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Will Test-Specific Adherence Predict the Best Colorectal Cancer Screening Strategy?
- Ann G. Zauber, PhD;
- Marjolein van Ballegooijen, MD, PhD; and
- Karen M. Kuntz, ScD
- From Memorial Sloan-Kettering Cancer Center, New York, NY 10065; Erasmus Medical Center, 3000CA Rotterdam, the Netherlands; and University of Minnesota, Minneapolis, MN 55455.
IN RESPONSE:
We agree that an interesting finding from our analysis (1) for the USPSTF is that all the screening strategies now recommended by the USPSTF are nearly equivalent for life-years gained with screening when all have equivalent 100% adherence. We note that the USPSTF recommendation for the strategies of a highly sensitive guaiac or immunochemical fecal occult blood test (FOBT) annually, flexible sigmoidoscopy every 5 years with a sensitive FOBT, and colonoscopy every 10 years are based on the perspective of a program of screening from age 50 to 75 years with the end point of life-years gained rather than for screening at a point in time with the end point of reducing colorectal cancer incidence (2). We also agree that the issue of adherence is a crucial component to the effectiveness of a screening intervention. The assumption of 100% adherence to all aspects of screening was used to provide a comparable assessment of potential efficacy for the different screening strategies and represents the best screening offer for those who adhere to testing, follow-up of positive findings, surveillance, and treatment. However, in clinical practice, adherence is very complex (and considerably less than 100%), with variation by screening test (3) and repeated screening. As shown in Figure 3 of our article (1), effectiveness of the intervention does vary by different levels of adherence. We noted that “in practice, adherence is critical and that ultimately the best option for a patient is the one that he or she will attend.” We agree that it is important to ask what levels of relative adherence for colonoscopy and another screening test provide comparable levels of life-years gained per number of colonoscopies. We also agree that we need randomized, controlled trials to compare adherence and clinical outcomes after an invitation to participate in a colorectal cancer screening program using sensitive FOBT or colonoscopy.
Marjolein van Ballegooijen, MD, PhD
Erasmus Medical Center
3000CA Rotterdam, the Netherlands
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
