Genetic predisposition, colonoscopy findings may help clarify CRC screening intervals
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Patients with a genetic predisposition for colorectal cancer could help define risk-adapted surveillance intervals after detection and removal of adenomas at colonoscopy, according to a study in Clinical Gastroenterology and Hepatology.
“Previous studies have suggested that polygenic risk scores (PRSs) could help define personalized colorectal cancer for screening strategies, such as starting ages for screening and rescreening intervals after colonoscopy with normal findings,” Feng Guo, PhD, MSc, of the division of clinical epidemiology and aging research at the German Cancer Research Center, and colleagues wrote. “So far, the recommended surveillance intervals after detecting and removing adenomas at colonoscopy are based on adenoma characteristics.”
Seeking to determine whether PRSs could help guide recommendations for CRC screening strategies, Guo and colleagues collected colonoscopy data from the ongoing, case-controlled DACHS study in Germany. A total of 8,405 participants, for whom a PRS was obtained based on 140 CRC-related single-nucleotide polymorphisms, were included in the analysis.
Of 4,696 CRC cases (60% men; nearly 80% older than 60 years) and 3,709 controls, 60% were diagnosed with colon cancer and 53% of cancers were diagnosed at stage 1 or 2. Lower education levels, history of CRC, smoking and an elevated BMI greater than or equal to 30 kg/m2 were common findings among cases.
Results also revealed that a PRS in the medium and high range correlated with a 1.7- and 2.6-fold increased risk of CRC, respectively. Researchers further estimated that the 10-year risk of CRC among men and women older than 50 years with no polyps was 0.2%, a risk-level reached within 3 to 5 years in people with low-risk adenomas and high PRS and with high-risk adenomas, regardless of the PRS.
When using participants without colonoscopy history in PRS groups as reference, risk of CRC was lower in those who had a colonoscopy with and without polypectomy for all PRS groups.
“Future studies should also consider both genetic factors and colonoscopy quality indicators to optimize the use of surveillance colonoscopy and pay particular attention to the practical and ethical challenges of bringing complex risk stratification to practice,” Guo and colleagues concluded.
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