结直肠癌筛查延误的影响：一项模拟研究。
The impact of cumulative colorectal cancer screening delays: A simulation study.
机构信息
Economics, Sociology & Statistics, RAND Corporation, Santa Monica, CA, USA.
Division of Gastroenterology, Department of Internal Medicine, 12348University of Utah School of Medicine, Salt Lake City, UT, USA.
出版信息
J Med Screen. 2022 Jun;29(2):92-98. doi: 10.1177/09691413211045103. Epub 2021 Dec 13.
OBJECTIVE
Annual fecal immunochemical tests can reduce colorectal cancer incidence and mortality. However, screening is a multi-step process and most patients do not perfectly adhere to guideline-recommended screening schedules. Our objective was to compare the reduction in colorectal cancer incidence and life-years gained based on US guideline-concordant fecal immunochemical test screening to scenarios with a range of delays.
METHOD
The Colorectal Cancer Simulated Population model for Incidence and Natural history (CRC-SPIN) microsimulation model was used to estimate the effect of systematic departures from fecal immunochemical test screening guidelines on lifetime screening benefit.
RESULTS
The combined effect of consistent modest delays in screening initiation (1 year), repeated fecal immunochemical test screening (3 months), and receipt of follow-up or surveillance colonoscopy (3 months) resulted in up to 1.3 additional colorectal cancer cases per 10,000, 0.4 additional late-stage colorectal cancer cases per 10,000 and 154.7 fewer life-years gained per 10,000. A 5-year delay in screening initiation had a larger impact on screening effectiveness than consistent small delays in repeated fecal immunochemical test screening or receipt of follow-up colonoscopy after an abnormal fecal immunochemical test. The combined effect of consistent large delays in screening initiation (5 years), repeated fecal immunochemical test screening (6 months), and receipt of follow-up or surveillance colonoscopy (6 months) resulted in up to 3.7 additional colorectal cancer cases per 10,000, 1.5 additional late-stage colorectal cancer cases per 10,000 and 612.3 fewer life-years gained per 10,000.
CONCLUSIONS
Systematic delays across the screening process can result in meaningful reductions in colorectal cancer screening effectiveness, especially for longer delays. Screening delays could drive differences in colorectal cancer incidence across patient groups with differential access to screening.
目的
年度粪便免疫化学检测可降低结直肠癌发病率和死亡率。然而，筛查是一个多步骤的过程，大多数患者并不能完全遵循指南推荐的筛查时间表。我们的目标是比较基于美国指南一致的粪便免疫化学检测筛查的结直肠癌发病率降低和获得的生命年数，以及各种延迟情况下的结果。
方法
使用结直肠癌模拟人群发病率和自然史（CRC-SPIN）微观模拟模型来估计系统偏离粪便免疫化学检测筛查指南对终生筛查益处的影响。
结果
筛查起始时间（1 年）、重复粪便免疫化学检测筛查（3 个月）和接受随访或监测结肠镜检查（3 个月）持续适度延迟的综合影响导致每 10000 人增加 1.3 例结直肠癌，每 10000 人增加 0.4 例晚期结直肠癌，每 10000 人减少 154.7 个生命年。筛查起始时间延迟 5 年对筛查效果的影响大于重复粪便免疫化学检测筛查或异常粪便免疫化学检测后接受随访结肠镜检查的持续小延迟。筛查起始时间（5 年）、重复粪便免疫化学检测筛查（6 个月）和接受随访或监测结肠镜检查（6 个月）持续大延迟的综合影响导致每 10000 人增加 3.7 例结直肠癌，每 10000 人增加 1.5 例晚期结直肠癌，每 10000 人减少 612.3 个生命年。
结论
筛查过程中的系统性延迟可能会显著降低结直肠癌筛查的效果，尤其是延迟时间较长时。筛查延迟可能会导致不同患者群体之间结直肠癌发病率的差异，因为这些患者群体获得筛查的机会不同。
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