November 2024
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6 Reads
Clinical and Translational Gastroenterology
Objective U.S. Multi-Society Task Force colonoscopy surveillance intervals are based solely on adenoma characteristics, without accounting for other risk factors. We investigated whether a risk model including demographic, environmental and genetic risk factors could individualize surveillance intervals under an “equal management of equal risks” framework. Methods Using 14,069 individuals from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who had a diagnostic colonoscopy following an abnormal flexible sigmoidoscopy, we modeled the risk of colorectal cancer (CRC), considering the diagnostic colonoscopy finding, baseline risk factors (e.g., age and sex), 19 lifestyle and environmental risk factors, and a polygenic risk score (PRS) for CRC. Ten-year absolute cancer risks for each diagnostic colonoscopy finding [advanced adenoma (N=2446), ≥3 non-advanced adenomas (N=483), 1-2 non-advanced adenomas (N=4400) and no adenoma (N=7183)] were used as implicit risk thresholds for recommended surveillance intervals. Results The area-under-the-curve (AUC) for the model including colonoscopy findings, baseline characteristics, and PRS was 0.658. Applying the “equal management of equal risks” framework, 28.2% of individuals with no adenoma and 42.7% of those with 1-2 non-advanced adenomas would be considered high risk and assigned a significantly shorter surveillance interval than currently recommended. Among individuals who developed cancer within 10 years, 52.4% with no adenoma and 48.3% with 1-2 non-advanced adenomas would have been considered high risk and assigned a shorter surveillance interval. Conclusion Using a personalized risk-based model has the potential to identify individuals with no adenoma or 1-2 non-advanced adenomas, who are higher risk and may benefit from shorter surveillance intervals.