scholarly journals Quantifying the impact of adherence to screening strategies on colorectal cancer incidence and mortality

2019 ◽  
Vol 9 (2) ◽  
pp. 824-836 ◽  
Author(s):  
Elvira D’Andrea ◽  
Dennis J. Ahnen ◽  
Daniel A. Sussman ◽  
Mehdi Najafzadeh
Keyword(s):  
Colorectal Cancer ◽  
Cancer Incidence ◽  
Incidence And Mortality ◽  
Screening Strategies ◽  
Colorectal Cancer Incidence ◽  
The Impact

scholarly journals CP*Trends: An Online Tool for Comparing Cohort and Period Trends Across Cancer Sites

2019 ◽  
Vol 188 (7) ◽  
pp. 1361-1370 ◽  
Author(s):  
Theodore R Holford ◽  
Huann-Sheng Chen ◽  
David Annett ◽  
Martin Krapcho ◽  
Asya Dorogaeva ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Incidence ◽  
Control Strategies ◽  
The United States ◽  
Bronchial Cancer ◽  
Data Set ◽  
Incidence And Mortality ◽  
Colorectal Cancer Incidence ◽  
New Research ◽  
The Impact

Abstract Cohort or period components of trends can provide a rationale for new research or point to clues on the effectiveness of control strategies. Graphical display of trends guides models that quantify the experience of a population. In this paper, a method for smoothing rates by single year of age and year is developed and displayed to show the contributions of period and cohort to trends. The magnitude of the contribution of period and/or cohort in a model for trends may be assessed by the percentage of deviance explained and the relative contributions of cohort (C) and period (P) individually, known as the C-P score. The method is illustrated using Surveillance, Epidemiology, and End Results data (1975–2014) on lung and bronchial cancer mortality in females and prostate and colorectal cancer incidence in males. Smoothed age-period and age-cohort rates provide a useful first step in studies of etiology and the impact of disease control without imposing a restrictive model. We found that, in this data set, cohort predominates for female lung and bronchial cancer and period predominates for male prostate cancer. However, the effects change with age for male colorectal cancer incidence, indicating an age shift in relevant exposures. These methods are applied on an interactive website for both incidence and mortality at over 20 cancer sites in the United States.

scholarly journals Quantifying the impact of adherence to screening on colorectal cancer incidence and mortality

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E D’Andrea ◽  
D J Ahnen ◽  
D A Sussman ◽  
M Najafzadeh
Keyword(s):  
Colorectal Cancer ◽  
Cancer Incidence ◽  
Fecal Occult Blood ◽  
Substantial Impact ◽  
Dna Test ◽  
Crc Screening ◽  
Life Years ◽  
Incidence And Mortality ◽  
Screening Strategies ◽  
The Impact

Abstract Background Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence to screening. Since adherence can largely affect the outcomes of a screening modality, we aimed to assess the comparative effectiveness of CRC screening strategies under published rates of actual adherence. Methods We developed an individual-level simulation model and validated it against landmark trials and USPSTF models. Then we assessed the effectiveness of colonoscopy (COL), flexible sigmoidoscopy (FS), high-sensitivity guaiac fecal occult blood test (HS-gFOBT), fecal immunochemical test (FIT), multitarget stool DNA test (FIT-DNA), computed tomography colonography (CTC), and methylated SEPT9 DNA test (SEPT9) in reducing CRC incidence and mortality. For each strategy, we also estimated the incremental life-years gained, number of colonoscopies, and adverse events. Results Assuming 100% adherence, FIT-DNA, FIT, HS-gFOBT, and SEPT9 averted 58 to 59 CRC cases and 28 CRC deaths; COL and CTC strategies 56 cases and 27 deaths, while FS averted 39 cases and 19 deaths per 1,000 individuals. Life-years gained were similar across FIT-DNA, FIT, HS-gFOBT, SEPT9, CTC, and COL strategies. The total number of colonoscopies was highest with COL (3,567), followed by SEPT9 (3,231), HS-gFOBT (2,584), FIT-DNA (2,079), FIT (2,067), CTC (1,691) and FS (1,538) strategies. Assuming actual adherence, SEPT9 averted 54 CRC cases and 26 CRC deaths, followed by COL with 49 cases and 24 deaths, and FIT-DNA, FIT, CTC and HS-gFOBT with approximately 36 to 41 cases and 18 to 21 deaths averted per 1000 individuals screened. Life-years gained reflected the effectiveness of each strategy in reducing CRC cases and deaths. Conclusions Adherence is a key factor in determining the effectiveness of CRC screening and strategies with higher expected adherence rates have the potential to reduce cancer incidence and mortality. Key messages Adherence has a substantial impact on screening outcomes, such as cancer incidence and mortality, and may influence selection of optimal screening strategies. Strategies with higher expected adherence rates can lead to clinically meaningful benefits compared to strategies that may have better one-time sensitivity and/or specificity.

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