Combining Colonoscopy With Fecal Immunochemical Test Can Improve Current Familial Colorectal Cancer Colonoscopy...

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Familial colorectal cancer (FCRC) surveillance aims to optimize care for individuals with an increased risk of CRC due to family history.
• Current surveillance strategies may not be the most efficient or cost-effective methods for managing FCRC risk.

Purpose of the Study:

• To assess and optimize familial colorectal cancer (FCRC) surveillance strategies in individuals without hereditary CRC.
• To identify the most effective and cost-efficient surveillance approach balancing benefits and burdens.

Main Methods:

• The Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA)-FCRC model was used to simulate CRC development in individuals with 2-fold and 4-fold increased CRC risk.
• Simulated strategies included no surveillance, the current Dutch guideline (5-yearly colonoscopy), and various combinations of colonoscopy and fecal immunochemical testing (FIT) at different intervals and age ranges.
• The optimal strategy was defined by maximizing quality-adjusted life-years (QALYs) while meeting criteria for cost-effectiveness, non-inferior effectiveness, and manageable colonoscopy burden compared to current surveillance.

Main Results:

• The optimal strategy involved 10-yearly colonoscopy with 2-yearly FIT between ages 40 to 80 years for both 2-fold and 4-fold increased CRC risk.
• For 2-fold risk, this strategy prevented more CRC deaths, gained QALYs, reduced colonoscopies by 731, and saved €98,000 per 1000 individuals compared to current surveillance.
• For 4-fold risk, it prevented more CRC deaths, gained QALYs, reduced colonoscopies by 567, and saved €127,000 per 1000 individuals, demonstrating superior efficiency over current methods.

Conclusions:

• Fecal immunochemical testing (FIT) can significantly enhance FCRC surveillance effectiveness and efficiency.
• The proposed strategy of 10-yearly colonoscopy combined with biennial FIT increases QALYs, reduces the colonoscopy burden, and lowers costs compared to current FCRC surveillance protocols.