Cost Effectiveness of Screening Individuals With Cystic Fibrosis for Colorectal Cancer

Gini, Andrea; Zauber, Ann G.; Cenin, Dayna R.; Omidvari, Amir‐Houshang; Hempstead, Sarah E.; Fink, Aliza K.; Lowenfels, Albert B.; Lansdorp–Vogelaar, Iris

doi:10.1053/j.gastro.2017.10.036

Cited by 20 publications

(19 citation statements)

References 46 publications

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“…A brief description of the methodology and main findings of the modeling procedures are presented here, more detailed information is available in a separate report in this journal. 30…”

Section: Modelingmentioning

confidence: 99%

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

et al. 2018

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“…A brief description of the methodology and main findings of the modeling procedures are presented here, more detailed information is available in a separate report in this journal. 30…”

Section: Modelingmentioning

confidence: 99%

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

et al. 2018

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“…Cancer‐screening strategies should be considered for patients with CF beginning at 40 years and even earlier for those who received transplantation according to the recently published CF consensus recommendations . Colon cancer screening in patients with CF after transplantation is likely to be cost‐effective, with an optimal strategy calculated to involve a colonoscopy every 3 years beginning at age 35 years, or at age 30 years if the transplant occurs at younger than 30 years of age . Such a strategy is predicted to prevent 82% of mortality associated with colorectal cancer when compared with no screening, although prospective effectiveness studies of these proposed screening strategies are needed.…”

Section: Postoperative Management In Lt For Cf Patientsmentioning

confidence: 99%

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

et al. 2019

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Approximately 5%‐10% of patients with cystic fibrosis (CF) will develop advanced liver disease with portal hypertension, representing the third leading cause of death among patients with CF. Cystic fibrosis with advanced liver disease and portal hypertension (CFLD) represents the most significant risk to patient mortality, second only to pulmonary or lung transplant complications in patients with CF. Currently, there is no medical therapy to treat or reverse CFLD. Liver transplantation (LT) in patients with CFLD with portal hypertension confers a significant survival advantage over those who do not receive LT, although the timing in which to optimize this benefit is unclear. Despite the value and efficacy of LT in selected patients with CFLD, established clinical criteria outlining indications and timing for LT as well as disease‐specific transplant considerations are notably absent. The goal of this comprehensive and multidisciplinary report is to present recommendations on the unique CF‐specific pre‐ and post‐LT management issues clinicians should consider and will face.

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“…Modeling might inform more nuanced screening guidelines for subpopulations. This is illustrated by studies focusing on persons with diabetes, 26 a family history of CRC, 27 high-risk patients in a regional screening program, 28 patients with cystic fibrosis, 29 and elderly persons with a spectrum of comorbidities. 30…”

Section: Modeling Populations Not At Average Riskmentioning

confidence: 99%

Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening

Robertson

Ladabaum

2019

Gastroenterology

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C olorectal cancer (CRC) remains the second most common cause of cancer death in the United States. 1 However, CRC incidence and mortality have been decreasing over the past 4 decades, and screening has contributed substantially to these gains. 2-4 Screening aims to identify disease in asymptomatic individuals at an early stage, in the hope of improving outcomes. CRC lends itself very well to screening, as early-stage CRC has a highly favorable prognosis relative to more advanced disease. Also, the transition from normal mucosa through preneoplastic disease (ie, polyps) to CRC is estimated to be a decade or more. 5 Therefore, finding and removing preneoplastic lesions can reduce CRC incidence. Screening is widely employed in the United States, largely in an opportunistic fashion. While there is no national CRC screening policy or program, there are multiple guidelines endorsing CRC screening. 6-10 Most guidelines, in average-risk populations, recommend initiating CRC screening at age 50 years with one of the available methods. While there is some variation in recommendations by age and race, factors beyond these are not currently used to tailor individual recommendations. This review addresses current CRC epidemiology, screening practice, and guidelines in the United States, and considers how individual risk factors might be used to personalize CRC screening. We first summarize the burden of CRC and current screening efforts. Next, we examine current guidelines for variation regarding the approach to age, sex, and race, and we explain how decision analytic modeling has informed recent guidelines. We then review factors beyond demographic characteristics (eg, smoking, obesity) that affect CRC risk and provide potential opportunities for personalized screening, including the development of risk-prediction models that include biomarkers. Finally, we consider future directions for research and practice, including the opportunities and challenges related to implementing personalized CRC screening. Current Status of Colorectal Cancer and Screening in the United States The American Cancer Society (ACS) provides annual cancer statistics for the United States. 1 These statistics are drawn from a number of sources. For example, mortality data are abstracted from the National Center for Health Statistics, and cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. The most recent ACS report estimates that there will be 145,600 new CRC cases and 51,020 CRC-related deaths in the United States this year. 1 CRC remains the third most common cause of cancer and cancer death for both sexes, trailing only lung and prostate cancer in men and lung and breast cancer in women. Age standardized CRC incidence and mortality trends in the United States are improving (Figure 1). From 1975 through 2015, overall CRC mortality fell from 28.1/100,000 to 14/100,000. 11 Like cancer statistics, data on screening are also drawn from various sources. Based on 2015 National Health Intervi...

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Cost Effectiveness of Screening Individuals With Cystic Fibrosis for Colorectal Cancer

Cited by 20 publications

References 46 publications

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening

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