Colorectal Cancer Screening

Abstract

Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.OBJECTIVE To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF. DESIGN, SETTING, AND PARTICIPANTS Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.EXPOSURES Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed. MAIN OUTCOME AND MEASURESEstimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.RESULTS Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer. CONCLUSIONS AND RELEVANCEThis microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.

A sex-specific propensity-adjusted analysis of colonic adenoma detection rates in a screening cohort

“…This model estimated that the optimal cut-off for screening was 45 years, and the ACS lowered their screening recommendations in 2018 to 45 for both sexes 1 . Another model predicted, that lowering the starting age of screening to 45 means 160 to 784 additional lifetime colonoscopies, 22 to 27 life years gained, 2 to 3 fewer CRC cases and 1 averted death per 1000 people 45 . This benefit is opposed by 0.1 to 2 additional complications over the lifetimes of these 1000 individuals 45 .…”

“…Another model predicted, that lowering the starting age of screening to 45 means 160 to 784 additional lifetime colonoscopies, 22 to 27 life years gained, 2 to 3 fewer CRC cases and 1 averted death per 1000 people 45 . This benefit is opposed by 0.1 to 2 additional complications over the lifetimes of these 1000 individuals 45 . It was, however also shown, that risk of bleeding and perforation increased with age with the youngest population being at the lowest risk for complications 46 , 47 .…”

The value of time-dependent risk predictions in a screening context - a comprehensive simulation analysis validated on German cancer registry data

“…The economic benefits of personalised screening have been demonstrated [ 3 , 4 ]. On individual level, it is important to reduce unnecessary screening examinations which may inflict serious impairments on a patient’s health [ 5 , 6 ]. In the current striving towards personalised medicine, risk-prediction tools are gaining importance [ 7 ].…”

CST: A Multitask Learning Framework for Colorectal Cancer Region Mining Based on Transformer

“…However, mere blood examination and colonoscopy inspection could not reveal the biological morphology and tumour statutes [ 4 , 5 ]. In the past decades, imaging approaches such as computed tomography (CT) and magnetic resonance imaging (MRI) have become an effective way for colorectal cancer diagnosis; doctors can get an overall scheme of the tumour region in a comprehensive way without invasion [ 2 , 6 ]. In addition, medical imaging can get detailed information of the tumour region without any physical cathartic cleansing, which has become a prevalent screening guideline [ 7 , 8 ].…”