Future of Colorectal Cancer Screening: Screening in the Big Data Era and Personalized Screening Strategy
Journal
Colorectal Cancer Screening: Theory and Practical Application
Pages
135
ISBN
9789811574825
Date Issued
2020-01-01
Author(s)
Abstract
Population-based colorectal cancer (CRC) screening with FIT is well established in Western countries. However, its application to the general population is still faced with inaccuracy of FIT and economic concern given scarce resources. To be more precise and efficient, an alternative is to adopt personalized screening strategy by making use of risk stratification computed by the risk assessment multistate model with the incorporation of multifactorial correlates. In this chapter, we design and frame a multistate and multifactorial natural history model to incorporate fecal hemoglobin (f-Hb) concentration, lifestyle factors, comorbidity, chromosomal instability (CSI), and CpG island methylator phenotype (CIMP) in the evolution of colorectal neoplasm. The computer simulation algorithm was developed to yield multistep scores for calculating multistate probabilities of developing colorectal neoplasia, which provide the basis for risk-based individually tailored screening policy and also its efficacy, utilization, and cost-effectiveness analysis compared with universal screening policy. Through this integrated approach, the individually tailored cancer screening under the concept of translational research has been proposed to solve many problems of current universal mass screening for colorectal cancer. We believe the application of personalized information on f-Hb concentration, genetic markers, and nongenetic factors opens a new avenue to develop a novel personalized population-based screening for CRC.
Subjects
Bleeding phenotype | Fecal hemoglobin concentration | Personalized colorectal cancer screening | Quantitative fecal immunochemical test | Stool-based test
Type
book part