Developing a strategy for implementation of risk stratification into bowel cancer screening programmes

Background Colorectal cancer (CRC) is the second leading cause of cancer-related death in the UK. There is good evidence that screening adults in the general population reduces CRC incidence and mortality.

Stratified screening, in which the age of first invitation, the choice of test and/or the screening interval are based on additional personal factors, has the potential to improve the efficiency of screening programmes: in a simulated population, when compared with inviting individuals at a fixed age, inviting individuals based on estimated risk is more cost effective, with reduced overall CRC incidence and mortality without increased resource use.

Support for stratified screening approaches is also reflected in a number of key recent UK policy documents.

However, there is very little research on the public acceptability of changing screening programmes to encompass personalisation or how stratified screening might be implemented.

Aims and objectives The overall aim is to develop a strategy for implementation of risk stratification within bowel cancer screening programmes.

Specific objectives are to: Explore the social and ethical considerations relating to the introduction of risk stratification into CRC screening; Explore views and preferences of individuals concerning the introduction of risk stratification into CRC screening and the acceptability of different strategies; Quantify the relative importance to members of the public of different attributes of risk stratified screening programmes; Quantify the potential impact of incorporating a risk stratified approach on uptake of first invitation to CRC screening; Establish the state-of-the-science and future research and policy requirements for incorporating risk stratification into CRC screening programmes.

Methods These objectives will be achieved through five work-packages: A community jury study; A semi-structured interview study and online survey with members of the public, informed by the Theoretical Framework of Acceptability; A discrete choice experiment; An online randomised trial including assessment of whether participants would opt to provide baseline risk information and attend screening as outcomes; A scoping review and workshop with key experts in the field.

Timelines for delivery This research will be conducted over a period of 40 months.

Anticipated impact and dissemination Overall, this research will provide key and timely evidence to inform research and policy decisions around the future implementation of risk stratification within CRC screening programmes. The findings will be disseminated in scientific publications, policy briefings and lay summaries.

In the short to medium term they will inform the design of a feasibility study and subsequently a large scale randomised trial of stratified screening.

They will also provide a framework for risk stratification within other new and existing screening programmes for cancer and other non-communicable diseases. Ultimately, this has the potential to save more lives at a lower cost to society.