Projected colorectal cancer incidence and mortality based on observed adherence to colonoscopy and sequential stool-based screening Journal Article
| Authors: | Meester, R. G. S.; Lansdorp-Vogelaar, I.; Winawer, S. J.; Church, T. R.; Allen, J. I.; Feld, A. D.; Mills, G.; Jordan, P. A.; Corley, D. A.; Doubeni, C. A.; Hahn, A. I.; Lobaugh, S. M.; Fleisher, M.; O'Brien, M. J.; Zauber, A. G. |
| Article Title: | Projected colorectal cancer incidence and mortality based on observed adherence to colonoscopy and sequential stool-based screening |
| Abstract: | INTRODUCTION: Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening colonoscopy every 10 years vs annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. METHODs: The MIcrosimulation SCreening ANalysis (MISCAN) model used observed sequential screening adherence, HSgFOBT positivity, and diagnostic colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (single-screening colonoscopy vs ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening or 10 yearly screening colonoscopy vs annual HSgFOBT with 100% and differential observed adherence from the trial. RESULTS: Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval 15.8-26.9) and 6.9 (5.0-9.2) per 1,000 participants, respectively. In the case of 100% adherence, only screening colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening colonoscopy and 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening colonoscopy vs HSgFOBT was 0.75 (95% probability interval 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. DISCUSSION: Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable - as observed in the national colonoscopy study, microsimulation, comparative effectiveness, screening recommendations. © 2024 by The American College of Gastroenterology. |
| Keywords: | adult; aged; middle aged; mortality; cancer risk; cancer incidence; sensitivity and specificity; sensitivity analysis; colorectal cancer; incidence; cancer screening; mass screening; cancer mortality; colorectal neoplasms; colonoscopy; colorectal tumor; diagnosis; patient compliance; screening test; life expectancy; feces; early detection of cancer; sigmoidoscopy; occult blood; feces analysis; guaiac; comparative effectiveness; diagnostic test accuracy study; procedures; humans; human; male; female; article; early cancer diagnosis |
| Journal Title: | American Journal of Gastroenterology |
| Volume: | 119 |
| Issue: | 7 |
| ISSN: | 0002-9270 |
| Publisher: | Wolters Kluwer Health |
| Date Published: | 2024-07-01 |
| Start Page: | 1392 |
| End Page: | 1401 |
| Language: | English |
| DOI: | 10.14309/ajg.0000000000002693 |
| PUBMED: | 38318949 |
| PROVIDER: | scopus |
| PMCID: | PMC11222052 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Ann Zauber -- Source: Scopus |
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