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Screening for colorectal cancer starting at age 45, it can be cost-effective

April 9, 2019 12:29

Researchers have reported that screening for colorectal cancer (CRC), starting at the age of 45 years instead of 50 years for persons at average risk is cost-effective.

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"It is reasonable to begin screening for colorectal cancer at age 45, based both on the expected clinical benefit, and the economic costs, but this should be done in parallel with the efforts to increase screening performance in the elderly and the subsequent positive study using fecal immunochemical test (FIT) », - said Dr. Uri Ladabaum school of Medicine at Stanford University in California.

In response to the growing incidence of CRC in young people the American Cancer Society recommends that screening begin at average risk at the age of 45 years. On the contrary, the Task Force on Preventive US services (USPSTF) and the Task Force on affairs of many US companies recommend screening starting at age 50.

Dr. Ladabaum and his colleagues used an analytical model of decision-making to assess the cost-effectiveness and national exposure beginning CRC screening at age 45 instead of 50, and to compare the distribution of the effect of screening resources for young people compared to older people and people with a higher risk.

The model with the start of colonoscopy at age 45 instead of 50 years has prevented four cases of CRC and two deaths from CRC and provided 14.4 years of life adjusted for quality (QALY) per 1,000 people, while 758 additional colonoscopies demanded and received 33,900 dollars . US / QALY.

Initiation of FIT at the age of 45 to 50 years instead of four CRC and prevented one death CRC and yielded 14.0 QALY per 1,000 people; researchers in the field of gastroenterology, March 28, reported that it took 267 additional colonoscopies and 3242 additional test feces of US / QALY 7700 dollars ..

Two other scenarios (single sigmoidoscopy at age 45, followed by screening colonoscopy or FIT, starting at 50 years; Annual FIT aged 45-49 with a transition to a colonoscopy every 10 years to 50 years of age) have reached almost the same clinical benefits at different costs.

These alternative provisions would result in net savings of $ 163 700-445 800 dollars, the researchers said.

At the national level, the change current patterns of participation in screening for five years at a younger age could prevent 29,400 cases of CRC and 11,100 cases of CRC death over the next five years, but at an additional cost and the need for the United States of 10.4 bln. Dollars. in 10.7 Mill. additional colonoscopies.

On the other hand, the goal of 80% interest in screening starting from 50 (without reducing the screening before age 45), can prevent the 2.6-fold increase in the incidence of CRC and 2.9-fold increase in the incidence of CRC at about one third additional costs, and if necessary 13% more additional colonoscopies.

"Supporters of any approach may find some support in our findings," - said Dr. Ladabaum. "Everything depends on whether we, as a society, do both: that is, to begin screening earlier and at the same time to improve the participation in a group of senior and higher risk."

Dr. Benjamin A. Weinberg of the Center for the integrated treatment of cancer Lombardi at Georgetown University in Washington, said: "We need to develop more efficient, adaptive strategies for screening."

"Our research in Georgetown, you can check whether the bacteria in the colorectal tumors of young and old people are different" - Dr. Weinberg said. "In the future, it may be possible to evaluate the composition of the fecal microbiome and high risk, to better determine who should do a colonoscopy at age 50, and to whom - 45 (or possibly even earlier) These techniques are adaptive to. the screening of risk allows us to be smarter when it comes to the one you need to check when and how often. "

Dr. Elena M. Stoffel from Rogelio Cancer Center, University of Michigan in Ann Arbor recently considered changing epidemiology of CRC. She said: "The growing frequency of CRC among young adults underscores the importance of conducting a risk assessment of the CRC for all patients, regardless of age A significant proportion of early deaths from CRC would be prevented if the symptoms clinicians investigated promptly and systematically. identify family history of cancer. "

"One in five young patients with CRC have a hereditary genetic factor associated with an increased risk of cancer," - Dr. Stoffel said. "Instead of screening for all 45 years, more effective (and cost effective) approach to assess the risk of each patient - some need colonoscopy earlier than 45 years, while others only noninvasive screening may be required in 50 or later."



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