Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model
Abstract Background Real‐world data for patients with positive colorectal cancer (CRC) screening stool‐tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool‐test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for f...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-04-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.3662 |
| _version_ | 1819078301883301888 |
|---|---|
| author | Deborah A. Fisher Leila Saoud Kristen Hassmiller Lich A. Mark Fendrick A. Burak Ozbay Bijan J. Borah Michael Matney Marcus Parton Paul J. Limburg |
| author_facet | Deborah A. Fisher Leila Saoud Kristen Hassmiller Lich A. Mark Fendrick A. Burak Ozbay Bijan J. Borah Michael Matney Marcus Parton Paul J. Limburg |
| author_sort | Deborah A. Fisher |
| collection | DOAJ |
| description | Abstract Background Real‐world data for patients with positive colorectal cancer (CRC) screening stool‐tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool‐test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow‐up to a known positive stool‐based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow‐up colonoscopies after positive stool‐tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC‐AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow‐up/surveillance colonoscopies. Methods Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt‐sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base‐case adenoma sensitivity values were identical for screening and follow‐up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results As the differences in adenoma sensitivity for screening versus follow‐up/surveillance colonoscopies became greater, life‐years gained (LYG) and reductions in CRC‐related incidence and mortality versus no screening increased for mt‐sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base‐case scenario and with mt‐sDNA in a “medium impact” scenario. Conclusions Assuming identical adenoma sensitivities for screening and follow‐up/surveillance colonoscopies underestimate the potential benefits of stool‐based screening strategies. |
| first_indexed | 2024-12-21T19:10:56Z |
| format | Article |
| id | doaj.art-047a18430d5f486e99ab14cbe42156ee |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-21T19:10:56Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-047a18430d5f486e99ab14cbe42156ee2022-12-21T18:53:12ZengWileyCancer Medicine2045-76342021-04-011082855286410.1002/cam4.3662Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation modelDeborah A. Fisher0Leila Saoud1Kristen Hassmiller Lich2A. Mark Fendrick3A. Burak Ozbay4Bijan J. Borah5Michael Matney6Marcus Parton7Paul J. Limburg8Department of Medicine Division of Gastroenterology Duke University Durham NC USAExact Sciences Corporation Madison WI USADepartment of Health Policy & Management Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USADivision of Gastroenterology University of Michigan Ann Arbor MI USAExact Sciences Corporation Madison WI USADepartment of Health Services Research Mayo Clinic Rochester MN USAExact Sciences Corporation Madison WI USAExact Sciences Corporation Madison WI USADivision of Gastroenterology and Hepatology Mayo Clinic Rochester MN USAAbstract Background Real‐world data for patients with positive colorectal cancer (CRC) screening stool‐tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool‐test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow‐up to a known positive stool‐based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow‐up colonoscopies after positive stool‐tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC‐AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow‐up/surveillance colonoscopies. Methods Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt‐sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base‐case adenoma sensitivity values were identical for screening and follow‐up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results As the differences in adenoma sensitivity for screening versus follow‐up/surveillance colonoscopies became greater, life‐years gained (LYG) and reductions in CRC‐related incidence and mortality versus no screening increased for mt‐sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base‐case scenario and with mt‐sDNA in a “medium impact” scenario. Conclusions Assuming identical adenoma sensitivities for screening and follow‐up/surveillance colonoscopies underestimate the potential benefits of stool‐based screening strategies.https://doi.org/10.1002/cam4.3662adenomacolonoscopycolorectal neoplasmsdiagnostic screening programssensitivity and specificity |
| spellingShingle | Deborah A. Fisher Leila Saoud Kristen Hassmiller Lich A. Mark Fendrick A. Burak Ozbay Bijan J. Borah Michael Matney Marcus Parton Paul J. Limburg Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model Cancer Medicine adenoma colonoscopy colorectal neoplasms diagnostic screening programs sensitivity and specificity |
| title | Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model |
| title_full | Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model |
| title_fullStr | Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model |
| title_full_unstemmed | Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model |
| title_short | Impact of screening and follow‐up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC‐AIM microsimulation model |
| title_sort | impact of screening and follow up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the crc aim microsimulation model |
| topic | adenoma colonoscopy colorectal neoplasms diagnostic screening programs sensitivity and specificity |
| url | https://doi.org/10.1002/cam4.3662 |
| work_keys_str_mv | AT deborahafisher impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT leilasaoud impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT kristenhassmillerlich impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT amarkfendrick impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT aburakozbay impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT bijanjborah impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT michaelmatney impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT marcusparton impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel AT pauljlimburg impactofscreeningandfollowupcolonoscopyadenomasensitivityoncolorectalcancerscreeningoutcomesinthecrcaimmicrosimulationmodel |