Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart?
Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart?
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DOI：
10.1053/j.gastro.2023.02.021
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发表时间：
2023-04
期刊：
影响因子：
29.4
通讯作者：
中科院分区：
文献类型：
--
作者：
目前的结直肠癌(CRC)筛查建议采用“一刀切”的方法，将年龄作为启动筛查的主要标准。精确筛查结合了年龄以外的因素来对个体进行风险分层，可以改进当前的方法，并优化利用现有资源，使患者、提供者和医疗保健系统受益。预测模型可以确定将从更密集的筛查中受益的高风险组，而低风险组可以被建议采用结合非侵入性筛查模式的较低强度的筛查。除年龄外，预测模型还纳入了公认的风险因素，如遗传学(如家族结直肠癌病史、生殖系和多基因风险评分)、生活方式(如吸烟、饮酒、饮食和缺乏体育锻炼)、性别以及种族和民族等。虽然几种风险预测模型已经得到验证，但很少有人对风险适应人群结直肠癌筛查进行系统研究。为了预见未来精确筛查的临床实施，关键是开发适用于人群中所有个体的可靠和准确的预测模型；在人群水平上前瞻性地研究风险适应的结直肠癌筛查；获得患者和提供者的接受；并评估这些新范例的可行性、资源、成本和成本效益。该综述评估了风险预测建模的现状，并为未来实施精确的结直肠癌筛查提供了路线图。
Current colorectal cancer (CRC) screening recommendations take a “one-size-fits-all” approach using age as the major criterion to initiate screening. Precision screening that incorporates factors beyond age to risk stratify individuals could improve on current approaches and optimally use available resources with benefits for patients, providers, and health care systems. Prediction models could identify high-risk groups who would benefit from more intensive screening, while low-risk groups could be recommended less intensive screening incorporating noninvasive screening modalities. In addition to age, prediction models incorporate well-established risk factors such as genetics (eg, family CRC history, germline, and polygenic risk scores), lifestyle (eg, smoking, alcohol, diet, and physical inactivity), sex, and race and ethnicity among others. Although several risk prediction models have been validated, few have been systematically studied for risk-adapted population CRC screening. In order to envisage clinical implementation of precision screening in the future, it will be critical to develop reliable and accurate prediction models that apply to all individuals in a population; prospectively study risk-adapted CRC screening on the population level; garner acceptance from patients and providers; and assess feasibility, resources, cost, and cost-effectiveness of these new paradigms. This review evaluates the current state of risk prediction modeling and provides a roadmap for future implementation of precision CRC screening.
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