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4 November 2008 | Volume 149 Issue 9
Background: The U.S. Preventive Services Task Force requested a decision analysis to inform their update of the recommendations for colorectal cancer screening.
Objective: To assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies and identify a set of recommendable screening strategies.
Design: Decision analysis using 2 colorectal cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network.
Data Sources: Derived from the literature.
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 years and stopping at age 75 or 85 years, 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 screening tests required.
Results of Base-Case Analysis: Beginning screening at age 50 years was consistently better than at age 60. Decreasing the stop age from 85 to 75 years decreased life-years gained by 1% to 4%, whereas colonoscopy use decreased by 4% to 15%. Assuming equally high adherence, 4 strategies provided similar life-years gained: colonoscopy every 10 years, annual Hemoccult SENSA (Beckman Coulter, Fullerton, California) testing or fecal immunochemical testing, and sigmoidoscopy every 5 years with midinterval Hemoccult SENSA. Hemoccult II and flexible sigmoidoscopy every 5 years alone were less effective.
Results of Sensitivity Analysis: The results were most sensitive to beginning screening at age 40 years.
Limitations: The stopping age for screening was based only on chronological age.
Conclusions: The findings support colorectal cancer screening with the following: colonoscopy every 10 years, annual screening with a sensitive FOBT, or flexible sigmoidoscopy every 5 years with a midinterval sensitive FOBT from ages 50 to 75 years.
Author and Article Information
From Memorial Sloan-Kettering Cancer Center, New York, New York; Erasmus Medical Center, Rotterdam, the Netherlands; Massachusetts General Hospital, Boston, Massachusetts; and University of Minnesota, Minneapolis, Minnesota.
Acknowledgment: The authors thank the following for helpful comments and review of earlier versions of this paper: Mary Barton, MD, MPH, and William Lawrence, MD, MSc, of the Agency for Healthcare Research and Quality; Steve Teutsch, MD, Diana Petitti, MD, Michael Lefevre, MD, and George Isham, MD, of the U.S. Preventive Services Task Force; Eric (Rocky) Feuer, PhD, of the National Cancer Institute; Evelyn Whitlock, PhD, of the Oregon Evidence Based Practice Center; and the outside reviewers: Laura Seeff, MD, David Ransohoff, MD, and Carolyn Rutter, PhD.
Grant Support: By the National Cancer Institute (U01-CA-088204, U01-CA-097426, and U01-CA-115953) and the Agency for Healthcare Research and Quality (HHSP233200700350P, HHSP233200700210P, and HHSP233200700196P).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Ann G. Zauber, PhD, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065; e-mail, zaubera{at}mskcc.org.
Current Author Addresses: Dr. Zauber: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065.
Ms. Lansdorp-Vogelaar, Ms. Wilschut and Dr. van Ballegooijen: Erasmus Medical Center, Dr. Molewaterplein 50, Rotterdam, The Netherlands 3000CA.
Dr. Knudsen: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA 02114.
Dr. Kuntz: University of Minnesota, Division of Health Policy and Management, MMC 729 Mayo, 15-232 PWB, 516 Delaware Street Southeast, Minneapolis, MN 55455. CLINICAL GUIDELINES
Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force
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