Editorial: risk scoring for colon cancer screening: validated, but still not ready for prime time

Risk stratification for colorectal cancer screening would allow us to use less expensive screening tests, such as sigmoidoscopy with or without fecal blood testing, on lower risk individuals, and reserve colonoscopy for those at higher risk. In this issue, Levitzky et al. validates a risk score that was previously developed by Imperiale et al., finding similar results among three ethnic groups. Risk scoring would detect 82-87% of proximal advanced neoplasia while decreasing colonoscopy use by 33-46%. However, before risk scoring is ready for widespread use, sigmoidoscopy access and performance issues need to be addressed, and we must be comfortable with missing some proximal neoplasms.