Life-years gained resulting from screening colonoscopy compared with follow-up colonoscopy after a positive stool-based colorectal screening test

Fendrick, A. Mark; Borah, Bijan J.; Ozbay, A. Burak; Saoud, Leila; Limburg, Paul J.

doi:10.1016/j.pmedr.2022.101701

Cited by 3 publications

(2 citation statements)

References 9 publications

(9 reference statements)

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“…19,21 Studies indicate that before the pandemic, stool testing had declined and remained low in higher socioeconomic groups despite evidence showing greater screening uptake when a stool-based test is offered to these groups along with direct visualization tests, 22 but it increased or remained stable among individuals with low education and income. 23,24 However, among individuals who have a positive stool test, follow-up colonoscopy commonly has imposed significant out-of-pocket costs, 25,26 and lack of follow-up has been a serious problem for many years, 27 increasing the risk of death from colorectal cancer. 28 These observations have led to the position that colorectal cancer screening with a noncolonoscopy test is incomplete if the test is positive until follow-up colonoscopy has been completed.…”

Section: Discussionmentioning

confidence: 99%

“…However, among individuals who have a positive stool test, follow-up colonoscopy commonly has imposed significant out-of-pocket costs, 25 , 26 and lack of follow-up has been a serious problem for many years, 27 increasing the risk of death from colorectal cancer. 28 These observations have led to the position that colorectal cancer screening with a noncolonoscopy test is incomplete if the test is positive until follow-up colonoscopy has been completed.…”

Section: Discussionmentioning

confidence: 99%

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Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic

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Bandi

Siegel

et al. 2023

JCO

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PURPOSE To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic

Star

Bandi

Siegel

et al. 2023

JCO

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Predictors of treatment refusal in patients with colorectal cancer: A systematic review

Moodley

Govender

Wyk

et al. 2022

Seminars in Oncology

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Clinical, social, and economic impacts of colorectal cancer screening with the multi-target stool-DNA test: 10-year experience - a simulated study

Estes,

Dehghani,

Ozbay

et al. 2024

Preprint

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IntroductionIn the United States, colorectal cancer (CRC) remains a substantial public health challenge, with approximately 150,000 new cases diagnosed annually. Guidelines from organizations such as the United States Preventive Services Task Force (USPSTF) recommend several screening strategies, including endoscopic, radiologic, and stool-based options such as the multi-target stool DNA (mt-sDNA) test. In this analysis, we analyzed the estimated clinical, social, and economic impacts of mt-sDNA screening over the inaugural 10-year period for test availability.MethodsTo assess the effectiveness of CRC screenings with the mt-sDNA test, published rates of advanced precancerous lesions (APL) and cancer prevalence by stage, as well as the transition rate of APL to CRC for the average-risk population in the US were used for a simulated population. The mt-sDNA test’s sensitivity and specificity for APL and CRC were derived from previously published data. To assess the economic impact of screening with mt-sDNA compared to colonoscopy, we utilized data from literature regarding the time and resources required to prepare and complete each test. Furthermore, the costs of treatment according to the stage of colorectal cancer are considered, to show the value of CRC prevention and early detection.ResultsOur analysis indicates that mt-sDNA screening detected an estimated 98,000 cases of CRC and 525,000 individuals were found to have APLs, precursors to CRC. When using 10-year survival rate from CRC, it is estimated that the mt-sDNA test led to more than 34,000 patients surviving due to earlier intervention compared to no screening. Furthermore, the mt-sDNA test demonstrated approximately $22.3 billion cost savings compared to no screening, including an estimated $9.7 billion in cancer treatment costs through early CRC detection and an additional $12.6 billion resulting from cancer prevention through APL detection and management.ConclusionClinical availability, adoption, and growth of stool-based CRC screening have significantly increased overall screening rates in the US. It is estimated that mt-sDNA utilization will continue to grow, providing a home-based CRC screening solution for millions of screen-eligible US adults over the next decade and beyond.

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Life-years gained resulting from screening colonoscopy compared with follow-up colonoscopy after a positive stool-based colorectal screening test

Cited by 3 publications

References 9 publications

Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic

Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic

Predictors of treatment refusal in patients with colorectal cancer: A systematic review

Clinical, social, and economic impacts of colorectal cancer screening with the multi-target stool-DNA test: 10-year experience - a simulated study

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