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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
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A Comparative Environmental Impact Analysis of Screening Tests for Colorectal Cancer.

Vivek A Rudrapatna1, Tzu An Wang2, Parsia Vazirnia3

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Fecal immunochemical tests (FITs) are the most environmentally friendly colorectal cancer (CRC) screening option. Prioritizing FITs over colonoscopies can significantly reduce healthcare

Keywords:
climate changecolonoscopycolorectal cancer screeningcomputed tomography colonographyfecal immunochemical testglobal healthglobal warminggreenhouse gas emissionshealth economicshealthcare sustainabilitylife cycle assessmentpopulation health

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Area of Science:

  • Environmental science and public health
  • Comparative life cycle assessment
  • Healthcare sustainability

Background:

  • Healthcare contributes significantly to global greenhouse gas emissions.
  • Colorectal cancer (CRC) screening is a widely utilized US healthcare service for 134 million adults.
  • Screening options include annual fecal immunochemical tests (FITs), CT colonography (CTC) every 5 years, or colonoscopy every 10 years.

Purpose of the Study:

  • To compare the environmental impacts of different CRC screening strategies.
  • To identify opportunities for reducing the environmental footprint of CRC screening.
  • To assess the population health benefits of prioritizing less impactful screening methods.

Main Methods:

  • Comparative life cycle assessment (LCA) of FITs, CTCs, and colonoscopies.
  • On-site audits to document materials and energy consumption.
  • ReCiPe 2016 method for estimating global warming potential (GWP) and human health damage.
  • Markov reward model for 10-year cumulative impacts and Monte Carlo simulations for uncertainty analysis.

Main Results:

  • FIT-based screening demonstrated the lowest environmental impacts, with a ~20% advantage over colonoscopies, robust in sensitivity analyses.
  • Patient and staff transportation via car was the primary contributor to environmental harm across all screening tests.
  • Prioritizing FITs over colonoscopies could yield ~5.2 million disability-adjusted life years (DALYs) per decade.
  • Transitioning to electric vehicles could decrease the GWP of all screening tests by 15-20%.

Conclusions:

  • Payors should prioritize FITs for low-risk patients due to similar efficacy and safety profiles.
  • Government initiatives supporting transportation decarbonization, telehealth, and environmental product declarations are crucial for reducing healthcare's environmental impact.
  • Resource-intensive preventative strategies for low-risk populations warrant careful consideration to avoid potential harm.