Enemy at the Gates! Can Intelligent Warfare (Artificial Intelligence) help India strategize, implement colorectal cancer screening?

Excerpt

Colorectal carcinoma (CRC) is the third most common cancer and the second leading cause for cancer-related mortality globally [1]. Geographical variation in incidence of CRC has always been attributed to differences in socio-economic status and dietary habits across the globe [2]. CRC screening programs in the west have demonstrated significant success rates at early adenoma detection and have positively influenced CRC-related deaths in the last several decades and CRC-related deaths are trending downwards in western countries. The Asian and predominantly Indian fiber-rich diet was traditionally considered protective against adenoma development and CRC. However, with globalization of lifestyle and dietary patterns, the situation is dramatically changing. Epidemiological studies suggest that the age-standardized incidence of CRC in India increased from 4.3 in 2008 to 7.2 per 100,000 male population in 2012 and is further expected to rise by 60% in males and 37% in females by 2026 [3]. Several Asian countries including Japan, Korea and Taiwan have already implemented national screening programs for CRC successfully. Within Asia, the 10-year average annual percent change (AAPC) in incidence of CRC is highest in India at 5.5% compared to 3.7% in Korea and 1.6% in Japan for age ≥ 50 years [4]. Therefore, although the most-reported prevalence of colonic adenoma in India is only 4.35% so far, which is still much lower than the west [5], given the alarming predictive statistics along with its rapid globalization and urbanization, India appears to be sitting on an impending timebomb of colonic adenomas and CRC that is waiting to explode! But the main concern here is—remains India ready? CRC screening can be performed using fecal occult blood test (FOBT), fecal immunochemical test (FIT) or colonoscopy. Colonoscopy remains the “gold standard”, although it has the problem of being invasive, requiring bowel preparation, increased costs to the health system, universal availability and patient acceptance, whereas FOBT and FIT have inherent limitations, especially for diagnosis of adenomas [6]. The Indian situation is unique. There is a general perception that India has a low CRC prevalence. Add to this the overwhelming population burden and the associated costs, universal CRC screening as is practiced in the west is not only impractical, but cannot be a reality in recent times. Therefore, we need to explore alternative strategies. …