Screening for Early Detection of Malignancies of the GI Tract

Daniel Chung, MD, is a gastroenterologist with the Division of Gastroenterology at Massachusetts General Hospital, and the medical co-director of the Center for Cancer Risk Analysis in the Mass General Cancer Center. In this video, he discusses his work on screening and early detection of malignancies of the gastrointestinal tract and how that work will improve detection rates during colonoscopy.

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Transcript

I'm very interested in screening and early detection of malignancies of the gastrointestinal (GI) tract.

So the GI tract is probably the most common site for tumors to form and that includes the esophagus, the stomach, large intestine, pancreas and liver. There are a number of very effective screening strategies and early detection strategies for many of these tumor types. However, there are still many deficiencies: There are many areas in which we don't do as good a job of screening as we could, and there certainly is a problem in terms of access and delivery of many of these screening modalities.

Screening and early detection are really the keys to reducing the morbidity and mortality associated with a number of these GI cancers. We have a particular interest in the group of patients who are what we call high risk, and these are individuals who typically have a strong hereditary or genetic predisposition to malignancy. Part of the problem is that people are not aware entirely of who should be screened and who actually belongs in that high-risk category.

We've been very interested in looking at different types of approaches to identifying these high-risk individuals. Some of these include taking a universal approach, meaning just screening everyone who has a particular type of cancer. Some of these have entailed using more electronic approaches where we're able to comb through the medical record to identify individuals who meet certain clinical criteria.

But the other aspect is that we've begun to look at how can we best offer genetic services. Genetic counseling and testing is critical because it can identify those who require more intensive surveillance. It also has huge implications for family members because it does mean additional family members will be at risk, and they may not be aware that they are at risk for these particular malignancies.

Within established screening techniques—so colon cancer for example is one of the most common malignancies that we screen for. [There is a] variety of effective techniques such as screening stool for occult blood or performing colonoscopies. However, these modalities are not perfect. And we're interested in learning about ways to actually enhance the quality of these particular techniques that are well-established.

One of the projects we're [working] at is using artificial intelligence to help us during the colonoscopy process so that there may be mechanisms that can be built in that can actually identify lesions, polyps of interest during the procedure that the endoscopist may or may not recognize. And artificial intelligence certainly has the potential to help us improve detection rates during colonoscopy, which are not perfect this time.

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