Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
World J Surg. 2022 Oct;46(10):2476-2486. doi: 10.1007/s00268-022-06656-0. Epub 2022 Jul 14.
In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine.
We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity.
Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence.
The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.
在乌克兰，尚未建立起完善的结直肠癌筛查计划。本研究旨在预测在乌克兰实施不同结直肠癌筛查策略所需的筛查结肠镜检查数量。
我们对之前开发的马尔可夫微模拟模型进行了修改，以反映平均风险为 50-74 岁人群中腺瘤和结直肠癌进展的自然史。我们模拟了以下筛查策略所需的结肠镜检查数量：不筛查、每年进行粪便潜血试验（FOBT）、每 5 年进行一次 FOBT 联合乙状结肠镜检查、每 5 年进行一次乙状结肠镜检查、每年进行一次粪便免疫化学试验（FIT）或每 10 年进行一次结肠镜检查。假设 80%的筛查依从性，我们根据实施率估计了 1 年和 5 年所需的结肠镜检查数量。在单因素敏感性分析中，我们改变了实施率、筛查依从性、敏感性和特异性。
假设 80%的筛查依从性和完全实施（100%），除了不筛查策略外，FOBT 方案所需的筛查结肠镜检查数量最少，分别在实施后 1 年和 5 年平均每 10 万人需要 6600 次和 26800 次结肠镜检查。结肠镜检查方案所需的筛查结肠镜检查数量最多，分别在实施后 1 年和 5 年平均每 10 万人需要 76600 次和 101000 次结肠镜检查。在敏感性分析中，所需结肠镜检查数量的最大驱动因素是筛查依从性。
所需结肠镜检查数量以及因此对医疗保健系统的潜在压力因筛查检测而异。这些发现可为乌克兰实施国家筛查计划时的利益相关者提供有关设备需求的有价值信息。
