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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
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Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential

Reinier G S Meester1, Iris Lansdorp-Vogelaar1, Sidney J Winawer2

  • 1Public Health Department, Erasmus MC, Rotterdam, the Netherlands.

The American Journal of Gastroenterology
|February 6, 2024
PubMed
Summary
This summary is machine-generated.

Screening colonoscopy every 10 years is more effective than annual fecal occult blood testing for reducing colorectal cancer incidence and mortality, especially when adherence is suboptimal. This study highlights the importance of adherence in screening test effectiveness.

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Area of Science:

  • Gastroenterology
  • Preventive Medicine
  • Health Services Research

Background:

  • Colorectal cancer (CRC) screening models often assume perfect adherence, but real-world adherence impacts long-term effectiveness.
  • Observed adherence rates for screening colonoscopy and stool-based tests like fecal occult blood testing (FOBT) differ significantly.
  • The comparative effectiveness of CRC screening strategies under realistic adherence scenarios is not well understood.

Purpose of the Study:

  • To evaluate the long-term effectiveness of screening colonoscopy every 10 years versus annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data.
  • To compare CRC incidence and mortality rates between different screening strategies under varying adherence levels.
  • To inform screening recommendations by assessing the impact of adherence on CRC prevention.

Main Methods:

  • Utilized the MIcrosimulation SCreening ANalysis (MISCAN) model incorporating observed sequential screening adherence data from the National Colonoscopy Study.
  • Compared CRC incidence and mortality over 15 years for no screening, 10-yearly screening colonoscopy, and annual HSgFOBT.
  • Modeled scenarios with 100% adherence and differential observed adherence rates for both screening modalities.

Main Results:

  • Without screening, simulated CRC incidence and mortality were 20.9 and 6.9 per 1,000 participants over 15 years.
  • With 100% adherence, screening colonoscopy reduced incidence more than HSgFOBT, while both lowered mortality similarly.
  • Observed adherence was higher for screening colonoscopy (83.6%) than for HSgFOBT (49.1% by round 4), leading to significantly lower simulated CRC incidence and mortality with colonoscopy compared to HSgFOBT.

Conclusions:

  • Screening colonoscopy every 10 years demonstrates superior effectiveness in reducing CRC incidence and mortality compared to annual HSgFOBT when accounting for observed, suboptimal adherence.
  • The findings underscore the critical role of adherence in the real-world performance of CRC screening tests.
  • Colonoscopy may be preferred when adherence to sequential stool-based testing is suboptimal and colonoscopy is accessible and acceptable.