The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut‐off level on yield of screening

Kooyker, Arthur I.; Toes‐Zoutendijk, Esther; Winden, Annemieke W.J. Opstal‐van; Spaander, Manon C.W.; Buskermolen, Maaike; Vuuren, Hanneke J. van; Kuipers, Ernst J.; Kemenade, Folkert J. van; Ramakers, Chris; Thomeer, Maarten G J; Dekker, Evelien; Nagtegaal, Irıs D.; Koning, Harry J. de; Leerdam, Monique E. van; Lansdorp–Vogelaar, Iris

doi:10.1002/ijc.32839

Cited by 35 publications

(29 citation statements)

References 18 publications

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“…In the third scenario, we accounted for suboptimal adherence to diagnostic and surveillance colonoscopy and for decreasing adherence over multiple screening rounds ( 36 ). For this scenario, we assumed a 100% adherence at the first screening and that 90% of the people screened at a given age would participate again at the next recommended age ( 37 , 38 ). In line with current CRC participation rates ( 39 ), we assumed screening adherence would not drop below 60% at any age by assuming that 15% of the people who previously did not participate would participate at the next recommended age.…”

Section: Methodsmentioning

confidence: 99%

Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

Peterse

Meester

Jonge

et al. 2020

JNCI: Journal of the National Cancer Institute

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Background Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underutilized. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. Methods The previously-validated MISCAN-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography (CTC) every 5 years, the multi-target stool DNA (mtSDNA) test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies to annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios (ICERs) were projected. We assumed a willingness-to-pay threshold of $100,000 per QALYG. Results Among the alternative tests, CTC every 5 years, annual mSEPT9 and annual mtSDNA screening had ICERs of $1,092, $63,253 and $214,974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these three. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted and CRC deaths averted than annual FIT screening, but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared to FIT and colonoscopy. Conclusion This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.

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Section: Methodsmentioning

confidence: 99%

Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

Peterse

Meester

Jonge

et al. 2020

JNCI: Journal of the National Cancer Institute

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“…A recent health economic modeling study revealed that adding an annual universal cancer screening test to the current standard of care in human medicine would reduce late-stage cancer incidence by 78% in those intercepted by the screening test, and result in an absolute reduction of 26% in all cancer deaths ( 227 ). The practice of screening at regular intervals relies on the concept of “cumulative detection” to improve the clinical sensitivity over time at the population level, as sequential testing holds the benefit of detecting cases missed on initial screening ( 108 , 109 , 228 ). Ultimately, this technology may support cancer screening in lower-risk canine populations as well, comparable to how NIPT technology expanded beyond high-risk cases to encompass all pregnancies in humans ( 229 ).…”

Section: Liquid Biopsy: the Next Frontier In Veterinary Cancer Carementioning

confidence: 99%

Horizons in Veterinary Precision Oncology: Fundamentals of Cancer Genomics and Applications of Liquid Biopsy for the Detection, Characterization, and Management of Cancer in Dogs

Chibuk¹,

Flory²,

Kruglyak³

et al. 2021

Front. Vet. Sci.

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Cancer is the leading cause of death in dogs, in part because many cases are identified at an advanced stage when clinical signs have developed, and prognosis is poor. Increased understanding of cancer as a disease of the genome has led to the introduction of liquid biopsy testing, allowing for detection of genomic alterations in cell-free DNA fragments in blood to facilitate earlier detection, characterization, and management of cancer through non-invasive means. Recent discoveries in the areas of genomics and oncology have provided a deeper understanding of the molecular origins and evolution of cancer, and of the “one health” similarities between humans and dogs that underlie the field of comparative oncology. These discoveries, combined with technological advances in DNA profiling, are shifting the paradigm for cancer diagnosis toward earlier detection with the goal of improving outcomes. Liquid biopsy testing has already revolutionized the way cancer is managed in human medicine – and it is poised to make a similar impact in veterinary medicine. Multiple clinical use cases for liquid biopsy are emerging, including screening, aid in diagnosis, targeted treatment selection, treatment response monitoring, minimal residual disease detection, and recurrence monitoring. This review article highlights key scientific advances in genomics and their relevance for veterinary oncology, with the goal of providing a foundational introduction to this important topic for veterinarians. As these technologies migrate from human medicine into veterinary medicine, improved awareness and understanding will facilitate their rapid adoption, for the benefit of veterinary patients.

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“…colonoscopies in CRC screening programs (4,19). However, this option is not always followed in countries that use FIT as the screening test, because it implies that lesions with insufficient bleeding might not test positive, and thus, would be missed.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have evaluated the impact of raising the FIT cut-off point to match the demand to the availability of colonoscopies in CRC screening programs ( 4 , 19 ). However, this option is not always followed in countries that use FIT as the screening test, because it implies that lesions with insufficient bleeding might not test positive, and thus, would be missed.…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

et al. 2021

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Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

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The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut‐off level on yield of screening

Cited by 35 publications

References 18 publications

Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

Horizons in Veterinary Precision Oncology: Fundamentals of Cancer Genomics and Applications of Liquid Biopsy for the Detection, Characterization, and Management of Cancer in Dogs

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

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