CT Colonoscopy Screening for CRC:Comparative Effectiveness vs Traditional Models

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DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and Specific Challenge Topic 05-CA-102: Comparative Effectiveness Research on Cancer Screening. Colorectal cancer (CRC) is the fourth most common cancer and the second most common cause of cancer- related death in the US. Screening for colorectal cancer and its precursor lesion, the adenomatous polyp, can effectively reduce cancer incidence and mortality. Randomized trials of colorectal cancer screening with a fecal occult blood test (FOBT) show a 20% reduction in cancer incidence and a 15% to 33% reduction in cancer mortality. Observational studies show that endoscopic polypectomy can markedly reduce colorectal cancer incidence and mortality, and randomized controlled trials of screening with flexible sigmoidoscopy are currently in the field. Despite this demonstrated benefit of CRC screening, only 50% of the US population for whom screening is recommended (i.e., those age 50 or older) adheres to current screening guidelines. Computed tomographic colonography (CTC) is a promising technique for colorectal cancer screening. With CTC, two- and three-dimensional images of the colon are reconstructed to allow the visualization of abnormalities that might represent adenomas or cancer. Recent studies have demonstrated that the sensitivity of CTC for large adenomas and cancer is similar to that of colonoscopy. CTC is also less invasive than colonoscopy, which may make it more acceptable to patients. However, unlike colonoscopy, where suspicious lesions can be biopsied or removed during the procedure, suspicious lesions identified on CTC require the patient to undergo a second procedure (colonoscopy) for biopsy or removal. Several studies have assessed the cost-effectiveness of CTC for routine CRC screening. The conclusions have varied depending upon the strategies that CTC is compared to, although most find that a CTC must cost substantially less than a colonosco