Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions

Abstract

Colorectal cancer (CRC) is the third most common cause of cancer-related death in the United States (U.S.), with estimates of 143,460 new cases and 51,690 deaths for the year 2012. Numerous organizations have published guidelines for CRC screening; however, these numerical estimates of incidence and disease-specific mortality have remained stable from years prior. Technological, genetic profiling, molecular and surgical advances in our modern era should allow us to improve risk stratification of patients with CRC and identify those who may benefit from preventive measures, early aggressive treatment, alternative treatment strategies, and/or frequent surveillance for the early detection of disease recurrence. To better negotiate future economic constraints and enhance patient outcomes, ultimately, we propose to apply the principals of personalized and precise cancer care to risk-stratify patients for CRC screening (Precision Risk Stratification-Based Screening, PRSBS). We believe that genetic, molecular, ethnic and socioeconomic disparities impact oncological outcomes in general, those related to CRC, in particular. This document highlights evidence-based screening recommendations and risk stratification methods in response to our CRC working group private-public consensus meeting held in March 2012. Our aim was to address how we could improve CRC risk stratification-based screening, and to provide a vision for the future to achieving superior survival rates for patients diagnosed with CRC.

Prevalence of Colorectal Neoplasia Among Young African Americans and Hispanic Americans

“…Epidemiological, genetic studies, molecular studies should allow us to improve risk qualification of patients with CRC and allow high risk patients use preventive modalities, early treatment, and efficient surveillance for the early detection of disease recurrence [18]. Adenoma is a precancerous lesion and its size, number and histologic features determine follow up colonoscopy surveillance pattern.…”

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

“…We limited the review to genetic testing related to breast, colorectal, and prostate cancer because these represent cancers of high incidence and mortality, 27 and for which genetic information may be particularly useful in risk-stratification decisions for the frequency and/or modality of screening tests. [13][14][15]28 …”

Impact of Project SCOPE on Racial/Ethnic Disparities in Screening Colonoscopies

“…Different insurers vary greatly on which colonoscopic procedures are covered completely and which require copayments [35]. The state of Delaware has taken the lead on expanding coverage for colon cancer screening using colonoscopy as the initial screening tool [36].…”