Division of Preventive Oncology, National Center for Tumor Diseases/German Cancer Research Center, DKFZ, Heidelberg, Germany.
Int J Cancer. 2012 Nov 1;131(9):2094-102. doi: 10.1002/ijc.27463. Epub 2012 Mar 29.
Several industrialized nations recommend fecal occult blood testing (FOBT) to screen for colorectal cancer (CRC), but corresponding screening guidelines do not specify how individuals with a prior false-positive FOBT result (fpFOBT) should be managed in terms of subsequent CRC screening. Accordingly, we conducted a decision analysis to compare different strategies for managing such individuals. We used a previously developed CRC microsimulation model, SimCRC, to calculate life-years and the lifetime number of colonoscopies (as a measure of required resources) for a cohort of 50-year-olds to whom FOBT-based CRC screening is offered annually from 50 to 75 years. We compared three management strategies for individuals with a prior fpFOBT: (i) resume screening in 10 years with 10-yearly colonoscopy (SwitchCol_long); (ii) resume screening in 1 year with annual FOBT (ContinueFOBT_Short) and (iii) resume screening in 10 years (i.e., the recommended interval following a negative colonoscopy) with annual FOBT (ContinueFOBT_long). We performed sensitivity analyses on various parameters and assumptions. When using different management strategies for individuals with a prior fpFOBT, the variation in the number of life-years gained relative to no screening was <2%, whereas the variation in the lifetime number of colonoscopies was 23% (percentages are calculated as the maximum difference across strategies divided by the lowest number across strategies). The ContinueFOBT_long strategy showed the lowest lifetime number of colonoscopies per life-year gained even when key assumptions were varied. In conclusion, the ContinueFOBT_long strategy was advantageous regarding both clinical benefit and required resources. Specifying an appropriate management strategy for individuals with a prior fpFOBT may substantially reduce required resources within a FOBT-based CRC screening program without limiting its effectiveness.
一些工业化国家建议使用粪便潜血检测（FOBT）进行结直肠癌（CRC）筛查，但相应的筛查指南并未明确规定先前 FOBT 假阳性（fpFOBT）结果的个体应如何管理后续 CRC 筛查。因此，我们进行了一项决策分析，以比较管理此类个体的不同策略。我们使用先前开发的 CRC 微模拟模型 SimCRC，根据从 50 岁开始每年进行一次 FOBT 筛查的队列，计算生命年和一生中需要进行的结肠镜检查次数（作为所需资源的衡量标准）。我们比较了三种管理策略：（i）在 10 年后恢复筛查，每 10 年进行一次结肠镜检查（SwitchCol_long）；（ii）在 1 年后恢复筛查，每年进行一次 FOBT（ContinueFOBT_Short）；（iii）在 10 年后恢复筛查（即在阴性结肠镜检查后推荐的间隔），每年进行一次 FOBT（ContinueFOBT_long）。我们对各种参数和假设进行了敏感性分析。当对先前 fpFOBT 的个体使用不同的管理策略时，与不筛查相比，获得的生命年数的变化小于 2%，而一生中结肠镜检查的次数变化为 23%（百分比是通过将策略之间的最大差异除以策略之间的最低数量来计算的）。即使关键假设发生变化，ContinueFOBT_long 策略也显示出每获得一个生命年所需的结肠镜检查次数最少。总之，ContinueFOBT_long 策略在临床获益和所需资源方面都具有优势。为先前 fpFOBT 的个体指定适当的管理策略可能会在不限制其有效性的情况下，显著减少基于 FOBT 的 CRC 筛查计划所需的资源。
