新冠疫情对澳大利亚、加拿大和荷兰基于粪便免疫化学试验的结直肠癌筛查项目的影响：一项比较建模研究。
Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study.
机构信息
Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
出版信息
Lancet Gastroenterol Hepatol. 2021 Apr;6(4):304-314. doi: 10.1016/S2468-1253(21)00003-0. Epub 2021 Feb 3.
BACKGROUND
Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and mortality in three countries using microsimulation modelling.
METHODS
In this modelling study, we used four country-specific colorectal cancer microsimulation models-Policy1-Bowel (Australia), OncoSim (Canada), and ASCCA and MISCAN-Colon (the Netherlands)-to estimate the potential impact of COVID-19-related disruptions to screening on colorectal cancer incidence and mortality in Australia, Canada, and the Netherlands annually for the period 2020-24 and cumulatively for the period 2020-50. Modelled scenarios varied by duration of disruption (3, 6, and 12 months), decreases in screening participation after the period of disruption (0%, 25%, or 50% reduction), and catch-up screening strategies (within 6 months after the disruption period or all screening delayed by 6 months).
FINDINGS
Without catch-up screening, our analysis predicted that colorectal cancer deaths among individuals aged 50 years and older, a 3-month disruption would result in 414-902 additional new colorectal cancer diagnoses (relative increase 0·1-0·2%) and 324-440 additional deaths (relative increase 0·2-0·3%) in the Netherlands, 1672 additional diagnoses (relative increase 0·3%) and 979 additional deaths (relative increase 0·5%) in Australia, and 1671 additional diagnoses (relative increase 0·2%) and 799 additional deaths (relative increase 0·3%) in Canada between 2020 and 2050, compared with undisrupted screening. A 6-month disruption would result in 803-1803 additional diagnoses (relative increase 0·2-0·4%) and 678-881 additional deaths (relative increase 0·4-0·6%) in the Netherlands, 3552 additional diagnoses (relative increase 0·6%) and 1961 additional deaths (relative increase 1·0%) in Australia, and 2844 additional diagnoses (relative increase 0·3%) and 1319 additional deaths (relative increase 0·4%) in Canada between 2020 and 2050, compared with undisrupted screening. A 12-month disruption would result in 1619-3615 additional diagnoses (relative increase 0·4-0·9%) and 1360-1762 additional deaths (relative increase 0·8-1·2%) in the Netherlands, 7140 additional diagnoses (relative increase 1·2%) and 3968 additional deaths (relative increase 2·0%) in Australia, and 5212 additional diagnoses (relative increase 0·6%) and 2366 additional deaths (relative increase 0·8%) in Canada between 2020 and 2050, compared with undisrupted screening. Providing immediate catch-up screening could minimise the impact of the disruption, restricting the relative increase in colorectal cancer incidence and deaths between 2020 and 2050 to less than 0·1% in all countries. A post-disruption decrease in participation could increase colorectal cancer incidence by 0·2-0·9% and deaths by 0·6-1·6% between 2020 and 2050, compared with undisrupted screening.
INTERPRETATION
Although the projected effect of short-term disruption to colorectal cancer screening is modest, such disruption will have a marked impact on colorectal cancer incidence and deaths between 2020 and 2050 attributable to missed screening. Thus, it is crucial that, if disrupted, screening programmes ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, since this could mitigate the impact on colorectal cancer deaths.
FUNDING
Cancer Council New South Wales, Health Canada, and Dutch National Institute for Public Health and Environment.
背景
全球范围内的结直肠癌筛查项目在 COVID-19 大流行期间受到了干扰。我们旨在使用微观模拟模型估计假设的基于粪便免疫化学试验的结直肠癌筛查计划中断对三个国家短期和长期结直肠癌发病率和死亡率的影响。
方法
在这项建模研究中，我们使用了四个特定于国家的结直肠癌微观模拟模型——Policy1-Bowel（澳大利亚）、OncoSim（加拿大）和 ASCCA 和 MISCAN-Colon（荷兰）——来估计与 COVID-19 相关的筛查中断对澳大利亚、加拿大和荷兰 2020-24 年期间每年以及 2020-50 年期间累积结直肠癌发病率和死亡率的潜在影响。建模情景因中断持续时间（3、6 和 12 个月）、中断后筛查参与度下降（0%、25%或 50%减少）和追赶筛查策略（中断期后 6 个月内或所有筛查延迟 6 个月）而有所不同。
结果
如果没有追赶筛查，我们的分析预测，在荷兰，50 岁及以上人群中，三个月的干扰将导致新增结直肠癌诊断病例增加 414-902 例（相对增加 0.1-0.2%），死亡人数增加 324-440 例（相对增加 0.2-0.3%）；在澳大利亚，新增诊断病例增加 1672 例（相对增加 0.3%），死亡人数增加 979 例（相对增加 0.5%）；在加拿大，新增诊断病例增加 1671 例（相对增加 0.2%），死亡人数增加 799 例（相对增加 0.3%），这将导致 2020 年至 2050 年之间的结直肠癌发病率和死亡率增加。6 个月的干扰将导致荷兰新增诊断病例增加 803-1803 例（相对增加 0.2-0.4%），死亡人数增加 678-881 例（相对增加 0.4-0.6%）；在澳大利亚，新增诊断病例增加 3552 例（相对增加 0.6%），死亡人数增加 1961 例（相对增加 1.0%）；在加拿大，新增诊断病例增加 2844 例（相对增加 0.3%），死亡人数增加 1319 例（相对增加 0.4%），这将导致 2020 年至 2050 年之间的结直肠癌发病率和死亡率增加。12 个月的干扰将导致荷兰新增诊断病例增加 1619-3615 例（相对增加 0.4-0.9%），死亡人数增加 1360-1762 例（相对增加 0.8-1.2%）；在澳大利亚，新增诊断病例增加 7140 例（相对增加 1.2%），死亡人数增加 3968 例（相对增加 2.0%）；在加拿大，新增诊断病例增加 5212 例（相对增加 0.6%），死亡人数增加 2366 例（相对增加 0.8%），这将导致 2020 年至 2050 年之间的结直肠癌发病率和死亡率增加。提供即时追赶筛查可以最大程度地减少干扰的影响，将 2020 年至 2050 年期间结直肠癌发病率和死亡率的相对增加限制在所有国家不到 0.1%。干扰后参与度的下降可能会导致 2020 年至 2050 年期间结直肠癌发病率增加 0.2-0.9%，死亡率增加 0.6-1.6%，与未中断筛查相比。
解释
尽管短期结直肠癌筛查中断的预期影响是适度的，但这种中断将对 2020 年至 2050 年期间的结直肠癌发病率和死亡率产生显著影响，这是由于错过了筛查。因此，如果受到干扰，筛查计划必须确保参与率恢复到之前观察到的水平，并尽可能提供追赶筛查，因为这可以减轻对结直肠癌死亡人数的影响。
资金来源
新南威尔士州癌症委员会、加拿大卫生部和荷兰国家公共卫生和环境研究所。
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