Predicting colorectal cancer risk among average risk persons

November 10, 2020

INDIANAPOLIS - Regenstrief Institute and Indiana University School of Medicine research scientists have developed and tested one of the first U.S.-based models to predict personal risk for advanced precancerous polyps and colon cancer in average risk individuals.

Colorectal cancer is the third most common cancer and second most lethal cancer in the U.S.

Especially during the COVID-19 pandemic, when many people are hesitant to visit medical facilities and healthcare resources are stretched, the new risk estimation model could help physicians determine whether an average risk patient's specific risk indicates an at-home stool test would be a good screening option or points to a colonoscopy as the most appropriate option.

"Our model helps to refine where on the average risk continuum an individual falls," said study leader Thomas Imperiale, M.D., of Regenstrief Institute and IU School of Medicine. "This information could be used to guide doctor-patient discussions about screening options, with the potential to increase patient acceptance of screening by giving them a choice correlated to their individual risk - true precision medicine. Studies have shown that giving individuals a choice increases screening uptake as many people look for alternatives to colonoscopy."

Personalized risk-based tailoring of colorectal screening is commonly recommended but not generally used, except for decisions about when to commence screening based on race and family history.

Eight out of 10 individuals who fall within the range for whom colorectal cancer screening is recommended by national guidelines are considered to be at average risk of the disease. The new predictive model for average risk individuals considers age, sex, lifestyle, diet, smoking history and eight other factors.

The study deriving and validating the tool evaluated 4,500 individuals ages 50 to 80 who had not had a previous colonoscopy and identified sizeable lower risk and higher risk groups among average risk individuals. About a quarter of average risk individuals in the study were found to be at 2 percent risk, which is considered low risk. Approximately 60 percent were found to be medium risk, reflective of truer "average risk." About 10 percent were deemed high risk for which a screening colonoscopy is appropriate.

"The importance of colorectal cancer screening cannot be overstated," said Dr. Imperiale. "A home annual FIT [fecal immunochemical test] testing, which looks for blood in the stool and is inexpensive, or stool DNA and blood testing every three years, are efficient ways to screen those at the low-risk end of the average risk population. "Particularly during the COVID-19 pandemic, as we see people less willing to consider screening colonoscopies, having an accurate risk assessment tool to determine for whom other options are perfectly good and letting them know which options are suitable is essential. It also has the added benefits of enabling us to prioritize those who are in greatest need of colonoscopy while conserving potentially scare resources -- from masks and other PPE (personal protective equipment) to the ancillary costs of anesthesia."

"Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults" is published in Gut, an official journal of the British Society of Gastroenterology, published by BMJ. Authors of the study, in addition to Dr. Imperiale are Patrick Monahan, PhD and Timothy Stump, M.A. of IU School of Medicine's Department of Biostatistics and David Ransohoff, M.D. of the University of North Carolina at Chapel Hill.
This work was supported by the National Cancer Institute (R01-CA104459); Walther Cancer Institute; Indiana University Melvin and Bren Simon Comprehensive Cancer Center; and Indiana Clinical and Translational Sciences Institute (grant UL1TR001108) from the National Center for Research Resources, National Institutes of Health.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

Thomas F. Imperiale, M.D.

In addition to his role as a research scientist at Regenstrief Institute, Thomas F. Imperiale, M.D., is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center. He is the Lawrence Lumeng Professor of Gastroenterology and Hepatology at Indiana University School of Medicine and a member of the Indiana University Melvin and Bren Simon Comprehensive Cancer Center. He is also a practicing gastroenterologist whose clinical responsibilities include performing colonoscopies.

Regenstrief Institute

Related Colorectal Cancer Articles from Brightsurf:

Colorectal cancer treatment: the winning combinations
Chemotherapy has distressing side effects for patients and increases the risk of developing resistance to the treatment.

A new model to predict survival in colorectal cancer
This signature could be useful in clinical practice, especially for colorectal cancer diagnosis and therapy.

Roadmap to reducing colorectal cancer deaths
The American Gastroenterological Association has outlined a strategy to increase the number of people screened via tests that are more convenient, accurate and less expensive and tailored to people's individual cancer risks.

Study provides new insight on colorectal cancer growth
A new study by researchers at the University of Kentucky identifies a novel function of the enzyme spermine synthase to facilitate colorectal cancer growth.

Researchers ID target for colorectal cancer immunotherapy
Researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center have identified a target for colorectal cancer immunotherapy.

Colorectal cancer partner-in-crime identified
A protein that helps colorectal cancer cells spread to other parts of the body could be an effective treatment target.

Cancer cell reversion may offer a new approach to colorectal cancer treatment
A novel approach to reverse the progression of healthy cells to malignant ones may offer a more effective way to eradicate colorectal cancer cells with far fewer side effects, according to a KAIST research team based in South Korea.

A novel pathway to target colorectal cancer
Survival rates for patients with late-stage colorectal cancer are dismal, and new therapeutic strategies are needed to improve outcomes.

Colorectal cancer rates in Canada
The incidence of colorectal cancer among younger adults increased in recent years in this analysis of data from Canadian national cancer registries that included about 688,000 new colorectal cancers diagnosed over more than 40 years.

Cancer drugs promote stem cell properties of colorectal cancer
Scientists from the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) and the Mannheim University Medical Center have now discovered that a certain group of cancer drugs (MEK Inhibitors) activates the cancer-promoting Wnt signalling pathway in colorectal cancer cells.

Read More: Colorectal Cancer News and Colorectal Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to