Open AccessThe Impact of the Rising Colorectal Cancer Incidence in Young Adults on the Optimal Age to Start Screening in the US: A Microsimulation Analysis
Author(s) -
Elisabeth F. P. Peterse,
Reinier Meester,
Rebecca L. Siegel,
J.C. Chen,
Andrea Dwyer,
D. J. Ahnen,
Randall A. Smith,
Ann G. Zauber,
Iris LansdorpVogelaar
Publication year - 2018
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.18.34900
Subject(s) - medicine , incidence (geometry) , colonoscopy , microsimulation , colorectal cancer , cohort , confidence interval , demography , colorectal cancer screening , young adult , rate ratio , cancer screening , cohort study , pediatrics , cancer , gerontology , sociology , transport engineering , optics , engineering , physics
Background: In 2016, the MISCAN-Colon model was used to inform the US Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening guidelines, which recommend screening from ages 50 to 75 years for average risk individuals. However, these models did not take into account the increase in CRC incidence below the age of 50 years. Aim: In this study, we reevaluated the optimal age to start screening, age to end screening and screening interval in light of the increase in CRC incidence observed in young adults. Methods: We adjusted the simulated lifetime CRC incidence in the MISCAN-Colon model to reflect the observed increase in young onset incidence. In line with the strong birth cohort effect, the current generation of 40-year-olds was assumed to carry forward escalated disease risk as they age. Life-years gained (benefit), the number of colonoscopies (burden) and the ratios of incremental burden to benefit (efficiency ratio) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start screening (40, 45, 50), ages to stop screening (75, 80, 85), and screening intervals (depending on screening modality). We then determined the model-recommended strategies in a similar way as we did for the USPSTF, using similar efficiency ratio thresholds to the previously accepted efficiency ratio of 39 incremental colonoscopies per life-year gained. Results: The life-years gained and the number of colonoscopies for each colonoscopy strategy are plotted in Fig 1. Because of the higher CRC incidence, model-predicted life-years gained from screening increased compared with our previous analyses for the USPSTF. Consequently, the balance of burden to benefit of screening improved, with colonoscopy screening every 10 years starting at age 45 years resulting in an efficiency ratio of 32 incremental colonoscopies per life-year gained. Conclusion: This decision-analytic modeling approach suggests that based on the increase in young-onset CRC incidence, screening initiation at age 45 years has a favorable balance between screening benefits and burden. Screening until age 75 years with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years was recommended by the model as these strategies provided similar life-years gained at an acceptable screening burden.[Figure: see text]