Modeling Population-Level Impacts of Cell-Free DNA Screening for Colorectal Cancer in Canada
John M Hutchinson1, Yibing Ruan2, Brendan J Chia3
1Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA Oncology
|May 1, 2025
Summary
Cell-free DNA (cfDNA) screening for colorectal cancer shows promise for increased detection and reduced mortality in Canada. However, high population participation is crucial for cfDNA testing to outperform existing methods like FIT.
Area of Science:
- Oncology
- Public Health
- Health Economics
Background:
- Cell-free DNA (cfDNA) testing is an emerging colorectal cancer screening method approved in the US.
- The impact of cfDNA screening in Canada, considering real-world adherence and assay performance, remains unquantified.
Purpose of the Study:
- To estimate the clinical and economic outcomes of cfDNA screening in Canada.
- To compare cfDNA screening with existing methods: fecal immunochemical testing (FIT) and colonoscopies.
Main Methods:
- Utilized the OncoSim-Colorectal model (version 3.6.5.7) for simulation.
- Modeled a population of 32 million Canadians from 2024 to 2092.
- Assessed outcomes including cancer cases, deaths, life-years, and costs for colonoscopy, FIT, and cfDNA screening.
Main Results:
- cfDNA screening detected significantly more colorectal cancer cases (393,087) compared to FIT (156,009) under higher participation scenarios.
- cfDNA screening reduced overall mortality by 121,383 deaths compared to FIT.
- Achieving lower mortality than colonoscopy requires high cfDNA participation (78% with 80% adherence or 69% with 100% adherence).
- cfDNA testing incurred higher costs per health-adjusted life-year (CAD $234.80) and had a higher cost per death averted compared to FIT.
- Lower participation rates for cfDNA (43%) resulted in worse population outcomes than FIT, highlighting the importance of uptake.
Conclusions:
- cfDNA testing has the potential to increase colorectal cancer detection and reduce mortality in Canada.
- Realizing these benefits is contingent upon achieving higher population participation rates than previously observed.
- Further research into patient acceptance of blood-based versus stool-based screening is essential for successful implementation.
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