Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force.

Autor:	Knudsen AB; Institute for Technology Assessment, Massachusetts General Hospital, Boston.; Harvard Medical School, Boston, Massachusetts., Rutter CM; RAND Corporation, Santa Monica, California., Peterse EFP; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.; Now with OPEN Health, Rotterdam, the Netherlands., Lietz AP; Institute for Technology Assessment, Massachusetts General Hospital, Boston.; Now with the Columbia University School of Nursing, New York, New York., Seguin CL; Institute for Technology Assessment, Massachusetts General Hospital, Boston., Meester RGS; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands., Perdue LA; Kaiser Permanente Evidence-based Practice Center and Center for Health Research, Kaiser Permanente, Portland, Oregon., Lin JS; Kaiser Permanente Evidence-based Practice Center and Center for Health Research, Kaiser Permanente, Portland, Oregon., Siegel RL; American Cancer Society, Atlanta, Georgia., Doria-Rose VP; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland., Feuer EJ; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland., Zauber AG; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Kuntz KM; Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis., Lansdorp-Vogelaar I; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2021 May 18; Vol. 325 (19), pp. 1998-2011.
DOI:	10.1001/jama.2021.5746
Abstrakt:	Importance: The US Preventive Services Task 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 Measures: Estimated 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 Relevance: This 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.
Databáze:	MEDLINE
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