Screening strategies for colorectal cancer: adjusting for individual risk factors

INTRODUCTION: Colorectal cancer (CRC) is a common cause of cancer-related mortality. While overall incidence has declined, certain populations - particularly younger patients - have experienced a rise. This suggests a more complex risk profile than the dichotomous average vs high risk delineated in guidelines. Risk is currently largely characterized by polyp and family history; however, many additional variables contribute to risk. AREAS COVERED: We synthesize the available data (Pubmed database, focus on article updates in the past 10 years) on non-modifiable and modifiable risk factors for CRC. We explore how these factors could affect screening and surveillance decisions in otherwise average-risk individuals. We then suggest strategies for personalized approaches to CRC screening, explore the role of shared decision making with patients, and highlight future directions for CRC screening. EXPERT OPINION: Our understanding of CRC risk must become increasingly more nuanced to adequately serve, screen, and surveil our patients. Precision medicine offers a pathway to accomplish this, but will require significant research to accurately measure risk, and the ability to adapt risk models as our data evolves. This undertaking grows evermore relevant as medicine becomes increasingly personalized and shared decision making becomes the mainstay of counseling between physicians and patients.