Tailored information increases patient/physician discussion of colon cancer risk and testing: The Cancer Risk Intake System trial

Skinner, Celette Sugg; Gupta, Samir; Bishop, Wendy Pechero; Ahn, Chul; Tiro, Jasmin A.; Halm, Ethan A.; Farrell, David; Marks, Emily G.; Morrow, Jay B.; Julka, Manjula; McCallister, Katharine; Sanders, Joanne M.; Rawl, Susan M.

doi:10.1016/j.pmedr.2016.04.008

Cited by 11 publications

(16 citation statements)

References 24 publications

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“…Although mutations in known susceptibility genes only account for a small proportion (3%–5%) of CRCs, 19 recent research efforts incorporate several strategies into clinical care that identify and screen high-risk individuals. 20 These include family history screening tools, 21,22 outreach to high-risk family members, 23 increased recognition of Lynch syndrome families in the population, 24 and testing all CRC cases, regardless of age at diagnosis, for microsatellite instability. 25 Penetrance of genetic mutations is unlikely to have changed over time, 26 but more conscientious adherence to these guidelines in higher risk populations could contribute to greater use of colonoscopy.…”

Section: Colonoscopy Rates In Younger Adults Parallel Increases In Crmentioning

confidence: 99%

Young-Onset Colorectal Cancer: Earlier Diagnoses or Increasing Disease Burden?

2017

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Section: Colonoscopy Rates In Younger Adults Parallel Increases In Crmentioning

confidence: 99%

Young-Onset Colorectal Cancer: Earlier Diagnoses or Increasing Disease Burden?

2017

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“…CRIS , described in detail elsewhere 9, 10 ,. 2, 3 CRIS algorithms link responses with US Multi-Society Task Force (USMTF) guideline-concordant recommendations and generate tailored printouts for the patient and referring physician.…”

Section: Methodsmentioning

confidence: 99%

“…The Cancer Risk Intake System ( CRIS ) 9, 10 was used by a large, diverse population of patients in two primary-care community-based clinics in Dallas County’s safety-net, Parkland Health and Hospital System. For these analyses, we used CRIS -collected data to characterize the subset of patients younger than 50 years who reported risk factors indicating need for CRC screening and to describe proportions who underwent guideline-concordant screening, non-guideline-concordant screening, or no screening.…”

Section: Introductionmentioning

confidence: 99%

Recommendation of colorectal cancer testing among primary care patients younger than 50 with elevated risk

Skinner

Ahn

Halm

et al. 2017

Preventive Medicine

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In the era of precision medicine, efforts are needed to identify and tailor screening recommendations among elevated-risk patients. Individuals younger than 50 years are an important target population, as they comprise 15% of colorectal (CRC) cases and often present with more advanced disease than their 50+ counterparts. In this large study, 2,470 patients ages 25–49 used a tablet-based program that assessed risks, matched risks with screening guidelines, and generated tailored printed guideline-concordant recommendations for patients and their providers. The tablet-based program identified 121 (4.9%) patients with risk factors warranting screening before age 50. Likelihood of risk warranting screening was greater for ages 40–49 than <40 years (OR: 2.38), females than males (OR: 1.82), and African Americans (OR: 1.69) and non-Hispanic Whites (OR: 2.89) compared to Hispanics. Most common risk factors were family history of polyps (23.1%), personal history of inflammatory bowel disease (19.8%), and combined family history of CRC + polyps (18.2%). Receipt of guideline-concordant screening within 6 months of identification was low, including only 5.3% of those who needed colonoscopy and 13.3% for whom colonoscopy or FIT was recommended. Although elevated-risk patients younger than 50 years can be readily identified, more than notification is necessary to facilitate screening participation.

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“…The Cancer Risk Intake System, for instance, is a tablet-based risk assessment tool designed for use before a primary care appointment. [72][73][74] The tool, which focuses on family history, demographics, and previous testing, attempts to translate guidelines into actionable recommendations. When applied to a large (n ¼ 2470) group of 25-to 49-year-olds, 5% were recommended for earlier screening based on the tool.…”

Section: Opportunitiesmentioning

confidence: 99%

Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening

Robertson

Ladabaum

2019

Gastroenterology

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C olorectal cancer (CRC) remains the second most common cause of cancer death in the United States. 1 However, CRC incidence and mortality have been decreasing over the past 4 decades, and screening has contributed substantially to these gains. 2-4 Screening aims to identify disease in asymptomatic individuals at an early stage, in the hope of improving outcomes. CRC lends itself very well to screening, as early-stage CRC has a highly favorable prognosis relative to more advanced disease. Also, the transition from normal mucosa through preneoplastic disease (ie, polyps) to CRC is estimated to be a decade or more. 5 Therefore, finding and removing preneoplastic lesions can reduce CRC incidence. Screening is widely employed in the United States, largely in an opportunistic fashion. While there is no national CRC screening policy or program, there are multiple guidelines endorsing CRC screening. 6-10 Most guidelines, in average-risk populations, recommend initiating CRC screening at age 50 years with one of the available methods. While there is some variation in recommendations by age and race, factors beyond these are not currently used to tailor individual recommendations. This review addresses current CRC epidemiology, screening practice, and guidelines in the United States, and considers how individual risk factors might be used to personalize CRC screening. We first summarize the burden of CRC and current screening efforts. Next, we examine current guidelines for variation regarding the approach to age, sex, and race, and we explain how decision analytic modeling has informed recent guidelines. We then review factors beyond demographic characteristics (eg, smoking, obesity) that affect CRC risk and provide potential opportunities for personalized screening, including the development of risk-prediction models that include biomarkers. Finally, we consider future directions for research and practice, including the opportunities and challenges related to implementing personalized CRC screening. Current Status of Colorectal Cancer and Screening in the United States The American Cancer Society (ACS) provides annual cancer statistics for the United States. 1 These statistics are drawn from a number of sources. For example, mortality data are abstracted from the National Center for Health Statistics, and cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. The most recent ACS report estimates that there will be 145,600 new CRC cases and 51,020 CRC-related deaths in the United States this year. 1 CRC remains the third most common cause of cancer and cancer death for both sexes, trailing only lung and prostate cancer in men and lung and breast cancer in women. Age standardized CRC incidence and mortality trends in the United States are improving (Figure 1). From 1975 through 2015, overall CRC mortality fell from 28.1/100,000 to 14/100,000. 11 Like cancer statistics, data on screening are also drawn from various sources. Based on 2015 National Health Intervi...

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Tailored information increases patient/physician discussion of colon cancer risk and testing: The Cancer Risk Intake System trial

Cited by 11 publications

References 24 publications

Young-Onset Colorectal Cancer: Earlier Diagnoses or Increasing Disease Burden?

Young-Onset Colorectal Cancer: Earlier Diagnoses or Increasing Disease Burden?

Recommendation of colorectal cancer testing among primary care patients younger than 50 with elevated risk

Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening

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