Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force

Area of Science:

• Preventive Medicine
• Gastroenterology
• Health Services Research

Background:

• The US Preventive Services Task Force (USPSTF) is revising its 2016 guidelines for colorectal cancer (CRC) screening.
• Updated evidence is needed to assess the benefits, burdens, and harms of various CRC screening strategies.

Purpose of the Study:

• To provide updated model-based estimates of CRC screening strategies.
• To identify strategies that efficiently balance life-years gained (LYG) with colonoscopy burden for USPSTF consideration.

Main Methods:

• Comparative modeling study using three microsimulation models.
• Evaluated screening from ages 45-85 with various tests (FIT, stool DNA, sigmoidoscopy, CT colonography, colonoscopy) in a hypothetical cohort of 40-year-old US individuals at average risk.
• Assessed LYG, lifetime colonoscopies, and complications; defined efficiency as fewer colonoscopies per additional LYG.

Main Results:

• Estimated LYG ranged from 171 to 381 per 1000 individuals; lifetime colonoscopies ranged from 624 to 6817.
• Screening initiation at age 45 was part of 41 of 49 efficient strategies identified across all models.
• Lowering the screening start age from 50 to 45 yielded an estimated 22-27 additional LYG per 1000 persons.

Conclusions:

• Colorectal cancer screening starting at age 45, utilizing stool tests, endoscopic procedures, or CT colonography, presents an efficient balance.
• This approach optimizes the trade-off between colonoscopy burden and life-years gained, informing updated screening recommendations.