Name
#89 Estimated Impact of Adenoma and Colorectal Cancer Early Detection on Health Outcomes and Screening Effectiveness
Speakers
Content Presented on Behalf of
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Services/Agencies represented
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Session Type
Posters
Room#/Location
Prince Georges Exhibit Hall A/B
Focus Areas/Topics
Clinical Care
Learning Outcomes
Methods: A cohort of average-risk US individuals undergoing colonoscopy (COL) every 10 years, annual FIT, triennial mt-sDNA, or triennial blood-based test (BBT) from ages 45–75 years was simulated. Performance inputs for FIT, mt-sDNA, and BBT were based on large clinical trials, while performance inputs for COL were identical to those used by the US Preventive Services Task Force (USPSTF). Modeled real-world (RWE) adherence rates for FIT and mt-sDNA based on published data were 42.6% and 65.6% respectively, for initial screening and 46.0% and 72.1%, respectively, for follow-up COL. Adherence to screening COL was assumed to be 42%, based on published data. There is a lack of published adherence for BBT, so adherence was considered at mt-sDNA RWE and perfect adherence. Outcomes were LYG vs no screening per 1000 persons screened, LYG attributed to adenoma or CRC detection, CRC cases averted by screening, and CRC cases by stage at detection.
Results: LYG was 190 (FIT), 275 (mt-sDNA), 177 (BBT RWE adherence), 237 (BBT perfect adherence) and 350 (COL). The primary driver of LYG among all screening tests was adenoma detection rather than CRC detection. The proportion of LYG attributed to adenoma detection was 74% (FIT), 82% (mt-sDNA), 63% (BBT RWE adherence), 67% (BBT perfect adherence) and 91% (COL). As a result of screening, the number of CRC cases averted was 30 (FIT), 46 (mt-sDNA), 24 (BBT RWE adherence), 34 (BBT perfect adherence) and 64 (COL).
Conclusions: Prior simulation studies have reported LYG based on 100% adherence to CRC screening tests. To our knowledge, this is the first modeling study to report the relative contributions of early-stage CRC detection and adenoma detection to clinical outcomes based on the type of screening test coupled with reported real-life adherence. These data demonstrate that increased adenoma detection results in fewer CRC cases, which translates to more LYG.
Results: LYG was 190 (FIT), 275 (mt-sDNA), 177 (BBT RWE adherence), 237 (BBT perfect adherence) and 350 (COL). The primary driver of LYG among all screening tests was adenoma detection rather than CRC detection. The proportion of LYG attributed to adenoma detection was 74% (FIT), 82% (mt-sDNA), 63% (BBT RWE adherence), 67% (BBT perfect adherence) and 91% (COL). As a result of screening, the number of CRC cases averted was 30 (FIT), 46 (mt-sDNA), 24 (BBT RWE adherence), 34 (BBT perfect adherence) and 64 (COL).
Conclusions: Prior simulation studies have reported LYG based on 100% adherence to CRC screening tests. To our knowledge, this is the first modeling study to report the relative contributions of early-stage CRC detection and adenoma detection to clinical outcomes based on the type of screening test coupled with reported real-life adherence. These data demonstrate that increased adenoma detection results in fewer CRC cases, which translates to more LYG.
Session Currently Live
Description
Background: Adenoma detection and removal through screening reduces colorectal cancer (CRC) incidence and mortality. Multitarget stool DNA test (mt-sDNA) and fecal immunochemical test (FIT) differ in respect to their ability to detect adenomas and CRCs by stage. Using the validated CRC-AIM microsimulation model, we evaluated how the differential ability of stool-based tests to detect precancerous adenomas and early-stage CRCs impacts life-years gained (LYG) and CRC cases associated with average-risk screening.