Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Piscitello, Andrew; Saoud, Leila; Fendrick, A. Mark; Borah, Bijan J.; Lich, Kristen Hassmiller; Matney, Michael; Ozbay, A. Burak; Parton, Marcus; Limburg, Paul J.

doi:10.1371/journal.pone.0244431

Cited by 20 publications

(38 citation statements)

References 52 publications

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“…The development and validation of the CRC-AIM model have been previously described. 14,16 Briefly, the model has 2 components, a natural history component and a screening component. The natural history component models the natural progression of adenomas to CRC if the adenomas were not removed.…”

Section: Crc-aim Modelmentioning

confidence: 99%

“…The assumptions in the natural history component of CRC-AIM include the risk of adenoma development based on age and sex, the rate of adenoma growth, the probability of a transition from adenoma to preclinical CRC, and CRC survival estimates, among others. 14,16 The screening component factors in assumptions related to CRC screening, such as the screening modality used, screening test sensitivity and specificity, the frequency of screening, and age at screening to determine the impact on screening compared with those who naturally progress to CRC (no screening). 14,16 The model assumes that screening will detect advanced precancerous lesions, which can be removed to prevent cancer incidence, and early-stage asymptomatic CRC, for which treatment lowers mortality.…”

Section: Crc-aim Modelmentioning

confidence: 99%

“…14,16 The screening component factors in assumptions related to CRC screening, such as the screening modality used, screening test sensitivity and specificity, the frequency of screening, and age at screening to determine the impact on screening compared with those who naturally progress to CRC (no screening). 14,16 The model assumes that screening will detect advanced precancerous lesions, which can be removed to prevent cancer incidence, and early-stage asymptomatic CRC, for which treatment lowers mortality. The ability to detect these screen-relevant neoplasms differs based on the sensitivity and specificity of the screening modality used.…”

Section: Crc-aim Modelmentioning

confidence: 99%

“…Assumptions for the natural history of SSPs were the same as those previously described for conventional adenomas modeled in CRC-AIM, 14,16,[23][24][25] except for an assumption that SSPs would be localized more toward the proximal colon. When incorporating the percentage of SSP-attributed CRCs (eg, 14.3%, 20%, or 30%) into the model, 15% more of the SSPs were assumed to develop in the cecum and ascending colon, as described in a previous CRC screening model analysis.…”

Section: Model Assumptionsmentioning

confidence: 99%

“…6,15 The lack of consideration for SSPs in CRC development is an acknowledged limitation of previous modeling analyses, mainly because of uncertainty around SSP biology. 15,16 One model, the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA), did incorporate the serrated polyp pathway when estimating outcomes with biennial FIT and one-time colonoscopy screening, but did not estimate outcomes with mt-sDNA. 17,18 We used the CRC-AIM model to assess how the detection of SSPs impacts predicted CRC outcomes of life-years gained (LYG), CRC incidence, and CRC mortality with mt-sDNA or FIT screening.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes

Kisiel

Itzkowitz

Ozbay

et al. 2022

Gastro Hep Advances

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BACKGROUND AND AIMS: Approximately 20%-30% of colorectal cancers (CRCs) arise from the serrated polyp pathway. CRC screening options have differential sensitivity to detect sessile serrated polyps (SSPs). We used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) to assess how the detection of SSPs impacts predicted life years gained (LYG), CRC incidence, and CRC mortality with multitarget stool DNA (mt-sDNA) or fecal immunochemical test (FIT) screening. METHODS: A simulated cohort of average-risk US individuals underwent triennial mt-sDNA or annual FIT screening between ages 45-75 years. SSP-attributed CRCs were modeled at 0% (base case), 14.3%, 20%, and 30%, in combination with 4 adherence & attendance scenarios: S1: 100% stool-screening adherence/100% followup colonoscopy attendance after a positive stool test; S2: reported stool-screening adherence (mt-sDNA ¼ 71%; FIT ¼ 43%)/100% follow-up colonoscopy attendance; S3: reported stool-screening adherence/reported follow-up colonoscopy attendance (mt-sDNA ¼ 72%; FIT ¼ 47%); and S4: reported stool-screening adherence/72% follow-up colonoscopy attendance. Outcomes were per 1000 individuals. Sensitivity analyses used ranges of stool-screening adherence or follow-up attendance. RESULTS:

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Section: Crc-aim Modelmentioning

confidence: 99%

Section: Crc-aim Modelmentioning

confidence: 99%

Section: Crc-aim Modelmentioning

confidence: 99%

Section: Model Assumptionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes

Kisiel

Itzkowitz

Ozbay

et al. 2022

Gastro Hep Advances

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Impact of race‐specific screening guideline on the uptake of colorectal cancer screening among young African Americans

et al. 2022

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Background African Americans (AAs) have had lower colorectal cancer (CRC) screening rates, higher incidence rate, and earlier mean age at onset. The 2017 U.S. Multi‐Society Task Force (MSTF) recommended initiating CRC screening at age 45 for AAs and age 50 for non‐AAs. Objective To investigate the impact of the 2017 MSTF's race‐specific guidelines on CRC screening rate among young AAs. Design, setting, and participants We used the 2015 and 2018 National Health Interview Survey to provide nationally representative estimates. The study sample included adults aged between 45 and 75 without a history of CRC, excluding screening recipients for diagnosis or surveillance purposes. Main measures The outcome is a binary variable of CRC screening. Primary independent variables were age and race category (non‐AAs aged 45–49, AAs 45–49, non‐AAs 50–75, AAs 50–75), a binary variable indicating before or after the 2017 MSTF guideline (2015 vs. 2018), and their interaction terms. We employed a multivariable logistic model, adjusting for individual characteristics, and accounting for complex survey design. Key results Among the total sample (n = 21,735), CRC screening rate increased from 54.6% in 2015 to 58.5% in 2018 (p < 0.01). By age and race, the screening rate exhibited an increase for all age and race groups except for young non‐AAs. Compared to young non‐AAs, the adjusted predicted probability (APP) of screening for young AAs was significantly higher by 0.10 (average marginal effect, 0.10; 95% confidence interval, 0.01–0.19) in 2018, while the difference was insignificant in 2015. Racial differences in screening among older adults were not significant in both years. The CRC screening rate was substantially lower among young AAs compared to older AAs (17.2% vs. 65.5% in 2018). Conclusion The race‐specific recommendation is an effective policy tool to increase screening uptake and would contribute to reducing cancer disparities among racial/ethnic minorities.

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Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort

Miller‐Wilson

Rutten

Thomme

et al. 2021

Int J Colorectal Dis

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Purpose Colorectal cancer (CRC) is the second most deadly cancer in the USA. Early detection can improve CRC outcomes, but recent national screening rates (62%) remain below the 80% goal set by the National Colorectal Cancer Roundtable. Multiple options are endorsed for average-risk CRC screening, including the multi-target stool DNA (mt-sDNA) test. We evaluated cross-sectional mt-sDNA test completion in a population of commercially and Medicare-insured patients. Methods Participants included individuals ages 50 years and older with commercial insurance or Medicare, with a valid mt-sDNA test shipped by Exact Sciences Laboratories LLC between January 1, 2018, and December 31, 2018 (n = 1,420,460). In 2020, we analyzed cross-sectional adherence, as the percent of successfully completed tests within 365 days of shipment date. Results Overall cross-sectional adherence was 66.8%. Adherence was 72.1% in participants with Traditional Medicare, 69.1% in participants with Medicare Advantage, and 61.9% in participants with commercial insurance. Adherence increased with age: 60.8% for ages 50–64, 71.3% for ages 65–75, and 74.7% for ages 76 + years. Participants with mt-sDNA tests ordered by gastroenterologists had a higher adherence rate (78.3%) than those with orders by primary care clinicians (67.2%). Geographically, adherence rates were highest among highly rural patients (70.8%) and ordering providers in the Pacific region (71.4%). Conclusions Data from this large, national sample of insured patients demonstrate high cross-sectional adherence with the mt-sDNA test, supporting its role as an accepted, noninvasive option for average-risk CRC screening. Attributes of mt-sDNA screening, including home-based convenience and accompanying navigation support, likely contributed to high completion rates.

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Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model

Cited by 20 publications

References 52 publications

Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes

Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes

Impact of race‐specific screening guideline on the uptake of colorectal cancer screening among young African Americans

Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort

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