Noninvasive Colorectal Cancer Screening Tests Help Close Screening Gaps During Coronavirus Disease 2019 Pandemic

Abstract

See Covering the Cover synopsis on page 379.BACKGROUND AND AIMS: Current guidelines recommend surveillance for patients with nondysplastic Barrett's esophagus (NDBE) but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. METHODS: We used 3 independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, and severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from 1 additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental costeffectiveness ratio of 1 more surveillance was just less than

Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions

“…Moreover, during lockdown months in a healthcare system in Los Angeles, the colonoscopy rates declined to about only 12 per week, compared to the 223 per week pre-pandemic, whereas the FIT dropped to 61 per week, compared to 154 per week pre-pandemic [33]. After the lockdown was lifted, the number of colonoscopy appointments recovered to the number before the pandemic, whereas the noninvasive FIT and stool DNA tests recovered, and exceeded the pre-pandemic numbers [34]. Lastly, the interruption in developing screening programs in the CRC "hotspot" Appalachian Kentucky region elicited a significant backlog, and furthered the barriers that the program already had to face during its development [35].…”

“…This mitigation approach was predicted to provide the additional CRC screening to approximately 588,800 novel patients, and establish about 2899 new CRC diagnoses, out of which 68.9% would be early-stage [19]. Furthermore, the utilization of other noninvasive stoolbased DNA tests was marked effective in identifying high-risk patients, and prioritizing them for diagnostic colonoscopy and CRC treatment [34,35]. Miller et al designed and implemented a novel CRC triage procedure named "COVID-adapted pathway", which successfully ameliorated the adverse effects of the diagnostic colonoscopy backlog [33].…”

Colorectal Cancer Screening: Impact of COVID-19 Pandemic and Possible Consequences

“…To have maximum effectiveness, FIT must be done once a year. With the use of kits containing directions and materials, patients can simply do the test at home and then send it to their medical provider [15,44]. FIT can serve as a triage to colonoscopy or other screening tests.…”

Delayed Colorectal Cancer Diagnosis during the COVID-19 Pandemic in Alberta: A Framework for Analyzing Barriers to Diagnosis and Generating Evidence to Support Health System Changes Aimed at Reducing Time to Diagnosis

“…In addition, a follow-up colonoscopy for patients with positive FIT results was curtailed due to the closure of endoscopy units. This reduction in the colonoscopy capacity was seen in many other healthcare systems worldwide [20,21]. Our findings suggest a combination of approaches would be needed to clear the colonoscopy backlog.…”

“…Our findings suggest a combination of approaches would be needed to clear the colonoscopy backlog. Various strategies have been suggested, including a reduction of colonoscopy for average risk screening and enhanced utilization of non-invasive fecal tests [20]. Our analysis suggests that the capacity to complete colonoscopies would need to increase beyond 100% of the pre-pandemic monthly volumes, with >2x the yield of CRC diagnoses from completed colonoscopies.…”