基于合并症和筛查史的结直肠癌筛查截止年龄计算。
Calculation of Stop Ages for Colorectal Cancer Screening Based on Comorbidities and Screening History.
机构信息
Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada.
出版信息
Clin Gastroenterol Hepatol. 2021 Mar;19(3):547-555. doi: 10.1016/j.cgh.2020.05.038. Epub 2020 May 23.
BACKGROUND & AIMS: Routine screening for colorectal cancer typically is recommended until age 74 years. Although it has been proposed that a screening stop age could be determined based on sex and comorbidity, less is known about the impact of screening history. We investigated the effects of screening history on the selection of an optimal age to stop screening.
METHODS
We used the Microsimulation Screening Analysis-Colon model to estimate the harms and benefits of screening with biennial fecal immunochemical tests by sex, comorbidity status, and screening history. The optimal screening stop age was determined based on the incremental number needed for 1 additional life-year per 1000 screened individuals compared with the threshold provided by stopping screening at 76 years in the average-health population with a perfect screening history (attended all required screening, diagnostic, and follow-up tests) to biennial fecal immunochemical testing from age 50 years.
RESULTS
For persons age 76 years, 157 women and 108 men with a perfect screening history would need to be screened to gain 1 life-year per 1000 screened individuals. Previously unscreened women with no comorbid conditions and no history of screening could undergo an initial screening through 90 years, whereas unscreened men could undergo initial screening through 88 years, before this balance is reached. As screening adherence improved or as comorbidities increased, the optimal age to stop screening decreased to a point that, regardless of sex, individuals with severe comorbidities and a perfect screening history should stop screening at age 66 years or younger.
CONCLUSIONS
Based on the harm-benefit balance, the optimal stop age for colorectal cancer screening ranges from 66 years for unhealthy individuals with a perfect screening history to 90 years for healthy individuals without prior screening. These findings can be used to assist patients and clinicians in making decisions about screening participation.
背景与目的
通常建议常规筛查结肠癌直至 74 岁。尽管已经提出可以根据性别和合并症来确定筛查停止年龄，但对于筛查史的影响知之甚少。我们研究了筛查史对选择停止筛查的最佳年龄的影响。
方法
我们使用 Microsimulation Screening Analysis-Colon 模型，根据性别、合并症状态和筛查史，估计每 1000 名筛查者中每增加 1 例额外生命年的筛查收益和危害。最佳筛查停止年龄是根据与在平均健康人群中停止 76 岁筛查相比，每 1000 名筛查者中每增加 1 例额外生命年的增量数来确定的，在具有完美筛查史（参加所有要求的筛查、诊断和随访检查）的人群中，从 50 岁开始进行每两年一次的粪便免疫化学检测。
结果
对于 76 岁的个体，157 名女性和 108 名男性如果具有完美的筛查史，则需要筛查 157 名女性和 108 名男性，才能使每 1000 名筛查者增加 1 例生命年。无合并症且无既往筛查史的从未筛查过的女性可以进行 90 岁之前的初始筛查，而从未筛查过的男性可以进行 88 岁之前的初始筛查，直到达到这一平衡。随着筛查依从性的提高或合并症的增加，停止筛查的最佳年龄会降低，以至于无论性别如何，患有严重合并症且具有完美筛查史的个体都应在 66 岁或更年轻时停止筛查。
结论
基于危害-效益平衡，结直肠癌筛查的最佳停止年龄范围为，对于具有完美筛查史的不健康个体为 66 岁，对于无既往筛查的健康个体为 90 岁。这些发现可用于协助患者和临床医生做出筛查参与决策。
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