title: Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy.
abstract: Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists. This review assesses published cost-effectiveness estimates of postpolypectomy surveillance to consider the potential for personalized recommendations by risk group. Meta-analyses of incidence of advanced neoplasia postpolypectomy for low-risk cases were comparable to those without adenoma, with both rates under the lifetime risk of 5%. This group may not benefit from intensive surveillance, which risks unnecessary harm and inefficient use of often scarce colonoscopy capacity. Therefore, greater personalization through deintensified strategies for low-risk individuals could be beneficial. The potential for noninvasive testing, such as fecal immunochemical tests, combined with primary prevention or chemoprevention may reserve colonoscopy for targeted use in personalized risk-stratified surveillance. This review appraised evidence supporting a program of personalized surveillance in patients with colorectal adenoma according to risk group and compared the effectiveness of surveillance colonoscopy with alternative prevention strategies. It assessed trade-offs among costs, benefits, and adverse effects that must be considered in a decision to adopt or reject personalized surveillance.
authors.forename: Ethna
authors.initials: E
authors.lastname: McFerran
authors.forename: James F
authors.initials: JF
authors.lastname: O'Mahony
authors.forename: Richard
authors.initials: R
authors.lastname: Fallis
authors.forename: Duncan
authors.initials: D
authors.lastname: McVicar
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D000236:Adenoma / Q000601:surgery*; D000359:Aftercare / Q000191:economics / Q000379:methods*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000191:economics / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005243:Feces / Q000737:chemistry; D006801:Humans; D007120:Immunochemistry; D015994:Incidence; D007417:Intestinal Polyps / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009780:Occult Blood; D057285:Precision Medicine; D016896:Treatment Outcome
keywords: adenoma; cancer prevention; colorectal cancer; cost-effectiveness; early detection; precision medicine; surveillance