New scoring tools developed to predict the risk of colon cancer and precancerous polyps
Researchers have created new scoring tools to predict the actual risk of colon cancer and advanced precancerous polyps for patients on average for the disease.
The work was led by Thomas F. Imperiale, MD, Regenstrief Institute and research scientist at the US Department of Veterans Affairs and professor of medicine at Indiana University School of Medicine.
The tools may be more useful in countries where colonoscopy is not routinely used for screening medium risk individuals, and include Canada, UK, Italy, Netherlands, Australia and others that typically screen medium-risk individuals with less invasive sigmoidoscopy and the many countries that do not use imaging tests for colon cancer screening.
The new weighted models are based on the assessment of various factors such as age, gender, smoking history, history of cohabitation, consumption of nonsteroidal anti-inflammatory drugs (e.g. ibuprofen) and aspirin, and moderate physical activity over the past year in average risk individuals. . These tools assess the importance of each factor in determining an individual’s personalized risk.
We need to measure the risk of individuals and populations more precisely, so that patients, clinicians and public health officials can make sound, science-based decisions about when and how to get screened for colorectal cancer. Our composite and weighted scoring methods allow for simple risk stratification to determine an individual’s risk, for example, of a precancerous polyp with certain worrisome features or colon cancer, both indicating the need for colonoscopy.. “
Dr Thomas. F Imperiale, practicing gastroenterologist, Institut Regenstrief
Imperial has studied colon cancer risks and screening for two decades.
He and his colleagues have developed two tools. One is applicable to patients who have undergone limited endoscopic screening of part of the colon by sigmoidoscopy and the other can be used for patients without any tests involving visualization of the colon.
For various reasons, especially the expense and the need for patient preparation and anesthesia, many countries other than the United States, Germany and Poland do not adopt routine screening colonoscopy, preferring to use the sigmoidoscopy, stool-based tests for hidden bleeding, or both. Sigmoidoscopy is a simpler procedure that only examines the lower part of the colon (medically called the distal colon) and is performed every five to ten years.
Stool samples are inexpensive, easy to use, and should be repeated annually or every two years. According to Dr Imperiale, the data-driven predictive tools to identify the highest-risk medium-risk patients are invaluable in determining who to recommend for colonoscopy and who can be well screened without a colonoscopy.
Statistics from the World Health Organization (WHO) indicate that colorectal cancer is the third most common cancer (after breast and lung) in the world and the second leading cause of cancer death (after lung) in 2020 (935,000 deaths).
“New scoring systems to predict advanced proximal neoplasia in asymptomatic adults with or without knowledge of distal colorectal findings: a prospective and cross-sectional study” is published in the European Journal of Cancer Prevention. The authors, in addition to Dr Imperiale, are Patrick Monahan, PhD and Timothy Stump, MS, of the IU School of Medicine; and David F. Ransohoff, MD, of the University of North Carolina at Chapel Hill.
Thomas, me, et al. (2021) New scoring systems to predict advanced proximal neoplasia in asymptomatic adults with or without knowledge of distal colorectal findings, a prospective and cross-sectional study. European Journal of Cancer Prevention. doi.org/10.1097/CEJ.0000000000000715.