Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation...

Area of Science:

• Oncology
• Preventive Medicine
• Health Services Research

Background:

• Colorectal cancer (CRC) remains a significant public health concern, necessitating effective screening strategies.
• Risk stratification is crucial for tailoring screening interventions to individual patient profiles.

Purpose of the Study:

• To evaluate the comparative benefits and harms of various colorectal cancer screening strategies.
• To stratify these effects based on baseline 15-year CRC risk.

Main Methods:

• A microsimulation modeling study using the MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon) model.
• Compared biennial or annual fecal immunochemical test (FIT), single sigmoidoscopy, and single colonoscopy against no screening in Norwegian adults aged 50-79.
• Assessed CRC mortality, incidence, burdens, and harms over 15 years, using GRADE for evidence certainty.

Main Results:

• All tested screening strategies reduced CRC mortality by 5-6 per 1000 individuals over 15 years.
• Colonoscopy and sigmoidoscopy showed greater reductions in CRC incidence (10 and 8 per 1000, respectively) compared to annual FIT (4 per 1000) and biennial FIT (1 per 1000).
• Serious harms were infrequent (3-5 per 1000), with similar magnitudes across strategies, increasing slightly with older age.

Conclusions:

• Over 15 years, various colorectal cancer screening strategies offer similar reductions in mortality.
• Endoscopic methods (colonoscopy, sigmoidoscopy) demonstrate greater potential for reducing CRC incidence compared to FIT.
• The study highlights that harms are rare and comparable across screening modalities, with benefits amplified in higher-risk individuals.