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Showing content from https://pubmed.ncbi.nlm.nih.gov/29846933/ below:

The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline

. 2018 Jul 15;124(14):2964-2973. doi: 10.1002/cncr.31543. Epub 2018 May 30. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline

Affiliations

¹ Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
² Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
³ Surveillance Information Services, American Cancer Society, Atlanta, Georgia.
⁴ Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
⁵ University of Colorado Cancer Center, Denver, Colorado.
⁶ Fight Colorectal Cancer, Springfield, Missouri.
⁷ University of Colorado Cancer Center and Gastroenterology of the Rockies, Denver, Colorado.
⁸ Cancer Control Department, American Cancer Society, Atlanta, Georgia.

PMID: 29846933
PMCID: PMC6033623
DOI: 10.1002/cncr.31543

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The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline

Elisabeth F P Peterse et al. Cancer. 2018.

. 2018 Jul 15;124(14):2964-2973. doi: 10.1002/cncr.31543. Epub 2018 May 30. Affiliations

¹ Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
² Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
³ Surveillance Information Services, American Cancer Society, Atlanta, Georgia.
⁴ Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
⁵ University of Colorado Cancer Center, Denver, Colorado.
⁶ Fight Colorectal Cancer, Springfield, Missouri.
⁷ University of Colorado Cancer Center and Gastroenterology of the Rockies, Denver, Colorado.
⁸ Cancer Control Department, American Cancer Society, Atlanta, Georgia.

PMID: 29846933
PMCID: PMC6033623
DOI: 10.1002/cncr.31543

Item in Clipboard

Abstract

Background: In 2016, the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re-evaluated the optimal screening strategies in light of the increase in CRC diagnosed in young adults.

Methods: The authors adjusted the MISCAN-Colon model to reflect the higher CRC incidence in young adults, who were assumed to carry forward escalated disease risk as they age. Life-years gained (LYG; benefit), the number of colonoscopies (COL; burden) and the ratios of incremental burden to benefit (efficiency ratio [ER] = ΔCOL/ΔLYG) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start (40 years, 45 years, and 50 years) and ages to stop (75 years, 80 years, and 85 years) screening, and screening intervals (depending on screening modality). The authors then determined the model-recommended strategies in a similar way as was done for the US Preventive Services Task Force, using ER thresholds in accordance with the previously accepted ER of 39.

Results: Because of the higher CRC incidence, model-predicted LYG from screening increased compared with the previous analyses. Consequently, the balance of burden to benefit of screening improved and now 10-yearly colonoscopy screening starting at age 45 years resulted in an ER of 32. Other recommended strategies included fecal immunochemical testing annually, flexible sigmoidoscopy screening every 5 years, and computed tomographic colonography every 5 years.

Conclusions: This decision-analysis suggests that in light of the increase in CRC incidence among young adults, screening may be offered earlier than has previously been recommended. Cancer 2018;124:2964-73. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Keywords: advisory committees; colorectal neoplasms; early detection of cancer; incidence; models; preventive health services; theoretical.

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Figures
Figure 1

Algorithm used to select model‐recommended…

Figure 1

Algorithm used to select model‐recommended strategies. LYG indicates life‐years gained (current recommendation is…

Figure 1

Algorithm used to select model‐recommended strategies. LYG indicates life‐years gained (current recommendation is colonoscopy screening from ages 50 to 75 years every 10 years); ER, efficiency ratio. The ER is calculated as and is an incremental burden‐to‐benefits ratio. Threshold ERs of 40, 45, and 50 colonoscopies per LYG were evaluated. The stool‐based strategies (fecal immunochemical test, high‐sensitivity guaiac‐based fecal occult blood test, and multitarget stool DNA test) were combined into 1 class because they have a similar noncolonoscopy burden. CTC, computed tomographic colonography; SIG, flexible sigmoidoscopy.

Figure 2

Lifetime number of colonoscopies and…

Figure 2

Lifetime number of colonoscopies and life‐years gained (LYG) for colonoscopy screening strategies.

Figure 2

Lifetime number of colonoscopies and life‐years gained (LYG) for colonoscopy screening strategies.