Global increases in colorectal cancer (CRC) risk have spurred debate about optimal use of screening resources. We explored the potential clinical and economic impact of CRC screening tailored to predicted CRC risk.We compared screening tailored to predicted risk vs. uniform screening in a validated decision analytic model, considering the average risk population's actual CRC risk distribution, and a risk-prediction tool's discriminatory ability and cost. Low, moderate, and high risk tiers were identified as CRC risk after age 50 of <=3%, >3 to <12%, and >=12%, respectively, based on threshold analyses with willingness-to-pay <$50,000/quality-adjusted life-year (QALY) gained. Tailored colonoscopy (once at 60 for low risk, every 10 years for moderate risk, every 5 years for high risk) was compared to colonoscopy every 10 years for all. Tailored fecal immunochemical testing [FIT]/colonoscopy (annual FIT for low and moderate risk, colonoscopy every 5 years for high risk) was compared to annual FIT for all.Assuming no CRC risk misclassification or risk-prediction tool costs, tailored screening was preferred over uniform screening. Tailored colonoscopy was minimally less effective than uniform colonoscopy, but saved $90,200-$889,000/QALY; tailored FIT/colonoscopy yielded more QALYs/person than annual FIT at $10,600-$60,000/QALY gained. Relatively modest CRC risk misclassification rates or risk-prediction tool costs resulted in uniform screening as the preferred approach.Current risk-prediction tools may not yet be accurate enough to optimize CRC screening.Uniform screening is likely to be preferred over tailored screening if a risk-prediction tool is associated with even modest misclassification rates or costs.
View details for DOI 10.1158/1055-9965.EPI-19-0949
View details for PubMedID 31796524