Title:VERGE: Verification-Enhanced Refinement for Grounded Extraction of Early-Onset Colorectal Cancer Symptoms in Clinical Notes

Abstract:Early-onset colorectal cancer is increasing among younger adults, yet red-flag symptoms in this age group have no evidence-based guidelines for follow-up testing, and structured encounter data do not capture the detail needed to support early detection and inform follow-up, including symptom duration, context, and fam- ily history, an established colorectal-cancer risk factor. This study aimed to develop and evaluate an automated method for extracting six red-flag symptoms and family-history risk status from free-text clinical notes. We developed VERGE, an agentic workflow in which an initial label and evidence are proposed using retrieval-augmented generation, then passed through a bounded verification- refinement cycle that checks textual grounding and clinical validity, corrects and rechecks a claim until resolved or a limit is reached, and escalates unresolved claims for human review. VERGE was evaluated on 4,033 clinician-labeled note-finding pairs against a single-agent baseline, a rule-based clinical language-processing baseline, and an alternative underlying language model. Compared with the single-agent baseline, VERGE reduced false positive find- ings, improving precision from 0.764 to 0.849 and MCC from 0.681 to 0.730, a balanced gain across the precision-recall trade-off, and resolved most flagged errors autonomously, with human review required for only 1.5 percent of claims. These results indicate that a bounded, verification-based workflow can reduce unnecessary positive findings without sacrificing the ability to detect true ones. This approach offers a path toward more reliable and trustworthy clinical language-processing tools to support colorectal cancer risk assessment in younger patients.