Alcock Rebecca, Shaukat Aasma, Kisiel John B, Hernandez Lyndon V, Delarmente Benjo A, Estes Chris, Bartels Jeff, Lester Jason, Vahdat Vahab, Limburg Paul J, Fendrick A Mark
Exact Sciences Corporation, Madison, WI 53719, United States.
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States.
Health Aff Sch. 2025 Feb 28;3(3):qxaf041. doi: 10.1093/haschl/qxaf041. eCollection 2025 Mar.
The substantial carbon footprint imparted by medical services warrants increased attention to their environmental impact. National guideline organizations such as the US Preventive Services Task Force (USPSTF) recommend multiple modalities for average-risk colorectal cancer (CRC) screening with varying resource intensity. The aim of this study was to quantify the environmental burden for 2 of the most used CRC screening modalities, colonoscopy and the multi-target stool DNA (mt-sDNA) test. A validated CRC microsimulation model was used to estimate the number of screening and follow-up tests for a cohort of 1 million average-risk individuals who underwent screening between ages 45 and 75. Component resources used for mt-sDNA, including waste products, energy, and transportation for colonoscopy and mt-sDNA, were collected from January 1, 2023, to January 1, 2024, and converted to carbon-equivalent emissions. Resources used for colonoscopy were captured from the literature. Resources devoted to screening colonoscopy were substantially (59%) higher than those to mt-sDNA, even when including follow-up colonoscopy. Of note, follow-up colonoscopy accounted for the majority (64%) of total emissions for the mt-sDNA screening strategy. Compared with colonoscopy screening, mt-sDNA substantially reduces the carbon emissions attributable to population-level CRC screening. Environmental impact should be included as a factor when choosing among guideline-recommended CRC screening strategies.
医疗服务所产生的巨大碳足迹值得人们更多地关注其对环境的影响。美国预防服务工作组（USPSTF）等国家指南制定组织推荐了多种针对平均风险结直肠癌（CRC）筛查的方式，这些方式的资源密集程度各不相同。本研究的目的是量化两种最常用的CRC筛查方式——结肠镜检查和多靶点粪便DNA（mt-sDNA）检测——所带来的环境负担。我们使用一个经过验证的CRC微观模拟模型，来估算100万名年龄在45岁至75岁之间接受筛查的平均风险个体的筛查和后续检测数量。2023年1月1日至2024年1月1日期间收集了用于mt-sDNA检测的各类资源，包括废物、能源以及结肠镜检查和mt-sDNA检测的运输资源，并将其转换为碳当量排放量。用于结肠镜检查的资源来自文献资料。即使将后续结肠镜检查计算在内，用于筛查性结肠镜检查的资源仍比用于mt-sDNA检测的资源高出很多（59%）。值得注意的是，后续结肠镜检查在mt-sDNA筛查策略的总排放量中占了大部分（64%）。与结肠镜检查筛查相比，mt-sDNA检测大幅减少了人群层面CRC筛查所产生的碳排放。在选择指南推荐的CRC筛查策略时，应将环境影响作为一个考量因素。
