Pathways for optimising colorectal cancer screening programs: a modelling assessment

Colorectal cancer is an important global public health issue. With over 1.8 million new diagnoses in 2018, colorectal cancer was the third leading cause of cancer incidence. Each year, almost half of all colorectal cancer patients die from the disease, making it the second leading cause of cancer-related deaths. Encouragingly, the burden of colorectal cancer can be reduced with screening. However, although screening has been widely implemented, programs differ markedly throughout the world. While some variation is not entirely unexpected given that risk of colorectal cancer varies significantly, the extent of variety suggests there may be room to improve screening programs. In this thesis we investigate pathways to improve colorectal cancer screening programs. In the first instance, we explore pathways to optimise uniform screening programs to ensure they are designed and implemented to achieve the best possible outcomes for the average risk population. Subsequently, as it is increasingly recognised that individuals may not benefit equally from the same screening protocol, we investigate personalisation as a pathway to improve colorectal cancer screening programs.

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