Intended for healthcare professionals


Personalised and risk based cancer screening

BMJ 2019; 367 doi: (Published 02 October 2019) Cite this as: BMJ 2019;367:l5558
  1. Philippe Autier, professor, population epidemiology1 2
  1. 1International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France
  2. 2Strathclyde Institute for Global Public Health at iPRI, Lyon, France
  1. philippe.autier{at}

A radical shift that prioritises informed choice over maximising uptake

Over the past 40 years, screening for colorectal cancer has gradually spread to most high income populations, and screening modalities have changed with the replacement of guaiac faecal occult blood testing with faecal immunochemical testing (FIT), and the use of colonoscopy.

Three randomised trials on once only sigmoidoscopy have recently published results after 15 to 17 years follow-up. An international panel of 22 doctors, nurses, patient representatives, and methodologists has seized the opportunity offered by these publications to evaluate the long term benefits and harms associated with this screening modality as well as for annual or biennial FIT and once only colonoscopy.1 In the absence of randomised trials on FIT and colonoscopy screening, the panel had recourse to results of microsimulation models.

The panel evaluated the benefit-to-harm balance of screening using a “risk based approach,” which means that, when examining the influence of a screening modality on colorectal cancer occurrence and mortality, …

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