Dr. Bu’ Hayee, deputy clinical director for gastroenterology, King’s College Hospital NHS Foundation Trust, discusses the role of AI technology in reducing variation in detection rates between endoscopists.
Colorectal cancer (CRC) or bowel cancer is the fourth most common cancer, yet the second biggest cancer killer in the UK responsible for 16,000 deaths each year1-4 The mortality rate from CRC can be reduced by colorectal screening,3,5 not only by detecting established cancers at an earlier stage, but also by detection and removal of polyps before they develop into cancers.
Most commonly, CRC starts as a polyp (adenoma), a benign growth on the lining of the colon or the rectum.5 Colonoscopy is considered the gold standard for colorectal screening, allowing physicians to detect and remove polyps,5 but it is well-recognised that there is an appreciable miss-rate for polyps even in expert hands.6 These missed polyps can later on develop into cancers, known as post-colonoscopy colorectal cancers (PCCRCs).5,7 The occurrence rate of PCCRCs is estimated to be between 1.8% - 9.0%,8,9 so while it must be that not all polyps turn into cancer, there is a biologically-plausible and statistical link between higher rates of polyp detection and removal and fewer PCCRCs
To add to the pre-existing challenges of early CRC diagnosis, the COVID-19 pandemic resulted in the suspension of all endoscopy in March-April 2020. This has resulted in a significant backlog.10,11 It is widely accepted that early diagnosis and detection is crucial for improved prognosis and delays negatively affect survival. The delays in diagnosis due to the pandemic could have a significant impact on the survival rates.3,11-13 Furthermore, as colonoscopy services resume patients may be hesitant to return to hospitals due to anxieties around transmissible infection.10,14 There is multicentre UK data to reassure patients that this risk is miniscule.15 Prior to the COVID pandemic, the demand for screening colonoscopy increased year-on-year in the UK (as high as 15% in some reports).1 The provision of high-quality colonoscopy to reduce miss-rates and maintain patient experience, therefore, represents a truly significant burden to training programmes and healthcare services worldwide
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