Original articleAlimentary tractConsequences of Increasing Time to Colonoscopy Examination After Positive Result From Fecal Colorectal Cancer Screening Test
Section snippets
Methods
For this study, we simulated an average-risk United States population cohort who received annual FIT screening between ages 50 and 75 years. The analyses used the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model developed by the Department of Public Health within Erasmus MC University Medical Center, Rotterdam, the Netherlands. MISCAN-Colon is part of the United States National Cancer Institute’s (NCI’s) Cancer Intervention and Surveillance Modeling Network.9 It has been used to
Colorectal Cancer Outcomes in Fecal Immunochemical Test Positive Patients
Among FIT screening participants with a positive test result, the lifetime risks of CRC incidence and mortality without any diagnostic follow-up were estimated as 82.8 and 34.4 per 1000 patients, respectively. Among patients who had diagnostic colonoscopy within 2 weeks, the risk of CRC was reduced to 35.5 per 1000 (Figure 1A), and the risk of death from CRC was reduced to 7.8 per 1000 (Figure 1B). Of the diagnosed cancers, 57% were stage I, 24% were stage II, 12% were stage III, and 7% were
Discussion
In the absence of high-quality observational data, we used an established microsimulation model to estimate the consequences of different times to colonoscopy after a positive FIT for the benefit and cost of CRC screening. Our results suggest that longer time to follow-up might lead to clinically relevant increases in the risks of CRC, advanced-stage CRC, and CRC mortality. Although FIT screening remained cost saving even with 12 months to follow-up, cancer-related mortality in patients with a
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by grants from the National Cancer Institute at the United States National Institutes of Health (#U54 CA163262 and also U01 CA152959, U01 CA151736, U24 CA171524, and P30 CA008748). This material is the result of work supported in part by resources from the VA Puget Sound Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Cancer Institute or of the Department of Veterans Affairs.