Simulation of colorectal cancer screening: what we do and do not know and does it matter.
Simulation modelling is increasingly used to inform decision-making on screening, including colorectal cancer screening strategies. The strength of simulation is its ability to handle complexity and to identify the implications of uncertainty in a formal, documented, reproducible and consistent way. Important specific uncertainties concerning colorectal cancer screening are the dwell time of adenomas and the associated sensitivity of the various tests. Concerning these issues, for distal colorectal neoplasia, knowledge has been greatly increased by the recent availability of the once only sigmoidoscopy randomised trial results. Other uncertainties concern the quality of life effects of screening, diagnostic and surveillance colonoscopies, and the true total costs of the various screening modalities in a routine high throughput efficient setting. A limitation of simulation of screening is that complexity leads to lack of insight and understanding into the models used, and therefore a lack of sound criticism, acceptance and use amongst decision makers. Modellers are currently focussing on ways to make models and the implications of assumptions more transparent. Thus it is important to further develop the quality and acceptability of simulation, especially that for colorectal cancer screening.
van Ballegooijen
Marjolein
M
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.vanballegooijen@erasmusmc.nl
Boer
Rob
R
Zauber
Ann G
AG
D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D009780:Occult Blood; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy; D013997:Time Factors