Source: Reinier G. S. Meester, MSc, et. al., 6/16/2015, Journal of American Medical Association
Colorectal cancer screening had higher adenoma detection rates, lowers lower lifetime risks of colorectal cancer and colorectal cancer mortality without raising higher overall costs according to a study published in the Journal of American Medical Association.
Colonoscopy is the most commonly used colorectal cancer screening test in the United States. Its quality, as measured by adenoma detection rates (ADRs), varies widely among physicians, with unknown consequences for the cost and benefits of screening programs.
Researchers conducted a microsimulation modeling with data from a community-based health care system on ADR variation and cancer risk among 57,588 patients examined by 136 physicians from 1998 through 2010. Using modeling, no screening was compared with screening initiation with colonoscopy according to ADR quintiles (averages 15.3%, quintile 1; 21.3%, quintile 2; 25.6%, quintile 3; 30.9%, quintile 4; and 38.7%, quintile 5) at ages 50, 60, and 70 years with appropriate surveillance of patients with adenoma. The main outcomes was estimated lifetime colorectal cancer incidence and mortality, number of colonoscopies, complications, and costs per 1000 patients, all discounted at 3% per year and including 95% confidence intervals from multiway probabilistic sensitivity analysis.
Study findings• Among unscreened patients, the lifetime risk of colorectal cancer incidence was 34.2 per 1000 and risk of death was 13.4 per 1000• Among screened patients, simulated lifetime incidence decreased with lower to higher ADRs to 26.6 per 1000 and risk of death was 5.7 per 1000.• Estimated net screening costs were lower from quintile 1 (US $2.1 million, 95% CI, $1.8-$2.4 million) to quintile 5 (US $1.8 million, 95% CI, $1.3-$2.3 million) due to averted cancer treatment costs.