Integrated Risk Prediction and Implementation Strategies for Colorectal Cancer Prevention
(termed surveillance), every 3-10 years for CRC risk reduction. Current guidelines for follow-up surveillance intervals categorize patients’ high or low risk status based only on limited polyp characteristics. The modest predictive value of this polyp-based risk stratification method has led to inappropriate utilization of surveillance colonoscopy, with low risk patients undergoing unnecessary procedures (overuse) and high risk patients having potential missed cancers (underuse); this increases both healthcare costs and patient harms. To improve the identification of patients at highest risk of developing advanced neoplasia and to reduce under- and overutilization of surveillance, we urgently need a risk prediction tool that incorporates the full spectrum of endoscopic (polyp characteristics), clinical (e.g., age, sex, family history, co-morbidities, tobacco use, etc.), and genetic risk factors.
This proposal’s overall goals are to examine the roles of detailed polyp characteristics, clinical factors, and PRS on predicting advanced neoplasia risk among patients eligible for surveillance and, based on these results, develop optimal surveillance strategies aligned with stakeholder’s perspectives.
AIM 1: Develop a prediction model to inform CRC surveillance using polyp characteristics in patients with a history of polyps; and determine the added value of incorporating clinical and genetic (i.e., PRS) risk factors.
AIM 2: Validate the performance of the comprehensive risk model (i.e., polyp characteristics, clinical and genetic risk factors) developed in Aim 1 using a separate, independent cohort.
AIM 3: Evaluate optimal strategies for CRC surveillance given an individual’s risk defined in Aims 1-2 using theestablished MISCAN-Colon microsimulation model. Aim 3a: evaluate the optimal time interval for surveillance given an individual’s risk. Aim 3b: evaluate the costs and outcomes of different comprehensive risk-stratified surveillance strategies compared to the current guideline, which only uses a polyp-based surveillance strategy.
AIM 4: Engage key stakeholders to understand patient, clinician, and service provider (e.g., health plan leader) acceptability and guide implementation of precision surveillance in clinical practice.
Jeffrey Lee, MD, MPH, Kaiser Permanente Northern California
Douglas Corley, MD, PhD, Kaiser Permanente Northern California
Ulrike Peters, PhD, Fred Hutchinson Cancer Center
Li Hsu, PhD, Fred Hutchinson Cancer Center
Iris Lansdorp-Vogelaar, PhD, Erasmus Medical Center
Carmit McMullen, PhD, Kaiser Permanente Northern California