Risk Stratification Could Make Colorectal Cancer Screening More Efficient

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Scoring system may identify patients who do not need colonoscopy to screen for colorectal cancer.
Scoring system may identify patients who do not need colonoscopy to screen for colorectal cancer.

A novel clinical scoring system may help physicians identify which patients do not need colonoscopy and could instead be screened for colorectal cancer (CRC) with less invasive methods, according to a study that was published in the August 2015 issue of Annals of Internal Medicine.1 The authors suggest that this system may increase the uptake and efficiency of CRC screening.

Several screening tests, including sigmoidoscopy and occult blood tests, are effective at detecting CRC in average-risk patients. Colonoscopy remains the most common screening test in spite of the fact that it is invasive, costly, and inefficient.

“Thirty-five percent of people who are screen-eligible choose not to be screened, by and large because they equate colon cancer screening with colonoscopy,”  the study's lead author, Thomas Imperiale, MD, of Indiana University's School of Medicine, Regenstrief Institute, Indianapolis, IN, said in an interview with Cancer Therapy Advisor. “We're doing them a disservice.” 

Using a risk stratification approach, physicians could identify which patients would benefit most from colonoscopy, and which would be better served with less invasive testing.

“If you take patient-specific variables,” said Dr. Imperiale, “you can use those to stratify the likelihood of finding something on colonoscopy that is going to require polypectomy and surveillance – those would be the advanced adenomas.”

The study included 4,460 patients in the Midwest age 50 to 80 years, who were scheduled to have their first screening colonoscopy.

Participants completed a survey that identified risk factors including family history, sociodemographic factors, and lifestyle factors such as cigarette smoking. Clinical scores were assigned based on this data and compared to colonoscopy and pathology reports.

RELATED: Obese Patients With Lynch Syndrome at Higher Risk for Colorectal Cancer

The researchers found that patients classified as low-risk had far fewer advanced adenomas than those classified as high-risk. They suggested that lower-risk patients could be given less invasive screening tests, while higher-risk patients receive colonoscopy.

In a follow-up study, the researchers will present their scoring system to both providers and patients to ensure it is understandable and to optimize its presentation and usability. Then, they intend to test it in a study of randomized groups of patients who are overdue for CRC screening to measure its effectiveness and patient uptake of screening.

“The real test is whether it will increase the uptake and choice of the screening test,” said Dr. Imperiale. “I think those are two things that will increase the awareness of these tools and their clinical utility.”

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