title: Endoscopic requirements of colorectal cancer screening programs in average-risk population. Estimation according to a Markov model.
abstract: BACKGROUND
  Although colorectal cancer (CRC) screening strategies are quite common in the United States, their systematic introduction in Europe has been delayed until the year 2008. To estimate endoscopic requirements of four different CRC screening strategies (annual and biennial fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years) in an average-risk population.
  
  
  METHODS
  A long-term Markov process model was designed combining three adherence rates for the four above-mentioned screening strategies in individuals aged from 50 to 74. Estimations included endoscopic procedures performed for both screening and surveillance purposes. Models were adjusted for age-related adenoma and CRC incidence rates, life expectancy, and cancer-related survival.
  
  
  RESULTS
  The mean number of annual colonoscopies per 100,000 individuals aged 50-74 ranged from 100 to 271 for annual FOBT, from 75 to 203 for biennial FOBT, from 222 to 601 for sigmoidoscopy, and from 903 to 2,449 for colonoscopy-based strategies, depending on the adherence rate. According to these estimations, annual and biennial FOBT strategies would generate a slight decrease of current endoscopic activity (1.4-3.8% and 2.7-7.2%, respectively), whereas sigmoidoscopy and colonoscopy-based strategies would induce a 4.7-12.8% and 32-87% increase, respectively, with respect to a non-screening scenario. The model confirmed a 3-16% mean reduction of CRC incidence depending on the strategy and adherence rate.
  
  
  CONCLUSIONS
  Whereas endoscopic capacity exists for widespread CRC screening with annual or biennial FOBT, implementation of potentially more effective strategies, such as flexible sigmoidoscopy or colonoscopy, would result in a significant increase of current endoscopic resources.
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Moranta
authors.forename: Marta
authors.initials: M
authors.lastname: Trapero-Bertran
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
authors.forename: Xavier
authors.initials: X
authors.lastname: Mas-Canal
authors.forename: Francesc
authors.initials: F
authors.lastname: Balaguer
authors.forename: Maria
authors.initials: M
authors.lastname: Pellisé
authors.forename: Victòria
authors.initials: V
authors.lastname: Gonzalo
authors.forename: Teresa
authors.initials: T
authors.lastname: Ocaña
authors.forename: Antoni
authors.initials: A
authors.lastname: Trilla
authors.forename: Josep M
authors.initials: JM
authors.lastname: Piqué
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005240:Feasibility Studies; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*