Personalized Risk Communication and Its Effect on CRC Screening Choice

Patients due for colorectal cancer screening are often offered two effective but fundamentally different tools: colonoscopy and fecal immunochemical testing (FIT). A randomized controlled trial by Plys et al. examines whether communicating a patient’s predicted 15-year colorectal cancer risk, along with corresponding screening recommendations, influences risk-appropriate screening uptake.

Here’s a quick look at what it found.

Trial Design and Intervention Framework

Conducted within an organized screening program in Vaud, Switzerland, the study randomized 515 adults aged 50 to 69 years to receive either a standard informational brochure or a tailored communication that included individualized risk estimates derived from the QCancer model alongside specific screening recommendations.

The intervention assigned recommendations based on predicted risk: FIT for individuals at low risk, colonoscopy for those at high risk, and either option for those at intermediate risk. The study population was predominantly low risk, with a mean predicted 15-year risk of 1.4% and more than 98% of participants classified below the 3% threshold.

Behavioral Signal Without Volume Change

At six months, risk-appropriate screening was reported in 37% of participants in the intervention group compared with 23% in the control group. Subgroup analyses did not identify statistically significant variation in this effect across measured demographic or clinical characteristics.

Overall screening uptake was similar between groups. Approximately half of participants in each arm completed a screening test, with no meaningful difference observed between intervention and control.

Anxiety, Acceptability, and Implementation

Reported anxiety related to the screening materials was low in both groups, with no statistically significant difference between intervention and control participants. The study indicates that providing individualized risk information alongside recommendations did not increase short-term anxiety within this cohort.

The intervention was delivered through mailed materials without direct clinician involvement. The authors note that similar approaches could be incorporated into organized screening programs, including through automated tools that calculate risk and generate recommendations.

Limits of Generalizability

Interpretation of these findings is shaped by the study population. Nearly all participants were classified as low risk, and no individuals were categorized as high risk, limiting assessment of the intervention’s effect in higher-risk groups.

Additional considerations include reliance on self-reported screening behavior and the classification of scheduled colonoscopy as completed screening, which reflects local practice patterns. Study materials were provided in French, and participation required completion of multiple study steps, which may influence the generalizability of the sample.

Clinical and System-Level Implications

The trial demonstrates that communicating individualized colorectal cancer risk together with corresponding screening recommendations can influence the alignment between predicted risk and selected screening modality without changing overall participation rates.

Further evaluation in populations with a broader distribution of risk and in settings that measure clinical outcomes will help clarify how this approach performs across screening programs and patient groups.

Reference:
Plys E, Bulliard JL, Chaouch A, et al. Colorectal Cancer Screening Based on Predicted Risk: A Randomized Controlled Trial. Am J Gastroenterol. 2025;120(10):2432-2439. doi:10.14309/ajg.0000000000003311