Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies Modeling Study for the US Preventive Services Task Force

Autor: Iris Lansdorp-Vogelaar, Steffie K. Naber, Sara E. Fischer, Colden Johanson, Carolyn M. Rutter, Chester Pabiniak, V. Paul Doria-Rose, Karen M. Kuntz, Ann G. Zauber, Amy B. Knudsen
Přispěvatelé: Public Health
Rok vydání: 2016
Předmět:
Adenoma
Adult
medicine.medical_specialty
Pediatrics
Time Factors
Colorectal cancer
Advisory Committees
Population
Colonoscopy
Sensitivity and Specificity
Cohort Studies
Feces
03 medical and health sciences
0302 clinical medicine
SDG 3 - Good Health and Well-being
Preventive Health Services
medicine
Humans
education
Sigmoidoscopy
Early Detection of Cancer
Aged
Aged
80 and over
education.field_of_study
medicine.diagnostic_test
business.industry
Fecal occult blood
Age Factors
DNA
General Medicine
Middle Aged
Models
Theoretical
medicine.disease
Immunohistochemistry
United States
Surgery
Quality-adjusted life year
Editorial
Occult Blood
030220 oncology & carcinogenesis
Cohort
030211 gastroenterology & hepatology
Quality-Adjusted Life Years
Colorectal Neoplasms
business
Colonography
Computed Tomographic
Cohort study
Zdroj: JAMA-Journal of the American Medical Association, 315(23), 2595-2609. American Medical Association
ISSN: 0098-7484
Popis: Importance The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations. Objective To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating the optimal ages to begin and end screening; and identifying a set of model-recommendable strategies that provide similar life-years gained (LYG) and a comparable balance between LYG and screening burden. Design, Setting, and Participants Comparative modeling with 3 microsimulation models of a hypothetical cohort of previously unscreened US 40-year-olds with no prior CRC diagnosis. Exposures Screening with sensitive guaiac-based fecal occult blood testing, fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy with or without stool testing, computed tomographic colonography (CTC), or colonoscopy starting at age 45, 50, or 55 years and ending at age 75, 80, or 85 years. Screening intervals varied by modality. Full adherence for all strategies was assumed. Main Outcomes and Measures Life-years gained compared with no screening (benefit), lifetime number of colonoscopies required (burden), lifetime number of colonoscopy complications (harms), and ratios of incremental burden and benefit (efficiency ratios) per 1000 40-year-olds. Results The screening strategies provided LYG in the range of 152 to 313 per 1000 40-year-olds. Lifetime colonoscopy burden per 1000 persons ranged from fewer than 900 (FIT every 3 years from ages 55-75 years) to more than 7500 (colonoscopy screening every 5 years from ages 45-85 years). Harm from screening was at most 23 complications per 1000 persons screened. Strategies with screening beginning at age 50 years generally provided more LYG as well as more additional LYG per additional colonoscopy than strategies with screening beginning at age 55 years. There were limited empirical data to support a start age of 45 years. For persons adequately screened up to age 75 years, additional screening yielded small increases in LYG relative to the increase in colonoscopy burden. With screening from ages 50 to 75 years, 4 strategies yielded a comparable balance of screening burden and similar LYG (median LYG per 1000 across the models): colonoscopy every 10 years (270 LYG); sigmoidoscopy every 10 years with annual FIT (256 LYG); CTC every 5 years (248 LYG); and annual FIT (244 LYG). Conclusions and Relevance In this microsimulation modeling study of a previously unscreened population undergoing CRC screening that assumed 100% adherence, the strategies of colonoscopy every 10 years, annual FIT, sigmoidoscopy every 10 years with annual FIT, and CTC every 5 years performed from ages 50 through 75 years provided similar LYG and a comparable balance of benefit and screening burden.
Databáze: OpenAIRE
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