Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force.
BACKGROUND
The U.S. Preventive Services Task Force requested a decision analysis to inform their update of 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.


METHODS
Decision analysis using 2 colorectal cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network.


METHODS
Derived from the literature.


METHODS
U.S. average-risk 40-year-old population.


CONCLUSIONS
Societal.


METHODS
Lifetime.


METHODS
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.


METHODS
Number of life-years gained compared with no screening and number of colonoscopies and noncolonoscopy tests required.


RESULTS
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 testing. Annual Hemoccult II and flexible sigmoidoscopy every 5 years alone were less effective.


RESULTS
The results were most sensitive to beginning screening at age 40 years.


CONCLUSIONS
The stop age for screening was based only on chronologic 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 age 50 to 75 years.
Zauber
Ann G
AG
Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. zaubera@mskcc.org.
Lansdorp-Vogelaar
Iris
I
Knudsen
Amy B
AB
Wilschut
Janneke
J
van Ballegooijen
Marjolein
M
Kuntz
Karen M
KM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003198:Computer Simulation; D003661:Decision Support Techniques; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods / Q000592:standards; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013997:Time Factors