The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Australia.
Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.
J Cancer Policy. 2022 Jun;32:100325. doi: 10.1016/j.jcpo.2022.100325. Epub 2022 Feb 8.
Australian Aboriginal and Torres Strait Islander peoples experience health and socioeconomic disparities, including lower life-expectancy, have a younger mean age of colorectal cancer (CRC) diagnosis, and lower CRC survival than non-Indigenous Australians. The National Bowel Cancer Screening Program (NBCSP) provides biennial CRC screening for Australians aged 50-74 years to reduce the burden of CRC. The 2019 participation rate was 42% nationwide and 23% in Aboriginal and Torres Strait Islander peoples. For Aboriginal and Torres Strait Islander peoples, this study aims to estimate the health outcomes and cost-effectiveness of the current NBCSP and extensions to include people < 50 years.
An existing microsimulation model, Policy1-Bowel, was adapted to the Aboriginal and Torres Strait Islander population and was used to evaluate three strategies assuming biennial iFOBT screening from 50-74, 45-74, or 40-74 years under two participation scenarios: 23% and 42% per screening round (psr.).
At 23-42% participation psr., the current NBCSP was predicted to reduce lifetime CRC incidence and mortality by 14-24% and 23-39%, respectively, be cost-effective (incremental cost-effectiveness ratio <$13,000/life-year saved), and be associated with a benefits-and-burden balance of 51-53 number-needed-to-colonoscope (NNC) per CRC death prevented of . Lowering the screening start age to 40(45) would further reduce CRC incidence and CRC mortality by 7-11(4-5) percentage points, be cost-effective, and be associated with an incremental NNC- of > 95 (> 60).
For Aboriginal and Torres Strait Islander peoples, the current NBCSP is cost-effective but participation is limited. Lowering the screening start age will further reduce CRC incidence and mortality.
These findings highlight a need to increase NBCSP participation whilst exploring the feasibility and acceptability of lowering the NBCSP start age for Aboriginal and Torres Strait Islander peoples. These findings could inform new co-designed, community-led strategies to improve CRC outcomes for Aboriginal and Torres Strait Islander peoples.
澳大利亚原住民和托雷斯海峡岛民在健康和社会经济方面存在差距，包括预期寿命较低、结直肠癌（CRC）诊断的平均年龄较小、CRC 生存率低于非原住民澳大利亚人。国家结直肠癌筛查计划（NBCSP）为 50-74 岁的澳大利亚人提供每两年一次的 CRC 筛查，以降低 CRC 的负担。2019 年，全国参与率为 42%，原住民和托雷斯海峡岛民为 23%。对于原住民和托雷斯海峡岛民，本研究旨在评估当前 NBCSP 的健康结果和成本效益，并扩展到包括<50 岁的人群。
对现有的 Policy1-Bowel 微观模拟模型进行了改编，以适用于原住民和托雷斯海峡岛民人群，并用于评估三种策略，假设从 50-74、45-74 或 40-74 岁开始每两年进行一次 iFOBT 筛查，在两种参与率情景下（每轮筛查 23%和 42%）。
在 23-42%的参与率下，当前的 NBCSP 预计将降低终生 CRC 发病率和死亡率 14-24%和 23-39%，具有成本效益（增量成本效益比<13,000 美元/人/年），并与 51-53 个结肠镜检查/每例 CRC 死亡的受益与负担平衡相关。将筛查起始年龄降低到 40（45）岁将进一步降低 7-11（4-5）个百分点的 CRC 发病率和 CRC 死亡率，具有成本效益，并与>95（>60）个的增量 NNC 相关。
对于原住民和托雷斯海峡岛民来说，当前的 NBCSP 具有成本效益，但参与度有限。降低筛查起始年龄将进一步降低 CRC 的发病率和死亡率。
这些发现强调需要提高 NBCSP 的参与率，同时探索降低原住民和托雷斯海峡岛民 NBCSP 起始年龄的可行性和可接受性。这些发现可以为新的共同设计、以社区为导向的策略提供信息，以改善原住民和托雷斯海峡岛民的 CRC 结果。
