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Showing content from https://pubmed.ncbi.nlm.nih.gov/33548185/ below:

Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study

Comparative Study

doi: 10.1016/S2468-1253(21)00003-0. Epub 2021 Feb 3. Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study Joachim Worthington², Francine van Wifferen³, Nicolas Iragorri⁴, Elisabeth F P Peterse⁵, Jie-Bin Lew², Marjolein J E Greuter³, Heather A Smith⁶, Eleonora Feletto², Jean H E Yong⁷, Karen Canfell⁸, Veerle M H Coupé³, Iris Lansdorp-Vogelaar⁵; COVID-19 and Cancer Global Modelling Consortium working group 2

Affiliations

¹ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: l.dejonge.3@erasmusmc.nl.
² Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
³ Department of Epidemiology and Data Science, Decision Modelling Center, Amsterdam University Medical Center, Amsterdam, Netherlands.
⁴ Canadian Partnership against Cancer, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
⁶ Telfer School of Management, University of Ottawa, Ottawa, ON, Canada.
⁷ Canadian Partnership against Cancer, Toronto, ON, Canada.
⁸ Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.

PMID: 33548185
PMCID: PMC9767453
DOI: 10.1016/S2468-1253(21)00003-0

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Comparative Study

Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study

Lucie de Jonge et al. Lancet Gastroenterol Hepatol. 2021 Apr.

doi: 10.1016/S2468-1253(21)00003-0. Epub 2021 Feb 3. Authors Lucie de Jonge¹, Joachim Worthington², Francine van Wifferen³, Nicolas Iragorri⁴, Elisabeth F P Peterse⁵, Jie-Bin Lew², Marjolein J E Greuter³, Heather A Smith⁶, Eleonora Feletto², Jean H E Yong⁷, Karen Canfell⁸, Veerle M H Coupé³, Iris Lansdorp-Vogelaar⁵; COVID-19 and Cancer Global Modelling Consortium working group 2 Affiliations

¹ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: l.dejonge.3@erasmusmc.nl.
² Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
³ Department of Epidemiology and Data Science, Decision Modelling Center, Amsterdam University Medical Center, Amsterdam, Netherlands.
⁴ Canadian Partnership against Cancer, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
⁶ Telfer School of Management, University of Ottawa, Ottawa, ON, Canada.
⁷ Canadian Partnership against Cancer, Toronto, ON, Canada.
⁸ Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.

PMID: 33548185
PMCID: PMC9767453
DOI: 10.1016/S2468-1253(21)00003-0

Item in Clipboard

Abstract

Background: Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and mortality in three countries using microsimulation modelling.

Methods: In this modelling study, we used four country-specific colorectal cancer microsimulation models-Policy1-Bowel (Australia), OncoSim (Canada), and ASCCA and MISCAN-Colon (the Netherlands)-to estimate the potential impact of COVID-19-related disruptions to screening on colorectal cancer incidence and mortality in Australia, Canada, and the Netherlands annually for the period 2020-24 and cumulatively for the period 2020-50. Modelled scenarios varied by duration of disruption (3, 6, and 12 months), decreases in screening participation after the period of disruption (0%, 25%, or 50% reduction), and catch-up screening strategies (within 6 months after the disruption period or all screening delayed by 6 months).

Findings: Without catch-up screening, our analysis predicted that colorectal cancer deaths among individuals aged 50 years and older, a 3-month disruption would result in 414-902 additional new colorectal cancer diagnoses (relative increase 0·1-0·2%) and 324-440 additional deaths (relative increase 0·2-0·3%) in the Netherlands, 1672 additional diagnoses (relative increase 0·3%) and 979 additional deaths (relative increase 0·5%) in Australia, and 1671 additional diagnoses (relative increase 0·2%) and 799 additional deaths (relative increase 0·3%) in Canada between 2020 and 2050, compared with undisrupted screening. A 6-month disruption would result in 803-1803 additional diagnoses (relative increase 0·2-0·4%) and 678-881 additional deaths (relative increase 0·4-0·6%) in the Netherlands, 3552 additional diagnoses (relative increase 0·6%) and 1961 additional deaths (relative increase 1·0%) in Australia, and 2844 additional diagnoses (relative increase 0·3%) and 1319 additional deaths (relative increase 0·4%) in Canada between 2020 and 2050, compared with undisrupted screening. A 12-month disruption would result in 1619-3615 additional diagnoses (relative increase 0·4-0·9%) and 1360-1762 additional deaths (relative increase 0·8-1·2%) in the Netherlands, 7140 additional diagnoses (relative increase 1·2%) and 3968 additional deaths (relative increase 2·0%) in Australia, and 5212 additional diagnoses (relative increase 0·6%) and 2366 additional deaths (relative increase 0·8%) in Canada between 2020 and 2050, compared with undisrupted screening. Providing immediate catch-up screening could minimise the impact of the disruption, restricting the relative increase in colorectal cancer incidence and deaths between 2020 and 2050 to less than 0·1% in all countries. A post-disruption decrease in participation could increase colorectal cancer incidence by 0·2-0·9% and deaths by 0·6-1·6% between 2020 and 2050, compared with undisrupted screening.

Interpretation: Although the projected effect of short-term disruption to colorectal cancer screening is modest, such disruption will have a marked impact on colorectal cancer incidence and deaths between 2020 and 2050 attributable to missed screening. Thus, it is crucial that, if disrupted, screening programmes ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, since this could mitigate the impact on colorectal cancer deaths.

Funding: Cancer Council New South Wales, Health Canada, and Dutch National Institute for Public Health and Environment.

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Figures
Figure 1

Natural history of colorectal cancer…

Figure 1

Natural history of colorectal cancer simulated by MISCAN-Colon, ASCCA, Policy1-Bowel, and OncoSim models…

Figure 1

Natural history of colorectal cancer simulated by MISCAN-Colon, ASCCA, Policy1-Bowel, and OncoSim models MISCAN-Colon and OncoSim only simulate the adenoma-carcinoma pathway, whereas ASCCA and Policy1-Bowel models include both the adenoma-carcinoma pathway and the serrated pathway. *ASCCA and Policy1-Bowel additionally assume that small and medium adenomas with high-grade dysplasia or villous structure and serrated sessile adenomas can progress to preclinical colorectal cancer.

Figure 2

Projected changes in colorectal cancer…

Figure 2

Projected changes in colorectal cancer mortality among individuals aged 50 years and older…

Figure 2

Projected changes in colorectal cancer mortality among individuals aged 50 years and older relative to the comparator scenario according to MISCAN-Colon, ASCCA, Policy1-Bowel and OncoSim models For the base case scenario, a 6-month disruption period from April to September, 2020, was assumed, with no catch-up or changes to participation in the recovery period. The predicted number of colorectal cancer deaths in 2020 in the comparator scenario was 4112 according to MISCAN-Colon, 5208 according to ASCCA, 6198 according to Policy1-Bowel, and 8134 according to OncoSim. MISCAN-Colon=MIcrosimulation SCreening ANalysis for colorectal cancer. ASCCA=Adenoma and Serrated pathway to Colorectal Cancer.

Figure 3

Projected changes in colorectal cancer…

Figure 3

Projected changes in colorectal cancer incidence among individuals aged 50 years and older…

Figure 3

Projected changes in colorectal cancer incidence among individuals aged 50 years and older relative to the comparator scenario according to MISCAN-Colon, ASCCA, Policy1-Bowel and OncoSim models For the base case scenario, a 6-month disruption period from April to September, 2020 was assumed, with no catch-up screening or changes to participation in the recovery period. The predicted number of colorectal cancer cases in 2020 for the comparator scenario was 12 512 according to MISCAN-Colon, 13 562 according to ASCCA, 17 391 according to Policy1-Bowel, and 21 721 according to OncoSim. MISCAN-Colon=MIcrosimulation SCreening ANalysis for colorectal cancer. ASCCA=Adenoma and Serrated pathway to Colorectal Cancer.