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Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.

ABSTRACT: Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years.To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result.Microsimulation model.Literature and data from the Surveillance, Epidemiology, and End Results program.Persons aged 50 years who had no adenomas or cancer detected on screening colonoscopy.Lifetime.Societal.No further screening or rescreening starting at age 60 years with colonoscopy every 10 years, annual highly sensitive guaiac fecal occult blood testing (HSFOBT), annual fecal immunochemical testing (FIT), or computed tomographic colonography (CTC) every 5 years.Lifetime cases of colorectal cancer, life expectancy, and lifetime costs per 1000 persons, assuming either perfect or imperfect adherence.Rescreening with any method substantially reduced the risk for colorectal cancer compared with no further screening (range, 7.7 to 12.6 lifetime cases per 1000 persons [perfect adherence] and 17.7 to 20.9 lifetime cases per 1000 persons [imperfect adherence] vs. 31.3 lifetime cases per 1000 persons with no further screening). In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy.Results were sensitive to test-specific adherence rates.Data on adherence to rescreening were limited.Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results.National Cancer Institute.

SUBMITTER: Knudsen AB

PROVIDER: S-EPMC3515652 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

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Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.

Knudsen Amy B AB Hur Chin C Gazelle G Scott GS Schrag Deborah D McFarland Elizabeth G EG Kuntz Karen M KM

Annals of internal medicine 20121101 9

<h4>Background</h4>Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years.<h4>Objective</h4>To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result.<h4>Design</h4>Microsimulation model.<h4>Data sources</h4>Literature and data from the Surveillance, Epidemiology, and End Results program.<h4>Target population</h4>Persons aged 50 years who had no adenomas or cancer dete ...[more]

PMID: 23128861

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Project description:OBJECTIVE:To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. DESIGN:Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). SETTING:A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. POPULATION:Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). COMPARISONS:Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. MAIN OUTCOME MEASURES:Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. RESULTS:Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. CONCLUSIONS:Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.

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Project description:BackgroundMammography trials, which are the primary sources of evidence for screening benefit, were conducted decades ago. Whether advances in systemic therapies have rendered previously observed benefits of screening less significant is unknown.ObjectiveTo compare the outcomes of breast cancer screening trials had they been conducted using contemporary systemic treatments with outcomes of trials conducted with previously used treatments.DesignComputer simulation model of 3 virtual screening trials with similar reductions in advanced-stage cancer cases but reflecting treatment patterns in 1975 (prechemotherapy era), 1999, or 2015 (treatment according to receptor status).Data sourcesMeta-analyses of screening and treatment trials; study of dissemination of primary systemic treatments; SEER (Surveillance, Epidemiology, and End Results) registry.Target populationU.S. women aged 50 to 74 years.Time horizon10 and 25 years.PerspectivePopulation.InterventionMammography, chemotherapy, tamoxifen, aromatase inhibitors, and trastuzumab.Outcome measuresBreast cancer mortality rate ratio (MRR) and absolute risk reduction (ARR) obtained by the difference in cumulative breast cancer mortality between control and screening groups.Results of base-case analysisAt 10 years, screening in a 1975 trial yielded an MRR of 90% and an ARR of 5 deaths per 10,000 women. A 2015 screening trial yielded a 10-year MRR of 90% and an ARR of 3 deaths per 10,000 women.Results of sensitivity analysisGreater reductions in advanced-stage disease yielded a greater screening effect, but MRRs remained similar across trials. However, ARRs were consistently lower under contemporary treatments. When contemporary treatments were available only for early-stage cases, the MRR was 88%.LimitationDisease models simplify reality and cannot capture all breast cancer subtypes.ConclusionAdvances in systemic therapies for breast cancer have not substantively reduced the relative benefits of screening but have likely reduced the absolute benefits because of their positive effect on breast cancer survival.Primary funding sourceUniversity of Washington and National Cancer Institute.

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Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.

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Rescreening of persons with a negative colonoscopy result: results from a microsimulation model.

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