Masterclass: Colorectal Screening Plus (On-Demand) | September 2025-From DRE to CADe for CRC Screening

Video Transcription

Video Summary

Dr. Jason Dominitz, a leading expert in colorectal cancer (CRC) screening, traced the evolution of CRC screening from early methods like digital rectal exams and rigid sigmoidoscopy to modern techniques including colonoscopy, fecal immunochemical tests (FIT), multi-target stool DNA tests, and emerging blood-based tests. CRC remains the second leading cause of cancer death in the U.S., but screening has significantly reduced incidence and mortality over decades. Early screening efforts lacked strong evidence, but landmark studies in the 1990s confirmed the mortality benefits of sigmoidoscopy and guaiac fecal blood testing. Colonoscopy, increasingly covered by Medicare since 2002, offers comprehensive detection but faces challenges with adherence and resource shortages. Non-invasive options like FIT and multi-target stool DNA tests have improved sensitivity and patient acceptance, though blood-based tests currently have lower sensitivity for precancerous lesions. Recent research supports starting screening at age 45 due to rising CRC rates in younger adults. Ongoing large randomized trials are comparing colonoscopy and FIT effectiveness, with adherence emerging as a critical factor influencing real-world outcomes. Future advances include computer-aided detection to improve colonoscopy yield and possible multi-cancer blood tests. Despite disruptive technologies, colonoscopy remains the gold standard for prevention and diagnosis but may increasingly serve as a follow-up tool to non-invasive screening. Optimizing colonoscopy quality and expanding patient choice are key to improving CRC screening impact.

Asset Subtitle

Jason Dominitz

Keywords

colorectal cancer screening

colonoscopy

fecal immunochemical test

multi-target stool DNA test

blood-based tests

screening adherence

early screening age