Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model

Deborah A. Fisher; Leila Saoud; Kristen Hassmiller Lich; A. Mark Fendrick; A. Burak Ozbay; Bijan J. Borah; Michael Matney; Marcus Parton; Paul J. Limburg

doi:10.1002/cam4.3662

Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model

Deborah A. Fisher, Leila Saoud, Kristen Hassmiller Lich, A. Mark Fendrick, A. Burak Ozbay, Bijan J. Borah, Michael Matney, Marcus Parton, Paul J. Limburg

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Real-world data for patients with positive colorectal cancer (CRC) screening stool-tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool-test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow-up to a known positive stool-based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow-up colonoscopies after positive stool-tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow-up/surveillance colonoscopies. Methods: Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt-sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base-case adenoma sensitivity values were identical for screening and follow-up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results: As the differences in adenoma sensitivity for screening versus follow-up/surveillance colonoscopies became greater, life-years gained (LYG) and reductions in CRC-related incidence and mortality versus no screening increased for mt-sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base-case scenario and with mt-sDNA in a “medium impact” scenario. Conclusions: Assuming identical adenoma sensitivities for screening and follow-up/surveillance colonoscopies underestimate the potential benefits of stool-based screening strategies.

Original language	English (US)
Pages (from-to)	2855-2864
Number of pages	10
Journal	Cancer medicine
Volume	10
Issue number	8
DOIs	https://doi.org/10.1002/cam4.3662
State	Published - Apr 2021

Keywords

adenoma
colonoscopy
colorectal neoplasms
diagnostic screening programs
sensitivity and specificity

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1002/cam4.3662

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@article{1641b7a9921e40e68ff0755a6f7f432c,

title = "Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model",

abstract = "Background: Real-world data for patients with positive colorectal cancer (CRC) screening stool-tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool-test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow-up to a known positive stool-based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow-up colonoscopies after positive stool-tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow-up/surveillance colonoscopies. Methods: Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt-sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base-case adenoma sensitivity values were identical for screening and follow-up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results: As the differences in adenoma sensitivity for screening versus follow-up/surveillance colonoscopies became greater, life-years gained (LYG) and reductions in CRC-related incidence and mortality versus no screening increased for mt-sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base-case scenario and with mt-sDNA in a “medium impact” scenario. Conclusions: Assuming identical adenoma sensitivities for screening and follow-up/surveillance colonoscopies underestimate the potential benefits of stool-based screening strategies.",

keywords = "adenoma, colonoscopy, colorectal neoplasms, diagnostic screening programs, sensitivity and specificity",

author = "Fisher, {Deborah A.} and Leila Saoud and {Hassmiller Lich}, Kristen and Fendrick, {A. Mark} and Ozbay, {A. Burak} and Borah, {Bijan J.} and Michael Matney and Marcus Parton and Limburg, {Paul J.}",

note = "Funding Information: Financial support for this study was provided by a contract with Exact Sciences Corporation. The authors gratefully acknowledge Andrew Piscitello for his valuable contributions to the methodology development. Medical writing and editorial assistance were provided by Erin P. Scott, PhD, of Maple Health Group, LLC, funded by Exact Sciences Corporation. Funding Information: D.A. Fisher is a consultant for Exact Sciences and Guardant Health. L. Saoud, M. Matney, A.B. Ozbay, and M. Parton are employees of Exact Sciences Corporation. K. Hassmiller Lich has nothing to disclose. A.M. Fendrick has been a consultant for AbbVie, Amgen, Centivo, Community Oncology Association, Covered California, EmblemHealth, Exact Sciences, Freedman Health, GRAIL, Harvard University, Health & Wellness Innovations, Health at Scale Technologies, MedZed, Penguin Pay, Risalto, Sempre Health, the State of Minnesota, U.S. Department of Defense, Virginia Center for Health Innovation, Wellth, and Zansors; has received research support from the Agency for Healthcare Research and Quality, Gary and Mary West Health Policy Center, Arnold Ventures, National Pharmaceutical Council, Patient‐Centered Outcomes Research Institute, Pharmaceutical Research and Manufacturers of America, the Robert Wood Johnson Foundation, the State of Michigan, and the Centers for Medicare and Medicaid Services. B.J. Borah has nothing to disclose. P.J. Limburg serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. Dr. Limburg and Mayo Clinic have contractual rights to receive royalties through this agreement. Publisher Copyright: {\textcopyright} 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.",

year = "2021",

month = apr,

doi = "10.1002/cam4.3662",

language = "English (US)",

volume = "10",

pages = "2855--2864",

journal = "Cancer Medicine",

issn = "2045-7634",

publisher = "John Wiley and Sons Ltd",

number = "8",

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TY - JOUR

T1 - Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model

AU - Fisher, Deborah A.

AU - Saoud, Leila

AU - Hassmiller Lich, Kristen

AU - Fendrick, A. Mark

AU - Ozbay, A. Burak

AU - Borah, Bijan J.

AU - Matney, Michael

AU - Parton, Marcus

AU - Limburg, Paul J.

N1 - Funding Information: Financial support for this study was provided by a contract with Exact Sciences Corporation. The authors gratefully acknowledge Andrew Piscitello for his valuable contributions to the methodology development. Medical writing and editorial assistance were provided by Erin P. Scott, PhD, of Maple Health Group, LLC, funded by Exact Sciences Corporation. Funding Information: D.A. Fisher is a consultant for Exact Sciences and Guardant Health. L. Saoud, M. Matney, A.B. Ozbay, and M. Parton are employees of Exact Sciences Corporation. K. Hassmiller Lich has nothing to disclose. A.M. Fendrick has been a consultant for AbbVie, Amgen, Centivo, Community Oncology Association, Covered California, EmblemHealth, Exact Sciences, Freedman Health, GRAIL, Harvard University, Health & Wellness Innovations, Health at Scale Technologies, MedZed, Penguin Pay, Risalto, Sempre Health, the State of Minnesota, U.S. Department of Defense, Virginia Center for Health Innovation, Wellth, and Zansors; has received research support from the Agency for Healthcare Research and Quality, Gary and Mary West Health Policy Center, Arnold Ventures, National Pharmaceutical Council, Patient‐Centered Outcomes Research Institute, Pharmaceutical Research and Manufacturers of America, the Robert Wood Johnson Foundation, the State of Michigan, and the Centers for Medicare and Medicaid Services. B.J. Borah has nothing to disclose. P.J. Limburg serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with Mayo Clinic. Dr. Limburg and Mayo Clinic have contractual rights to receive royalties through this agreement. Publisher Copyright: © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PY - 2021/4

Y1 - 2021/4

N2 - Background: Real-world data for patients with positive colorectal cancer (CRC) screening stool-tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool-test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow-up to a known positive stool-based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow-up colonoscopies after positive stool-tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow-up/surveillance colonoscopies. Methods: Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt-sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base-case adenoma sensitivity values were identical for screening and follow-up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results: As the differences in adenoma sensitivity for screening versus follow-up/surveillance colonoscopies became greater, life-years gained (LYG) and reductions in CRC-related incidence and mortality versus no screening increased for mt-sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base-case scenario and with mt-sDNA in a “medium impact” scenario. Conclusions: Assuming identical adenoma sensitivities for screening and follow-up/surveillance colonoscopies underestimate the potential benefits of stool-based screening strategies.

AB - Background: Real-world data for patients with positive colorectal cancer (CRC) screening stool-tests demonstrate that adenoma detection rates are lower when endoscopists are blinded to the stool-test results. This suggests adenoma sensitivity may be lower for screening colonoscopy than for follow-up to a known positive stool-based test. Previous CRC microsimulation models assume identical sensitivities between screening and follow-up colonoscopies after positive stool-tests. The Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) was used to explore the impact on screening outcomes when assuming different adenoma sensitivity between screening and combined follow-up/surveillance colonoscopies. Methods: Modeled screening strategies included colonoscopy every 10 years, triennial multitarget stool DNA (mt-sDNA), or annual fecal immunochemical test (FIT) from 50 to 75 years. Outcomes were reported per 1000 individuals without diagnosed CRC at age 40. Base-case adenoma sensitivity values were identical for screening and follow-up/surveillance colonoscopies. Ranges of adenoma sensitivity values for colonoscopy performance were developed using different slopes of odds ratio adjustments and were designated as small, medium, or large impact scenarios. Results: As the differences in adenoma sensitivity for screening versus follow-up/surveillance colonoscopies became greater, life-years gained (LYG) and reductions in CRC-related incidence and mortality versus no screening increased for mt-sDNA and FIT and decreased for screening colonoscopy. The LYG relative to screening colonoscopy reached >90% with FIT in the base-case scenario and with mt-sDNA in a “medium impact” scenario. Conclusions: Assuming identical adenoma sensitivities for screening and follow-up/surveillance colonoscopies underestimate the potential benefits of stool-based screening strategies.

KW - adenoma

KW - colonoscopy

KW - colorectal neoplasms

KW - diagnostic screening programs

KW - sensitivity and specificity

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JF - Cancer Medicine

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Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model

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