INDIANAPOLIS — A new Indiana University School of Medicine clinical trial — the largest of its kind to date — found that providing personalized colorectal cancer risk information to patients and their health care providers did not improve screening rates for the deadly ailment.
The study, recently published in the Annals of Internal Medicine , discussed the results of the trial, which enrolled 214 providers and 1,084 average-risk patients due for colorectal cancer screening in the Eskenazi Health and IU Health systems in Indianapolis. All patients were given a basic screening guide before their doctor's appointments, and half of the participants also received personalized messages about their risk of colorectal cancer. Providers were randomly assigned to receive notifications that the patient was due for screening, with or without a personalized message about the patient's individual risk.
All patient participants in the study signed up for screening within six months of their doctor appointments at about the same rate, suggesting the personalized messages had little to no effect on decision making during this timeframe.
"Colorectal cancer screening is important, as it saves lives and is not used enough," said Peter Schwartz, MD, PhD , lead author of the study, director of the IU Center for Bioethics and a professor of medicine. "Only about 60% of eligible adults get screened, leading to a lot of unnecessary disease and death every year."
Colorectal cancer is the second-most common cause of death from cancer in the United States, the study notes, claiming nearly 55,000 lives annually.
"Many people talk about the importance of 'personalized prevention,' or giving patients specific information about their risk level to guide decisions like cancer screening," Schwartz said. "There have been theories that screening should be directed based on individual risk, not just age, since it would result in more precise targeting and possibly be more cost-effective."
Currently, adults are recommended to screen for colorectal cancer regularly once they turn 45 years old. This is most frequently done through colonoscopy, a medical procedure done at a hospital, but at-home stool tests can provide excellent screening, though slightly less-comprehensive results.
Patients in this study were counseled on both options.
"Few studies have been done that tried to give patients this sort of information and see if it has any effect on their being screened," Schwartz said. "The studies that have been done have mostly found no effect."
The trial incorporated a risk projection tool created by Thomas F. Imperiale, MD , senior author of the article and Lawrence Lumeng Professor of Gastroenterology and Hepatology at the IU School of Medicine. According to his research, people eligible for screening have between a 2% and 22% chance of currently having either the cancer or an advanced, precancerous polyp.
"The trial was designed to measure the effect of providing patient-specific risk information to patients, their providers or both on top of general information about colorectal cancer screening," Imperiale said. "Had we tested the risk prediction model without the general information on screening or by providing it to the providers alone, the results may have been different."
The personalized information sent to patients and their doctors did have an effect at one health system: At Eskenazi, though not at IU Health, personalized information increased uptake of stool testing, a less-invasive option for screening.
The Center for Bioethics has made its generalized colorectal cancer screening decision aid — a 10-minute video — available online and to physicians from both health groups going forward in hopes of informing more patients. The same site also provides examples of the personalized risk information that was provided to patients.
"One of the most important steps in all of this research is helping people realize that screening is important and saves lives, as well as to help people and their providers realize that screening can be done with more than just colonoscopy," Schwartz said.
About the Indiana University School of Medicine
The IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 13 in 2024 National Institutes of Health funding among all public medical schools in the country.
