Model based evaluation of long‐term efficacy of existing and alternative colorectal cancer screening offers: A case study for Germany. Issue 9 (24th December 2021)

• Record Type: Journal Article
• Authors: Heisser, Thomas; Hoffmeister, Michael; Brenner, Hermann
• Is Part Of: International journal of cancer. Volume 150:Issue 9(2022)
• Page Start: 1471
• Page End: 1480
• Publication Date: 2021-12-24
• Subjects: colonoscopy -- colorectal cancer -- fecal immunochemical testing -- modeling -- screening; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33894
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: For individuals willing to minimize their lifetime risk of colorectal cancer (CRC), the most effective screening approach remains unclear. Here, we sought to compare the long‐term performance of existing and alternative CRC screening offers in a case study for Germany. Applying the perspective of a perfectly adhering man or woman at average risk, we used COSIMO, a validated Markov‐based multistate model, to simulate the effects of current CRC screening offers in Germany. These include age‐ and sex‐dependent offers for fecal immunochemical testing (FIT) or screening colonoscopy, which may be used twice starting at age 50 in men and age 55 in women. For comparison, we modeled screening colonoscopies at ages 50, 60 and 70, screening colonoscopies at ages 50 and 60, followed by biennial FITs and conventional FIT‐based strategies at varying intervals. We found that the highest reductions in lifetime risks of developing (76%‐84%) and dying from CRC (82%‐90%) were achieved by three colonoscopies, followed by annual FIT screening and strategies combining both modalities. In men, additional screening from age 70 onwards reduced the risk of dying from CRC by another 9% units and resulted in 32 to 39 additional life‐years‐gained per 1000 individuals. Among women, three colonoscopies outperformed current screening offers in all outcomes, at little risk of screening‐related complications. In summary, several FIT‐ and colonoscopy‐based offers yield comparably high CRC risk reductions, including approaches combining both modalities. German screening offers may be optimized by lowering the eligibility age for screening colonoscopy for women, along with additional offers for the elderly. Abstract : What's new? Endoscopy‐ and fecal test‐based colorectal cancer screening strategies have been introduced in population‐based screening programmes around the world. However, it remains unclear which screening strategy may be most effective. Using a validated simulation tool, here the authors compare the long‐term performance of the age‐ and sex‐dependent screening strategies currently offered in Germany to potential alternatives. This case study illustrates strong potential for improvement of the currently‐offered German screening options. In particular, screening colonoscopy could be offered from age 50 to both sexes and complementary screening options could be made available at older ages, preferably based on fecal testing.