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Open research questions in Colorectal Cancer Screening and Detection

40 unresolved questions extracted from the limitations and future-work sections of 499 Colorectal Cancer Screening and Detection papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • If biography reflects history, then individual stories of diagnostic delay reflect collective failures of healthcare structure. Co-author Martinez Espino works as a health equity organizing director with Latino families in the Bay Area, where the gap between healthcare need and healthcare access is daily and visible. Her contribution to this editorial reflects practice-based knowledge developed through years of community organizing on cancer access, screening, and survivorship. Recent federal policies have further restricted access to healthcare for marginalized communities, compounding long-standing inequities in coverage and care. As Martinez Espino observes in her organizing work, community-based organizations translate individual suffering into collective response. Survivorship alone is insufficient when the conditions producing late diagnosis remain unchanged. Community organizing and participatory approaches have been shown to strengthen power among marginalized populations, leading to measurable policy outcomes and advances in health equity [10-12]. The Latino Health Assessment in Santa Clara County, California, documents that Latino communities face systematic barriers to accessing care, including language and communication challenges, insurance confusion and bureaucracy, delays in care, deep distrust in quality of care, widespread misinformation and stigma around illness, cost concerns, and delayed screenings. These are not individual challenges. They are systemic conditions, public issues in Mills's sense. One community member quoted in the Santa Clara assessment captured the cost of these failures directly: "I had cancer last year, and I did not qualify for many aids. And those that I did qualify for were not in Spanish. They translated for me, and it was horrible. A translator is not a way to receive or communicate expressions. They told me I was in Stage 4 when in reality, it was Stage 2". A translation error of two cancer stages is 2026 Aguilar Avila et al. Cureus 18(7): e112022. DOI 10.7759/cureus.112022 2 of 4 not an interpretive nuance. It is a structural failure with potentially fatal consequences. In Martinez Espino's organizing practice, the Promotoras Model engages trained community members with firsthand experience to deliver education in culturally and linguistically appropriate ways. This approach empowers community members, often patients themselves, to dispel myths and misinformation, build trust, and foster open dialogue that supports informed health decisions and improved outcomes. Evidence supports community health worker (CHW) and patient navigation programs as effective interventions to increase colorectal cancer screening in Latino communities [14-16]. Mailed fecal immunochemical testing combined with navigation has been shown to increase screening participation and reduce disparities.

    From Personal Trouble to Public Issue: Early-Onset Colorectal Cancer Among Young Latino Men · 2026 · DOI

  • Current evidence suggests that AI may support the detection of SB abnormalities, particularly in capsule endoscopy, where automated analysis could help reduce reading time and missed findings; however, the current level of evidence remains limited and should be interpreted with caution.

    Artificial Intelligence for the Detection of Small Bowel Lesions and Neoplasia: A Scoping Review · 2026 · DOI

  • An important finding of this review is the discrepancy between the growing number of AI applications developed for SB endoscopy and the relatively limited evidence addressing lesions directly relevant to cancer diagnosis [24-35]. Consequently, the potential role of AI in the early detection of SB malignancies should be interpreted cautiously, as current evidence remains limited and largely indirect.

    Artificial Intelligence for the Detection of Small Bowel Lesions and Neoplasia: A Scoping Review · 2026 · DOI

  • Abstract Background In recent years, only a few cases of mucinous adenocarcinoma with signet-ring cell carcinoma (MAC-SRC) have been reported, and detailed endoscopic imaging features remain poorly characterized.

    Colorectal mucinous adenocarcinoma with signet-ring cells: a case report · 2026 · DOI

  • Nonetheless, our study has limitations. First, there were not enough indicators to evaluate patient tolerance, and more symptoms (e.g., nau- sea, vomiting, and sleep quality) could have been included. Second, other baseline information such as specific drug classifications (like TCA, laxative, and opioids), bowel habits and colorec- tal diverticula were missing and may have had a biased effect on the results. Third, we did not add an additional group undergoing the 4 L PEG cleansing regimen but instead used the 3L PEG regimen alone, which is commonly used in China. Finally, although the multicenter bowel-cleansing regimen research was conducted, the total num- ber of people included in the present study was still relatively small, and more studies may be needed in the future to investigate the effects of the combination of two drugs on bowel preparation.

    Efficacy of linaclotide with polyethylene glycol at high risk of inadequate bowel preparation: A randomized controlled trial · 2026 · DOI

  • Our retrospective study did not account for operator vari- ability. Both CT and colonoscopy are prone to subjective interpretation, and colonoscopic estimation of anatomical location is also operator dependent. Our study was con- ducted in a tertiary care referral setting, where we encounter advanced colon cancers in clinical practice. This could have affected colonic localization accuracy. Future research should investigate how combining modalities or using ad- vanced techniques (e.g., 3D reconstruction and navigation tools) may improve localization accuracy.

    Concordance between Contrast Enhanced CT, Colonoscopy, and IntraOperative Localization of Colon Tumors · 2026 · DOI

  • intervention implement to 20. Thompson DM, Fernald DH, Mold JW. Intraclass correlation coefficients typical of cluster-randomized studies: estimates from the robert wood johnson prescription for health projects. Ann Fam Med (2012) 10(3):235–40. doi:10.1370/afm.1347 21. Rutterford C, Copas A, Eldridge S. Methods for sample size determination in cluster randomized trials. Int Journal Epidemiology (2015) 44(3):1051–67. doi:10.1093/ije/ dyv113 22. Auer R. Randomized controlled trial on colorectal cancer screening among quality circles of primary care physicians (2025). Available online at: https://clinicaltrials.gov/ study/NCT03510858 (Accessed May 11, 2026). 23. Schneider R, Syrogiannouli L, Bissig S, Scharf T, Bulliard JL, Ducros C, et al. Ten-year changes in colorectal cancer screening in switzerland: the swiss health interview survey 2007, 2012 and 2017. Prev Medicine Reports (2022) 27:101815. doi:10.1016/j.pmedr. 2022.101815 24. Bissig S, Syrogiannouli L, Schneider R, Tal K, Selby K, Del Giovane C, et al. Change in colorectal cancer (crc) testing rates associated with the introduction of the first organized screening program in canton uri, switzerland: evidence from insurance claims data analyses from 2010 to 2018. Prev Medicine Reports (2022) 28:101851. doi:10.1016/j. pmedr.2022.101851 25. Ornstein S, Nemeth LS, Jenkins RG, Nietert PJ. Colorectal cancer screening in primary care: translating research into practice. Med Care (2010) 48(10):900–6. doi:10. 1097/MLR.0b013e3181ec5591 26. Adhikari K, Manalili K, Law J, Bischoff M, Teare GF. Interventions to increase colorectal cancer screening uptake in primary care: a systematic review. J Am Board Fam Med: JABFM (2022) 35(4):840–58. doi:10.3122/jabfm.2022.04.210399 27. Rohrbasser A, Wong G, Mickan S, Harris J. Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis. BMJ Open (2022) 12(5):e058453. doi:10.1136/bmjopen-2021-058453 28. Wong G. Is complexity just too complex? J Clin Epidemiol (2013) 66(11):1199–201. doi:10.1016/j.jclinepi.2013.06.019 29. Wong G. Making theory from knowledge syntheses useful for public health. Int J Public Health (2018) 63:555–6. doi:10.1007/s00038-018-1098-2 30. Faulkner-Gurstein R, Wyatt D, Cowan H, Hare N, Harris C, Wolfe C. The organization and impacts of clinical research delivery workforce redeployment during the COVID-19 pandemic: a qualitative case study of one research-intensive acute Hospital Trust. Health Res Policy Syst (2022) 20(1):68. doi:10.1186/s12961-022- 00876-5 31. Upadhaya S, Yu JX, Oliva C, Hooton M, Hodge J, Hubbard-Lucey VM. Impact of COVID-19 on oncology clinical trials. Nat Reviews Drug Discovery (2020) 19(6):376–7.

    Optimizing colorectal cancer screening through quality circles of primary care physicians: a cluster randomized controlled trial · 2026 · DOI

  • Our decision to use de-identified patient data and rely on PCP self-reports meant PCPs did not need to obtain patient consent for data collecting, which reduced the risk of selection bias in the patients from whom PCPs retrieved data. However, this choice also meant that we could not verify the CRC testing rates reported by physicians, so we cannot rule out social desirability bias. As a result, we thus might have overestimated screening rates. But our estimates were only slightly higher than the 48.4% estimate from our earlier study in the general Swiss population. We decided not to collect baseline screening uptake from patients in the control group (directly post-randomization), to prevent data collection from becoming an intervention (i.e., PCP inquiring about screening status could trigger testing). Consequently, our primary analysis compared screening uptake between groups at follow-up, not the change between baseline and follow-up. This design choice limited our ability to assess comparability between groups at baseline at the patient-level. A baseline imbalance in screening rates, or other source of residual confounding, could have caused us to overestimate intervention effect. Indeed, the screening rate was 55% in the intervention group prior to the intervention, compared to 42% in the control group, without any intervention. This issue reflects baseline non-comparability rather than selection bias. Selection or participation bias may instead arise from PCP recruitment and participation processes, which are discussed separately below. As the randomization process occurred at the quality circle level, this resulted in a small number of clusters.

    Optimizing colorectal cancer screening through quality circles of primary care physicians: a cluster randomized controlled trial · 2026 · DOI

  • The trade-off between recall and precision in early polyp detection—where φ_fixed achieves 0.77 recall but only 0.70 precision—creates different clinical risks depending on screening versus surveillance scenarios, yet no study directly compares clinician decision-making and diagnostic outcomes when using these two threshold modes for actual endoscopic procedures.

    Deep learning for the analysis of medical images in endoscopy: approaches to early diagnosis · 2026 · DOI

  • The paper proposes diagnostic indicators (mask area growth, multiple components emergence, probability calibration degradation) to select safe operating thresholds for the φ-regularized model, but no computational framework or automated detection mechanism for these indicators during inference on endoscopic video streams has been implemented or tested.

    Deep learning for the analysis of medical images in endoscopy: approaches to early diagnosis · 2026 · DOI

  • The performance gains of φ_fixed regularization are concentrated in small and medium-sized polyps while conclusions on large polyps are limited by few test examples; a stratified evaluation with balanced representation across polyp size categories in endoscopic image datasets is needed to determine generalization of the boundary-aware regularization approach.

    Deep learning for the analysis of medical images in endoscopy: approaches to early diagnosis · 2026 · DOI

  • The largest connected component post-processing strategy improved mask readability for video viewing but poses quality risks in rare cases where the true polyp mask fragments into two significant regions or extends beyond the field of view; this mode requires explicit validation on specific types of endoscopic scenes beyond the CVC-ClinicDB dataset structure.

    Deep learning for the analysis of medical images in endoscopy: approaches to early diagnosis · 2026 · DOI

  • The φ-regularization mechanism for polyp segmentation is identified as potentially vulnerable in endoscopic scenes with poorly-defined object boundaries (strong glare, pronounced folding, contamination), yet no systematic evaluation protocol has been established to quantify failure modes across these specific challenging conditions in deep learning segmentation.

    Deep learning for the analysis of medical images in endoscopy: approaches to early diagnosis · 2026 · DOI

  • It is remains to be seen whether KRAS mutated mismatch repair proficient tumors arising from traditional serrated adenomas and conventional ade- nomas can be separated by virtue of their methylation signatures. Lack of evidence for germline RNF43 mutations in patients with serrated polyposis syndrome from a large multinational study.

    Linked color imaging versus artificial intelligence-assisted linked color imaging for neoplasia detection in the colorectum: a randomized trial in Brazil · 2026 · DOI

  • First, we acknowledge the underrepresentation of countries in CI5plus, particularly in Africa, Asia, and small islands where ongoing socioeconomic transitions are likely to increase colorectal cancer rates, yet detailed assessment remains scarce, due to the absence of population-based cancer registries. Considering differences in aetiologies and the effectiveness of screening,28 detailed and systematic analyses of subsite-specific trends are warranted to elucidate reasons behind the concerning trends.

    Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data · 2024 · DOI

  • Factors regulating Sertoli cell number are not fully understood but androgens, probably acting through the peritubular myoid cells (PMCs), stimulate proliferation in utero while FSH is required post-natally (Johnston et al.

    Do you know your proximal serrated lesions detection rate? New major quality indicator for colonoscopy · 2024 · DOI

  • Increases in CRC knowledge, perceived benefits of CRC screening, and awareness of the screening modalities and decreases in perceived barriers to screening suggested that this type of intervention may be promising for CRC control and should be examined further.

    Your Body Is the Temple · 2011 · DOI

  • Although the health belief model constructs of perceived benefits and barriers have been related to other cancer screening behaviors, benefits and barriers to fecal occult blood testing (FOBT) have not been measured consistently, and little is known about these variables in relation to flexible sigmoido-scopy and colonoscopy.

    Validation of Scales to Measure Benefits of and Barriers to Colorectal Cancer Screening · 2001 · DOI

  • Background/Aims: Cold snare polypectomy (CSP) technique for polyps <10 mm varies widely among endoscopists.

    Effect of external evaluation and training on the incomplete resection rate in cold snare polypectomies for colonic lesions <10 mm: a prospective Spanish study (POLIPEVA) · 2026 · DOI

  • It remains unclear whether dynamic improvements in metabolic health can prevent metachronous advanced colorectal neoplasia (ACRN).

    Metabolic Optimization and Risk of Metachronous Advanced Colorectal Neoplasia in Patients With MASLD · 2026 · DOI

  • Whether the ability to detect multiple cancers can offset the loss of CRC prevention remains unclear.

    Should Multi-Cancer Early Detection Testing Replace Guideline-Recommended Colorectal Cancer Screening? A Comparative Modeling Analysis · 2026 · DOI

  • Our results indicates that CADx is a promising future adjunct to colonoscopy, but its current performance is insufficient for reliable implementation in resect-and-discard or leave-in-situ strategies.

    Diagnostic performance of real-time characterization in artificial intelligence-assisted colonoscopy · 2026 · DOI

  • However, the impact of multicomponent lifestyle interventions (such as dietary modification, physical activity, and counselling) on behavioural modification, risk of colorectal neoplasia, and quality of life (QoL) in this population has not yet been systematically reviewed.

    Multicomponent Lifestyle Interventions During Colorectal Cancer Surveillance: A Systematic Review · 2026 · DOI

  • However, there is no standard set of PROs and PRO measures (PROMs) to be applied in individuals undergoing regular surveillance colonoscopy.

    Patient-reported outcomes and measures applied in individuals undergoing colonoscopy surveillance for colorectal cancer: a scoping review · 2026 · DOI

  • A positive predictive value of the completed colonoscopies showed that further work on observing the stages of diagnosed adenomas and carcinomas would reach the goals of the expected improvement in early detection of colorectal cancer in Serbia.

    Organized colorectal cancer screening in Serbia - the first round within 2013-2014 · 2015 · DOI

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40 open questions have been extracted from the limitations and future-work passages of 499 Colorectal Cancer Screening and Detection papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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