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

Abstract

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

Model based evaluation of long‐term efficacy of existing and alternative colorectal cancer screening offers: A case study for Germany

“…(5) reverses the sequence of the current offer (scenario 2), which may be a more efficient approach to using screening capacities. 12 A biennial FIT interval was used as most evidence on fecal testing is based on biennial screening. 1 scenarios (6-10) allow a comparison to typically recommended, purely FIT-based strategies.…”

“…Individuals willing to minimize their lifetime CRC risk will be concerned about which strategy may be the most effective. In particular, sequencing FIT and colonoscopy may be ineffective, as it implies a high number of colonoscopies to detect one case of cancer after several negative FITs 12 . Men who opt for the colonoscopy‐only strategy starting at age 50 face an upper age limit at age 60, which contradicts guideline recommendations to continue screening at least until age 75 13 .…”

Strongly Divergent Impact of Adherence Patterns on Efficacy of Colorectal Cancer Screening: The Need to Refine Adherence Statistics

“…Specific strengths and limitations of the model per se have been described previously. 10,20,40 Briefly, a major strength is the use of input parameters derived specifically from the German general population using the world's largest screening colonoscopy registry. Furthermore, the model was subjected to a thorough assessment of its external validity, and was found to adequately predict colorectal neoplasm prevalences and incidences in a German population, with estimated patterns of the effect of screening colonoscopy resembling those seen in registry data and real-world studies.…”

Effects of screening for colorectal cancer: Development, documentation and validation of a multistate Markov model

“…Based on similar grounds, we could not assess the model's ability to reproduce the effects of fecal testing in a German population, even though the model can principally be used to simulate stool‐test‐based screening at varying intervals. 26 …”