The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program

In many countries, population colorectal cancer (CRC) screening is based on age and family history, though more precise risk prediction could better target screening. This Australian study examined the impact of a CRC risk prediction model (incorporating age, sex, lifestyle, genomic, and family history factors) to target screening under three different scenarios: (1) highly tailored, (2) three risk categories, (3) four sex-specific risk categories. Under each scenario, the researchers calculated the number of CRC screens by immunochemical fecal occult blood testing (iFOBT) and colonoscopy and the proportion of predicted CRCs over 10 years in each screening group. They found that the highly tailored CRC screening scenario results in many fewer screens but more cancers in those unscreened. The category-based scenarios may provide a good balance between number of screens and cancers detected and would be simpler to implement. This is the first study to assess a categorical risk based model against a very tailored model. The results demonstrate that adding lifestyle and genomic risk to family history and age using simple screening algorithms would identify a larger number of people for screening who are expected to develop CRC.

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