Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity

Abstract

Background In 2014 a national campaign was launched to increase colorectal cancer (CRC) screening rates in the U.S. to 80% by 2018; it is unknown if there is sufficient colonoscopy capacity to reach this goal. We estimate the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy, and if there is sufficient colonoscopy capacity to meet the need. Methods The Microsimulation Screening Analysis-colon (MISCAN-colon) model was used to simulate CRC screening test use in the U.S. (2014–2040), assuming the implementation of a national screening program in 2014 with FIT or colonoscopy with 80% participation. The 2012 Survey of Endoscopic Capacity (SECAP) estimated the number of colonoscopies that were performed and the number that could be performed. Results If a national screening program started in 2014, by 2024, approximately 47 million FITs and 5.1 million colonoscopies would be needed annually to screen the eligible population with a program using FIT as the primary screening test; approximately 11 to 13 million colonoscopies would be needed annually to screen the eligible population with a colonoscopy only screening program. Based on the SECAP survey, an estimated 15 million colonoscopies were performed in 2012 and an additional 10.5 million colonoscopies could be performed. Conclusions The estimated colonoscopy capacity is sufficient to screen 80% of the eligible U.S. population with FIT, colonoscopy, or a mix of tests. Future analyses should take into account the geographic distribution of colonoscopy capacity.

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

“…Whereas newer CRC screening programs based on mailed fecal immunochemical tests and screening colonoscopy can reach a majority of patients in some settings [35,36], there is concern that fecal immunochemical tests may be less sensitive than colonoscopy for right-sided colorectal cancers [37]. Colonoscopy resources are also limited [38], and there is evidence of overuse of screening and surveillance colonoscopy in the USA [31,32], which may reduce access for others with higher risk of CRC. Our CRC detection model can be applied to broad populations to identify persons at increased risk of CRC (in particular, right-sided CRC); this can enable organized health systems to more effectively target colonoscopy resources.…”

Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

“…The ACS remains fully committed to increasing screening rates; both expanding the screening to include adults aged 45 to 49 years and increasing screening rates in the population aged 50 years and older can be achieved within the current health care infrastructure. A study that combined results from the 2012 Survey of Endoscopic Capacity with a modeling analysis indicated that increasing screening rates to 80% (with any combination of screening modalities) can be accommodated with current excess capacity . In addition, this guideline places increased emphasis on choice of screening options (not limited to colonoscopy) for those initiating CRC screening.…”

“…First, the potential harms of colonoscopy (as either a primary screening or follow‐up examination) are lower in younger versus older adults . Second, recent estimates indicate that the current colonoscopy capacity in the United States should be able to accommodate the anticipated increase in colonoscopies, performed both as primary screens and as follow‐up to positive noncolonoscopy tests . Finally, starting CRC screening earlier also may contribute to reducing disparities in population groups with a higher disease burden (including blacks, Alaska Natives, and some American Indian groups).…”

Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

“…First, with respect to capacity, we noted a recent study by Joseph et al exploring whether screening capacity was sufficient to fulfill the National Colorectal Cancer Roundtable (NCCRT) goal for the nation of 80% screening by 2018. Over a period from 2014 to 2040, a colonoscopy‐only scenario would require from 11 to 13 million colonoscopies annually, with an additional capacity of up to 10.5 million colonoscopies available . Some confidence can be derived from these results; however, throughout the United States, there are areas in which a colonoscopy is not easily obtained, and large segments of the target population do not have access because they are uninsured or underinsured.…”