Abstract
Background: Estimation of absolute risk of developing colorectal neoplasm is essential for personalized colorectal cancer (CRC) screening. We developed models to determine relative and absolute risks of colorectal neoplasm based on lifestyle and genetic variants and to validate their application in risk-adapted screening. Methods: We prospectively collected data from 203 advanced neoplasms, 464 non-advanced adenomas, and 1,213 healthy controls from a CRC screening trial in China in 2018–2019. The risk prediction model based on four lifestyle factors and a polygenic risk score (PRS) consisted of 19 CRC-associated single-nucleotide polymorphisms. We assessed the relative and 10-year absolute risks of developing colorectal neoplasm and the yield of a risk-adapted screening approach incorporating risk models, fecal immunochemical test, and colonoscopy. Results: Compared to the participants with favorable lifestyle and lower PRS, those with unfavorable lifestyle and higher PRS had 2.87- and 3.79-fold higher risk of colorectal neoplasm in males and females, respectively. For a 50-year-old man or a 50-year-old woman with the highest risk profile, the estimated 10-year absolute risk of developing colorectal neoplasm was 6.59% (95% CI: 6.53–6.65%) and 4.19% (95% CI: 4.11–4.28%), respectively, compared to 2.80% (95% CI: 2.78–2.81%) for men and 2.24% (95% CI: 2.21–2.27%) for women with the lowest risk profile. The positive predictive value for advanced neoplasm was 31.7%, and the number of colonoscopies needed to detect one advanced neoplasm was 3.2. Conclusion: The risk models, absolute risk estimates, and risk-adapted screening presented in our study would contribute to developing effective personalized CRC prevention and screening strategies.
Highlights
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and fourth leading cause of cancer-related death worldwide (Bray et al, 2018)
For a 50-year-old man or a 50-year-old woman with the highest risk profile, the estimated 10-year absolute risk of developing colorectal neoplasm was 6.59% and 4.19%, respectively, compared to 2.80% for men and 2.24% for women with the lowest risk profile
The risk models, absolute risk estimates, and risk-adapted screening presented in our study would contribute to developing effective personalized CRC prevention and screening strategies
Summary
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and fourth leading cause of cancer-related death worldwide (Bray et al, 2018). Whole-genome–wide association studies (GWASs) have identified more than 100 common genetic variants associated with the risk of CRC (Peters et al, 2013; Zhang et al, 2014; Schmit et al, 2019), among which 24 loci were validated in eastern Asian populations (Lu et al, 2019). In addition to genetic predisposition, there are several well-established modifiable lifestyle factors related to CRC (Dekker et al, 2019), including physical activity, intake of red/processed meat and dietary fruits and vegetables, lower body mass index/waist circumference, smoking, and alcohol consumption. Estimation of absolute risk of developing colorectal neoplasm is essential for personalized colorectal cancer (CRC) screening. We developed models to determine relative and absolute risks of colorectal neoplasm based on lifestyle and genetic variants and to validate their application in risk-adapted screening
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