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Optimal Stopping Ages for Colorectal Cancer Screening.

Matthias Harlass1, Ronit R Dalmat2, Jessica Chubak3,4

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Optimal colorectal cancer (CRC) screening ages vary by individual factors like sex, health, and screening history. This study identifies personalized stopping ages for CRC screening to improve cost-effectiveness and guide decision-making.

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Area of Science:

  • Oncology
  • Health Economics
  • Preventive Medicine

Background:

  • Colorectal cancer (CRC) screening benefits, harms, and costs vary by patient characteristics.
  • Previous studies on CRC screening cessation were hypothetical and lacked real-world data.
  • Individualized screening strategies are needed for older adults.

Purpose of the Study:

  • To determine optimal ages to stop CRC screening based on sex, comorbidity, and screening history.
  • To evaluate CRC screening from a cost-effectiveness perspective in older populations.
  • To inform clinical guidelines and patient decision-making for CRC screening.

Main Methods:

  • Economic evaluation using the MISCAN-Colon microsimulation model.
  • Model validation against community-based CRC incidence and mortality data.
  • Simulation of CRC screening scenarios in US adults aged 76-90 years, varying by sex and comorbidity.

Main Results:

  • Optimal CRC screening cessation ages varied significantly by sex, comorbidity, and prior screening history.
  • Older age, male sex, higher comorbidity, and recent screening reduced cost-effectiveness.
  • Optimal stopping ages ranged from <76 to 86 years for colonoscopy and <76 to 88 years for FIT.

Conclusions:

  • CRC screening cessation age should be individualized based on patient factors.
  • Cost-effectiveness of screening decreases with older age, higher comorbidity, and recent screening.
  • Findings support personalized CRC screening recommendations and informed patient choices.