Cascade colorectal cancer screening guidelines: a global conceptual model
Sidney J Winawer1, Justus Krabshuis, Rene Lambert
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. winawers@mskcc.org
Journal of Clinical Gastroenterology
|February 9, 2011
Summary
This study introduces a resource-driven cascade model for colorectal cancer screening, adapting evidence-based guidelines to available healthcare resources. It emphasizes "doing what you can with what you have" to improve colorectal cancer prevention and early detection globally.
Area of Science:
- Gastroenterology
- Public Health
- Health Services Research
Background:
- Traditional colorectal cancer screening guidelines prioritize effectiveness but may not suit all healthcare settings due to resource limitations.
- A new conceptual model for cascade colorectal cancer screening guidelines is proposed, balancing evidence-based practices with resource availability.
- This model emphasizes colonoscopy resources for prevention and early detection of colorectal cancer precursor lesions.
Purpose of the Study:
- To present a resource-driven, evidence-based conceptual model for cascade colorectal cancer screening guidelines.
- To adapt colorectal cancer screening recommendations to varying levels of medical and financial resources.
- To facilitate the development of flexible and applicable colorectal cancer screening strategies worldwide.
Main Methods:
- A systematic review of colorectal cancer screening was conducted to develop an evidence-based cascade model.
- Hierarchical recommendations were created considering different healthcare resource levels, particularly colonoscopy availability.
- A multidisciplinary review team, including experts from developed and developing countries, contributed to guideline development.
Main Results:
- Four distinct resource levels were defined, ranging from high to low, based on available data (colonoscopy, sigmoidoscopy, fecal occult blood tests).
- Colorectal cancer screening recommendations were tailored for each resource level for average-risk individuals.
- The model primarily considered endoscopic resources but allows for reordering of various screening tests.
Conclusions:
- Healthcare settings must assess their priorities and resources to determine the feasibility of colorectal cancer screening.
- The proposed cascade model aids decision-making for colorectal cancer screening methods in settings with sufficient resources and a significant disease burden.
- This adaptable, resource-driven model aims to enhance colorectal cancer screening globally, especially in developing nations facing rising incidence and mortality.
