Colorectal cancer screening based on predicted risk: a pilot randomized controlled trial

Abstract

AbstractBackground & AimsColorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk (i.e. personalized screening) may maximize benefit with lower risks, individual burdens, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on appropriate screening uptake in an organized screening setting.MethodsPilot randomized controlled trial among residents aged 50-69 years old not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and corresponding screening recommendation. The control group received a brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, colonoscopy if ≥6%), assessed by a mailed questionnaire at 6 months. A secondary outcome was overall screening uptake.ResultsOf 5396 invitations, 1059 people responded (19%), of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% (SD 0.5), age 52.2 years (SD 2.2), 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95%CI 6%-22%, p<0.001). Overall screening uptake was 50% in the intervention and 49% in the control group (absolute difference 1%, 95CI −7%−10%, p=0.758).ConclusionsIn a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk.Trial registration:Clinicaltrials.govNCT05357508.What You Need to KnowBackgroundColorectal cancer can be effectively prevented by screening using colonoscopy or fecal immunochemical test (FIT). Optimizing use of colonoscopy resources is crucial to reduce screening burden for patients and society.FindingsAfter reading our intervention brochure, participants were 14% more likely to choose the screening test appropriate to their risk level. This result did not impact overall screening participation.Implications for patient careRisk-based screening recommendations for FIT or colonoscopy could be a means of better allocating colonoscopy resources in countries relying heavily on colonoscopy for screening, thus decreasing the burden of CRC screening for low-risk participants.