title: Predicting the effectiveness of the Finnish population-based colorectal cancer screening programme.
abstract: Objective Because colorectal cancer (CRC) has a long natural history, estimating the effectiveness of CRC screening programmes requires long-term follow-up. As an alternative, we here demonstrate the use of a temporal multi-state natural history model to predict the effectiveness of CRC screening. Methods In the Finnish population-based biennial CRC screening programme using faecal occult blood tests (FOBT), which was conducted in a randomised health services study, we estimated the pre-clinical incidence, the mean sojourn time (MST), and the sensitivity of FOBT using a Markov model to analyse data from 2004 to 2007. These estimates were applied to predict, through simulation, the effects of five rounds of screening on the relative rate of reducing advanced CRC with 6 years of follow-up, and on the reduction in mortality with 10 years of follow-up, in a cohort of 500,000 subjects aged 60 to 69. Results For localised and non-localised CRC, respectively, the MST was 2.06 and 1.36 years and the sensitivity estimates were 65.12% and 73.70%. The predicted relative risk of non-localised CRC and death from CRC in the screened compared with the control population was 0.86 (95% CI: 0.79-0.98) and 0.91 (95% CI: 0.85-1.02), respectively. Conclusion Based on the preliminary results of the Finnish CRC screening programme, our model predicted a 9% reduction in CRC mortality and a 14% reduction in advanced CRC.
authors.affiliation: 1 Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.|2 Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Sherry Yueh-Hsia
authors.initials: SY
authors.lastname: Chiu
authors.affiliation: 3 School of Health Sciences, University of Tampere, Tampere, Finland.|4 Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.affiliation: 5 School of Oral Hygiene, Taipei Medical University, Taipei, Taiwan.
authors.forename: Amy Ming-Fang
authors.initials: AM
authors.lastname: Yen
authors.affiliation: 5 School of Oral Hygiene, Taipei Medical University, Taipei, Taiwan.
authors.forename: Sam Li-Sheng
authors.initials: SL
authors.lastname: Chen
authors.affiliation: 6 Department of Health Industry Management, Kainan University, Tao-Yuan, Taiwan.
authors.forename: Jean Ching-Yuan
authors.initials: JC
authors.lastname: Fann
authors.affiliation: 3 School of Health Sciences, University of Tampere, Tampere, Finland.|4 Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity
keywords: Colorectal cancer screening; effectiveness; natural history; population-based