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Stratified/risk-based screening for colorectal cancer in the UK: an overview

Maxwell, Susanne; Weller, David; Dennison, Becky; Taylor, Lily; Miles, Hannah; Cairns, Joanne; Von Wagner, Christian; ... Usher-Smith, Juliet; + view all (2025) Stratified/risk-based screening for colorectal cancer in the UK: an overview. Colorectal Cancer , 14 (1) , Article 2501851. 10.1080/1758194x.2025.2501851. Green open access

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Abstract

While colorectal cancer screening is well-established in the UK, at present, it uses a ‘one-size fits-all’ approach – that is, individual risk is not considered when determining screening regimens (except for some specific conditions such as Lynch syndrome). Stratified screening offers the prospect of directing more intensive screening toward those at higher risk – with a corresponding reduction of screening intensity among lower-risk individuals. Two key opportunities for stratifying colorectal cancer screening are (1) making better use of an individual’s quantitative fecal hemoglobin result rather than the current approach of deeming tests to be positive over an arbitrary threshold and (2) gathering information on lifestyle, family history, genetics and other factors to establish risk of colorectal cancer – and using this information to tailor screening regimens. While there is encouraging evidence from modeling studies demonstrating reduced colonoscopy requirements and increased positive prediction of colorectal cancer when incorporating risk assessments within screening, we need ‘real world’ evidence on stratified screening to establish whether it is effective, improves screening outcomes and is acceptable to the public. We also need to know the impact these changes would have on existing screening programs, and how programs might adapt their organizational and IT processes.

Type: Article
Title: Stratified/risk-based screening for colorectal cancer in the UK: an overview
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/1758194x.2025.2501851
Publisher version: https://doi.org/10.1080/1758194x.2025.2501851
Language: English
Additional information: © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10209266
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