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Incremental benefits of screening colonoscopy over sigmoidoscopy in average-risk populations: a model-driven analysis

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Abstract

Purpose

Screening colonoscopy and flexible sigmoidoscopy (FSG) reduce the risk of colorectal cancer (CRC), but the magnitude and duration of protection, particularly against right-sided cancer, remain uncertain. We computed the incremental benefit of colonoscopy over FSG using a validated mathematical model, which reflects colorectal neoplasia growth characteristics while allowing uncertainty in endoscopic detection and removal of adenomas.

Methods

We calibrated models of CRC incidence within a multistage clonal expansion framework to data from: (1) San Francisco-Oakland SEER registry (reference population) and (2) FSG long-term follow-up data from 50,757 individuals after a negative FSG in the Kaiser Permanente system. We compared the residual CRC risks after FSG with full-length colonoscopy.

Results

Our model mirrors trial data with 10-year CRC risk reductions after FSG screening at age 50 years of approximately one-third; the optimal age for a ‘once-only’ FSG exam was between ages 50 and 60 years; and the greater benefit was for men compared with women. There were considerable incremental gains in reduction in CRC risk by colonoscopy compared with FSG with the greatest benefit for screening colonoscopy at age 50 years. These results held up against lowering the right-sided adenoma detection sensitivity by 30 %, as well as reducing the curative efficacy of polypectomy throughout the colon.

Conclusions

Mathematical modeling of CRC screening, which takes account of important aspects of tumor biology, demonstrates superior risk reductions by colonoscopy over FSG. Our predictions provide further rationale for recommending screening colonoscopy in average-risk populations before the age of 60.

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Acknowledgments

We thank Dr. Paul Doria-Rose (NCI) for helpful discussions and Dr. Theodore R. Levin (Kaiser Permanente) for making the FSG study data available. This study was funded through National Cancer Institute Grants: R01CA107028 and R03CA92767.

Conflict of interest

The authors have no conflict of interest.

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Authors and Affiliations

  1. Program of Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M2-B500, Seattle, WA, 98109-1024, USA

    Jihyoun Jeon

  2. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

    Rafael Meza

  3. Program of Computational Biology, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M1-B514, Seattle, WA, 98109-1024, USA

    William D. Hazelton & E. Georg Luebeck

  4. Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

    Andrew G. Renehan

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  1. Jihyoun Jeon
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  2. Rafael Meza
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  3. William D. Hazelton
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  4. Andrew G. Renehan
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  5. E. Georg Luebeck
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Correspondence to Jihyoun Jeon or E. Georg Luebeck.

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Jeon, J., Meza, R., Hazelton, W.D. et al. Incremental benefits of screening colonoscopy over sigmoidoscopy in average-risk populations: a model-driven analysis. Cancer Causes Control 26, 859–870 (2015). https://doi.org/10.1007/s10552-015-0559-7

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  • DOI: https://doi.org/10.1007/s10552-015-0559-7

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