CISNET Provides Support for Development of Colorectal Cancer Screening Recommendations
The U.S. Preventive Services Task Force (USPSTF) requested a decision analysis to inform their 2008 update of the recommendations for colorectal cancer screening. The objective was to assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies and identify a set of recommendable screening strategies. The decision analysis used two of CISNET's microsimulation models, MISCAN and SimCRC, to assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies, and identify a set of recommendable screening strategies.
Results of the study were published in the following article in the Annals of Internal Medicine: Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2008 Oct 6. [Full-text PDF Version].
The 2008 USPSTF recommendations for colorectal cancer screening are now outdated and have been replaced by the 2016 recommendations. The archived 2008 final recommendation statement is available.
The archived 2008 final evidence summary is available.
The 2016 USPSTF recommendations for colorectal cancer screening were issued in June 2016. The CISNET-Colorectal Working Group authored the modeling study for the 2016 recommendations. The PDF Version of the modeling study is available.
The final recommendation statement was published on June 21, 2016. US Preventive Services Task Force. June 21, 2016 Recommendation Statement. Screening for Colorectal Cancer. Recommendation Statement. JAMA. 2016;315(23):2564-2575. [Full-text article]
The final evidence summary is available (PDF Version).
Comparative modeling with SimCRC, CRC-SPIN, and MISCAN-Colon was used for the USPSTF screening recommendation update. A hypothetical cohort of 10 million previously unscreened 40 year olds with no prior diagnosis was simulated. Assuming 100% screening compliance, the cohort was screened with sensitive guaiac-based fecal occult blood testing, fecal immunochemical testing, multi-target stool DNA, flexible sigmoidoscopy with or without stool testing, computed tomographic colonography, or colonoscopy. The models considered age to start screening beginning at 45, 50, and 55 years and age to end screening at 75, 80, and 85 years, with varying intervals per screening modality. Overall, colonoscopy every 10 years, annual fecal immunochemical test, flexible sigmoidoscopy every 10 years with annual FIT, and computed tomographic colonography every 5 years performed from ages 50‒75 years provided similar life-years gained and a comparable balance of benefit and screening burden. Methods and recommendations are described in more detail in the 2016 JAMA article cited above.