Colorectal Cancer Screening in the Era of Precision Prevention: A Narrative Review of Risk Stratification and Personalized Approaches

Abstract

Colorectal cancer (CRC) remains a leading cause of cancer-related mortality globally. However, it is highly preventable through effective screening strategies. Traditional population-based screening approaches using age as the primary criterion have demonstrated success in reducing CRC incidence and mortality. However, emerging evidence suggests that personalized, risk-stratified screening strategies may optimize resource allocation and improve outcomes. In this narrative review, we examine the utility of recent advances in precision medicine approaches for CRC prevention, including polygenic risk scores, gut microbiome profiling, circulating tumor DNA detection, and artificial intelligence-enhanced colonoscopy. We explore how these innovations are transforming screening paradigms from one-size-fits-all protocols to individualized prevention strategies. The integration of genetic, environmental, and lifestyle factors into screening enables more accurate risk prediction and tailored screening intervals. Novel noninvasive screening modalities, including multitarget stool DNA tests and blood-based biomarkers, can enable easy screening accessibility and high patient adherence. Furthermore, advances in colonoscopy technology, including computer-aided detection (CADe) systems, have led to improvements in adenoma detection rates and reduction of the risk of interval cancers. In this review, we synthesize the current evidence on risk-stratified screening approaches and discuss the challenges in their implementation in diverse healthcare settings. Moreover, this review provides perspectives and future directions on risk-stratified screening for CRC prevention. To optimize CRC screening programs, healthcare professionals (i.e., preventive medicine specialists, gastroenterologists, and public health practitioners) should be aware of the recent advances in personalized CRC screening. These screening strategies can reduce the global burden of this preventable malignancy.