Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study

Maaike Buskermolen, Dayna R. Cenin, Lise M. Helsingen, Gordon Guyatt, Per Olav Vandvik, Ulrike Haug, Michael Bretthauer, Iris Lansdorp-Vogelaar

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE: To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk.

DESIGN: Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon).

SETTING: A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures.

POPULATION: Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%).

COMPARISONS: Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence.

MAIN OUTCOME MEASURES: Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach.

RESULTS: Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates.

CONCLUSIONS: Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.

Original languageEnglish
Article numberl5383
JournalThe BMJ
Volume367
DOIs
Publication statusPublished - 2 Oct 2019

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Sigmoidoscopy
Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
Incidence
Mortality
Guidelines
Uncertainty
Colon
Outcome Assessment (Health Care)

Cite this

Buskermolen, M., Cenin, D. R., Helsingen, L. M., Guyatt, G., Vandvik, P. O., Haug, U., ... Lansdorp-Vogelaar, I. (2019). Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. The BMJ, 367, [l5383]. https://doi.org/10.1136/bmj.l5383
Buskermolen, Maaike ; Cenin, Dayna R. ; Helsingen, Lise M. ; Guyatt, Gordon ; Vandvik, Per Olav ; Haug, Ulrike ; Bretthauer, Michael ; Lansdorp-Vogelaar, Iris. / Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy : a microsimulation modelling study. In: The BMJ. 2019 ; Vol. 367.
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author = "Maaike Buskermolen and Cenin, {Dayna R.} and Helsingen, {Lise M.} and Gordon Guyatt and Vandvik, {Per Olav} and Ulrike Haug and Michael Bretthauer and Iris Lansdorp-Vogelaar",
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Buskermolen, M, Cenin, DR, Helsingen, LM, Guyatt, G, Vandvik, PO, Haug, U, Bretthauer, M & Lansdorp-Vogelaar, I 2019, 'Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study' The BMJ, vol. 367, l5383. https://doi.org/10.1136/bmj.l5383

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy : a microsimulation modelling study. / Buskermolen, Maaike; Cenin, Dayna R.; Helsingen, Lise M.; Guyatt, Gordon; Vandvik, Per Olav; Haug, Ulrike; Bretthauer, Michael; Lansdorp-Vogelaar, Iris.

In: The BMJ, Vol. 367, l5383, 02.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy

T2 - a microsimulation modelling study

AU - Buskermolen, Maaike

AU - Cenin, Dayna R.

AU - Helsingen, Lise M.

AU - Guyatt, Gordon

AU - Vandvik, Per Olav

AU - Haug, Ulrike

AU - Bretthauer, Michael

AU - Lansdorp-Vogelaar, Iris

PY - 2019/10/2

Y1 - 2019/10/2

N2 - OBJECTIVE: To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk.DESIGN: Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon).SETTING: A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures.POPULATION: Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%).COMPARISONS: Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence.MAIN OUTCOME MEASURES: Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach.RESULTS: Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates.CONCLUSIONS: Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.

AB - OBJECTIVE: To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk.DESIGN: Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon).SETTING: A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures.POPULATION: Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%).COMPARISONS: Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence.MAIN OUTCOME MEASURES: Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach.RESULTS: Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates.CONCLUSIONS: Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.

KW - Aged

KW - Colonoscopy/adverse effects

KW - Colorectal Neoplasms/diagnosis

KW - Early Detection of Cancer/methods

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Male

KW - Mass Screening/methods

KW - Middle Aged

KW - Models, Statistical

KW - Norway/epidemiology

KW - Occult Blood

KW - Outcome and Process Assessment (Health Care)/statistics & numerical data

KW - Practice Guidelines as Topic

KW - Sigmoidoscopy/adverse effects

KW - Survival Analysis

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U2 - 10.1136/bmj.l5383

DO - 10.1136/bmj.l5383

M3 - Article

VL - 367

JO - BMJ: British Medical Journal

JF - BMJ: British Medical Journal

SN - 0959-535X

M1 - l5383

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