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Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study.

Minmin Zhu1, Xuan Zhong2, Tong Liao3

  • 1Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen City, 518054, Guangdong, China. zhuminmin1982@163.com.

BMC Public Health
|March 1, 2024
PubMed
Summary

This study identifies efficient colorectal cancer (CRC) screening strategies for Shenzhen, finding that starting screening at age 40 is often optimal. Efficient strategies, like fecal immunochemical tests (FIT), can reduce CRC incidence and mortality, even with limited colonoscopy resources.

Keywords:
Colorectal cancerFecal immunochemical testMicrosimulation modelRisk assessment toolScreeningShenzhen

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Area of Science:

  • Public Health
  • Epidemiology
  • Health Economics

Background:

  • Colorectal cancer (CRC) presents a significant global health challenge due to high incidence and mortality rates.
  • Microsimulation models provide an efficient method for analyzing various CRC screening strategies.
  • This research focuses on identifying effective organized CRC screening strategies specifically for Shenzhen City.

Purpose of the Study:

  • To determine efficient organized colorectal cancer (CRC) screening strategies for Shenzhen City's population.
  • To evaluate the trade-offs between screening effectiveness (life-years gained) and resource utilization (colonoscopies).
  • To inform public health policy regarding CRC screening program design.

Main Methods:

  • A microsimulation model (CMOST) simulated CRC screening in 1 million individuals in Shenzhen.
  • Simulations incorporated two CRC development pathways and realistic participation rates.
  • Evaluated strategies included National Colorectal Polyp Care score (NCPCS), fecal immunochemical test (FIT), and risk-stratification (RS) models, with varying start/stop ages and intervals, followed by colonoscopy.

Main Results:

  • Screening strategies reduced CRC incidence by 30.9-59.0% and mortality by 41.5-71.3%, gaining 83-155 life-years (LYG) per 1000 individuals.
  • 23 out of 81 simulated strategies were deemed efficient, with most starting at age 40 and ending at age 70.
  • Optimal screening intervals varied: annual for NCPCS, biennial for FIT, and triennial for RS models.

Conclusions:

  • Efficient CRC screening strategies for Shenzhen's average-risk population were identified, with a common optimal start age of 40.
  • The choice of screening strategy, particularly FIT and NCPCS, should consider colonoscopy resource availability.
  • The study acknowledges potential age-dependency biases in the results for NCPCS and RS models.