Evaluating test strategies for colorectal cancer screening : age to begin, age to stop, and timing of screening intervals : a decision analysis of colorectal cancer screening for the U.S. Preventive Services Task Force from the Cancer Intervention and Surveillance Modeling Network (CISNET)
BACKGROUND: The U.S. Preventive Services Task Force requested a decision analysis to inform their update of the recommendations for colorectal cancer (CRC) screening. OBJECTIVE: To assess life-years gained and colonoscopy requirements for CRC screening strategies and identify a set of recommendable...
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Agency for Healthcare Research and Quality (US)
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|Summary:||BACKGROUND: The U.S. Preventive Services Task Force requested a decision analysis to inform their update of the recommendations for colorectal cancer (CRC) screening. OBJECTIVE: To assess life-years gained and colonoscopy requirements for CRC screening strategies and identify a set of recommendable screening strategies. DESIGN: Decision analysis using two CRC microsimulation models from the Cancer Intervention and Surveillance Modeling Network. DATA SOURCES: Derived from recent published literature on test characteristics of single use applications of various screening strategies. TARGET POPULATION: U.S. average-risk 40-year-old population. PERSPECTIVE: Societal. TIME HORIZON: Lifetime. INTERVENTIONS: Fecal occult blood tests (FOBTs), flexible sigmoidoscopy, or colonoscopy screening beginning at age 40, 50, or 60 and stopping at age 75 or 85 with screening intervals of 1, 2, or 3 years for FOBT and 5, 10, or 20 years for sigmoidoscopy and colonoscopy.|
CONCLUSIONS: Our findings support CRC screening from ages 50 to 75 with annual screening with a high sensitivity FOBT, 10-yearly colonoscopy, or high sensitivity FOBT every 2 to 3 years with a 5-yearly flexible sigmoidoscopy
OUTCOME MEASURES: Number of life-years gained compared with no screening and number of colonoscopies and non-colonoscopy tests required. RESULTS OF BASE-CASE ANALYSIS: Beginning screening at age 50 was consistently better than age 60. Lowering the stop age from 85 to 75 decreased life-years gained by 1% to 4%, while colonoscopy use fell by 4% to 15%. Assuming equally high adherence, four strategies provided comparable life-years gained, namely 10-yearly colonoscopy, annual Hemoccult SENSA or fecal immunochemical test, and 5-yearly flexible sigmoidoscopy in conjunction with Hemoccult SENSA every 2 to 3 years. Annual Hemoccult II alone and 5-yearly flexible sigmoidoscopy alone were less effective. RESULTS OF SENSITIVITY ANALYSIS: The results were most sensitive to beginning screening at age 40. LIMITATIONS: Stopping age for screening was based only on chronological age.
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