March 19, 2018
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Personalized colon cancer screening may be helpful in those without family history

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Clinical risk factors may help guide colorectal cancer screening for average-risk individuals with no family history of the disease, according to new research publish in Gastrointestinal Endoscopy.

Chan Hyuk Park, MD, PhD, of the department of internal medicine at Hanyang University Guri Hospital in South Korea, and colleagues wrote that because family history of colorectal cancer (CRC) is an important risk factor in advanced colorectal neoplasia (ACRN), current guidelines suggest different screening strategies for people with and without a family history of CRC.

“However, in contrast to individuals with a family history of CRC, those with other risk factors such as male sex, smoking and obesity are considered to have an average risk, and a uniform CRC screening strategy is recommended despite a different risk for ACRN,” they wrote. “We speculated that individuals with risk factors other than family history of CRC may also need different CRC screening strategies.”

Using a logistic regression model, Park and colleagues identified clinical risk factors of ACRN among 34,658 patients from the Kangbuk Samsung Health Study with no family history of CRC who underwent colonoscopy and a fecal immunochemical test (FIT). The researchers assigned each risk factor a risk score with male sex receiving a score of 1; smoking, 2; and obesity, 1. Researchers further determined prevalence for ACRN in individuals with a score of 0, 1, or 2 or more.

They found that prevalence for ACRN in patients aged 50 to 51 years increased with each additional risk point (1.4% for 0 points; 1.6% for 1 point; 2.9% for 2 points). Prevalence for ACRN was higher in patients older than 66 years, and the investigators found that it also increased along with their risk point scale (3.1% for 0 points; 5.5% for 1 point; and 7.5% for 2).

Additionally, among patients with a positive FIT, the prevalence for ACRN was 11% for patients aged between 50 and 51 years and 21.2% in patients older than 66 years. Prevalence for ACRN in patients with more than 2 risk scale points was 2.5% and for those with a negative FIT it was 6%.

According to Park and colleagues, patients with a clinical risk score of more than 2 points may need to undergo colonoscopy screenings at an earlier age even if they do not have any family history for the disease. They said FIT may be a better screening method than colonoscopy for patients with a low clinical risk score.

“Our study will help policy-makers and clinicians select appropriate CRC screening strategies according to the age and risk factors for ACRN,” the authors wrote. – by Alex Young

Disclosures: Healio Gastroenterology and Liver Disease was unable to confirm relevant financial disclosures prior to publication.