Using the Cancer Risk Management Model to Evaluate Colorectal Cancer Screening Options for Canada

Coldman, Andrew J.; Phillips, Norm; Brisson, Jacques; Flanagan, W. Michael; Wolfson, Michael; Nadeau, Claude; Miller, Anthony B.

doi:10.3747/co.22.2013

Cited by 24 publications

(27 citation statements)

References 55 publications

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“…To facilitate policymakers' decision, a number of cost-effectiveness analyses assessing FIT have emerged [43–46], with 2 studies assessing FIT cut-offs across a range of 50 to 100 ng/mL [45] and 50 to 200 ng/mL [46]. Both models found that a FIT cut-off of 50 ng/mL was the most cost-effective strategy.…”

Section: Discussionmentioning

confidence: 99%

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

Shahidi

Gentile

Gondara

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP). Methods. From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 μg/g (≥50 ng/mL) was used. Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs. Conclusions. As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.

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Section: Discussionmentioning

confidence: 99%

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

Shahidi

Gentile

Gondara

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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“…In the early 1990s, Statistics Canada developed the Population Health Model to "assist in the evaluation of cancer control interventions and policy decision-making" 1 , with a focus on lung 2,3 , breast [4][5][6] , and colorectal cancers 7 . More recently, the Canadian Partnership Against Cancer developed the Cancer Risk Management Model to "gain insight into the cost/benefit of cancer control strategies to help guide and strengthen decision-making" 8 , with a focus on lung 9 and colorectal cancers 10 . Other Canadian researchers have focused on prostate cancer 11,12 or the 21 most common cancers (brain, female breast, cervix, colorectal, corpus uteri, esophagus, gastric, head-and-neck, leukemia, liver, lung, lymphoma, melanoma, multiple myeloma, ovary, pancreas, prostate, renal, testis, thyroid, and urinary bladder) 13,14 .…”

Section: Introductionmentioning

confidence: 99%

The Economic Burden of Cancers Attributable to Tobacco Smoking, Excess Weight, Alcohol Use, and Physical Inactivity in Canada

et al. 2016

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ObjectivesThe purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada. MethodsWe used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age-and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs. ResultsIn Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci:38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion.Conclusions Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.

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“…The cervical cancer model in CRMM is more complex than the lung and colorectal cancer models [11,12] because the development of cervical cancer depends on HPV infection and individuals must come in contact with one another for the disease to spread. For cervical cancer two coupled models were built, one for the infectious spread of HPV within a population, including the effects of vaccination (CRMM-HPV) and the other for the pathway from infection to disease onset, progression, screening, treatment, and mortality (CRMM-Cervical).…”

Section: Introductionmentioning

confidence: 99%

“…The initial priorities were the development of a microsimulation model to evaluate the future burden of cancer in Canada, focusing on areas where it was felt progress could be made. The first two disease-specific models completed were on lung and colorectal cancer [11,12]. In view of the major investment in screening for cancer of the cervix in Canada it was decided that a model for cervical cancer could provide input into the development of policies for organized screening and dovetail into the policy of promoting vaccination of teenage girls against human papillomavirus (HPV) types 16, 18, 6 and 11, initiated Cancer of the uterine cervix is unique among cancers as it has a single necessary cause, infection with an oncogenic human papillomavirus (HPV) [13].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the natural history of cancer of the cervix, implications for prevention. The Cancer Risk Management Model (CRMM) – Human papillomavirus and cervical components

Miller

Gribble

Nadeau

et al. 2015

Journal of Cancer Policy

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a b s t r a c tThe Cancer Risk Management Model (CRMM) initiative of the Canadian Partnership Against Cancer offers policy makers a tool for making decisions regarding prevention and screening for their particular landscape.The cervical cancer component of CRMM is complex because the development of cervical cancer depends on HPV infection and has to take account of the fact that individuals must come in contact with one another for HPV to spread. Two tightly coupled models were built, one for the infectious spread of HPV (CRMM-HPV), and the other for the pathway from infection to disease onset, progression, screening, treatment, and mortality (CRMM-Cervical). This paper provides an overview of methods and functionality for CRMM components which simulate vaccination, screening, HPV incidence, disease progression, and cancer incidence.CRMM-HPV is a continuous-time, interacting-agent, Monte-Carlo microsimulation model that simulates sexual networks and HPV transmission. Six HPV groups (6, 11, 16, 18, other non-carcinogenic, other carcinogenic) and two vaccination types (bivalent, quadrivalent) were modeled. Input parameters include demography, sexual debut, partnership formation/separation and virus transmission, clearance, natural immunity. CRMM-HPV provides a 100-year projection of impacts of vaccinations on HPV infections. Results were scaled to reflect the Canadian population aged 10+ in 2011.Various vaccination scenarios can be compared by altering vaccination program design (target age, sex, program years, participation rate, vaccine type), vaccine efficacy, duration of protection and previous vaccination status. These parameters enable users to explore impacts of various scenarios such as targeting various age groups, adding boys, and booster and catch-up programs.

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Using the Cancer Risk Management Model to Evaluate Colorectal Cancer Screening Options for Canada

Cited by 24 publications

References 55 publications

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

The Economic Burden of Cancers Attributable to Tobacco Smoking, Excess Weight, Alcohol Use, and Physical Inactivity in Canada

Evaluation of the natural history of cancer of the cervix, implications for prevention. The Cancer Risk Management Model (CRMM) – Human papillomavirus and cervical components

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