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Optimizing colorectal cancer screening by race and sex: Microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline
Author(s) -
Meester Reinier G. S.,
Peterse Elisabeth F. P.,
Knudsen Amy B.,
de Weerdt Anne C.,
Chen Jennifer C.,
Lietz Anna P.,
Dwyer Andrea,
Ahnen Dennis J.,
Siegel Rebecca L.,
Smith Robert A.,
Zauber Ann G.,
LansdorpVogelaar Iris
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31542
Subject(s) - medicine , microsimulation , colorectal cancer , demography , incidence (geometry) , guideline , colonoscopy , cancer , cancer screening , gerontology , pathology , sociology , physics , optics , transport engineering , engineering
BACKGROUND Colorectal cancer (CRC) risk varies by race and sex. This study, 1 of 2 microsimulation analyses to inform the 2018 American Cancer Society CRC screening guideline, explored the influence of race and sex on optimal CRC screening strategies. METHODS Two Cancer Intervention and Surveillance Modeling Network microsimulation models, informed by US incidence data, were used to evaluate a variety of screening methods, ages to start and stop, and intervals for 4 demographic subgroups (black and white males and females) under 2 scenarios for the projected lifetime CRC risk for 40‐year‐olds: 1) assuming that risk had remained stable since the early screening era and 2) assuming that risk had increased proportionally to observed incidence trends under the age of 40 years. Model‐based screening recommendations were based on the predicted level of benefit (life‐years gained) and burden (required number of colonoscopies), the incremental burden‐to‐benefit ratio, and the relative efficiency in comparison with strategies with similar burdens. RESULTS When lifetime CRC risk was assumed to be stable over time, the models differed in the recommended age to start screening for whites (45 vs 50 years) but consistently recommended screening from the age of 45 years for blacks. When CRC risk was assumed to be increased, the models recommended starting at the age of 45 years, regardless of race and sex. Strategies recommended under both scenarios included colonoscopy every 10 or 15 years, annual fecal immunochemical testing, and computed tomographic colonography every 5 years through the age of 75 years. CONCLUSIONS Microsimulation modeling suggests that CRC screening should be considered from the age of 45 years for blacks and for whites if the lifetime risk has increased proportionally to the incidence for younger adults. Cancer 2018;124:2974‐85 . © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.