Effect of Time to Diagnostic Testing for Breast, Cervical, and Colorectal Cancer Screening Abnormalities on Screening Efficacy: A Modeling Study
Effect of Time to Diagnostic Testing for Breast, Cervical, and Colorectal Cancer Screening Abnormalities on Screening Efficacy: A Modeling Study
复制标题
DOI：
10.1158/1055-9965.epi-17-0378
复制
发表时间：
2018-02-01
影响因子：
3.8
通讯作者：
Tosteson, Anna N. A.
中科院分区：
文献类型：
--
作者：
Rutter, Carolyn M.;Kim, Jane J.;Tosteson, Anna N. A.
背景资料：接受异常癌症筛查结果的患者需要随访诊断测试，但随访时间因患者和practice.Methods而异：我们使用了一项模拟研究来估计乳腺癌，宫颈癌和结直肠癌随访时间增加时终身筛查益处的变化。估计值基于四个独立开发的微观模拟模型，每个模型都模拟了适合乳腺癌（50-74岁的女性），宫颈癌（21-65岁的女性）或结直肠癌（50-75岁的成年人）筛查的成年人的生命过程。我们假设筛查基于乳腺癌的两年一次的乳房X光检查，宫颈癌的三年一次的巴氏涂片检测，以及结直肠癌的年度粪便免疫化学检测。对于每种癌症类型，我们模拟了异常筛查检查后立即以及3个月、6个月和12个月的诊断测试。结果：我们发现，随着诊断测试时间的延长，筛查益处会下降，特别是对于乳腺癌筛查。与即时诊断检测相比，在3个月时进行检测会降低筛查益处，每1，000例筛查患者获得的未贴现生命年数较少（乳腺癌：17.3%，宫颈癌：0.8%，结直肠癌：2.0%和2.7%，来自两种结直肠癌模型），可预防的癌症较少（宫颈癌：减少1.4%，结直肠癌：分别减少0.5%和1.7%），乳腺癌和结直肠癌的分期分布不太有利。在异常筛查测试后进行诊断测试的时间较长会降低筛查的有效性，影响：了解诊断测试的时间对筛查有效性的影响有助于为质量改进工作提供信息。(C)2017年AACR。
Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices.Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to follow-up for breast, cervical, and colorectal cancers was increased. Estimates were based on four independently developed microsimulation models that each simulated the life course of adults eligible for breast (women ages 50-74 years), cervical (women ages 21-65 years), or colorectal (adults ages 50-75 years) cancer screening. We assumed screening based on biennial mammography for breast cancer, triennial Papanicolaou testing for cervical cancer, and annual fecal immunochemical testing for colorectal cancer. For each cancer type, we simulated diagnostic testing immediately and at 3, 6, and 12 months after an abnormal screening exam.Results: We found declines in screening benefit with longer times to diagnostic testing, particularly for breast cancer screening. Compared to immediate diagnostic testing, testing at 3 months resulted in reduced screening benefit, with fewer undiscounted life years gained per 1,000 screened (breast: 17.3%, cervical: 0.8%, colorectal: 2.0% and 2.7%, from two colorectal cancer models), fewer cancers prevented (cervical: 1.4% fewer, colorectal: 0.5% and 1.7% fewer, respectively), and, for breast and colorectal cancer, a less favorable stage distribution.Conclusions: Longer times to diagnostic testing after an abnormal screening test can decrease screening effectiveness, but the impact varies substantially by cancer type.Impact: Understanding the impact of time to diagnostic testing on screening effectiveness can help inform quality improvement efforts. (C) 2017 AACR.