A decision analysis model for colorectal cancer screening

Background and Objective. With minor differences, most national colorectal cancer (CRC) screening programs in Europe consist of one-size-fits-all aged-based strategies. This paper provides a decision analysis-based approach to personalized CRC screening, supporting decisions concerning whether and which screening method to consider and/or whether a colonoscopy should be administered. Methods. We use an influence diagram which characterizes CRC risk with respect to different variables of interest and includes comfort, costs, complications, and information as decision criteria, the last one assessed through information theory measures. The criteria are integrated with a multi-attribute utility model. Optimal screening policies are then computed. Results. The proposed model is used to support personalized individual screening based on relevant characteristics. It serves to assess existing national screening programs and design new ones. In particular, it suggests replacing current age-based strategies followed in many European countries by more personalized strategies based on the type of model proposed. Additionally, the model facilitates benchmarking of novel screening devices. Conclusions. This work creates a framework supporting personalized CRC screening improving upon current age-based screening strategies.