Colonoscopic Screening of Average-Risk Women for Colorectal Neoplasia

Schoenfeld, Philip; Cash, Brooks D.; Flood, Andrew; Dobhan, Richard; Eastone, John A.; Coyle, Walter; Kikendall, James Walter; Kim, Hyungjin Myra; Weiss, David G.; Emory, Theresa S.; Schatzkin, Arthur; Lieberman, David A.

doi:10.1056/nejmoa042990

Cited by 448 publications

(276 citation statements)

References 25 publications

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“…Likewise, the NNscreen to detect an advanced neoplasia was lower in men than in women. Similar differences in detection rates for advanced neoplasia between both sexes were found in two colonoscopy screening studies (Lieberman et al, 2000;Schoenfeld et al, 2005;Regula et al, 2006). Furthermore, the CRC incidence rates are on an average 1.5 times higher in men than in women aged 50 -75 years (Ries et al, 2007;Jemal et al, 2008).…”

Section: Discussionmentioning

confidence: 59%

Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels

et al. 2009

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Immunochemical faecal occult blood testing (FIT) provides quantitative test results, which allows optimisation of the cut-off value for follow-up colonoscopy. We conducted a randomised population-based trial to determine test characteristics of FIT (OC-Sensor micro, Eiken, Japan) screening at different cut-off levels and compare these with guaiac-based faecal occult blood test (gFOBT) screening in an average risk population. A representative sample of the Dutch population (n ¼ 10 011), aged 50 -74 years, was 1 : 1 randomised before invitation to gFOBT and FIT screening. Colonoscopy was offered to screenees with a positive gFOBT or FIT (cut-off 50 ng haemoglobin/ml). When varying the cut-off level between 50 and 200 ng ml À1 , the positivity rate of FIT ranged between 8.1% (95% CI: 7.2 -9.1%) and 3.5% (95% CI: 2.9 -4.2%), the detection rate of advanced neoplasia ranged between 3.2% (95% CI: 2.6 -3.9%) and 2.1% (95% CI: 1.6 -2.6%), and the specificity ranged between 95.5% (95% CI: 94.5 -96.3%) and 98.8% (95% CI: 98.4 -99.0%). At a cut-off value of 75 ng ml À1 , the detection rate was two times higher than with gFOBT screening (gFOBT: 1.2%; FIT: 2.5%; Po0.001), whereas the number needed to scope (NNscope) to find one screenee with advanced neoplasia was similar (2.2 vs 1.9; P ¼ 0.69). Immunochemical faecal occult blood testing is considerably more effective than gFOBT screening within the range of tested cut-off values. From our experience, a cut-off value of 75 ng ml À1 provided an adequate positivity rate and an acceptable trade-off between detection rate and NNscope.

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Section: Discussionmentioning

confidence: 59%

Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels

et al. 2009

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“…Esse resultado está de acordo com os estudos americanos que relatam a taxa de intubação de 97% (15,19) . Tal fato possivelmente foi facilitado pela realização de sedação consciente, que permitiu o emprego de manobras colonoscópicas para atingir-se o ceco.…”

Section: Discussionunclassified

Achados colonoscópicos em pessoas sem quadro clínico de doença colorretal

Petroianu

Alberti

Lima³

et al. 2009

Arq. Gastroenterol.

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RESUMO -Contexto -O câncer colorretal é causa de morte frequente e sua prevenção deve fazer parte dos programas de rastreamento em indivíduos assintomáticos. Objetivo -Avaliar os achados colonoscópicos de pessoas assintomáticas submetidas a colonoscopia. pólipos em 64,28%, doença diverticular em 27,92%, alterações inflamatórias em 9,74%, melanose colônica em 2,6% e angioectasias em 7,8%. Houve incidência maior de pólipos em indivíduos acima de 50 anos. A análise de regressão logística mostrou a idade e sexo como fatores preditores para a presença de pólipos (RR = 1,69; 1,23

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“…Following polypectomy, these patients underwent a surveillance colonoscopy in five years or in three years if an advanced adenoma was excised (Schoenfeld et al, 2009). Following a diagnosis of colorectal cancer, patients entered a stage-specific colorectal cancer health state for the next five years during which time they had a yearly probability of dying of other causes, dying of colorectal cancer, or sustaining a relapse.…”

Section: Resultsmentioning

confidence: 99%

Markov's Modeling for Screening Strategies for Colorectal Cancer

Barouni

Larizadeh²,

Sabermahani³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

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Colonoscopic Screening of Average-Risk Women for Colorectal Neoplasia

Abstract: Colonoscopy may be the preferred method of screening for colorectal cancer in women.

Cited by 448 publications

References 25 publications

Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels

Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels

Achados colonoscópicos em pessoas sem quadro clínico de doença colorretal

Markov's Modeling for Screening Strategies for Colorectal Cancer

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