INDIANAPOLIS — A landmark clinical trial conducted by the Indiana University School of Medicine has shed new light on the effectiveness of personalized risk communication in colorectal cancer screening. Despite being the largest study of its kind, involving over a thousand patients and more than two hundred healthcare providers, the trial concluded that delivering individualized colorectal cancer risk information to patients and their doctors did not increase the overall rates of cancer screening within six months. The findings, recently published in the Annals of Internal Medicine, challenge prevailing assumptions about personalized prevention strategies and raise important questions about how best to encourage early detection of this deadly disease.
Colorectal cancer remains a significant public health challenge in the United States, ranking as the second-leading cause of cancer mortality, with nearly 55,000 Americans dying from the disease annually. Screening is known to save lives by detecting cancer early or identifying precancerous lesions, yet only about 60% of eligible adults adhere to recommended screening guidelines. This gap has spurred considerable interest in interventions aimed at improving screening uptake, including the use of personalized risk assessments tailored to an individual’s likelihood of disease.
The trial enrolled 1,084 average-risk patients overdue for colorectal cancer screening, drawn from two Indianapolis health systems—Eskenazi Health and IU Health. Each participant received basic information about colorectal cancer screening before their medical appointments. In an innovative design, half of these patients additionally received customized messages outlining their personal risk of developing or already harboring colorectal cancer or advanced precancerous polyps. Simultaneously, healthcare providers were randomized to receive alerts that their patients were due for screening, either with or without patient-specific risk details.
Despite the sophisticated delivery of personalized risk information, the study found no significant difference in overall screening enrollment between patients exposed solely to general guidance and those who also received individualized risk messaging. Approximately equal proportions of both groups signed up for screening within six months, indicating that personalized communication did not materially influence short-term decision-making. This outcome highlights the complex behavioral drivers underlying screening adherence and suggests that risk prediction alone may not be sufficient to alter patient and provider action.
Peter Schwartz, MD, PhD, the study’s lead author and director of the IU Center for Bioethics, emphasized the ongoing imperative to increase colorectal cancer screening rates. “Only about 60% of eligible adults get screened, leading to a lot of unnecessary disease and death every year,” Schwartz noted. He underscored the importance of exploring novel approaches to prevention but cautioned that simply providing patients with their individualized risk profiles may not translate into increased screening participation.
A prevailing concept in cancer prevention is the idea of “personalized prevention,” which advocates for directing screening efforts based on individual risk rather than broad age-based criteria. This approach, proponents argue, could optimize resource allocation by focusing on those most likely to benefit and potentially reduce unnecessary procedures in low-risk populations. Currently, guidelines recommend that adults begin routine colorectal cancer screening at age 45, utilizing modalities such as colonoscopy or non-invasive stool-based tests, with the goal of detecting early-stage cancer or precancerous growths.
In this trial, patients were counseled on both colonoscopy and stool testing options to reflect current clinical practices. The personalized risk predictions provided to patients and clinicians were generated using a validated risk projection model, designed by Thomas F. Imperiale, MD, senior author of the publication. According to Dr. Imperiale’s research, individuals eligible for screening possess a risk ranging from approximately 2% to 22% of having colorectal cancer or an advanced precancerous polyp at the time of assessment, underscoring significant heterogeneity within the screened population.
While the overall trial results showed limited impact of personalized messaging on screening uptake, a notable exception emerged at the Eskenazi Health system. Here, the provision of individualized risk information was associated with increased utilization of stool-based testing, a less invasive and more accessible screening modality compared to colonoscopy. This finding suggests that personalized risk data may influence the choice of screening method in select contexts, potentially enhancing patient acceptance of non-invasive options when informed about their risk status.
The researchers emphasized that the trial was designed to evaluate the additive effect of personalized risk information on top of standard screening education. As Dr. Imperiale explained, “Had we tested the risk prediction model in isolation or provided personalized risk data only to providers without accompanying general screening information, the outcomes might have differed.” This caveat points to the intricate interplay between general health education and personalized risk communication, highlighting the need for further investigation into optimal strategies for integrating these components.
Beyond the trial itself, the IU Center for Bioethics has made available a decision aid—a concise, 10-minute video resource designed to inform patients about colorectal cancer screening options. This tool, accessible online and distributed to physicians in both health systems, aims to enhance patient understanding of the benefits and logistics of screening. The decision aid also presents examples of personalized risk information similar to that used in the trial, supporting informed dialogue between patients and providers.
This research adds to a growing body of evidence indicating that personalized risk information alone may not be the panacea for increasing adherence to cancer screening. Behavioral factors, healthcare system constraints, patient-provider communication dynamics, and broader sociocultural influences all interact to shape screening behaviors. As Schwartz concluded, emphasizing the life-saving potential of screening and clarifying that multiple screening modalities exist may be as crucial as tailoring risk messages. Ensuring that adults understand both the importance and accessibility of colorectal cancer screening remains a vital public health priority.
The implications of this study extend beyond colorectal cancer to other areas of cancer prevention where personalized risk assessments are increasingly being promoted. Balancing the promise of precision medicine with the realities of patient engagement and adherence requires ongoing research and innovation. This trial serves as a call to action for the medical community to continue exploring multifaceted interventions that effectively motivate patients while also supporting providers in delivering personalized, actionable healthcare guidance.
Subject of Research: Colorectal cancer screening and personalized risk communication
Article Title: Effect of Personalized Risk Messages on Uptake of Colorectal Cancer Screening
Web References:
Indiana University School of Medicine Newsroom
IU Center for Bioethics Decision Aids
Annals of Internal Medicine Article
Keywords: Colorectal cancer, colon cancer, cancer screening, personalized risk, colorectal cancer screening, precision prevention, risk communication, stool testing, colonoscopy
