‘Why don’t I need a colonoscopy?’ A novel approach to communicating risks and benefits of colorectal cancer screening

Emery, Jon; Pirotta, Marie; Macrae, Finlay; Walker, Jenny; Qama, Ashleigh; Boussioutas, Alex; Jenkins, Mark A.

doi:10.31128/ajgp-11-17-4386

Cited by 13 publications

(11 citation statements)

References 14 publications

(25 reference statements)

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“…Similarly, a relative risk does not in itself provide information on the absolute risk of a disease and so both absolute and relative risks should be reported. Finally, graphs or diagrams should be presented wherever possible 6,11,22‐24,29‐34 …”

Section: Resultsmentioning

confidence: 99%

Relative risks and odds ratios: Simple rules on when and how to use them

McKenzie

Thomas

2020

Eur J Clin Investigation

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Aim Relative risks and odds ratios are widely reported in the medical literature, but can be very difficult to understand. We sought to further clarify these important indices. Methods We illustrated both relative risks and odds ratios using bar charts, then looked at the types of study for which each statistic is suited. We demonstrated calculation of relative risks and odds ratios through analysis of tabled data from a recent published longitudinal study, using a 2 × 2 table and R, the open‐source statistical programming language. Simple rules for when and how to use relative risks and odds ratios are presented. Conclusion Understanding the difference between relative risks and odds ratios and when and how to use them may aid clinical interpretation, dissemination and translation of research findings.

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Section: Resultsmentioning

confidence: 99%

Relative risks and odds ratios: Simple rules on when and how to use them

McKenzie

Thomas

2020

Eur J Clin Investigation

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“…An expected frequency tree was also given to all participants showing the relative harms and benefits of iFOBT screening, colonoscopic screening, and no screening, tailored for their risk level. Based on our previous work, these risk outputs were chosen to encourage participants towards the “risk-appropriate” screening option for each risk level [26, 27].…”

Section: Methodsmentioning

confidence: 99%

“…Genomic test results were given in a second appointment with the research genetic counsellor at their general practice, discussing risk and screening recommendations. Results were presented verbally, in writing, and pictorially as absolute 10-year risks of CRC [26, 27]. iFOBT kits were given to participants who were due according to the national guidelines.…”

Section: Methodsmentioning

confidence: 99%

A Genomic Test for Colorectal Cancer Risk: Is This Acceptable and Feasible in Primary Care?

Saya

McIntosh

Winship

et al. 2020

Public Health Genomics

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Introduction: Genomic tests can predict risk and tailor screening recommendations for colorectal cancer (CRC). Primary care could be suitable for their widespread implementation. Objective: We aimed to assess the feasibility and acceptability of administering a CRC genomic test in primary care. Methods: Participants aged 45-74 years recruited from 4 Australian general practices were offered a genomic CRC risk test. Participants received brief verbal information about the test comprising 45 CRC-associated single-nucleotide polymorphisms, before choosing whether to undertake the test. Personalized risks were given to testers. Uptake and knowledge of the genomic test, cancer-specific anxiety (Cancer Worry Scale), psychosocial impact (Multidimensional Impact of Cancer Risk Assessment [MICRA] score), and impact on CRC screening behaviour within 6 months were measured. Results: In 150 participants, test uptake was high (126, 84%), with 125 (83%) having good knowledge of the genomic test. Moderate risk participants were impacted more by the test (MICRA mean: 15.9) than average risk participants (mean: 9.5, difference in means: 6.4, 95% confidence interval (CI): 1.5, 11.2, p = 0.01), but all scores were low. Average risk participants' cancer-specific anxiety decreased (mean differences from baseline: 1 month −0.5, 95% CI: −1.0, −0.1, p = 0.03; 6 months −0.6, 95% CI: −1.0, −0.2, p = 0.01). We found limited evidence for genomic testers being more likely to complete the risk-appropriate CRC screening than nontesters (41 vs. 17%, odds ratio = 3.4, 95% CI: 0.6, 34.8, p = 0.19), but some mediators of screening behaviour were altered in genomic testers. Conclusions: Genomic testing for CRC risk in primary care is acceptable and likely feasible. Further development of the risk assessment intervention could strengthen the impact on screening behaviour.

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“…This scenario provides a highly tailored approach: Screening is based on absolute risk exceeding 2 thresholds. The iFOBT, then colonoscopy, would begin when one’s 10-year risk of CRC exceeds 0.9% (equalling the average 10-year risk of CRC for an Australian aged 50 years, the current starting age for screening) ( 33 ) and 4.0% (in current Australian guidelines, this threshold balances cancer risk with risk of complications from colonoscopy) ( 36 ), respectively. In 2 sensitivity analyses, these absolute risk thresholds were altered to match the total number of screeners (scenarios 2a) or CRC cases (scenario 2b) as the current guidelines ( Supplementary Methods , available online).…”

Section: Methodsmentioning

confidence: 99%

The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program

Saya

Emery

Dowty

et al. 2020

JNCI Cancer Spectrum

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Background In many countries, population colorectal cancer (CRC) screening is based on age and family history, though more precise risk prediction could better target screening. We examined the impact of a CRC risk prediction model (incorporating age, sex, lifestyle, genomic and family history factors) to target screening under several feasible screening scenarios. Methods We estimated the model’s predicted CRC risk distribution in the Australian population. Predicted CRC risks were categorised into screening recommendations under three proposed scenarios to compare to current recommendations: a) highly tailored; b) three risk categories; c) four sex-specific risk categories. Under each scenario, for 35-74-year-olds, we calculated the number of CRC screens by immunochemical faecal occult blood testing (iFOBT) and colonoscopy, and the proportion of predicted CRCs over ten years in each screening group. Results Currently, 1.1% of 35-74-year-olds are recommended screening colonoscopy and 56.2% iFOBT. 5.7% and 83.2% of CRCs over ten years were predicted to occur in these groups respectively. For the scenarios: a) colonoscopy was recommended to 8.1% and iFOBT to 37.5%, with 36.1% and 50.1% of CRCs in each group; b) colonoscopy recommended to 2.4% and iFOBT to 56.0%, with 13.2% and 76.9% of cancers in each group; c) colonoscopy recommended to 5.0% and iFOBT to 54.2%, with 24.5% and 66.5% of cancers in each group. Conclusions A highly tailored CRC screening scenario results in many fewer screens but more cancers in those unscreened. Category-based scenarios may provide good balance between number of screens and cancers detected and be simpler to implement.

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‘Why don’t I need a colonoscopy?’ A novel approach to communicating risks and benefits of colorectal cancer screening

Cited by 13 publications

References 14 publications

Relative risks and odds ratios: Simple rules on when and how to use them

Relative risks and odds ratios: Simple rules on when and how to use them

A Genomic Test for Colorectal Cancer Risk: Is This Acceptable and Feasible in Primary Care?

The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program

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