title: Risk of Advanced Neoplasia Using the National Cancer Institute's Colorectal Cancer Risk Assessment Tool.
abstract: There is no validated, discriminating, and easy-to-apply tool for estimating risk of colorectal neoplasia. We studied whether the National Cancer Institute's (NCI's) Colorectal Cancer (CRC) Risk Assessment Tool, which estimates future CRC risk, could estimate current risk for advanced colorectal neoplasia among average-risk persons.
  
  
  
  This cross-sectional study involved individuals age 50 to 80 years undergoing first-time screening colonoscopy. We measured medical and family history, lifestyle information, and physical measures and calculated each person's future CRC risk using the NCI tool's logistic regression equation. We related quintiles of future CRC risk to the current risk of advanced neoplasia (sessile serrated polyp or tubular adenoma ≥ 1 cm, a polyp with villous histology or high-grade dysplasia, or CRC). All statistical tests were two-sided.
  
  
  
  For 4457 (98.5%) with complete data (mean age = 57.2 years, SD = 6.6 years, 51.7% women), advanced neoplasia prevalence was 8.26%. Based on quintiles of five-year estimated absolute CRC risk, current risks of advanced neoplasia were 2.1% (95% confidence interval [CI] = 1.3% to 3.3%), 4.8% (95% CI = 3.5% to 6.4%), 6.4% (95% CI = 4.9% to 8.2%), 10.0% (95% CI = 8.1% to 12.1%), and 17.6% (95% CI = 15.5% to 20.6%; P < .001). For quintiles of estimated 10-year CRC risk, corresponding current risks for advanced neoplasia were 2.2% (95% CI = 1.4% to 3.5%), 4.8% (95% CI = 3.5% to 6.4%), 6.5% (95% CI = 5.0% to 8.3%), 9.3% (95% CI = 7.5% to 11.4%), and 18.4% (95% CI = 15.9% to 21.1%; P < .001). Among persons with an estimated five-year CRC risk above the median, current risk for advanced neoplasia was 12.8%, compared with 3.7% among those below the median (relative risk = 3.4, 95 CI = 2.7 to 4.4).
  
  
  
  The NCI's Risk Assessment Tool, which estimates future CRC risk, may be used to estimate current risk for advanced neoplasia, making it potentially useful for tailoring and improving CRC screening efficiency among average-risk persons.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine; Regenstrief Institute, Inc. and Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center, Indianapolis, IN.
authors: Thomas F
authors: TF
authors: Imperiale
authors: Division of Gastroenterology and Hepatology, Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors: Menggang
authors: M
authors: Yu
authors: Division of Gastroenterology and Hepatology, Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors: Patrick O
authors: PO
authors: Monahan
authors: Division of Gastroenterology and Hepatology, Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors: Timothy E
authors: TE
authors: Stump
authors: Division of Gastroenterology and Hepatology, Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors: Rebeka
authors: R
authors: Tabbey
authors: Indianapolis Gastroenterology Research Foundation, Indianapolis, IN.
authors: Elizabeth
authors: E
authors: Glowinski
authors: Department of Medicine University of North Carolina, Chapel Hill, NC.
authors: David F
authors: DF
authors: Ransohoff
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D014481:United States