1. Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening 
Douglas J. Robertson, Uri Ladabaum 
Gastroenterology 
Volume 156, Issue 4, Pages (March 2019)
DOI: /j.gastro
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2. Figure 1
Long-term trends in United States age standardized colorectal cancer mortality (1975–2015), based upon US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. Figure created using seer.cancer.gov/explorer/application.php.
Gastroenterology  , DOI: ( /j.gastro )
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3. Figure 2
(A) Age-specific rate and (B) case count for new colorectal cancers in Based upon data from US Cancer Statistics Working Group. US Cancer Statistics Data Visualizations Tool, based on November 2017 submission data (1999–2015): US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute (
Gastroenterology  , DOI: ( /j.gastro )
Copyright © 2019 AGA Institute Terms and Conditions

4. Figure 3
Long-term trends in United States colorectal cancer incidence (2000–2015), stratified by race, based upon SEER 18 registry data and created using seer.cancer.gov/explorer/application.php.
Gastroenterology  , DOI: ( /j.gastro )
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5. Figure 4
Potential benefit of risk stratification and tailored screening, and potential impact of misclassification. Top left: The “average risk” population is made up of sub-populations with a gradient of colorectal cancer risk (very low, low, average, high, and very high). Bottom left: Without screening, the lifetime colorectal cancer rate in the population is approximately 7%, with a hypothetical range from 1.3% for very-low-risk persons to 13% for very-high-risk persons. This hypothetical 10-fold difference in risk may be extreme, but it serves to contrast a dramatic RR for very-high-risk vs very-low-risk persons and the modest (but still substantial) absolute risk of the very-high-risk group. Top right: Risk stratification without any misclassification yields 5 risk quintiles with perfect risk discrimination (ie, predicted risk reflects actual risk). Screening tailored to predicted risk achieves profound colorectal cancer risk reduction with optimal use of resources. Bottom right: Risk stratification with a 15% misclassification rate yields 5 risk quintiles without perfect risk discrimination. Screening tailored to predicted risk delivers suboptimal screening intensity to some people, leading to less profound colorectal cancer risk reduction. The critical question is how this imperfect risk-stratification compares to a standardized approach to all “average risk” persons, without risk stratification.
Gastroenterology  , DOI: ( /j.gastro )
Copyright © 2019 AGA Institute Terms and Conditions