Thomas C, Mandrik O, Saunders CL, et al. - Given that recognition of various genetic and phenotypic risk factors for colorectal cancer (CRC) has contributed to the advent of CRC risk scores with varying discrimination but these are not currently employed by population screening programmes, researchers herein evaluated the cost-effectiveness, clinical results as well as resource effect of implementing risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective, in this economic analysis. They compared biennial faecal immunochemical test (FIT), initiating at an age ascertained via risk-assessment at age 40, vs FIT screening initiating at a fixed age for all people. They found that using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, vs inviting everyone from age 60, offered 418 QALYs, costed £247,000, and led to 218 fewer CRC cases and 156 fewer CRC deaths per 100,000 people, with similar FIT screening invites. The likelihood of risk-stratification being cost-effective was 96%, with net monetary advantage (based on £20,000 per QALY threshold) estimated at £8.1m per 100,000 people. Males were more benefited from risk stratified screening than females. Overall, improved clinical results as well as cost-effectiveness of CRC screening could be obtained by using risk to determine FIT screening start age, without using significant additional screening resources.