In familial colorectal cancer (FCRC), relatives of colorectal cancer patients have an increased risk of developing CRC compared to the general population. These individuals are currently recommended to undergo 5-yearly colonoscopy surveillance from age 45-75, leading to a crudely estimated 25,000-35,000 colonoscopies per year. To avoid waiting lists, minimise patient burden as well as to increase the efficiency of health care, colonoscopy should only be offered to those individuals at risk for FCRC who are likely to benefit from this invasive procedure. There is accumulating evidence that both family history and baseline colonoscopy findings can be used to distinguish between individuals differing in FCRC risk. This enables a more personalised approach for FCRC surveillance in which the surveillance strategy is dependent on FCRC risk.

Aim of the project

This project is a collaboration between multiple institutes (Amsterdam UMC, Radboudumc, Aarhus University, Rijnstate Ziekenhuis, Netherlands Cancer Institute and Cancer Council NSW) and led by Dr. Veerle Coupé, chair of the Decision Modeling Center. It aims to evaluate the benefits, harms and costs of risk-based surveillance strategies for individuals at increased FCRC risk with the ASCCA model. To achieve this goal, the project team received a grant from The Netherlands Organisation for Health Research  and Development (ZonMw).

ASCCA model

The ASCCA model is developed within the DMC and has previously been used to evaluate the impact of colorectal cancer screening in average-risk individuals. For this project, the ASCCA model will be adapted for individuals with FCRC while accounting for differences in CRC risk between FCRC risk groups based on their family history. With the ASCCA-FCRC model, three evaluations will be conducted in which a range of risk-based strategies will be considered.