ABSTRACT
Background
Several online calculators estimate colorectal cancer risk, but their consistency
is unknown. Our objectives were to quantify the variation in predicted risk and to
determine which calculators are best used in the clinical setting.
Methods
We used the Google search engine to identify online colorectal cancer risk calculators
and assessed each's output for 3 hypothetical screening scenarios (low-, average-,
and high-risk), varied by age (50, 62, 75 years), sex, and race (Black, White), with
risk levels based on risk-appropriate values for variables in each model. Estimated
risks for models within a given scenario were rated as consistent or inconsistent
based on comparison to either the absolute magnitude of difference or average lifetime
risk of colorectal cancer. Summary statistics for consistent and inconsistent estimates
were compared using Chi-square and Fisher's exact tests.
Results
We identified 5 online colorectal cancer risk calculators. Inconsistencies were found
in none of 5-year, 19% of 10-year, and 81% of lifetime colorectal cancer risk estimate
comparisons (p<0.001). For a 50-year-old, 22% of risk estimate comparisons were inconsistent
versus 33% for a 62-year-old, and 36% for a 75-year-old (p=0.14).
Conclusions
Online colorectal cancer risk models are more consistent in predicting colorectal
cancer risk for 5- and 10-year time frames compared to lifetime. For a U.S. population,
the National Cancer Institute's Colorectal Cancer Risk Assessment Tool is a rigorously
developed calculator that can be used in the clinical setting to provide 5-year and
lifetime risk estimates.
Clinical Significance
• Currently available colorectal cancer risk calculators are more consistent in estimating
risk for shorter time frames than for longer time frames. • The methodology with which
a model was developed, population of interest, and desired time frame for risk estimates
should be considered when deciding which risk calculator to use for screening decision-making.
• The National Cancer Institute Colorectal Cancer Risk Assessment Tool provides the
most accurate estimates for a U.S. patient population.
Keywords
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Article Info
Publication History
Accepted:
August 9,
2022
Received in revised form:
August 3,
2022
Received:
September 19,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Running Title: Colorectal Cancer Risk Calculators
Identification
Copyright
© 2022 Published by Elsevier Inc.
