Risk-adapted cancer screening-what are the consequences for those affected?

Risk stratification of colorectal cancer (CRC) enables personalized recommendations regarding who should be screened when. This procedure is able to reduce the burden of screening. Ascreening strategy is even more important for persons with ahigher than average risk for CRC. The best established risk factor is familial risk. This risk is mentioned in the German guidelines for the prevention and treatment of CRC: Screening for familial members of patients with CRC younger than 50years should be started 10years before the age of index family members. The German Bundesausschuss recently decided to start screening colonoscopy in men with 50years and not with 55years as it was in the past. Recently developed genetic risk scores based on genome-wide analyses combined with lifestyle factors help to more accurately predict the risk of CRC. This requires structured surveys for relevant groups (e.g., at the check-up at 35 years). The logical consequence of differentiated risk stratification is adifferent start of the invasive investigations and the use of invasive diagnostic methods (screening colonoscopy) for persons at increased risk.