A2 GATHERING AND ASSESSING EVIDENCE TO INFORM A GUIDELINE ON SCREENING FOR COLORECTAL CANCER IN INDIVIDUALS WITH A FAMILY HISTORY
Bibliographic record
Abstract
Existing guidelines on colorectal cancer (CRC) screening for individuals with a family history (FH) of CRC or adenoma have not been based on systematic reviews or comprehensive assessment of the quality (=trustworthiness) of evidence (QoE). To systematically review the literature to inform the ongoing development of a Canadian Association of Gastroenterology-supported Canadian and US guideline on CRC screening for individuals with FH of nonhereditary CRC or adenoma. Multiple parallel systematic review streams, informed by a series of 10 literature searches, gathered evidence on 4 principal questions around the 1) effect of FH of CRC (or adenoma) on an individual’s risk of CRC, 2) age at which screening should begin, 3) recommended screening tests, and 4) recommended testing intervals for individuals with FH of CRC or adenoma. The GRADE approach was used to assess the QoE. The relative risk (RR) of CRC among individuals with FH of 1 first-degree relative (FDR) with CRC was estimated to be approximately 2-fold greater than among those without. The RR increased with an increasing number of FDRs with CRC. A FH of only second-degree relatives was associated with no or minimally elevated risk. The risk of CRC was increased by FH of advanced adenoma, but not with FH of a non-advanced adenoma. The age-specific risk of CRC fell on a continuum: RR increased with decreasing age of affected FDR, and increasing age of the screened individual, but RR was elevated at all ages compared to those with no FH. All the above were of very low QoE. Using data on efficacy (QoE ranging from very low to high), patient preference (very low QoE), and cost-effectiveness (very low QoE), colonoscopy and FIT ranked highest among screening test for individuals with FH of a FDR with CRC. Data on the optimal interval for CRC screening were limited (very low QoE), but suggested a potential benefit of shorter intervals for some individuals with FH compared to those at average risk. A FH of CRC or advanced adenoma is associated with a clinically important increased risk of CRC, which falls on an age continuum. Canadian Partnership Against Cancer (CPAC)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.173 | 0.503 |
| Meta-epidemiology (narrow) | 0.002 | 0.004 |
| Meta-epidemiology (broad) | 0.006 | 0.012 |
| Bibliometrics | 0.027 | 0.020 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.011 | 0.010 |
| Open science | 0.006 | 0.008 |
| Research integrity | 0.009 | 0.006 |
| Insufficient payload (model declined to judge) | 0.013 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".