Could artificial intelligence-powered colonoscopies change the future of colorectal cancer screening?

Table 4 Real-life recommendations of world-wide major associations[148-153]

Organization	Starting age	Screening methods	Interval	AI integration/position
American Cancer Society	45	Colonoscopy, stool-based (FIT/FIT-DNA), CT-colonography	Colonoscopy: 10 years; FIT: Annually; FIT-DNA: Every 3-years	Supports emerging AI technologies in clinical research and potential guideline updates
American Gastroenterological Association	45	Colonoscopy preferred; other options acceptable for shared decision-making	Based on method	Draft guidelines recommend AI-assisted colonoscopy (CADe) as a quality enhancing tool
European Society of Gastrointestinal Endoscopy	50 (varies by country)	FIT-based programs, colonoscopy in select setting	FIT: Every two years; colonoscopy: Every ten years	Encourages integration of CADe systems in clinical practice to improve adenoma detection rates
National Comprehensive Cancer Network	45	Colonoscopy, stool-based tests, CT colonography	Colonoscopy: Ten years; FIT/FIT-DNA: Per test	Supports AI use for colonoscopy enhancement particularly in high-risk population
World Health Organization	50 (resource dependent)	FIT-based screening for population level programs	FIT: Every two years	Recognizes potential role of AI in expanding access and accuracy in low-resource setting; encourages cost-effective AI research
Japanese Society of Gastroenterology	40 (or even earlier for workplace health checks)	FIT	FIT: Annually	Japan’s first major AI-colonoscopy system, EndoBRAIN, received regulatory approval and reimbursement starting in 2024
Food and Drug Administration	45 (earlier initiation for those with higher risk factors)	Colonoscopy, FIT, stool DNA-FIT, CT colonography, flexible sigmoidoscopy	Colonoscopy: Every ten years; FIT: Annually; Stool DNA-FIT: Every 1-3 years; CT colonography: Every five years; Flexible sigmoidoscopy: Every 5-10 years	FDA has cleared CADe systems for real-time detection assistance during colonoscopy, but explicitly prohibits there use for lesion diagnosis or automated clinical decision making

AI: Artificial intelligence; FIT: Fecal immunochemical test; CT: Computed tomography; CADe: Computer-aided detection; FDA: Food and Drug Administration.