Simple Scoring System Stratifies Colon Cancer Risk in Adults

Thomas F. Imperiale, MD Indiana University Medical Center Regenstrief Institute Indianapolis, IN 46202 Interview with:

Thomas F. Imperiale, MD
Indiana University Medical Center
Regenstrief Institute
Indianapolis, IN 46202


Medical Research: What is the background for this study?

Dr. Imperiale: The background is that colorectal cancer (CRC) screening is effective and cost-effective, but it is underutilized (35% of eligible persons in the U.S. are not current with screening; 28% have never been screened) and inefficient (persons at low risk have colonoscopy; persons at high risk have stool blood testing or nothing). We know about several risk factors for colorectal cancer and advanced, precancerous polyps. We wanted to see how those factors perform together in stratifying (or separating) risk among the 85% of the U.S. population that is considered to be “average-risk”.

Medical Research: What are the main findings?

Dr. Imperiale: We found that age, sex, whether a first-degree relative has or had colorectal cancer, cigarette smoking, and waist circumference do a good job in separating risk into the 4 categories described in the paper.  When tested in the validation subgroup, the risk estimates reproduced themselves fairly well. 

Medical Research: What should clinicians and patients take away from your report?

Dr. Imperiale: It is possible to estimate current risk for advanced colorectal neoplasia using reliable and easily-obtained patient-specific factors.  These factors do a pretty good job in stratifying risk into one of the four categories. Based on these categories, patients may consider screening tests that are less invasive than colonoscopy or may see that their risk is high, suggesting that a colonoscopy is warranted.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Imperiale:

  1. Determine the reproducibility of these findings in a separate study sample.
  2. Determine whether and to what extent the scoring system affects the uptake of screening and choice of screening test.


Ann Intern Med. 2015 Aug 11. doi: 10.7326/M14-1720. [Epub ahead of print]

Derivation and Validation of a Scoring System to Stratify Risk for Advanced Colorectal Neoplasia in
Asymptomatic Adults: A Cross-sectional Study.

Imperiale TF, Monahan PO, Stump TE, Glowinski EA, Ransohoff DF.

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Thomas F. Imperiale, MD (2015). Simple Scoring System Stratifies Colon Cancer Risk in Adults 

Last Updated on August 14, 2015 by Marie Benz MD FAAD