Personalized Genetic Risk Assessment Does Not Increase Colorectal Cancer Screening in an Average-Risk Population

Key Points

  • Knowledge of individualized risk for colorectal cancer was not enough to persuade previously nonadherent patients to undergo recommended colorectal cancer screening.
  • The study’s findings raise concern about the effectiveness of predictive assessment of genetic risk to promote favorable health-care behavior.
  • Additional studies are needed to determine whether information in addition to a personalized genetic and environmental risk assessment for common diseases like colorectal cancer.

A large prospective, randomized, controlled trial investigating whether individualized genetic and environmental risk assessment of colorectal cancer susceptibility improves adherence to screening in average-risk persons, has found that the information was not enough to persuade nonadherent patients to undergo screening. The findings raise concern about the effectiveness of predictive assessment of genetic risk to promote favorable health-care behavior. The study by Weinberg et al is published in Annals of Internal Medicine.

Study Methodology

A total of 783 people at average risk for colorectal cancer who were not adherent to recommended colorectal cancer screenings were enrolled in the study. The study participants were randomly assigned to usual care or risk assessment, which evaluated methylenetetrahydrofolate reductase polymorphisms and serum folate levels. On the basis of prespecified combinations of polymorphisms and serum folate levels, patients in the risk-assessment group were told that they were at elevated or average risk for colorectal cancer. The primary outcome was colorectal cancer screening within 6 months of study entry.

Study Findings

At the end of 6 months, overall screening rates for colorectal cancer did not statistically significantly differ between the usual care (35.7%) and risk-assessment (33.1%) groups. After adjustment for baseline participant factors, the odds ratio for screening completion for genetic and environmental risk assessment vs usual care was 0.88 (95% confidence interval [CI] = 0.64–1.22). Within the risk-assessment group, screening rates did not significantly differ between average-risk (38.1%) and elevated-risk (26.9%) participants. Odds ratios for elevated- vs average-risk participants remained nonsignificant after adjustment for covariates (odds ratio = 0.75, 95% CI = 0.39–1.42).

While the role of genetic and molecular testing to predict response to specific therapeutic options in health-care delivery is increasing, the potential for similar testing to motivate changes in behavior is less clear.

“These findings raise concern about the effectiveness of moderately predictive assessment of genetic risk to promote favorable health-care behavior,” concluded the researchers.

David S. Weinberg, MD, MSc, of Fox Chase Cancer Center, is the corresponding author for the Annals of Internal Medicine article.

This study was funded by the National Institutes of Health. For full disclosures of the study authors, visit www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum_M14-0765.

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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