Optimal Stopping Ages for Colorectal Cancer Screening

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.