Realizing the Promise of Personalized Colorectal Cancer Screening in Practice
Menée à partir de données portant sur 75 873 femmes et 42 875 hommes (durée médiane de suivi : 26 ans), cette étude évalue, en fonction de profils de risque (établis à l'aide d'un système de score basé sur des comportements de santé), l'intérêt d'une coloscopie de dépistage pour réduire l'incidence du cancer colorectal à 10 ans et la mortalité spécique, puis détermine pour chaque profil de risque l'âge optimal à partir duquel il est possible de participer au programme de dépistage
Current recommendations for age of initiation of colorectal cancer (CRC) screening and selection of screening strategies such as colonoscopy and fecal immunochemical testing take a one-size-fits-all approach, except for those with a family history of CRC[1, 2]. Even with riskstratification usingrisk calculators or family history, it is unclear whether screening is similarly effective across the risk spectrumfor both low and high-risk groups. In their recent JNCIarticle, Wang et al. address these evidence gaps utilizing data from the Nurses’ Health Study and Health Professionals Follow-up Study cohorts[3]. Specifically, theyderived a risk score based on 8 CRC risk factors—family history, aspirin, height, body mass index, smoking history, physical activity, alcohol use,and diet—and measured cumulative CRC incidence and mortalityacross risk groups to 1) determine whether increased risk scoreswereassociated with CRC risk,2) establish whether exposure to screening colonoscopy reduced riskfor incident and fatal CRC across risk scores,and 3) estimate risk-adapted starting agesof screening, defined as when individuals with a given CRC risk score reached the CRC cumulative incidence of the general populationat commonly recommended ages to initiate screening. Higher risk scores were associated with increasingrisk, with a 2.5-fold increased risk for the highest compared to the lowestscore group. Screening colonoscopywas associated with decreased incident and fatal CRC risk across all groups. Notably, absolute risk reductions associated with screening colonoscopyincreased with increasing risk score, with absolute CRC incidence reduction being 0.34%for the highest, and 0.15% for the lowest risk group. The CRC incidence threshold associated with guideline-recommended screening initiation at age 45 or 50 years was reached at earlier ages for Downloaded from https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djab044/6178006 by guest on 24 March 2021 the higher risk groupsand at an older age for the lower risk groups. For example, the highest and lowest risk groups reached the general population CRC incidence threshold at age 45 years by age38and 51, respectively. The main limitation of the study is the focus on a mostlynon-Hispanic White, health professional population, possibly affectinggeneralizability.
Journal of the National Cancer Institute , commentaire en libre accès, 2020