Optimizing colonoscopy-based colorectal cancer screening by low-barrier, low-threshold pretesting.

Area of Science:

• Gastroenterology
• Preventive Medicine
• Oncology

Background:

• Conventional colorectal cancer (CRC) screening methods have limitations in targeting individuals most likely to benefit.
• The 'gateopener' concept proposes using a sensitive fecal immunochemical test (FIT) with a lower positivity threshold to better select individuals for colonoscopy.
• Optimizing this approach could enhance CRC incidence and mortality reduction.

Purpose of the Study:

• To explore the optimized use of 'gateopener' colonoscopy-based screening for reducing CRC incidence and mortality.
• To compare the effectiveness of 'gateopener' screening against conventional FIT-based and colonoscopy-based screening strategies using simulation.

Main Methods:

• Utilized the COSIMO simulation tool, a validated model for CRC screening.
• Modeled 'gateopener' screening using SENTiFIT-FOB Gold FIT at various low hemoglobin cut-offs (10, 8, 6, 4, and 3 μg/g feces).
• Compared outcomes of 'gateopener' screening scenarios with conventional screening colonoscopy and biennial FIT.

Main Results:

• Gateopener screening at cut-offs of 6, 4, or 3 μg/g significantly outperformed conventional screening colonoscopy in CRC incidence reduction (16%-72% more cases prevented over 10 years).
• All gateopener scenarios substantially increased prevented CRC deaths, with low cut-offs more than doubling the numbers achieved by conventional colonoscopy.
• Compared to biennial FIT, gateopener screening prevented 7%-163% more CRC cases and 12%-21% more CRC deaths, with lower cut-offs yielding higher gains.

Conclusions:

• 'Gateopener' colonoscopy-based screening demonstrates superior effectiveness in reducing CRC incidence and mortality compared to conventional screening methods.
• Lower hemoglobin detection thresholds in the 'gateopener' FIT significantly enhance screening effectiveness.
• A pilot study is recommended to assess the real-world feasibility of the 'gateopener' screening concept.