Project Summary/Abstract Title: Optimizing Screening of Early-Onset Colorectal Cancer Background: Colorectal cancer (CRC) constitutes a significant source of morbidity and mortality, with screening playing a pivotal role in alleviating this burden. The routine incorporation of screening colonoscopy for individuals aged 50 or older, who are at average risk, has contributed to a notable reduction in CRC incidence and mortality, by 35% and 37% respectively. Nevertheless, a substantial proportion of eligible individuals do not undergo screening, contributing to 28-44% of CRC-related deaths. In the United States, disparities are evident among Black individuals, who are more prone to being diagnosed at younger ages and in advanced disease stages. Timely detection of CRC can significantly enhance survival by enabling curative colonoscopy procedures. Innovative, targeted strategies for CRC prevention hold promise for improving overall population health and mitigating CRC disparities in the U.S. Goal: The overarching objective is to enhance the effectiveness of cancer surveillance for individuals at risk of early-onset colorectal cancer by tailoring the surveillance approach to each person's estimated risk of CRC incidence and mortality. This goal aims to improve the overall well-being of patients, optimize resource allocation, and foster greater acceptance of surveillance among both patients and healthcare providers.

Project Narrative/Public Health Significance Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most commonly diagnosed cancer worldwide. Regular use of colonoscopy contributes to a decrease in CRC incidence rates, but one-third of eligible Americans have not undergone CRC screening and missed screening accounts for 28-44% of CRC-related deaths. The primary goal of the proposed research is to optimize colorectal cancer surveillance for early-onset CRC by personalizing it according to each individual's estimated CRC risk for both incidence and mortality.