By Cancer Care Team–Contributor: Michael Kattan, PhD, Chair, Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute

What is your risk of having colorectal cancer? If you are approaching or have passed your 50th birthday, your doctor probably has advised you to have colorectal cancer screening to determine that. And that’s the problem.

Since the late 20th century, this one-size-fits-all advice has been standard because there has been no other reliable way of predicting a specific individual’s risk of developing this deadly disease. That’s why our team at Cleveland Clinic’s Lerner Research Institute invented an online calculator to help physicians decide when patients truly need colorectal screenings.

Colorectal Cancer Predicted Risk Online (CRC-PRO)

We call this the CRC-PRO, for Colorectal Cancer Predicted Risk Online. It allows physicians to quickly and accurately determine an individual patient’s likelihood of developing colorectal cancer. Our team analyzed about a decade’s worth of data on more than 180,000 patients and identified strong links between certain risk factors and colorectal cancer. We produced separate calculators for men and women. In addition, we took into account differences among racial groups, for which the risks differ dramatically. This was important because, until now, research into colorectal cancer risk mainly focused on Caucasians. A calculator that accounts for multiple factors provides clinicians with a more accurate way of predicting risk than relying on a single risk factor, such as age.
Clinicians using this calculator can decide to screen high-risk patients before age 50, for instance, while delaying or forgoing screening in low-risk individuals, regardless of their age.

Safer approach can save lives

This approach is much safer for patients who might not need the procedure and can be lifesaving for younger patients who ordinarily would not have the screening until years later, when it might be too late. Also important: Accurate prediction helps improve the efficiency of screening while lowering healthcare costs by reducing unnecessary testing. Our research results, which showed that the tool is accurate and user-friendly, were published in the Journal of the American Board of Family Medicine. As someone who has had cancer — I received a Stage IV Hodgkin’s lymphoma diagnosis while I was beginning work on my doctorate — I have been driven to help find a better way of predicting cancer risk as well as outcomes. I’m also driven to use that information to develop a personalized prevention or management strategy. I learned firsthand how inaccurate existing cancer staging systems were at the time of my diagnosis.

Why we need personalized cancer predictions

Staging systems are based on physical exams, imaging procedures, lab tests, and pathology and surgical reports that help doctors determine the cancer’s severity. I soon recognized the need to have personalized predictions through calculators. And I changed my career path from financial prediction to healthcare outcomes.

Developing risk prediction calculators like the CRC-PRO is vital for improving medical decision-making. Our research team is creating a number of such online tools for other diseases, including heart disease and cancers of the breast, prostate and thyroid.

We also are working on software to integrate these tools for automatic calculation in a patient’s electronic health record, making it even easier for physicians to devise an effective treatment plan.

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