Adjusted risk score-based screening for advanced adenomas and colorectal cancer

Post by Master, Doctor Mai Vien Phuong - Head of Department of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Despite the availability of multiple screening modalities and various public health initiatives to increase colorectal cancer screening, nearly one-third of the eligible US population is not screened . Colorectal cancer screening rates must be optimized to achieve an aspirational goal of >80%. Significant reductions can be achieved by achieving high compliance rates and providing fail-safe systems to reduce barriers through the spectrum of care from positive endoscopic test to endoscopy. colon to complete the screening process.
Acknowledging existing screening tools for use in population-appropriate settings will increase compliance across different populations. Consistent with this goal, adopting cost-effective, high-precision, non-invasive methods that are associated with reduced complications and barriers compared with more invasive methods can improve general acceptance of the screening process. The fecal occult blood test is a test for colorectal cancer. The non-invasive 2-step is widely accepted and cost-effective, and is the optimal method for programmed and systematic screening for navigating patients to colonoscopy.
Colonoscopy is a screening test for colorectal cancer. 1-step is the final common pathway for a non-positive colonoscopy screening test and the most appropriate screening test for individuals with a family history of colorectal cancer.

Women reach similar cumulative morbidity at a higher age than men. Brenner et al used age and sex-specific data from SEER registry data for the years 2000–2003 to calculate the 10-year cumulative colorectal cancer incidence for men and women in the United States. each age from 50 to 70 years old.
They found that women reached 10-year cumulative morbidity 4–6 years later than men aged 50, 55, and 60 years. This is thought to be due to the protective effects of estrogen and a healthier lifestyle in women. However, women are expected to live longer than men. Therefore, a woman's lifetime risk of developing colorectal cancer is about the same as that of men. In an update to the Minnesota fecal occult blood test, the authors report that men benefited more than women (RR of colorectal cancer deaths 0.62 (KTC 95). % 0.50–0.78) in men compared with 0.83 (95% CI 0.67–1.04) in women in the combined screening group versus no screening group.

Tailor screening to individual risk scores, including: age, sex, race, body mass index, aspirin use, smoking history, and other regimen risk factors diet and lifestyle. It would be desirable to stratify individuals into their risk of advanced cancer and to recommend appropriate screening. Although many such models have been developed and validated, large-scale trials testing strategies and validating risk scores across different populations are needed.
Peng et al compared the performance of 17 risk models to predict the presence of advanced cancer in colorectal cancer screening and concluded that the models confer discriminatory power modest and needs further validation in diverse populations. Imperiale et al reported a 13-variable predictive model for advanced cancer with good discriminant power. Guo et al developed a polygenic risk score for colorectal cancer based on 90 single nucleotide polymorphisms that can be used to prolong the repeat colonoscopy interval by more than 10 years for individuals with low or average scores. External validation of these models and the development of other models specific to the US population are awaited.

To provide evidence on the comparative effectiveness of colorectal cancer screening tests, there are several ongoing randomized controlled studies. Colonoscopy versus fecal immunochemical testing in reducing mortality from the rectal cancer trial. (ClinicalTrials.gov number NCT01239082) was a randomized comparison of one-time colonoscopy with fecal occultoscopy plus annual colonoscopy to monitor positive test results and for screening colorectal cancer rates, 10-year mortality rates.
A randomized trial comparing colonoscopy with a biennial fecal occult blood test is underway in Spain (ClinicalTrials.gov number, NCT00906997). Two additional studies in Europe are comparing screening colonoscopy with no screening (the Nordic-European Initiative trial on Colorectal Cancer) (ClinicalTrials.gov no NCT00883792) or having a fecal occult blood test or no screening (Swedish Colon Screening, NCT02078804) is associated with colorectal cancer mortality.

The authors recognize that further studies are needed to develop validated risk stratification tools, especially during those 45–49 years. Developing one or more highly accurate blood-based colorectal cancer screening tests is an important research priority. Interventions to improve colorectal cancer screening should focus on baseline ethnic and socioeconomic disparities. Studies are needed to evaluate the utility of colonoscopy over a 5-year period in those with 1 first-degree relative with colorectal cancer <50 and a negative colonoscopy every 5 years. until 65 years old.
The quality of the delivery of colorectal cancer screening by any means, must be monitored and improved to reduce colorectal cancer morbidity and mortality. The fecal occult blood test is a test for colorectal cancer. The noninvasive 2-step is widely accepted and cost-effective, and is the optimal method for programmed and systematic screening for navigating patients to colonoscopy.
Colonoscopy is a 1-step colorectal cancer screening test, which is the final common pathway to a non-positive colonoscopy screening test and the most appropriate screening test for individuals with precancerous conditions. family history of colorectal cancer.

References
Shaukat, Aasma MD et al. ACG Clinical Guidelines: Screening for Colorectal Cancer 2021. American Journal of Gastroenterology: March 2021 - Volume 116 - Issue 3 - pp. 458-479