ArticleDigestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society2026
Risk Stratification to Optimize Colorectal Cancer Screening: Development and Validation of a Decision-Tree Model for Colonoscopy Prioritization.
Article in Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsFecal immunochemical test-based colorectal cancer screening is effective; however, colonoscopy demand exceeds endoscopy capacity. Delays in colonoscopy after a positive test reduce screening effectiveness. We developed and validated a decision-tree model to stratify colorectal cancer risk among individuals with a positive test to prioritize colonoscopy for those at highest risk.
methodsProspective study including participants with a positive fecal immunochemical test referred for colonoscopy within a Spanish regional population-based screening program (2021-2024). Individuals were randomly assigned to derivation (65%) and validation (35%) cohorts using a stratified random split. Fecal hemoglobin concentration, clinical and laboratory data were collected to develop the decision-tree model. The primary outcomes were colorectal cancer and advanced-stage colorectal cancer.
resultsA total of 1773 participants were included. Colorectal cancer was detected in 97 participants (5.5%), including 25 cases (1.5%) with advanced-stage disease. The model stratified participants into low-, intermediate-, high-, and very high-risk groups. A progressive increase in the prevalence of colorectal cancer and advanced-stage disease was observed across risk groups in both cohorts (p < 0.001). The very high-risk group (fecal hemoglobin > 100 μg/g and > 65 years) included 6.7% of participants, with colorectal cancer and advanced-stage prevalence of 21.8% and 7.6%, respectively. Prioritizing colonoscopy for this group yielded a number needed to scope of 4.6 for colorectal cancer and 13.2 for advanced-stage disease, both significantly lower than the current one-size-fits-all strategy.
conclusionsA decision-tree model was developed to stratify the risk of colorectal cancer and optimize endoscopic resources in screening programs.
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