Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer Journal Article


Authors: Meester, R. G. S.; Doubeni, C. A.; Zauber, A. G.; van Ballegooijen, M.; Corley, D. A.; Lansdorp-Vogelaar, I.
Article Title: Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer
Abstract: Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related to patients' post-colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) vs. primary colonoscopy screening for colorectal cancer. Using an established microsimulation model, we predicted the lifetime colorectal cancer incidence and mortality benefits of annual FIT vs. 10-yearly colonoscopy screening at differing ADR levels (quintiles; averages 15.3–38.7%), with colonoscopy performance assumptions estimated from community-based data on physician ADRs and patients' post-colonoscopy risk of cancer. For patients receiving FIT screening with follow-up colonoscopy by physicians from the highest ADR quintile, simulated lifetime cancer incidence and mortality were 28.8 and 5.4 per 1,000, respectively, vs. 20.6 and 4.4 for primary colonoscopy screening (risk ratios, RR = 1.40; 95% probability interval (PI), 1.19–1.71 for incidence, and RR = 1.22; 95%PI, 1.02–1.54 for mortality). With every 5% point ADR decrease, lifetime cancer incidence was predicted to increase on average 9.0% for FIT vs. 12.3% for colonoscopy, and mortality increased 9.9% vs. 13.3%. In ADR quintile 1, simulated mortality was lower for FIT than colonoscopy screening (10.1 vs. 11.8; RR = 0.85; 95%PI, 0.83–0.90), while incidences were more similar. This suggests that relative cancer incidence and mortality reductions for FIT vs. colonoscopy screening may differ by ADR, with fewer predicted deaths with colonoscopy screening in higher ADR settings and fewer deaths with annual FIT screening in lower ADR settings. © 2017 UICC
Keywords: controlled study; cancer risk; follow up; cancer incidence; colorectal cancer; cancer screening; mass screening; prediction; cancer mortality; colorectal neoplasms; simulation; chemistry; death; adenoma; models, statistical; colonoscopy; colorectal adenoma; statistical model; feces; early detection of cancer; early detection; procedures; occult blood test; humans; human; priority journal; article; early cancer diagnosis; immunochemical test
Journal Title: International Journal of Cancer
Volume: 141
Issue: 11
ISSN: 0020-7136
Publisher: John Wiley & Sons  
Date Published: 2017-12-01
Start Page: 2359
End Page: 2367
Language: English
DOI: 10.1002/ijc.30933
PUBMED: 28815573
PROVIDER: scopus
PMCID: PMC5890914
DOI/URL:
Notes: Article -- Export Date: 2 November 2017 -- Source: Scopus
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  1. Ann G Zauber
    216 Zauber