Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality
Abstract Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence. Since adherence can have a large effect on screening outcomes, we aimed to compare the effectiveness of CRC screening str...
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Wiley
2020-01-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2735 |
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| author | Elvira D’Andrea Dennis J. Ahnen Daniel A. Sussman Mehdi Najafzadeh |
| author_facet | Elvira D’Andrea Dennis J. Ahnen Daniel A. Sussman Mehdi Najafzadeh |
| author_sort | Elvira D’Andrea |
| collection | DOAJ |
| description | Abstract Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence. Since adherence can have a large effect on screening outcomes, we aimed to compare the effectiveness of CRC screening strategies under reported adherence rates at the population level. We developed and validated a microsimulation model to assess the effectiveness of colonoscopy (COL), flexible sigmoidoscopy (FS), high‐sensitivity guaiac fecal occult blood‐test (HS‐gFOBT), fecal immunochemical test (FIT), multitarget stool DNA test (FIT‐DNA), computed tomography colonography (CTC), and methylated SEPT9 DNA test (SEPT9) in terms of CRC incidence and mortality, incremental life years gained (LYG), number of colonoscopies, and adverse events for men and women 50 years or older over their lifetime. We assessed outcomes under 100% adherence rates and reported adherence rates. We also performed sensitivity analyses to evaluate the impact of varying adherence levels on CRC outcomes. Assuming 100% adherence, FIT‐DNA, FIT, HS‐gFOBT, and SEPT9 averted 42‐45 CRC cases and 25‐26 CRC deaths, COL 46 cases and 26 deaths, CTC 39 cases and 23 deaths, FS 32 cases and 19 deaths per 1000 individuals. Assuming reported adherence, SEPT9 averted 37 CRC cases and 23 CRC deaths, COL 34 cases and 20 deaths, FIT‐DNA, FIT, CTC and HS‐gFOBT 16‐25 cases and 10‐16 deaths per 1000 individuals. LYG reflected the effectiveness of each strategy in reducing CRC cases and deaths. Adverse events were more common for COL (3.7 per 1000 screened) and annual SEPT9 (3.4 per 1000 screened), and proportional to the number of colonoscopies. Among the screening strategies recommended by USPSTF, colonoscopy results in the largest benefit when we account for adherence. Adherence rates higher than 65%‐70% would be required for any stool or blood‐based screening modality to match the benefits of colonoscopy. |
| format | Article |
| id | doaj-art-da307b81a5e24dfa86ff01f941459115 |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-da307b81a5e24dfa86ff01f9414591152025-08-25T10:14:05ZengWileyCancer Medicine2045-76342020-01-019282483610.1002/cam4.2735Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortalityElvira D’Andrea0Dennis J. Ahnen1Daniel A. Sussman2Mehdi Najafzadeh3Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women’s Hospital Harvard Medical School Boston MassachusettsSchool of Medicine and Gastroenterology of the Rockies University of Colorado Denver ColoradoDivision of Gastroenterology Department of Medicine University of Miami Miller School of Medicine Miami FloridaDivision of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women’s Hospital Harvard Medical School Boston MassachusettsAbstract Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence. Since adherence can have a large effect on screening outcomes, we aimed to compare the effectiveness of CRC screening strategies under reported adherence rates at the population level. We developed and validated a microsimulation model to assess the effectiveness of colonoscopy (COL), flexible sigmoidoscopy (FS), high‐sensitivity guaiac fecal occult blood‐test (HS‐gFOBT), fecal immunochemical test (FIT), multitarget stool DNA test (FIT‐DNA), computed tomography colonography (CTC), and methylated SEPT9 DNA test (SEPT9) in terms of CRC incidence and mortality, incremental life years gained (LYG), number of colonoscopies, and adverse events for men and women 50 years or older over their lifetime. We assessed outcomes under 100% adherence rates and reported adherence rates. We also performed sensitivity analyses to evaluate the impact of varying adherence levels on CRC outcomes. Assuming 100% adherence, FIT‐DNA, FIT, HS‐gFOBT, and SEPT9 averted 42‐45 CRC cases and 25‐26 CRC deaths, COL 46 cases and 26 deaths, CTC 39 cases and 23 deaths, FS 32 cases and 19 deaths per 1000 individuals. Assuming reported adherence, SEPT9 averted 37 CRC cases and 23 CRC deaths, COL 34 cases and 20 deaths, FIT‐DNA, FIT, CTC and HS‐gFOBT 16‐25 cases and 10‐16 deaths per 1000 individuals. LYG reflected the effectiveness of each strategy in reducing CRC cases and deaths. Adverse events were more common for COL (3.7 per 1000 screened) and annual SEPT9 (3.4 per 1000 screened), and proportional to the number of colonoscopies. Among the screening strategies recommended by USPSTF, colonoscopy results in the largest benefit when we account for adherence. Adherence rates higher than 65%‐70% would be required for any stool or blood‐based screening modality to match the benefits of colonoscopy.https://doi.org/10.1002/cam4.2735adherencecolorectal cancer screeningcompliancesimulation modeling |
| spellingShingle | Elvira D’Andrea Dennis J. Ahnen Daniel A. Sussman Mehdi Najafzadeh Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality Cancer Medicine adherence colorectal cancer screening compliance simulation modeling |
| title | Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| title_full | Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| title_fullStr | Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| title_full_unstemmed | Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| title_short | Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| title_sort | quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality |
| topic | adherence colorectal cancer screening compliance simulation modeling |
| url | https://doi.org/10.1002/cam4.2735 |
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