351 Adherence to Screening in a Randomized Controlled Trial of a One-Time Screening Colonoscopy Versus Program of Annual Fecal Occult Blood Test (gFOBt): Implications of Lower gFOBt Adherence to Screening on Colorectal Cancer Mortality Reduction

Zauber, Ann G.; Winawer, Sidney J.; Mills, Glenn; Church, Timothy R.; Feld, Andrew D.; Allen, John I.; Jordan, Paul; O’Brien, Michael J.; Kauff, Noah D.; Orlow, Irene; Jammula, Anjani; Close, Georgia; Ruckel, Andrew M.; Morgan, Georgia A.; Kuk, Deborah; Hees, Frank van; Lansdorp–Vogelaar, Iris; Ballegooijen, Marjolein van; Fleisher, Martin

doi:10.1016/s0016-5085(12)60312-6

Cited by 4 publications

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“…Assuming no repeat colonoscopy after 10 years in the colonoscopy arm increased predicted mortality to 3.2 per 1,000 (−54%), while assuming 88.5% adherence based on an 18-month window decreased mortality to 2.7 (−61%). Furthermore, despite differences in observed adherence and simulated outcomes across participating study centers (see Supplementary Appendix Table 4, Supplementary Digital Content 1, http://links.lww.com/AJG/D193) (25), colonoscopy resulted in substantially greater simulated mortality reductions for all centers. We found only modest effects of alternative test performance assumptions (maximum 6 percentage-point), including lower diagnostic colonoscopy adherence, lower colonoscopy sensitivity for small adenomas (40), lower HSgFOBT specificity (base-case specificity was higher than in previous studies to accommodate for the lower observed positivity rate in NCS) (36), and performance characteristics from using FIT.…”

Section: Resultsmentioning

confidence: 99%

“…NCS is the first published RCT to assess HSgFOBT adherence and outcomes in up to 7 subsequent rounds (25). The study population was representative of the US screening population in demographics, and the model was able to accurately replicate performance data from the NCS for up to 5 rounds (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, we reproduced the distribution of the cumulative number of tests completed by round, among those still eligible to receive HSgFOBT. As this estimates the cumulative adherence over time among all those still eligible to receive HSgFOBT rather than all initially enrolled (25), this approach adjusts estimates for loss to follow-up or crossover colonoscopy receipt, when extrapolating sequential HSgFOBT use over time. For extrapolation of patterns, we assumed stable rates of conditional adherence from the fifth round onward.…”

Section: Methodsmentioning

confidence: 99%

“…Adherence to each arm was defined as screening colonoscopy uptake within 12 months of randomization and yearly adherence (4-7 years, depending on enrollment) to HSgFOBT and diagnostic colonoscopy in the case of a positive test. Further details of this RCT, including the trial design, along with adherence and pathology outcomes can be found elsewhere in the paper published by Zauber et al (25). colorectal neoplasia through the adenoma-carcinoma sequence (28) and potential reductions in life expectancy due to cancer.…”

Section: Ncs Overviewmentioning

confidence: 99%

“…The National Colonoscopy Study (NCS) was an RCT designed to assess the feasibility of screening colonoscopy vs a program of annual HSgFOBT for CRC, with participant adherence and pathological findings as the primary outcomes (25). Another aim of that study, which we report here, is to evaluate the long-term CRC incidence and mortality effects for each test using microsimulation modeling informed by NCS data.…”

Section: Introductionmentioning

confidence: 99%

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Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening

Meester,

Lansdorp-Vogelaar,

Winawer

et al. 2024

Am J Gastroenterol

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INTRODUCTION: Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening-colonoscopy every ten years versus annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. METHODS: MIcrosimulation SCreening ANalysis (MISCAN) model using observed sequential screening adherence, HSgFOBT positivity, and diagnostic-colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (NCS; single screening-colonoscopy versus ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening, or ten-yearly screening-colonoscopy versus annual HSgFOBT with 100% and differential observed adherence from the trial. RESULTS: Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval, 15.8-26.9) and 6.9 (5.0-9.2) per 1000 participants, respectively. In the case of 100% adherence, only screening-colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening-colonoscopy; 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening-colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening-colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic-colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening-colonoscopy versus HSgFOBT was 0.75 (95%PI, 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. DISCUSSION: Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable – as observed in NCS – offering screening-colonoscopy can increase screening effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Ncs Overviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening

Meester,

Lansdorp-Vogelaar,

Winawer

et al. 2024

Am J Gastroenterol

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Cribado del cáncer colorrectal

Castells

2012

Gastroenterología y Hepatología

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Colorectal cancer is one of the neoplasms most suitable for preventive measures, especially screening. Several cost-effective screening strategies are available: detection of fecal occult bleeding through chemical (guaiac tests) or immunological tests and endoscopic procedures such as flexible sigmoidoscopy or colonoscopy. This article reviews the most important studies on colorectal cancer screening presented at the annual congress of the American Gastroenterological Association, held in San Diego in May 2012, with special emphasis on its effectiveness in reducing the incidence and/or mortality associated with this neoplasm.

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Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

Tinmouth

Vella

Baxter

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

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351 Adherence to Screening in a Randomized Controlled Trial of a One-Time Screening Colonoscopy Versus Program of Annual Fecal Occult Blood Test (gFOBt): Implications of Lower gFOBt Adherence to Screening on Colorectal Cancer Mortality Reduction

Cited by 4 publications

References 0 publications

Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening

Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening

Cribado del cáncer colorrectal

Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

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