Cost-Effectiveness of Colorectal Cancer Screening Strategies—A Systematic Review

Tao, Ran; Cheng, Chen-Yang; Misselwitz, Benjamin; Brenner, Hermann; Ubels, Jasper; Schlander, Michael

doi:10.1016/j.cgh.2019.01.014

Cited by 112 publications

(93 citation statements)

References 70 publications

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“…Increasing cancer screening rates would require additional resources for the delivery of clinical services, as well as strategies to promote uptake of screening in population groups with lower use of screening. Previous studies that examined the cost of public provision of programs to increase screening found that such programs include not only cost of screening services but also substantial cost of administering and promoting the programs (21,22). The incremental costs associated with additional screenings may be offset by early detection of cancer or precancerous abnormalities through routine screening.…”

Section: Discussionmentioning

confidence: 99%

Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening

et al. 2020

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What is already known on this topic? Screening for colorectal cancer and for female breast and cervical cancers can effectively reduce deaths from these cancers. Yet many preventive services, including cancer screening, remain underutilized in the United States. What is added by this report? Increased use of screening from current levels to 100% would prevent an additional 2,821 deaths from breast cancer, 6,834 deaths from cervical cancer, and 35,530 deaths from colorectal cancer over a lifetime of the respective single-year cohort. Increasing use of colorectal cancer screening would prevent more deaths than an equivalent increase in breast and cervical cancer screening. What are the implications for public health practice? Public health programs incorporating strategies shown to be effective can help increase screening rates. Organized screening approaches leveraging partnerships between public health and primary health care to implement such strategies could be used to reduce the prevalence of these cancers.

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Section: Discussionmentioning

confidence: 99%

Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening

et al. 2020

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“…Many countries such as Sweden and Finland are currently putting up screening protocols for CRC in old individuals in selected regions. Although it has been concluded that CRC screening is cost effective compared to no screening [49], discrepancies between countries exist and the cost benefit may be improved if only individuals at increased risk are included in these screening programs. Hence, if biological age could be assessed in a cheap and easily accessible way to pre-select individuals at risk, this could improve the efficiency of the screening programs.…”

Section: Monitoring Prognosis After Diagnosis and Treatmentmentioning

confidence: 99%

Should we invest in biological age predictors to treat colorectal cancer in older adults?

Hägg

Jylhävä

2020

European Journal of Surgical Oncology

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Colorectal cancer (CRC) is a chronic disease of the old population with slow development progressing into clinical signs and symptoms. Biological aging is characterized by e.g. mitochondrial dysfunction and epigenetic alterations (e.g. methylation)-mechanisms that are also important in cancer development. For CRC, specific types of tumors are distinguishable by their methylation patterns and several detection methods using different epigenetic marks have been developed as signatures for the disease. Biological age assessed by DNA methylation patterns from blood, i.e. the epigenetic clock, is higher in CRC patients compared to controls, and may be a tool for identifying individuals at increased risk for CRC. Other types of biomarkers of aging are useful to calculate biological age, such as metabolites, protein levels, inflammatory markers and clinical biomarkers, where composite scores of biomarkers have been used to assess the risk of CRC and colorectal adenomas. Clinical assessments of biological aging includes frailty, which is a geriatric syndrome characterized by increased vulnerability to adverse outcomes. More than half of the CRC patients are estimated to be frail or pre-frail, and these individuals are at increased risk of postoperative complications, poorer prognosis, treatment intolerance and death. Hence, considering frailty as part of biological age in CRC patients may help identifying those at need of close monitoring. In summary, future screening programs for CRC may make use of biological age assessments, e.g. by epigenetic clock or composite scores. Monitoring disease relapse and treatment response should be enhanced in frail individuals for better prognosis.

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“…CRC is a disease process that is appropriate for employing population-based screening, given that its natural history typically involves a slow progression from adenoma to cancer [2]. Colonoscopy has been shown to reduce CRC incidence and mortality in a cost-effective fashion [3,4], given its capacity to both identify and remove adenomatous polyps. It can thus potentially act either as a primary screening modality or a primary method of following up on other abnormal screening tests.…”

Section: Introductionmentioning

confidence: 99%

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

et al. 2020

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Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators. Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models. Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses. Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

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Cost-Effectiveness of Colorectal Cancer Screening Strategies—A Systematic Review

Cited by 112 publications

References 70 publications

Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening

Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening

Should we invest in biological age predictors to treat colorectal cancer in older adults?

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

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