Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study

Abstract

Background Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and mortality in three countries using microsimulation modelling. Methods In this modelling study, we used four country-specific colorectal cancer microsimulation models-Policy1-Bowel (Australia), OncoSim (Canada), and ASCCA and MISCAN-Colon (the Netherlands)-to estimate the potential impact of COVID-19-related disruptions to screening on colorectal cancer incidence and mortality in Australia, Canada, and the Netherlands annually for the period 2020-24 and cumulatively for the period 2020-50. Modelled scenarios varied by duration of disruption (3, 6, and 12 months), decreases in screening participation after the period of disruption (0%, 25%, or 50% reduction), and catch-up screening strategies (within 6 months after the disruption period or all screening delayed by 6 months). Findings Without catch-up screening, our analysis predicted that colorectal cancer deaths among individuals aged 50 years and older, a 3-month disruption would result in 414-902 additional new colorectal cancer diagnoses (relative increase 0•1-0•2%) and 324-440 additional deaths (relative increase 0•2-0•3%) in the Netherlands, 1672 additional diagnoses (relative increase 0•3%) and 979 additional deaths (relative increase 0•5%) in Australia, and 1671 additional diagnoses (relative increase 0•2%) and 799 additional deaths (relative increase 0•3%) in Canada between 2020 and 2050, compared with undisrupted screening. A 6-month disruption would result in 803-1803 additional diagnoses (relative increase 0•2-0•4%) and 678-881 additional deaths (relative increase 0•4-0•6%) in the Netherlands, 3552 additional diagnoses (relative increase 0•6%) and 1961 additional deaths (relative increase 1•0%) in Australia, and 2844 additional diagnoses (relative increase 0•3%) and 1319 additional deaths (relative increase 0•4%) in Canada between 2020 and 2050, compared with undisrupted screening. A 12-month disruption would result in 1619-3615 additional diagnoses (relative increase 0•4-0•9%) and 1360-1762 additional deaths (relative increase 0•8-1•2%) in the Netherlands, 7140 additional diagnoses (relative increase 1•2%) and 3968 additional deaths (relative increase 2•0%) in Australia, and 5212 additional diagnoses (relative increase 0•6%) and 2366 additional deaths (relative increase 0•8%) in Canada between 2020 and 2050, compared with undisrupted screening. Providing immediate catch-up screening could minimise the impact of the disruption, restricting the relative increase in colorectal cancer incidence and deaths between 2020 and 2050 to less than 0•1% in all countries. A post-disruption decrease in participation could increase colorectal cancer incidence by 0•2-0•9% and deaths by 0•6-1•6% between 2020 and 2050, compared with undisrupted screening. Interp...

The national FIT-based colorectal cancer screening program in the Netherlands during the COVID-19 pandemic

“…Nevertheless, a comparative modelling study conducted on behalf of the COVID-19 and Cancer and Cancer Global Modelling Consortium (CCGMC) predicted that CRC-related deaths in the Netherlands could increase up to 0.3% between 2020 and 2050 in case of a 3 months disruption without catching up and with unaffected participation rates after restart. ( de Jonge et al, 2021 ) This excess mortality could almost completely be mitigated in case of catching up missed individuals, which is already happening as can be observed in our study.…”

Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain)

“…A range of strategies are possible, from skipping one screening round for those affected by the pause to implementing catch-up. In the latter case, it would be important to shorten recovery time as much as possible, for instance, by increasing FIT positivity threshold [19][20][21]. To maximize diagnostic yield with limited endoscopic capacity, we could also consider prioritizing colonoscopies after a FIT positive result rather than post-polypectomy surveillance colonoscopies due to their greater bene ts [22].…”

CAD systems for colorectal cancer from WSI are still not ready for clinical acceptance

“…It is worth mentioning that, due to the Covid-19 pandemic, CRC screening programmes have been disrupted worldwide. As such, it is crucial that catch-up screening is provided as soon and effectively as possible, hoping to mitigate the impact on CRC deaths 14 , 15 . Computer-aided diagnosis (CAD) solutions in CRC could help in this task, contributing to improve pathology diagnostic capacity.…”