Masterclass: Colorectal Screening Plus (On-Demand) | September 2025-Dominitz.Flashback.From DRE to CADe.ASGE Masterclass.Sept 2025.Trimmed

Dominitz.Flashback.From DRE to CADe.ASGE Masterclass.Sept 2025.Trimmed

Pdf Summary

This presentation by Dr. Jason A. Dominitz traces the evolution of colorectal cancer (CRC) screening in the United States from early methods such as digital rectal exams (DRE) and guaiac fecal occult blood testing (gFOBT) to advanced technologies including computer-assisted detection (CADe), stool DNA tests, CT colonography, and emerging blood-based assays. CRC remains the second leading cause of cancer death, with over 150,000 new cases and nearly 53,000 deaths annually in the U.S. CRC screening is ideal due to the long precancerous latency period, and screening guidelines have evolved substantially since their inception in 1980.<br /><br />Early CRC screening efforts involved gFOBT and sigmoidoscopy, which led to modest reductions in incidence and mortality. Colonoscopy coverage by Medicare in 2001 marked a major advance, with evidence showing significant reductions in both CRC incidence and mortality, especially for left-sided colon cancers. More recently, stool-based multitarget DNA (mt-sDNA) testing and the fecal immunochemical test (FIT) have improved detection sensitivity, with Medicare coverage expanding to include these.<br /><br />Non-invasive imaging methods such as CT colonography and magnetic resonance colonography offer alternatives, though concerns exist regarding radiation exposure with CT and interpretation challenges. New blood-based screening tests measuring circulating tumor DNA have shown promising sensitivity and specificity and gained Medicare coverage in 2024.<br /><br />Randomized controlled trials continue to evaluate the comparative effectiveness of colonoscopy and non-invasive screening strategies. Despite advances, CRC screening rates remain suboptimal, particularly among younger adults aged 45-49, amid rising CRC incidence in this group. Technology such as AI-based CADe systems enhance polyp detection rates during colonoscopy, supporting improved quality.<br /><br />The presentation emphasizes that gastroenterologists must optimize colonoscopy quality and advocate for high adherence to screening to maintain its role as the gold standard. Emerging non-invasive tests offer attractive alternatives but require continued validation. Overall, CRC screening strategies have significantly evolved, improving outcomes while underscoring ongoing challenges to increase uptake and quality nationwide.

Keywords

colorectal cancer

CRC screening

digital rectal exam

guaiac fecal occult blood test

colonoscopy

stool DNA test

CT colonography

blood-based assays

AI computer-assisted detection

screening guidelines