Screening for colorectal cancer: spoiled for choice?

Area of Science:

• Oncology
• Public Health
• Health Economics

Background:

• Colorectal cancer (CRC) screening strategies vary in effectiveness and resource impact.
• Cost-effectiveness analysis is crucial for determining optimal CRC screening approaches.
• Decision models aid in comparing diverse screening modalities.

Purpose of the Study:

• To review recent decision models comparing flexible sigmoidoscopy and fecal immunochemical test (FIT) screening for colorectal cancer.
• To evaluate the cost-effectiveness and mortality benefits of different CRC screening strategies.

Main Methods:

• Review of recent decision models utilizing Markov or microsimulation.
• Comparison of one-off flexible sigmoidoscopy versus FIT-based screening strategies.
• Assessment of cost-effectiveness and health service impact.

Main Results:

• All population-based screening is more cost-effective than no screening.
• FIT-based screening demonstrates greater effectiveness in reducing CRC mortality compared to one-off sigmoidoscopy.
• Combining sigmoidoscopy with FIT yields the highest life-saving potential but also the greatest health service burden.

Conclusions:

• Biennial FIT-based screening aligns with current evidence for cost-effective CRC population screening.
• FIT-based screening is a preferred strategy over one-off sigmoidoscopy for CRC mortality reduction.
• Combined screening strategies offer maximum benefit but require careful consideration of resource allocation.