A Risk-stratified Approach to Colorectal Cancer Prevention and Diagnosis

Overview

Journal Nat Rev Gastroenterol Hepatol

Specialty Gastroenterology

Date 2020 Oct 17

PMID 33067592

Citations 56

Authors

Mark A Hull

Colin J Rees

Linda Sharp

Sara Koo

Affiliations

Soon will be listed here.

Abstract

Population screening and endoscopic surveillance are used widely to prevent the development of and death from colorectal cancer (CRC). However, CRC remains a major cause of cancer mortality and the increasing burden of endoscopic investigations threatens to overwhelm some health services. This Perspective describes the rationale for and approach to improved risk stratification and decision-making for CRC prevention and diagnosis. Limitations of current approaches will be discussed using the UK as an example of the challenges faced by a particular health-care system, followed by discussion of novel risk biomarker utilization. We explore how risk stratification will be advantageous to current health-care providers and users, enabling more efficient use of limited colonoscopy resources. We discuss risk stratification in the setting of population screening as well as the surveillance of high-risk groups and investigation of symptomatic patients. We also address challenges in the development and validation of risk stratification tools and identify key research priorities.

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References

Cross A, Robbins E, Pack K, Stenson I, Kirby P, Patel B . Long-term colorectal cancer incidence after adenoma removal and the effects of surveillance on incidence: a multicentre, retrospective, cohort study. Gut. 2020; 69(9):1645-1658. PMC: 7456728. DOI: 10.1136/gutjnl-2019-320036. View

Markar S, Chin S, Romano A, Wiggins T, Antonowicz S, Paraskeva P . Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-tube Mass Spectrometry. Ann Surg. 2017; 269(5):903-910. DOI: 10.1097/SLA.0000000000002539. View

Cuzick J, Thorat M, Bosetti C, Brown P, Burn J, Cook N . Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol. 2014; 26(1):47-57. PMC: 4269341. DOI: 10.1093/annonc/mdu225. View

Weigl K, Chang-Claude J, Knebel P, Hsu L, Hoffmeister M, Brenner H . Strongly enhanced colorectal cancer risk stratification by combining family history and genetic risk score. Clin Epidemiol. 2018; 10:143-152. PMC: 5783152. DOI: 10.2147/CLEP.S145636. View

Xin J, Chu H, Ben S, Ge Y, Shao W, Zhao Y . Evaluating the effect of multiple genetic risk score models on colorectal cancer risk prediction. Gene. 2018; 673:174-180. DOI: 10.1016/j.gene.2018.06.035. View

Schreuders E, Ruco A, Rabeneck L, Schoen R, Sung J, Young G . Colorectal cancer screening: a global overview of existing programmes. Gut. 2015; 64(10):1637-49. DOI: 10.1136/gutjnl-2014-309086. View

Widlak M, Neal M, Daulton E, Thomas C, Tomkins C, Singh B . Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers. Colorectal Dis. 2018; 20(12):O335-O342. DOI: 10.1111/codi.14431. View

Ladabaum U, Schoen R . Post-Polypectomy Surveillance That Would Please Goldilocks--Not Too Much, Not Too Little, but Just Right. Gastroenterology. 2016; 150(4):791-6. DOI: 10.1053/j.gastro.2016.01.033. View

Westwood M, Lang S, Armstrong N, van Turenhout S, Cubiella J, Stirk L . Faecal immunochemical tests (FIT) can help to rule out colorectal cancer in patients presenting in primary care with lower abdominal symptoms: a systematic review conducted to inform new NICE DG30 diagnostic guidance. BMC Med. 2017; 15(1):189. PMC: 5654140. DOI: 10.1186/s12916-017-0944-z. View

10.

Selby K, Levine E, Doan C, Gies A, Brenner H, Quesenberry C . Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis. Gastroenterology. 2019; 157(6):1494-1505. PMC: 6878177. DOI: 10.1053/j.gastro.2019.08.023. View

11.

Libby G, Fraser C, Carey F, Brewster D, Steele R . Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality. Gut. 2018; 67(12):2116-2123. PMC: 6241609. DOI: 10.1136/gutjnl-2018-316483. View

12.

Saftoiu A, Hassan C, Areia M, Bhutani M, Bisschops R, Bories E . Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2020; 52(4):293-304. DOI: 10.1055/a-1104-5245. View

13.

Idrissi Janati A, Karp I, Sabri H, Emami E . Is a fusobacterium nucleatum infection in the colon a risk factor for colorectal cancer?: a systematic review and meta-analysis protocol. Syst Rev. 2019; 8(1):114. PMC: 6511124. DOI: 10.1186/s13643-019-1031-7. View

14.

Stegeman I, de Wijkerslooth T, Stoop E, van Leerdam M, Dekker E, van Ballegooijen M . Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy. Gut. 2013; 63(3):466-71. DOI: 10.1136/gutjnl-2013-305013. View

15.

Han J, Wang Y, Zhu L, Cui Y, Li L, Zeng Z . Preventing the spread of COVID-19 in digestive endoscopy during the resuming period: meticulous execution of screening procedures. Gastrointest Endosc. 2020; 92(2):445-447. PMC: 7130750. DOI: 10.1016/j.gie.2020.03.3855. View

16.

Senore C, Basu P, Anttila A, Ponti A, Tomatis M, Vale D . Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut. 2018; 68(7):1232-1244. DOI: 10.1136/gutjnl-2018-317293. View

17.

Terhaar Sive Droste J, van Turenhout S, Oort F, van der Hulst R, Steeman V, Coblijn U . Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study. BMC Gastroenterol. 2012; 12:94. PMC: 3444435. DOI: 10.1186/1471-230X-12-94. View

18.

Schroy 3rd P, Emmons K, Peters E, Glick J, Robinson P, Lydotes M . Aid-assisted decision making and colorectal cancer screening: a randomized controlled trial. Am J Prev Med. 2012; 43(6):573-83. PMC: 3966107. DOI: 10.1016/j.amepre.2012.08.018. View

19.

Widlak M, Thomas C, Thomas M, Tomkins C, Smith S, OConnell N . Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther. 2016; 45(2):354-363. DOI: 10.1111/apt.13865. View

20.

Esposito K, Chiodini P, Capuano A, Bellastella G, Maiorino M, Rafaniello C . Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine. 2013; 44(3):634-47. DOI: 10.1007/s12020-013-9939-5. View