title: The impact of stratifying by family history in colorectal cancer screening programs.
abstract: In the province-wide colorectal cancer (CRC) screening program in Ontario, Canada, individuals with a family history of CRC are offered colonoscopy screening and those without are offered guaiac fecal occult blood testing (gFOBT, Hemoccult II). We used microsimulation modeling to estimate the cumulative number of CRC deaths prevented and colonoscopies performed between 2008 and 2038 with this family history-based screening program, compared to a regular gFOBT program. In both programs, we assumed screening uptake increased from 30% (participation level in 2008 before the program was launched) to 60%. We assumed that 11% of the population had a family history, defined as having at least one first-degree relative diagnosed with CRC. The programs offered screening between age 50 and 74 years, every two years for gFOBT, and every ten years for colonoscopy. Compared to opportunistic screening (2008 participation level kept constant at 30%), the gFOBT program cumulatively prevented 6,700 more CRC deaths and required 570,000 additional colonoscopies by 2038. The family history-based screening program increased these numbers to 9,300 and 1,100,000, a 40% and 93% increase, respectively. If biennial gFOBT was replaced with biennial fecal immunochemical test (FIT), annual Hemoccult Sensa or five-yearly sigmoidoscopy screening, both the added benefits and colonoscopies required would decrease. A biennial gFOBT screening program that identifies individuals with a family history of CRC and recommends them to undergo colonoscopy screening would prevent 40% (range in sensitivity analyses: 20-51%) additional deaths while requiring 93% (range: 43-116%) additional colonoscopies, compared to a regular gFOBT screening program.
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Simon Lucas
authors: SL
authors: Goede
authors: Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.
authors: Linda
authors: L
authors: Rabeneck
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Iris
authors: I
authors: Lansdorp-Vogelaar
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors: Ann G
authors: AG
authors: Zauber
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors: Lawrence F
authors: LF
authors: Paszat
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St., Michael's Hospital, Toronto, Canada.
authors: Jeffrey S
authors: JS
authors: Hoch
authors: Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St., Michael's Hospital, Toronto, Canada.
authors: Jean H E
authors: JH
authors: Yong
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Frank
authors: F
authors: van Hees
authors: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Department of Medicine, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Jill
authors: J
authors: Tinmouth
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Marjolein
authors: M
authors: van Ballegooijen
mesh_terms: D000368:Aged; D002170:Canada; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D010375:Pedigree
keywords: colorectal cancer; computer simulation; prevention and control; screening