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How much colonoscopy screening should be recommended to individuals with various degrees of family history of colorectal cancer?
Article first published online: 8 MAR 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 18, pages 4166–4174, 15 September 2011
How to Cite
Wilschut, J. A., Steyerberg, E. W., van Leerdam, M. E., Lansdorp-Vogelaar, I., Habbema, J. D. F. and van Ballegooijen, M. (2011), How much colonoscopy screening should be recommended to individuals with various degrees of family history of colorectal cancer?. Cancer, 117: 4166–4174. doi: 10.1002/cncr.26009
- Issue published online: 2 SEP 2011
- Article first published online: 8 MAR 2011
- Manuscript Accepted: 1 FEB 2011
- Manuscript Revised: 17 DEC 2010
- Manuscript Received: 1 NOV 2010
- early detection of cancer;
- colorectal neoplasm;
- familial risk;
- cost-effectiveness analysis
Individuals with a family history of colorectal cancer (CRC) are at increased risk for CRC. Current screening recommendations for these individuals are based on expert opinion. The authors investigated optimal screening strategies for individuals with various degrees of family history of CRC based on a cost-effectiveness analysis.
The MISCAN-Colon microsimulation model was used to estimate costs and effects of CRC screening strategies, varying by the age at which screening was started and stopped and by screening interval. The authors defined 4 risk groups, characterized by the number of affected first-degree relatives and their age at CRC diagnosis. For all risk groups, the optimal screening strategy had an incremental cost-effectiveness ratio of approximately $50,000 per life-year gained.
The optimal screening strategy for individuals with 1 first-degree relative diagnosed after age 50 years was 6 colonoscopies every 5 years starting at age 50 years, compared with 4 colonoscopies every 7 years starting at age 50 years for average risk individuals. The optimal strategy had 10 colonoscopies every 4 years for individuals with 1 first-degree relative diagnosed before age 50 years, 13 colonoscopies every 3 years for individuals with 2 or more first-degree relatives diagnosed after age 50 years, and 15 colonoscopies every 3 years for individuals with 2 or more first-degree relatives of whom at least 1 was diagnosed before age 50 years.
The optimal screening strategy varies considerably with the number of affected first-degree relatives and their age of diagnosis. Shorter screening intervals than the currently recommended 5 years may be appropriate for the highest risk individuals. Cancer 2011;. © 2011 American Cancer Society.