178 Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach to Inform the US Preventive Services Task Force

Zauber, Ann G.; Knudsen, Amy B.; Carolyn, Rutter; Naber, Steffie K.; Doria-Rose, V. Paul; Pabiniak, Chester; Fischer, Sara; Lansdorp–Vogelaar, Iris; Kuntz, Karen M.

doi:10.1016/s0016-5085(16)30279-7

Cited by 29 publications

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“…In the current study, 11% of enrolled patients had a familial history of colon cancer, which is higher than the percentage reported in previous studies [43,44] . This difference may be due to the frequent consanguineous marriages in the Saudi community.…”

Section: Discussioncontrasting

confidence: 78%

Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia

et al. 2016

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Background/Aims: Colorectal cancer (CRC) is the most frequent cancer and a leading cause of cancer death in the Kingdom of Saudi Arabia (KSA). To date, no nationwide screening programs have been adopted. This prospective, longitudinal study investigated factors influencing the outcome of CRC in Saudi patients. Methods: Patients completed a CRC awareness questionnaire. Colonoscopy, CT/MRI, histopathology of tumor biopsies, and KRAS and BRAF testing were performed. Patients were treated according to their stage. All patients were followed until the end of the study and 3- and 5-year survival was assessed. Results: Sixty percent of study patients with sporadic CRC presented with significantly advanced disease (stages III and IV) with or without metastases at entry. Patients showed low levels of awareness of the risk factors and signs of CRC. Patients presented at a median age of 50 years. Family history of CRC and ulcerative colitis were positive in 11 and 6% of patients, respectively. Stage III/IV tumors with distant metastases at enrollment, right-sided tumors, mucinous tumors, lymphovascular invasion, and KRAS (51%) or BRAF (28%) mutations predicted poor prognosis and survival. Conclusion: CRC in KSA is usually diagnosed at advanced stages with metastases and KRAS/BRAF, and is associated with poor prognosis and short survival. Nationwide awareness campaigns and screening programs for CRC are critical for prevention, early detection and adequate management of CRC.

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Section: Discussioncontrasting

confidence: 78%

Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia

et al. 2016

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“…14 Modeling studies conducted by CISNET also consistently estimate that combined testing yields more life-years gained and colorectal cancer deaths averted compared with flexible sigmoidoscopy alone. 2 Flexible sigmoidoscopy can result in direct harms, such as colonic perforations and bleeding, although the associated event rates are much lower than those observed with colonoscopy. 1 Harms can also occur as a result of follow-up colonoscopy.…”

Section: Direct Visualization Testsmentioning

confidence: 99%

“…The CISNET models estimated that these strategies would produce about 226 to 275 lifeyears gained over a lifetime, or about 20 to 24 colorectal cancer deaths averted per 1000 adults aged 50 to 75 years screened. 2 …”

Section: Effectiveness Of Early Detection and Treatmentmentioning

confidence: 99%

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Screening for Colorectal Cancer

Bibbins‐Domingo

Grossman

Curry

et al. 2016

JAMA

1,786

457

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US Preventive Services Task Force T he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendations and EvidenceThe USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation) (Figure 1).The risks and benefits of different screening methods vary. See the Clinical Considerations section later in this article and the Table for details about screening strategies.The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history (C recommendation).• Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. IMPORTANCE Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with the disease, and about 49 000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 73 years. OBJECTIVE To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods.FINDINGS The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirica...

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“…Examples abound across a wide spectrum of policy domains. For instance, the effects of federal regulations are often assessed initially and are (ideally) updated regularly (Sunstein 2012), a policy analysis is needed to quantify gains and losses every time there is a discussion about the U.S. minimum wage (Office 2007;, and analyses assessing the appropriateness of medical treatments should be updated periodically (Zauber et al, 2016).…”

Section: Challenging To Automate and Improve Systematically Recurringmentioning

confidence: 99%

A Framework for Open Policy Analysis

Guardia¹,

Grant²,

Miguel³

2018

Preprint

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178 Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach to Inform the US Preventive Services Task Force

Cited by 29 publications

References 0 publications

Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia

Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia

Screening for Colorectal Cancer

A Framework for Open Policy Analysis

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