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.
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.
Authors: Wendy S Atkin; Rob Edwards; Ines Kralj-Hans; Kate Wooldrage; Andrew R Hart; John M A Northover; D Max Parkin; Jane Wardle; Stephen W Duffy; Jack Cuzick Journal: Lancet Date: 2010-04-27 Impact factor: 79.321
Authors: Robert E Schoen; Paul F Pinsky; Joel L Weissfeld; Lance A Yokochi; Timothy Church; Adeyinka O Laiyemo; Robert Bresalier; Gerald L Andriole; Saundra S Buys; E David Crawford; Mona N Fouad; Claudine Isaacs; Christine C Johnson; Douglas J Reding; Barbara O'Brien; Danielle M Carrick; Patrick Wright; Thomas L Riley; Mark P Purdue; Grant Izmirlian; Barnett S Kramer; Anthony B Miller; John K Gohagan; Philip C Prorok; Christine D Berg Journal: N Engl J Med Date: 2012-05-21 Impact factor: 91.245
Authors: Amit Rastogi; Dayna S Early; Neil Gupta; Ajay Bansal; Vikas Singh; Michael Ansstas; Sreenivasa S Jonnalagadda; Christine E Hovis; Srinivas Gaddam; Sachin B Wani; Steven A Edmundowicz; Prateek Sharma Journal: Gastrointest Endosc Date: 2011-07-29 Impact factor: 9.427
Authors: Jeremy T Hetzel; Christopher S Huang; Jennifer A Coukos; Kelsey Omstead; Sandra R Cerda; Shi Yang; Michael J O'Brien; Francis A Farraye Journal: Am J Gastroenterol Date: 2010-08-17 Impact factor: 10.864
Authors: Jihyoun Jeon; Mengmeng Du; Robert E Schoen; Michael Hoffmeister; Polly A Newcomb; Sonja I Berndt; Bette Caan; Peter T Campbell; Andrew T Chan; Jenny Chang-Claude; Graham G Giles; Jian Gong; Tabitha A Harrison; Jeroen R Huyghe; Eric J Jacobs; Li Li; Yi Lin; Loïc Le Marchand; John D Potter; Conghui Qu; Stephanie A Bien; Niha Zubair; Robert J Macinnis; Daniel D Buchanan; John L Hopper; Yin Cao; Reiko Nishihara; Gad Rennert; Martha L Slattery; Duncan C Thomas; Michael O Woods; Ross L Prentice; Stephen B Gruber; Yingye Zheng; Hermann Brenner; Richard B Hayes; Emily White; Ulrike Peters; Li Hsu Journal: Gastroenterology Date: 2018-02-17 Impact factor: 33.883