Background and Objective. With minor differences, most national colorectal cancer (CRC) screening programs in Europe consist of one-size-fits-all aged-based strategies. This paper provides a decision analysis-based approach to personalized CRC screening, supporting decisions concerning whether and which screening method to consider and/or whether a colonoscopy should be administered. Methods. We use an influence diagram which characterizes CRC risk with respect to different variables of interest and includes comfort, costs, complications, and information as decision criteria, the last one assessed through information theory measures. The criteria are integrated with a multi-attribute utility model. Optimal screening policies are then computed. Results. The proposed model is used to support personalized individual screening based on relevant characteristics. It serves to assess existing national screening programs and design new ones. In particular, it suggests replacing current age-based strategies followed in many European countries by more personalized strategies based on the type of model proposed. Additionally, the model facilitates benchmarking of novel screening devices. Conclusions. This work creates a framework supporting personalized CRC screening improving upon current age-based screening strategies.

翻译：背景与目的。欧洲大多数国家的结直肠癌（CRC）筛查方案虽存在细微差异，但普遍采用基于年龄的“一刀切”策略。本文提出了一种基于决策分析的个性化CRC筛查方法，为是否应考虑筛查、选择何种筛查方法以及是否应进行结肠镜检查等决策提供支持。方法。我们采用影响图来表征CRC风险与不同相关变量的关系，并将舒适度、成本、并发症和信息作为决策准则，其中信息准则通过信息论度量进行评估。这些准则通过多属性效用模型进行整合，进而计算出最优筛查策略。结果。所提出的模型可用于基于相关特征的个性化个体筛查支持。它有助于评估现有的国家筛查方案并设计新的方案。具体而言，该模型建议用基于所提模型类型的更个性化策略，取代当前许多欧洲国家采用的基于年龄的策略。此外，该模型有助于对新型筛查设备进行基准测试。结论。本研究建立了一个支持个性化CRC筛查的框架，对当前基于年龄的筛查策略进行了改进。