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Age-specific sequence of colorectal cancer screening options in Germany: A model-based critical evaluation


Autoři: Thomas Heisser aff001;  Korbinian Weigl aff001;  Michael Hoffmeister aff001;  Hermann Brenner aff001
Působiště autorů: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany aff001;  Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany aff002;  German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany aff003;  Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany aff004
Vyšlo v časopise: Age-specific sequence of colorectal cancer screening options in Germany: A model-based critical evaluation. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003194
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003194

Souhrn

Background

The current organized screening program for colorectal cancer in Germany offers both sexes 5 annual fecal immunochemical tests (FITs) between ages 50 and 54 years, followed by a first screening colonoscopy at age 55 years if all of these FITs were negative. We sought to assess the implications of this approach for key parameters of diagnostic performance.

Methods and findings

Using a multistate Markov model, we estimated the expected detection rates of advanced neoplasms (advanced adenomas and cancers) and number needed to scope (NNS) to detect 1 advanced neoplasm at a first screening colonoscopy conducted at age 55 after 5 preceding negative FITs and compared them with the corresponding estimates for a first screening colonoscopy at age 55 with no preceding FIT testing. In individuals with 5 consecutive negative FITs undergoing screening colonoscopy at age 55, expected colonoscopy detection rate (NNS) was 3.7% (27) and 0.10% (1,021) for any advanced neoplasm and cancer, respectively, in men, and 2.1% (47) and 0.05% (1,880) for any advanced neoplasm and cancer, respectively, in women. These NNS values for detecting 1 advanced neoplasm are approximately 3-fold higher, and the NNS values for detecting 1 cancer are approximately 8-fold higher, than those for a first screening colonoscopy at age 55 without prior FITs. This study is limited by model simplifying assumptions and uncertainties related to input parameters.

Conclusions

Screening colonoscopy at age 55 after 5 consecutive negative FITs at ages 50–54, as currently offered in the German cancer early detection program, is expected to have very low positive predictive value. Our results may inform efforts to enhance the design of screening programs.

Klíčová slova:

Adenomas – Cancer detection and diagnosis – Cancer screening – Colorectal cancer – Death rates – German people – Neoplasms – colonoscopy


Zdroje

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. doi: 10.3322/caac.21492 30207593

2. Zentrum für Krebsregisterdaten. Datenbankabfrage. Berlin: Zentrum für Krebsregisterdaten; 2020 [cited 2020 Jun 29]. Available from: https://www.krebsdaten.de/Krebs/DE/Datenbankabfrage/datenbankabfrage_stufe1_node.html.

3. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008;103:1541–9. doi: 10.1111/j.1572-0241.2008.01875.x 18479499

4. Heitman SJ, Hilsden RJ, Au F, Dowden S, Manns BJ. Colorectal cancer screening for average-risk North Americans: an economic evaluation. PLoS Med. 2010;7:e1000370. doi: 10.1371/journal.pmed.1000370 21124887

5. Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening—an overview. Best Pract Res Clin Gastroenterol. 2010;24:439–49. doi: 10.1016/j.bpg.2010.04.004 20833348

6. Tao S, Hoffmeister M, Brenner H. development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastroenterol Hepatol. 2014;12:478–85. doi: 10.1016/j.cgh.2013.08.042 24022090

7. Senore C, Hassan C, Regge D, Pagano E, Iussich G, Correale L, et al. Cost-effectiveness of colorectal cancer screening programmes using sigmoidoscopy and immunochemical faecal occult blood test. J Med Screen. 2019;26:76–83. doi: 10.1177/0969141318789710 30180780

8. Bénard F, Barkun AN, Martel M, von Renteln D. Systematic review of colorectal cancer screening guidelines for average-risk adults: summarizing the current global recommendations. World J Gastroenterol. 2018;24:124–38. doi: 10.3748/wjg.v24.i1.124 29358889

9. Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJ, Young GP, et al. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64:1637–49. doi: 10.1136/gutjnl-2014-309086 26041752

10. Brenner H, Altenhofen L, Stock C, Hoffmeister M. Prevention, early detection, and overdiagnosis of colorectal cancer within 10 years of screening colonoscopy in Germany. Clin Gastroenterol Hepatol. 2015;13:717–23. doi: 10.1016/j.cgh.2014.08.036 25218160

11. Brenner H, Altenhofen L, Stock C, Hoffmeister M. Expected long-term impact of the German screening colonoscopy programme on colorectal cancer prevention: analyses based on 4,407,971 screening colonoscopies. Eur J Cancer. 2015;51:1346–53. doi: 10.1016/j.ejca.2015.03.020 25908273

12. Brenner H, Kretschmann J, Stock C, Hoffmeister M. Expected long-term impact of screening endoscopy on colorectal cancer incidence: a modelling study. Oncotarget. 2016;7:48168–79. doi: 10.18632/oncotarget.10178 27340865

13. Chen C, Stock C, Hoffmeister M, Brenner H. How long does it take until the effects of endoscopic screening on colorectal cancer mortality are fully disclosed?: a Markov model study. Int J Cancer. 2018;143:2718–24. doi: 10.1002/ijc.31716 29978478

14. Chen C, Stock C, Hoffmeister M, Brenner H. Optimal age for screening colonoscopy: a modeling study. Gastrointest Endosc. 2019;89:1017–25.e12. doi: 10.1016/j.gie.2018.12.021 30639539

15. van Roon AHC, Hol L, Wilschut JA, Reijerink JCIY, van Vuuren AJ, van Ballegooijen M, et al. Advance notification letters increase adherence in colorectal cancer screening: a population-based randomized trial. Prev Med. 2011;52:448–51. doi: 10.1016/j.ypmed.2011.01.032 21457725

16. Toes-Zoutendijk E, van Leerdam ME, Dekker E, van Hees F, Penning C, Nagtegaal I, et al. Real-time monitoring of results during first year of Dutch colorectal cancer screening program and optimization by altering fecal immunochemical test cut-off levels. Gastroenterology. 2017;152:767–75.e2. doi: 10.1053/j.gastro.2016.11.022 27890769

17. Starker A, Buttmann-Schweiger N, Krause L, Barnes B, Kraywinkel K, Holmberg C. [Cancer screening in Germany: availability and participation.] 2018;61:1491–9. doi: 10.1007/s00103-018-2842-8 30406892

18. Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose VP, Pabiniak C, et al. Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US Preventive Services Task Force. JAMA. 2016;315:2595–609. doi: 10.1001/jama.2016.6828 27305518

19. Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135:1899–906. doi: 10.1053/j.gastro.2008.08.058 18938166

20. Stock C, Ihle P, Sieg A, Schubert I, Hoffmeister M, Brenner H. Adverse events requiring hospitalization within 30 days after outpatient screening and nonscreening colonoscopies. Gastrointest Endosc. 2013;77:419–29. doi: 10.1016/j.gie.2012.10.028 23410698

21. Faivre J, Dancourt V, Denis B, Dorval E, Piette C, Perrin P, et al. Comparison between a guaiac and three immunochemical faecal occult blood tests in screening for colorectal cancer. Eur J Cancer. 2012;48:2969–76. doi: 10.1016/j.ejca.2012.04.007 22572481

22. Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer. 2013;49:3049–54. doi: 10.1016/j.ejca.2013.04.023 23706981

23. Wieten E, Schreuders EH, Grobbee EJ, Nieboer D, Bramer WM, Lansdorp-Vogelaar I, et al. Incidence of faecal occult blood test interval cancers in population-based colorectal cancer screening: a systematic review and meta-analysis. Gut. 2019;68:873–81. doi: 10.1136/gutjnl-2017-315340 29934436

24. van Roon AH, Goede SL, van Ballegooijen M, van Vuuren AJ, Looman CW, Biermann K, et al. Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening. Gut. 2013;62:409–15. doi: 10.1136/gutjnl-2011-301583 22387523

25. Haug U, Grobbee EJ, Lansdorp-Vogelaar I, Spaander MCW, Kuipers EJ. Immunochemical faecal occult blood testing to screen for colorectal cancer: can the screening interval be extended? Gut. 2017;66:1262. doi: 10.1136/gutjnl-2015-310102 27006184

26. Altenhofen L. Projekt Wissenschaftliche Begleitung von Früherkennungs-Koloskopien in Deutschland: Berichtszeitraum 2014. 12. Jahresbericht, Version 2. Berlin: Zentralinstitut für die kassenärztliche Versorgung in Deutschland; 2016 [cited 2020 Jun 30]. Available: https://www.zi.de/fileadmin/user_upload/Jahresbericht_2014_Darmkrebs_Frueherkennung.pdf.

27. Brenner H, Altenhofen L, Stock C, Hoffmeister M. Incidence of colorectal adenomas: birth cohort analysis among 4.3 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev. 2014;23:1920–7. doi: 10.1158/1055-9965.EPI-14-0367 25012996

28. Federal Joint Committee. [Resolution of the Federal Joint Committee on the Directive for Organized Cancer Screening Programmes and an amendment of the Directive on Cancer Screening.] Berlin: Federal Joint Committee; 2018 [cited 2020 Jun 29]. Available from: https://www.g-ba.de/downloads/39-261-3418/2018-07-19_2018-08-02_oKFE-RL_Beschluss-oKFE-RL-Aenderung_KFE-RL_konsolidiert_BAnz.pdf

29. Zhao S, Wang S, Pan P, Xia T, Chang X, Yang X, et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology. 2019;156:1661–74.e11. doi: 10.1053/j.gastro.2019.01.260 30738046

30. Brenner H, Zwink N, Ludwig L, Hoffmeister M. Should screening colonoscopy be offered from age 50? Dtsch Arztebl Int. 2017;114:94–100. doi: 10.3238/arztebl.2017.0094 28266302


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