J Cancer 2013; 4(3):172-192. doi:10.7150/jca.5834

Review

Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions

Itzhak Avital1,2,3,4, Russell C. Langan5, Thomas A. Summers3,6, Scott R. Steele2,3,7, Scott A. Waldman8, Vadim Backman9, Judy Yee10, Aviram Nissan3,4,11, Patrick Young12, Craig Womeldorph12, Paul Mancusco13, Renee Mueller13, Khristian Noto13, Warren Grundfest14, Anton J. Bilchik3,4,15,16,17, Mladjan Protic3,4,18,19, Martin Daumer4,20, John Eberhardt21, Yan Gao Man22, Björn LDM Brücher1,2,4,23, Alexander Stojadinovic1,2,3,4,24 ✉

1. Bon Secours Cancer Institute, Richmond VA
2. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
3. United States Military Cancer Institute, Bethesda, MD
4. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy, Munich, Germany
5. Georgetown University Hospital, Washington DC
6. Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD
7. Department of Surgery, Madigan Army Medical Center, Tacoma, WA
8. Kimmel Cancer Center, Thomas Jefferson University; Department of Pharmacology and Experimental Therapeutics Jefferson Medical College, Philadelphia, PA
9. Department of Biomedical Engineering, Northwestern University, Evanston, IL
10. University of California, San Francisco School of Medicine - Radiology and Biomedical Imaging, San Francisco, CA
11. Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
12. Department of Medicine, Division of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, MD
13. MD Anderson Cancer Center - Orlando, Orlando, FL
14. Telemedicine and Advanced Technology Research Center - West; Food and Drug Administration; University of California- Los Angeles, Los Angeles, CA
15. John Wayne Cancer Institute, Santa Monica, CA
16. Department of Medicine, University of California - Los Angeles, Los Angeles, CA
17. California Oncology Research Center, Los Angeles, CA Diagnostic
18. Clinic of Abdominal, Endocrine, and Transplantation Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
19. University of Novi Sad - Medical Faculty, Novi Sad, Serbia
20. Sylvia Lawry Center for MS Research, Munich, Germany
21. DecisionQ Corporation, Washington, D.C.
22. Diagnostic and Translational Research Center, Henry Jackson Foundation for the Advancement of Military Medicine, Gaithersburg, MD
23. Theodor-Billroth-Academy, Munich, Germany
24. Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD

Abstract

Colorectal cancer (CRC) is the third most common cause of cancer-related death in the United States (U.S.), with estimates of 143,460 new cases and 51,690 deaths for the year 2012. Numerous organizations have published guidelines for CRC screening; however, these numerical estimates of incidence and disease-specific mortality have remained stable from years prior. Technological, genetic profiling, molecular and surgical advances in our modern era should allow us to improve risk stratification of patients with CRC and identify those who may benefit from preventive measures, early aggressive treatment, alternative treatment strategies, and/or frequent surveillance for the early detection of disease recurrence. To better negotiate future economic constraints and enhance patient outcomes, ultimately, we propose to apply the principals of personalized and precise cancer care to risk-stratify patients for CRC screening (Precision Risk Stratification-Based Screening, PRSBS). We believe that genetic, molecular, ethnic and socioeconomic disparities impact oncological outcomes in general, those related to CRC, in particular. This document highlights evidence-based screening recommendations and risk stratification methods in response to our CRC working group private-public consensus meeting held in March 2012. Our aim was to address how we could improve CRC risk stratification-based screening, and to provide a vision for the future to achieving superior survival rates for patients diagnosed with CRC.

Keywords: cancer screening, risk identification, colon, rectal, colorectal cancer, evidence-based medicine, consensus

How to cite this article:
Avital I, Langan RC, Summers TA, Steele SR, Waldman SA, Backman V, Yee J, Nissan A, Young P, Womeldorph C, Mancusco P, Mueller R, Noto K, Grundfest W, Bilchik AJ, Protic M, Daumer M, Eberhardt J, Man YG, Brücher BL, Stojadinovic A. Evidence-based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons learned from the US Armed Forces: Consensus and Future Directions. J Cancer 2013; 4(3):172-192. doi:10.7150/jca.5834. Available from http://www.jcancer.org/v04p0172.htm