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Evaluating Test Strategies for Colorectal Cancer Screening—Age to Begin, Age to Stop, and Timing of Screening Intervals

A Decision Analysis of Colorectal Cancer Screening for the U.S. Preventive Services Task Force from the Cancer Intervention and Surveillance Modeling Network (CISNET)

Evidence Syntheses, No. 65.2

, PhD, , MS, , PhD, , MS, , MD, PhD, and , ScD.

Author Information

, PhD,1,* , MS,2 , PhD,3 , MS,2 , MD, PhD,2 and , ScD4.

1 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
2 Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
3 Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
4 Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
*Corresponding Author: Ann G Zauber, PhD, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065, 646-735-8160 (office), 646-735-0012 (fax). gro.ccksm@rebuaz
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 08-05124-EF-2

Structured Abstract

Background:

The U.S. Preventive Services Task Force requested a decision analysis to inform their update of the recommendations for colorectal cancer (CRC) screening.

Objective:

To assess life-years gained and colonoscopy requirements for CRC screening strategies and identify a set of recommendable screening strategies.

Design:

Decision analysis using two CRC microsimulation models from the Cancer Intervention and Surveillance Modeling Network.

Data Sources:

Derived from recent published literature on test characteristics of single use applications of various screening strategies.

Target Population:

U.S. average-risk 40-year-old population.

Perspective:

Societal.

Time Horizon:

Lifetime.

Interventions:

Fecal occult blood tests (FOBTs), flexible sigmoidoscopy, or colonoscopy screening beginning at age 40, 50, or 60 and stopping at age 75 or 85 with screening intervals of 1, 2, or 3 years for FOBT and 5, 10, or 20 years for sigmoidoscopy and colonoscopy.

Outcome Measures:

Number of life-years gained compared with no screening and number of colonoscopies and non-colonoscopy tests required.

Results of Base-Case Analysis:

Beginning screening at age 50 was consistently better than age 60. Lowering the stop age from 85 to 75 decreased life-years gained by 1% to 4%, while colonoscopy use fell by 4% to 15%. Assuming equally high adherence, four strategies provided comparable life-years gained, namely 10-yearly colonoscopy, annual Hemoccult SENSA or fecal immunochemical test, and 5-yearly flexible sigmoidoscopy in conjunction with Hemoccult SENSA every 2 to 3 years. Annual Hemoccult II alone and 5-yearly flexible sigmoidoscopy alone were less effective.

Results of Sensitivity Analysis:

The results were most sensitive to beginning screening at age 40.

Limitations:

Stopping age for screening was based only on chronological age.

Conclusions:

Our findings support CRC screening from ages 50 to 75 with annual screening with a high sensitivity FOBT, 10-yearly colonoscopy, or high sensitivity FOBT every 2 to 3 years with a 5-yearly flexible sigmoidoscopy.

U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

This report was funded by the National Cancer Institute (U01-CA-088204, U01-CA-097426, and U01-CA-115953) and the Agency for Healthcare Research and Quality1 (HHSP233200700350P, HHSP233200700210P, and HHSP233200700196P).

Suggested citation:

Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating Test Strategies for Colorectal Cancer Screening—Age to Begin, Age to Stop, and Timing of Screening Intervals: A Decision Analysis of Colorectal Cancer Screening for the U.S. Preventive Services Task Force from the Cancer Intervention and Surveillance Modeling Network (CISNET). Evidence Synthesis No. 65, Part 2. AHRQ Publication No. 08-05124-EF-2. Rockville, Maryland, Agency for Healthcare Research and Quality, March 2009.

The findings and conclusions in this document are those of the authors who are responsible for its contents; the finding s and conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK34013PMID: 20722163
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