Probability model for estimating colorectal polyp progression rates

Abstract

According to the American Cancer Society, colorectal cancer (CRC) is the third most common cause of cancer related deaths in the United States. Experts estimate that about 85% of CRCs begin as precancerous polyps, early detection and treatment of which can significantly reduce the risk of CRC. Hence, it is imperative to develop population-wide intervention strategies for early detection of polyps. Development of such strategies requires precise values of population-specific rates of incidence of polyp and its progression to cancerous stage. There has been a considerable amount of research in recent years on developing screening based CRC intervention strategies. However, these are not supported by population-specific mathematical estimates of progression rates. This paper addresses this need by developing a probability model that estimates polyp progression rates considering race and family history of CRC; note that, it is ethically infeasible to obtain polyp progression rates through clinical trials. We use the estimated rates to simulate the progression of polyps in the population of the State of Indiana, and also the population of a clinical trial conducted in the State of Minnesota, which was obtained from literature. The results from the simulations are used to validate the probability model.

Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic

“…Mathematical modeling based on Indiana and Minnesota data have estimated the times of disease progression as 3.4 years from in-situ to local, 3.5 years from local to regional, and 0.9 years from regional to distant disease. 33 Whether the presence of an area of invasive cancer remains confined within a polyp depends, among other factors, on the gross configuration of the polyp. Access to lymphovascular structures is more concerning in sessile than in pedunculated polyps.…”

Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer

“…These progression rates are not well studied in the scientific literature. Therefore, the authors relied on indirect methods that used real‐world prevalence/incidence data and mathematical methods for estimating the yearly progression rates. Also in the model is a certain yearly probability that an unknown condition, such adenoma or colorectal cancer, can be diagnosed; this can be done either by deliberate screening or spontaneous detection (opportunistic screening or symptomatic presentation).…”

How Can Screening Colonoscopy Be Optimized?

“…We do know that not all adenomas become malignant [5]. However, the problem is that there is no certain predictor of which adenomas will degenerate into cancer, even though attempts have been made to predict the probability of polyp progression [6,7]. Projected annual transition rates from advanced adenomas to CRC range from 2.6 to 5.6% [7].…”