region: A systematic review.

Ultrasensitive detection of colorectal cancer biomarkers in exhaled breath using superhydrophobic HCPs-2Br-based SPME-GC-MS with a two-step pre-enrichment strategy.

Protocol paper for an implementation science approach to promoting colorectal cancer screening in Federally Qualified Health Center Clinics: A stepped-wedge, multilevel intervention trial.

Population-Based Cancer Screening analysis in Northern Portugal Using Process Mining.

Can Colonoscopy Still Be Promoted as the Best Choice for Colorectal Cancer Screening?

Objective Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States. Multi-target stool DNA (mt-sDNA) testing is a noninvasive, highly sensitive screening option, but its effectiveness is limited by workflow inefficiencies and suboptimal patient adherence. University of Washington Medicine (UWM) implemented Epic Aura, an electronic health record (EHR) interface that automates test ordering, patient outreach, and results communication, alongside shared decision-making (SDM) interventions. This study evaluated the impact of these implementations on mt-sDNA utilization and adherence. Methods This retrospective cohort study used de-identified laboratory data from Exact Sciences for UWM patients aged ≥45 years. The pre-implementation period spanned December 5, 2022–December 4, 2023, and the post-implementation period December 5, 2023–December 4, 2024. The primary outcome was adherence, defined as return of a valid mt-sDNA kit within 365 days of shipment. Descriptive analyses and multivariable logistic regression compared adherence across periods and identified associated factors. Results A total of 125 pre-implementation and 1,160 post-implementation mt-sDNA shipments were analyzed. Utilization increased nearly 10-fold following implementation. Adherence improved from 64.0% pre-implementation to 79.1% post-implementation (p < .001), with faster kit return post-implementation (59.0% vs 48.8% within 30 days). Post-implementation was independently associated with higher adherence (adjusted odds ratio [aOR] = 1.98; 95% CI = 1.30–3.02; p = .002). Higher adherence was also associated with insurance type, higher household income, and digital outreach. Conclusions EHR-integrated workflows combined with SDM were associated with marked improvements in mt-sDNA utilization, timeliness, and adherence, supporting scalable strategies to enhance CRC screening in real-world settings.

Fecal immunochemical tests (FITs) from various manufacturers yield different results, leading to variable positivity rates and clinical performance. These differences can influence the healthcare costs of a colorectal cancer screening program (CRC-SP), specifically when switching among FIT manufacturers. The analytical and clinical performance of three FITs was investigated to determine adjusted thresholds using positivity rate harmonization. A cohort of 6,600 participants from the Quebec CRC-SP received collection kits from three different manufacturers to sample the same fresh stool. Participants with positive results were referred for a colonoscopy which was considered positive if advanced neoplasia (AN) was detected. Positivity rates were determined for each FIT at an unadjusted threshold. Adjusted thresholds were determined using a positivity rate harmonization strategy. Clinical performance was then evaluated for each supplier at unadjusted and adjusted thresholds. Among 5,513 participants who fulfilled the inclusion criteria, 327 underwent colonoscopy. The FIT positivity rates at unadjusted thresholds differed between manufacturers. The adjusted thresholds determined to yield the same positivity rate were different for each FIT. A total of 69 participants were diagnosed with AN. Significant differences in concordance, discordance, sensitivity, and specificity were observed when using the unadjusted threshold. After applying adjusted thresholds, differences in clinical performance between manufacturers were no longer statistically significant. Threshold adjustment using a positivity rate harmonization strategy render differences in clinical performance statistically nonsignificant and leads to a stable colonoscopy rate between manufacturers. CRC screening programs should determine adjusted thresholds when changing FIT suppliers or when using multiple assays.

There is a need to quantify the benefits and harms of colorectal cancer (CRC) screening using primary colonoscopy or fecal immunochemical testing (FIT) compared with usual care with no screening. Guidelines recommend screening in individuals aged 50-75 years using colonoscopy or FIT, and many screening programs use one-sample biennial FIT. Here we compare incidence of diagnosed CRCs and gastrointestinal and cardiovascular events between screening and usual care during the diagnostic phase of the SCREESCO trial. A randomized block method (no masking) assigned 278,280 individuals aged 60 years to once-only colonoscopy, 2 rounds of two-stool FIT with a low cutoff (10 μg g-1 feces) or usual care (control group) in a ratio of 1:6 for colonoscopy versus control and 1:2 for FIT versus control. In the analysis, 31,113 individuals were in the primary colonoscopy arm and 60,267 were in the FIT arm, and there were 186,671 primary colonoscopy controls, of whom 120,521 were also controls for comparison with the FIT arm. After a median follow-up of 4.8 years, the incidence rate of CRC was 107.9 in the colonoscopy arm and 99.9 in controls per 100,000 person-years (incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91-1.28) and 96.0 in the FIT arm and 103.9 in controls (IRR: 0.92, 95% CI: 0.81-1.05). Rates of stage I-II CRC were higher in the colonoscopy arm (IRR: 1.38, 95% CI: 1.09-1.74) and in the FIT arm (IRR: 1.19, 95% CI: 0.99-1.43) versus controls. Rates of cardiovascular and gastrointestinal events were slightly higher in the intervention arms during the first year and were subsequently more similar to controls. Our findings of an increase in CRC detection implies a benefit of screening while the increase in adverse events suggests some initial harm. ClinicalTrials.gov: NCT02078804 .

Colorectal cancer screening and incidence and mortality of colorectal and other cancers in the United Kingdom.

ABSTRACT Promoting adherence to cancer screenings through effective communication campaigns is critical for the prevention and early detection of cancer, significantly enhancing patients’ health outcomes. This systematic review aims to assess the effectiveness of tailored messaging interventions in promoting screenings for cervical, breast, and colorectal cancer. Randomized controlled trials conducted between January 2000 and August 2025, which personalized the intervention content based on at least one tailored psychological variable and measured screening intention or behavior as outcome variables, were included. Data were extracted from the PsycINFO, PubMed, and Scopus databases, resulting in the final identification of 42 studies that met the inclusion criteria. These studies were narratively synthesized and critically analyzed. Findings revealed a mixed but promising landscape: tailored interventions were consistently effective when compared to passive control groups (e.g. usual care), but showed more variable success against active, non-tailored message conditions. This superiority was more pronounced for female cancer screenings than for colorectal cancer screening. Successful interventions were consistently grounded in behavioral theories, and a key feature was the use of multiple communication formats, with the vast majority enhancing text with visual or audio components. This suggests that tailored messaging can positively influence cancer screening behaviors, but its value lies in strategic application. Therefore, a promising direction for future research is to explore the conditions under which different communication strategies are most effective. Future studies could develop and test stratified intervention models to investigate for which subgroups a resource-intensive tailored approach provides a clear advantage over simpler, more cost-effective strategies.

In Hungary, population-based colorectal cancer (CRC) screening was introduced shortly before the onset of COVID-19 pandemic. We aimed to assess the combined impact of these two factors on the incidence and characteristics of CRC. The retrospective cohort study included all patients with newly diagnosed CRC between 2014 and 2023 and divided into pre-pandemic with screening (2015-2016, 2019), pre-pandemic without screening (2014, 2017-2018), pandemic (2020-2021), and post-pandemic (2022-2023) subgroups. CRC incidence, diagnostic patterns, and tumor stage were compared across subgroups. Crude CRC incidence in institution's care area was lower during pandemic (102.51 per 100,000) compared with the pre-pandemic with screening (117.92 per 100,000; p=0.060) and post-pandemic (120.60 per 100,000; p=0.044) subgroups. Age-standardized incidence differed significantly only between the pre-pandemic with screening and pandemic subgroups (125.30 vs. 105.88 per 100,000; p<0.001). During pandemic, the proportion of early-stage (AJCC 0-I) cancers was significantly reduced compared with the pre-pandemic with screening subgroup (18.74% vs. 25.08%; p=0.048) and the proportion of T1 cancers was also lower compared with the post-pandemic subgroup (6.90 vs. 12.2%; p=0.026). During pandemic, both the annual number of colonoscopies (2,706.00) and the mean number of colonoscopies required to detect one CRC (15.56) were markedly lower compared with the pre-pandemic with screening (4,590.67 and 13.97), pre-pandemic without screening (3,824.33 and 10.67), and post-pandemic (4,573.50 and 15.50) subgroups. The COVID-19 pandemic was associated with unfavorable changes in CRC epidemiology. Organized screening may have mitigated the negative impact during the pandemic and post-pandemic periods.

Background Barrett’s esophagus (BE) is a premalignant condition associated with gastroesophageal reflux disease (GERD) and an increased risk of esophageal adenocarcinoma (EAC). While Helicobacter pylori (H. pylori) has been proposed as a potential protective factor against BE, evidence remains conflicting, and clinical implications are uncertain. We aimed to investigate the association between H. pylori infection and BE in a largescreening cohort from Central Europe. Methods We analyzed data from 4,074 asymptomatic participants who underwent upper endoscopy at a single center as part of a colorectal cancer screening between 2007 and 2020. BE was defined by endoscopic evidence and histologic confirmationof specialized intestinal metaplasia. H. pylori status was determined histologically;endoscopic classification of H. pylori–associated gastritis was not used due to non standardized assessment. Multivariable logistic regression examined the association, adjusting for demographic, metabolic, and lifestyle confounders; univariable models were descriptive. Results BE prevalence was 1.2%, and H. pylori infection was present in 18.8% of participants, consistent with Austrian estimates (∼20%). No significant association was found between H. pylori infection and BE (adjusted OR 0.70, 95% CI 0.31–1.58, p = 0.395). Male sex (adjusted OR 3.45, 95% CI 1.66–7.20, p = 0.001) and active smoking (adjusted OR 2.15, 95% CI 1.02–4.54, p = 0.045) were the strongest independent predictors. Interaction analyses revealed no effect modification by age, sex, metabolic syndrome, or proton pump inhibitor use. Conclusions In this cohort, current H. pylori infection was not significantly associated with prevalent BE, and the adjusted effect estimate did not suggest a meaningful relationship.

Risk factors associated with false-positive fecal immunochemical test results in colorectal cancer screening.

Colorectal cancer (CRC) screening is effective and cost-effective in average-risk individuals. The COLONPREV study recently showed that individuals invited to a faecal immunochemical test (FIT) were more likely to participate in screening than those invited to colonoscopy, and that FIT-based screening was non-inferior to colonoscopy with respect to CRC-related mortality and CRC incidence. To assess whether the outcomes of colonoscopy- and FIT-based screening differ according to sex and age in the invited population. Presumptively healthy men and women aged 50-69years were randomised to either a one-time screening colonoscopy or biennial FIT. In this analysis, we report participation and crossover rates, CRC-related mortality, CRC incidence, all-cause mortality, and diagnostic yield for both screening strategies, stratified by sex and by age group (50-59 and 60-69years). The eligible population consisted of 26,332 individuals assigned to colonoscopy and 26,719 assigned to FIT. As expected, participation and crossover rates were higher in women than in men and in older individuals compared with younger individuals. Participation was also consistently higher in those invited to FIT screening than in those assigned to colonoscopy across both sexes and age groups. The observed reductions in CRC-related mortality and CRC incidence, which were consistent across both screening strategies, were independent of sex or age. However, CRC-related mortality, all-cause mortality, and CRC incidence remained higher in men and older participants than in women and younger participants. Colonoscopy screening showed a higher diagnostic yield of premalignant precursor lesions across all demographic subgroups. Participation and reductions in CRC-related mortality and incidence were consistent across sex and age groups for both FIT- and colonoscopy-based screening strategies. The higher baseline risk observed in men could not be fully mitigated by screening. ClinicalTrials.gov: NCT00906997.

The classification and clinical implications of colorectal intramucosal adenocarcinoma remain controversial. Given the increasing frequency of diagnosis through colorectal cancer screening programmes, a reassessment of terminology and its impacts is necessary. This paper critically examines the diagnostic criteria, biological behaviour and clinical consequences of labelling these lesions as colorectal intramucosal carcinoma. While intramucosal adenocarcinoma exhibits cytological and architectural atypia beyond high-grade dysplasia, it remains confined to the mucosa and has minimal metastatic potential, with rare documented exceptions. Conversely, the use of carcinoma terminology has been associated with potential overtreatment, including unnecessary surgical resection, increased patient anxiety and financial burdens such as insurance complications. We explore geographic variations in classification and analyse the impact of terminology shifts. We propose a standardised framework that restricts the term intramucosal adenocarcinoma to intramucosal lesions exhibiting tumour budding or poorly differentiated clusters, signet ring cells, desmoplasia, vascular invasion, mucinous differentiation or features of neuroendocrine carcinoma, while reclassifying adenomas with cribriform architecture and complex glands as high-grade dysplasia. This nomenclature shift aims to reduce overtreatment, align with current oncologic understanding and ensure optimal patient care and communication.

To examine whether the growth of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) and Medicare Advantage (MA) penetration was associated with changes in health care use among commercially insured populations. Observational study using claims data. Using Health Care Cost Institute claims data (2015-2019), we conducted a repeated cross-sectional study of 13,041,197 enrollees aged 55 to 64 years in 50 states and the District of Columbia in employer-sponsored insurance plans of 4 national payers. Linear models estimated relationships between enrollees' health care use and county-level MSSP ACO and MA penetration, controlling for enrollee and market characteristics and county and year fixed effects. Outcomes of interest were enrollees' probability of receiving preventive care services (influenza immunization, breast cancer screening, colorectal cancer screening), having any outpatient emergency department visits, and having any inpatient hospitalization in a year. A majority of counties (72.1%) experienced increases in penetration of MSSP ACOs and MA from 2015 to 2019. Median (IQR) MSSP ACO penetration increased from 5.9% (1.6%-16.9%) to 18.9% (9.3%-31.5%), and median (IQR) MA penetration increased from 19.5% (11.2%-29.3%) to 26.8% (15.9%-36.6%). MSSP ACO and MA penetration was not substantively associated with changes in commercial enrollees' use of preventive care, emergency department, and hospital services. The expansion of MSSP ACOs and MA was not associated with substantive changes in health care use among commercial enrollees. The lack of spillovers from Medicare to commercial enrollees may stem from misaligned incentives from different payers, indicating the potential importance of multipayer alignment in ongoing payment reforms.