Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study
Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study
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DOI：
10.1136/bmj.l5383
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发表时间：
2019-10-02
影响因子：
105.7
通讯作者：
Lansdorp-Vogelaar, Iris
中科院分区：
文献类型：
--
作者：
Buskermolen, Maaike;Cenin, Dayna R.;Lansdorp-Vogelaar, Iris
评估不同结直肠癌筛查策略的益处和危害，按（基线）15年结直肠癌风险。使用Microsimulation Screening Analysis-Colon的微模拟建模研究（MISCAN-Colon）.SETTINGA平行准则委员会（BMJ快速建议）定义了时间框架和筛查干预措施，包括结果测量的选择。人口挪威男性和女性，年龄50-79岁，15年结肠直肠癌风险不同（1-7%）。比较四种筛查策略与无筛查进行比较：两年一次或每年一次的粪便免疫化学试验（FIT）或单次乙状结肠镜检查或结肠镜检查，100%依从。主要结果测量结直肠癌死亡率和发病率，负担和危害超过15年的随访。使用GRADE方法评估证据的确定性。在15年的随访中，通过每年一次的FIT或单次结肠镜检查筛查年龄在50-79岁的结直肠癌风险为3%的个体，使结直肠癌死亡率降低了6/1000个体。单次乙状结肠镜检查和两年一次的FIT使其每1000人减少5人。结肠镜检查、乙状结肠镜检查和每年的FIT分别使结直肠癌发病率降低了10/1000、8/1000和4/1000。两年一次FIT的估计发病率降低为1/1000人。严重伤害估计在3/1000（两年一次的FIT）和5/1000（结肠镜检查）之间;伤害随着年龄的增长而增加。筛查的绝对益处随着结直肠癌风险的增加而增加，而危害受基线风险的影响较小。结果对指南小组定义的设置敏感。由于与建模假设的不确定性，我们采用了低的确定性证据等级的所有estimation. CONCLUSIONSOover 15年的时间内，所有的筛查策略可能会降低结直肠癌死亡率到类似的程度。结肠镜检查和乙状结肠镜检查也可能降低结直肠癌的发病率，而FIT显示出较小的发病率降低。所有筛查策略的损害均罕见且程度相似。
OBJECTIVETo estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk.DESIGNMicrosimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon).SETTINGA parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures.POPULATIONNorwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%).COMPARISONSFour screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence.MAIN OUTCOME MEASURESColorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach.RESULTSOver 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates.CONCLUSIONSOver a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.