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Optimal age for screening colonoscopy: a modeling study.

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New guidelines suggest earlier colorectal cancer (CRC) screening. A simulation found optimal once-only screening colonoscopy around age 55, while multiple screenings should start by age 50.

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Health Economics

Background:

  • Recent colorectal cancer (CRC) screening guidelines advocate for earlier initiation.
  • Optimal timing for once-only and repeated screening colonoscopies requires examination.

Purpose of the Study:

  • To simulate and compare optimal ages for initiating CRC screening colonoscopies.
  • To evaluate the impact of screening colonoscopy timing on CRC mortality and years of potential life lost (YPLL).

Main Methods:

  • A Markov model simulated the adenoma-carcinoma process using German registry data.
  • Estimated CRC deaths and YPLL for a hypothetical German population undergoing single or multiple screening colonoscopies at various ages.

Main Results:

  • A single screening colonoscopy between ages 50-65 could reduce CRC deaths by 49-69% and YPLL by 51-68%.
  • Optimal age for once-only screening colonoscopy to maximize YPLL reduction was ~54 for men and ~56 for women.
  • Starting multiple (2-3) screening colonoscopies at age 50 or younger yielded greater benefits.

Conclusions:

  • For high-incidence countries like Germany, optimal once-only screening colonoscopy is around age 55, potentially younger for men.
  • If multiple screening colonoscopies are performed at 10-year intervals, initiation at age 50 or younger is recommended for both genders.