Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study
Objective To estimate the benefits, burden, and harms of implementing computer aided detection (CADe) of polyps in colonoscopy of population based screening programmes for colorectal cancer.Design Microsimulation modelling study.Setting Cost effectiveness working package in the OperA (optimising col...
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Medicine |
| Online Access: | https://bmjmedicine.bmj.com/content/4/1/e001446.full |
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| author | Cesare Hassan Alessandro Repici Farid Foroutan Lise M Helsingen Michael Bretthauer Mette Kalager Marco Spadaccini Yuichi Mori Magnus Løberg Per Olav Vandvik Loredana Correale Natalie Halvorsen Nastazja Pilonis Shanaz Sultan |
| author_facet | Cesare Hassan Alessandro Repici Farid Foroutan Lise M Helsingen Michael Bretthauer Mette Kalager Marco Spadaccini Yuichi Mori Magnus Løberg Per Olav Vandvik Loredana Correale Natalie Halvorsen Nastazja Pilonis Shanaz Sultan |
| author_sort | Cesare Hassan |
| collection | DOAJ |
| description | Objective To estimate the benefits, burden, and harms of implementing computer aided detection (CADe) of polyps in colonoscopy of population based screening programmes for colorectal cancer.Design Microsimulation modelling study.Setting Cost effectiveness working package in the OperA (optimising colorectal cancer prevention through personalised treatment with artificial intelligence) project. A parallel guideline committee panel (BMJ Rapid recommendation) was consulted in defining the screening interventions and selection of outcome measures.Population Four cohorts of 100 000 European individuals aged 60-69 years.Intervention The intervention was one screening of colonoscopy and a screening of colonoscopy after faecal immunochemical test every other year with CADe. The comparison group had the same screening every other year without CADe.Main outcome measures Benefits (colorectal cancer incidence and death), burden (surveillance colonoscopies), and harms (colonoscopy related adverse events) over 10 years were measured. The certainty in each outcome was assessed by use of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.Results For 100 000 individuals participating in colonoscopy screening, 824 (0.82%) were diagnosed with colorectal cancer within 10 years without CADe versus 713 (0.71%) with CADe (risk difference –0.11% (95% CI –0.43% to 0.21%)). For faecal immunochemical test screening colonoscopy, the risk was 5.82% (n=5820) without CADe versus 5.77% (n=5770) with CADe (difference –0.05% (–0.33% to 0.15%)). The risk of surveillance colonoscopy increased from 26.45% (n=26 453) to 32.82% (n=32 819) (difference 6.37% (5.8% to 6.9%)) for colonoscopy screening and from 52.26% (n=52 263) to 53.08% (n=53 082) (difference 0.82% (0.38% to 1.26%)) for faecal immunochemical test screening colonoscopy. No significant differences were noted in adverse events related to the colonoscopy between CADe and no CADe. The model estimates were sensitive to the assumed effects of screening on colorectal cancer risk and of CADe on adenoma detection rates. All outcomes were graded as low certainty.Conclusion With low certainty of evidence, adoption of CADe in population based screening provides small and uncertain clinical meaningful benefit, no incremental harms, and increased surveillance burden after screening. |
| format | Article |
| id | doaj-art-cd9b09235cda4e63b24a8d5ce6d5b7f5 |
| institution | DOAJ |
| issn | 2754-0413 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Medicine |
| spelling | doaj-art-cd9b09235cda4e63b24a8d5ce6d5b7f52025-08-20T02:54:22ZengBMJ Publishing GroupBMJ Medicine2754-04132025-03-014110.1136/bmjmed-2025-001446Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling studyCesare Hassan0Alessandro Repici1Farid Foroutan2Lise M Helsingen3Michael Bretthauer4Mette Kalager5Marco Spadaccini6Yuichi Mori7Magnus Løberg8Per Olav Vandvik9Loredana Correale10Natalie Halvorsen11Nastazja Pilonis12Shanaz Sultan13Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalymethodologistClinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway13 Clinical Effectiveness Research Group, University of Oslo, Oslo, NorwayClinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway24 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyClinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, NorwayClinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, NorwayDepartment of Medicine, Lovisenberg Diaconal Hospital, Oslo, NorwayEndoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, ItalyClinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, NorwayClinical Effectiveness Research Group, Oslo University Hospital, Oslo, NorwayMinneapolis VA Healthcare System, University of Minnesota, Minneapolis, Minnesota, USAObjective To estimate the benefits, burden, and harms of implementing computer aided detection (CADe) of polyps in colonoscopy of population based screening programmes for colorectal cancer.Design Microsimulation modelling study.Setting Cost effectiveness working package in the OperA (optimising colorectal cancer prevention through personalised treatment with artificial intelligence) project. A parallel guideline committee panel (BMJ Rapid recommendation) was consulted in defining the screening interventions and selection of outcome measures.Population Four cohorts of 100 000 European individuals aged 60-69 years.Intervention The intervention was one screening of colonoscopy and a screening of colonoscopy after faecal immunochemical test every other year with CADe. The comparison group had the same screening every other year without CADe.Main outcome measures Benefits (colorectal cancer incidence and death), burden (surveillance colonoscopies), and harms (colonoscopy related adverse events) over 10 years were measured. The certainty in each outcome was assessed by use of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.Results For 100 000 individuals participating in colonoscopy screening, 824 (0.82%) were diagnosed with colorectal cancer within 10 years without CADe versus 713 (0.71%) with CADe (risk difference –0.11% (95% CI –0.43% to 0.21%)). For faecal immunochemical test screening colonoscopy, the risk was 5.82% (n=5820) without CADe versus 5.77% (n=5770) with CADe (difference –0.05% (–0.33% to 0.15%)). The risk of surveillance colonoscopy increased from 26.45% (n=26 453) to 32.82% (n=32 819) (difference 6.37% (5.8% to 6.9%)) for colonoscopy screening and from 52.26% (n=52 263) to 53.08% (n=53 082) (difference 0.82% (0.38% to 1.26%)) for faecal immunochemical test screening colonoscopy. No significant differences were noted in adverse events related to the colonoscopy between CADe and no CADe. The model estimates were sensitive to the assumed effects of screening on colorectal cancer risk and of CADe on adenoma detection rates. All outcomes were graded as low certainty.Conclusion With low certainty of evidence, adoption of CADe in population based screening provides small and uncertain clinical meaningful benefit, no incremental harms, and increased surveillance burden after screening.https://bmjmedicine.bmj.com/content/4/1/e001446.full |
| spellingShingle | Cesare Hassan Alessandro Repici Farid Foroutan Lise M Helsingen Michael Bretthauer Mette Kalager Marco Spadaccini Yuichi Mori Magnus Løberg Per Olav Vandvik Loredana Correale Natalie Halvorsen Nastazja Pilonis Shanaz Sultan Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study BMJ Medicine |
| title | Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study |
| title_full | Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study |
| title_fullStr | Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study |
| title_full_unstemmed | Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study |
| title_short | Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study |
| title_sort | benefits burden and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening microsimulation modelling study |
| url | https://bmjmedicine.bmj.com/content/4/1/e001446.full |
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