title: Colorectal cancer deaths attributable to nonuse of screening in the United States.
abstract: OBJECTIVE
  Screening is a major contributor to colorectal cancer (CRC) mortality reductions in the United States but is underused. We estimated the fraction of CRC deaths attributable to nonuse of screening to demonstrate the potential benefits from targeted interventions.
  
  
  METHODS
  The established microsimulation screening analysis colon model was used to estimate the population attributable fraction (PAF) in people aged ≥50 years. The model incorporates long-term patterns and effects of screening by age and type of screening test. PAF for 2010 was estimated using currently available data on screening uptake. PAF was also projected assuming constant future screening rates to incorporate lagged effects from past increases in screening uptake. We also computed PAF using Levin's formula to gauge how this simpler approach differs from the model-based approach.
  
  
  RESULTS
  There were an estimated 51,500 CRC deaths in 2010, about 63% (N ∼ 32,200) of which were attributable to nonscreening. The PAF decreases slightly to 58% in 2020. Levin's approach yielded a considerably more conservative PAF of 46% (N ∼ 23,600) for 2010.
  
  
  CONCLUSIONS
  Most of the current United States CRC deaths are attributable to nonscreening. This underscores the potential benefits of increasing screening uptake in the population. Traditional methods of estimating PAF underestimated screening effects compared with model-based approaches.
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: r.meester@erasmusmc.nl.
authors.forename: Reinier G S
authors.initials: RG
authors.lastname: Meester
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: S Lucas
authors.initials: SL
authors.lastname: Goede
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Levin
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marjolein van
authors.initials: Mv
authors.lastname: Ballegooijen
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Adenomas; Adenomatous polyps; Colorectal neoplasms; Computer simulation; Epidemiology; Screening and early detection; Secondary prevention