title: Long-Term Impact of the Dutch Colorectal Cancer Screening Program on Cancer Incidence and Mortality-Model-Based Exploration of the Serrated Pathway.
abstract: BACKGROUND
  We aimed to predict the long-term colorectal cancer incidence, mortality, and colonoscopy demand of the recently implemented Dutch colorectal cancer screening program.
  
  
  METHODS
  The Adenoma and Serrated pathway to Colorectal Cancer model was set up to simulate the Dutch screening program consisting of biennial fecal immunochemical testing combined with the new Dutch surveillance guidelines, between 2014 and 2044. The impact of screening and surveillance was evaluated under three sets of natural history assumptions differing in the contribution of the serrated pathway to colorectal cancer incidence. In sensitivity analyses, other assumptions concerning the serrated pathway were varied. Model-predicted outcomes were yearly colorectal cancer incidence, mortality, and colonoscopy demand per year.
  
  
  RESULTS
  Assuming an aging population, colorectal cancer incidence under 30 years of screening is predicted to decrease by 35% and 31% for a contribution of 0% and 30% of the serrated pathway to colorectal cancer, respectively. For colorectal cancer mortality, reductions are 47% and 45%. In 2044, 110,000 colonoscopies will be required annually assuming no contribution of the serrated pathway (27 per 1,000 individuals in the screening age range). Including the serrated pathway influences predicted screening effectiveness if serrated lesions are neither detected nor treated at colonoscopy, and/or if colorectal cancers arising from serrated lesions have substantially lower survival rates than those arising from adenomas.
  
  
  CONCLUSIONS
  The Dutch screening program will markedly decrease colorectal cancer incidence and mortality but considerable colonoscopy resources will be required.
  
  
  CONCLUSIONS
  Predictions of long-term screening effectiveness are preferably based on both pathways to colorectal cancer to transparently describe the impact of uncertainties regarding the serrated pathway on long-term predictions.
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands. mj.greuter@vumc.nl.
authors.forename: Marjolein J E
authors.initials: MJ
authors.lastname: Greuter
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Erhan
authors.initials: E
authors.lastname: Demirel
authors.affiliation: Lowy Cancer Research Centre, The University of NSW, New South Wales, Australia. Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, New South Wales, Australia.
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.affiliation: Lowy Cancer Research Centre, The University of NSW, New South Wales, Australia. Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, New South Wales, Australia.
authors.forename: Xiang-Ming
authors.initials: XM
authors.lastname: Xu
authors.affiliation: Lowy Cancer Research Centre, The University of NSW, New South Wales, Australia. Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Gerrit A
authors.initials: GA
authors.lastname: Meijer
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Veerle M H
authors.initials: VM
authors.lastname: Coupé
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors