Like most physicians, I'm a great believer in preventive medicine. Among other measures such as vaccines and mammograms, I recommend colonoscopies to detect early cancers in the colon or rectum. Mixing my metaphors, I recently voted with my feet and came face to face with artificial intelligence (AI) that assisted in my colonoscopy.
And yes, I know colonoscopy is a hard sell because it— or, to be more accurate, the required preparation (the "cleanout")—isn't pleasant. However, it's important; it could save your life.
According to the National Institutes of Health, colorectal cancer is the third-leading cause of cancer in the United States. It is insidious because it can progress for a long time before it becomes symptomatic, and by then it becomes harder to treat.
Colorectal cancer usually starts from polyps or other precancerous growths in the rectum or the colon. As a part of the screening, clinicians perform colonoscopies to detect changes or abnormalities in the lining of the colon and rectum. A colonoscopy involves threading an endoscope — a thin, flexible tube with a camera at the end — through the rectum and throughout the colon, allowing a clinician to see signs of cancer or precancerous lesions. (The patient is anesthetized, so it's not painful or uncomfortable.)
Although colorectal cancer now mainly occurs in people over age 50, incidence rates are rising for young adults. Incidence and death rates are projected to double by 2030. By then, it is estimated that more than one in 10 colon cancers will be diagnosed in people younger than 50. Colonoscopy screenings, which should begin at 45 years old, may reduce colorectal cancer mortality by 60 percent to 70 percent.
Courtesy: U.S. Navy (via Wikimedia Commons)
My recent routine screening colonoscopy was notable in two ways. First, the gastroenterologist — the specialist who does the procedure — prescribed a new cleanout regimen called SUTAB, which consists, in part, of a large number of tablets, instead of the old one, which required drinking vast amounts of a disgusting liquid. It was still no picnic but was more palatable, literally and figuratively. The less said about that, the better...
The second notable aspect of the experience was something I learned from chatting with the gastroenterologist. While we were discussing the new frontier of the contributions of artificial intelligence to medicine, he mentioned that he and his colleagues had begun to use a new AI tool called "GI Genius" to assist with colonoscopies — specifically to help detect abnormalities such as polyps or adenomas (precancerous lesions) in the colon.
According to the FDA, here's how it works: The GI Genius is composed of hardware and software designed to highlight portions of the colon where the device detects a potential lesion. The software uses artificial intelligence algorithm techniques to identify regions of interest. During a colonoscopy, the GI Genius system generates markers, which look like green squares and are accompanied by a short, low-volume sound, and superimposes them on the video from the endoscope camera when it identifies a potential lesion. These signs signal to the clinician that further assessment may be needed, such as a closer visual inspection, tissue sampling, testing or removal, or ablation of (burning) the lesion.
The FDA's Center for Medical Devices and Radiological Health approved it in 2021 based on a randomized, controlled study in Italy with 700 subjects 40 to 80 years old undergoing a colonoscopy for colorectal cancer screening. In the study, colonoscopy plus GI Genius identified lab-confirmed adenomas or carcinomas in 55.1 percent of patients compared to 42 percent of patients with standard colonoscopy, an improvement of 13 percent.
In subsequent clinical studies, the module showed a sensitivity of 99.7 percent with fewer than 1 percent false positives. My doctor said he occasionally found polyps that GI Genius missed, and vice versa, but that the module was getting smarter and more accurate as more examples of colonoscopies were being fed into its database.
Welcome to a tiny part of the Brave New World of AI-assisted medicine. And please — to prevent a potentially life-threatening illness, get a colonoscopy at the recommended intervals!
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. He was the founding director of the FDA's Office of Biotechnology.