Impact of screening programme using the faecal immunochemical test on stage of colorectal cancer: Results from the IMPATTO study

Vicentini, Massimo; Zorzi, Manuel; Bovo, Emanuela; Mancuso, Pamela; Zappa, Marco; Manneschi, Gianfranco; Mangone, Lucìa; Rossi, Paolo Giorgi

doi:10.1002/ijc.32089

Cited by 27 publications

(18 citation statements)

References 21 publications

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“…Our data suggest that differences in survival between right and left colon cancer cannot be due to early diagnosis or to the surgical procedure used because when we adjusted for these factors, the difference in survival between left and right colon cancer increased. Excluding any role of early diagnosis as well as any role of the difference between surgical procedures, our analyses support the hypothesis of a major role for other possible causes, such as the different distribution of the molecular profiles [ 18 , 19 ] and/or different microbiota [ 21 – 23 ].…”

Section: Discussionsupporting

confidence: 66%

“…The survival of right-sided CRC resulted lower than that of left-sided CRC only when also adjusting for screening history (HR1.12 [95%CI 1.04–1.21]. It is worth noting that screening changes the distribution of right- and left-sided cancers through the identification and treatment of cancer precursors, which leads to the prevention especially of left-sided cancers [ 19 ], but screening is also associated with better survival through early diagnosis and stage shift, decreasing the hazard of participants by about 50%. We did not included stage, grade, and extent of lymphadenectomy in our main model since they could be mediators of the effect of screening and cancer site.…”

Section: Discussionmentioning

confidence: 99%

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Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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“…The small difference between early and late stage CRC incidence prevention may be caused by the data from the first-year pilot populationbased CRC screening project in Thailand 30 which lead to the detection of both early and late stages of cancer. The late stage detection should be lower in the long term after campaign is well established as national policy, which is similar to the results from recent published study 56 .…”

Section: Discussionsupporting

confidence: 91%

Cost-effectiveness and budget impact analyses of colorectal cancer screenings in a low- and middle-income country: example from Thailand

Phisalprapa

Supakankunti

Chaiyakunapruk

2019

Journal of Medical Economics

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Objectives: Colorectal cancer (CRC) screening programs have been reported to be cost-effective in many high-income countries. However, there was no such study in low-and middle-income countries. This study aimed to evaluate cost-effectiveness and budget impact of CRC screening modalities for average-risk persons in Thailand. Methods: A decision tree coupled with a Markov model was used to estimate lifetime costs and health benefits of fecal immunochemical test (FIT) and colonoscopy using a societal perspective. The input parameters were obtained from a CRC screening project at a Thai tertiary care hospital, Thai health care costs and databases, and systematic literature review. Results were reported as incremental cost-effectiveness ratios (ICERs) in 2017 US Dollars (USD) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the influence of parameter uncertainty. Finally, budget impact analysis was conducted. Results: At the Thai ceiling threshold of societal willingness-to-pay of 4,706 USD, the screening colonoscopy every 10 years and annual FIT, starting at age 50, was cost-effective, as compared to no screening resulting in 15.09 and 15.00 QALYs with the ICERs of 600.20 and 509.84 USD/QALY gained, respectively. Colonoscopy every 10 years and annual FIT could prevent 17.9% and 5.7% of early stage cancer and 27.8% and 9.2% of late stage cancer per 100,000 screening over lifetime when compared to no screening, respectively. The colonoscopy screening was cost-effective with the ICER of 646.53 USD/QALY gained when compared to FIT. The probabilities of being cost-effective for the colonoscopy and FIT were 75% and 25%, respectively. Budget impact analysis showed the colonoscopy screening required an 8-times higher budget than FIT. Conclusions: Colonoscopy offers the best value for money of CRC screenings in Thailand. Annual FIT is potentially feasible since it requires less resources. Our findings can be used as part of evidence for informing policy decision making. KEY POINTS FOR DECISION MAKERSThere was a lack of cost-effective study of colorectal cancer screening programs in low-and middle-income countries. This study evaluated lifetime health outcomes and costs, and the cost-effectiveness of colorectal screening options for average-risk persons in Thailand. Colonoscopy screening every 10 years is cost-effective with high probability of being cost-effective as compared with annual fecal immunochemical test. Screening by annual fecal immunochemical test is more feasible in terms of human resource and budgetary burden. Colorectal screening programs provides an opportunity for early diagnosis and treatments to prevent advance colorectal stages and avoid higher consequent costs. This study contributes a new evidence-based knowledge for Thailand and can be used to support policy decision making process.

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“…To quantify the expected number of deaths resulting from the funnel effect on the otherwise ongoing screening, we focused on the Italian population and determined the number of individuals targeted by the screening program (in the 50-to 69-year old group equaling 834,4721 individuals). We estimated a total of 6,439,047 invitations for screening according to Vicentini et al 30 Furthermore, on the basis of 2017 data from the most recent National Screening Observatory report, we estimated 3184 CRC cases for the whole year, corresponding to 2.28% subjects with a positive FIT (Supplementary Table 4). The number of CRC cases was used to quantify the expected number of deaths.…”

Section: Estimate Of Screening Participants and Number Of Colorectal Cancers In Italy: An Illustrative Example Of The Delay Effect On Stamentioning

confidence: 99%

Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality

Ricciardiello

Ferrari

Cameletti

et al. 2021

Clinical Gastroenterology and Hepatology

111

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Background and Aims The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed to evaluate whether screening procedure delays can affect the outcomes of CRC screening. Methods We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach. Results With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (p=0.068). Compared to baseline (0-3-months), moderate (7-12-months) and long (>12-months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; p=0.008 and p<0.001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (p=0.005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (p<0.001). Conclusions Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.

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Impact of screening programme using the faecal immunochemical test on stage of colorectal cancer: Results from the IMPATTO study

Cited by 27 publications

References 21 publications

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Cost-effectiveness and budget impact analyses of colorectal cancer screenings in a low- and middle-income country: example from Thailand

Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality

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