Fit and Colonoscopy Uptake after the First Round of Testing in a Randomized Health Services Study Offering Competing Strategies for Colorectal Cancer Screening (Piccolino Study)
Nastazja PilonisMarek BugajskiPaulina WieszczyMaciej RupińskiMałgorzata PiseraErica A. PawlakJarosław RegułaMF Kaminski
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Aims Primary colonoscopy and fecal immunochemical testing (FIT) are considered first tier tests for colorectal cancer (CRC) screening. Although colonoscopy is considered the most efficacious test, FIT may achieve higher participation rates. We assessed diagnostic yield of FIT and colonoscopy after the first round of testing in the PICCOLINO study.Keywords:
Colorectal cancer screening
Screening for colorectal cancer (CRC) using the fecal immunochemical test (FIT) has been rapidly implemented worldwide. Alongside primary colonoscopy, it is a first-tier recommended screening test. FIT testing offers several advantages, including noninvasiveness, high acceptance among the target population, and cost-effectiveness [1] [2] [3]. However, it is not without challenges, particularly concerning the management of individuals with a negative colonoscopy following a positive FIT result.
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Screening colonoscopy for early detection and prevention of colorectal cancer (CRC) is mostly used inefficiently. Here, we assessed the potential of an innovative approach to colonoscopy-based screening, by use of a single, low threshold fecal immunochemical test (FIT) as a "gateopener" for screening colonoscopy. Using COSIMO, a validated simulation model, we modeled scenarios including either direct invitation to screening colonoscopy or an alternative approach involving mailing a single ("gateopener") FIT along with an invitation to colonoscopy contingent on a FIT value above a low threshold yielding a 50% positivity rate (ie, every other pretest will be positive). Under plausible assumptions on screening offer adherence, we found that such "gateopener screening" (use of screening colonoscopy contingent on a positive, low threshold gateopener FIT) approximately doubled cancer detection rates vs conventional screening. In those spared from screening colonoscopy due to a negative gateopener FIT pretest, numbers needed to screen were 10-times higher vs those for individuals with a positive FIT, peaking in >2000 and >3800 (hypothetically) needed colonoscopies to detect one case of cancer in men and women, respectively. Gateopener screening resulted in 42%-51% and 59%-65% more prevented CRC cases and deaths, respectively. In summary, by directing colonoscopy capacities to those most likely to benefit, offering screening colonoscopy contingent on a "gateopener" low-threshold FIT would substantially enhance efficiency of colonoscopy screening.
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To assess patient preferences for colorectal cancer screening with stool-based tests after initial colonoscopy with suboptimal bowel preparation.An online scenario-based survey of adults aged 45 to 75 years at average risk for colorectal cancer was performed.When presented with a hypothetical scenario of screening colonoscopy with suboptimal bowel preparation, 59% of respondents chose stool-based testing as a next step, 29% preferred a repeat colonoscopy within a year, and 12% preferred a repeat colonoscopy in 10 years (N = 1,080).Clinicians should consider offering stool-based screening tests as an alternative to repeat colonoscopy after suboptimal bowel preparation.
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The morbidity of colorectal cancer has been increasing year by year in China.Screening test of colorectal cancer can effectively decrease the morbidity and mortality of it.However,the current screening technique has obvious defect.Screening of exfoliated colonocytes isolated from human stool for early detection of colorectal cancer is noninvasive and well tolerated by patients;it has a potential for colorectal cancer screening.
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To examine predictors of provider recommendations for colorectal cancer (CRC).We examined proportions of patients without prior screening for colonoscopy and their willingness to get a colonoscopy if recommended by a healthcare provider.The rate of CRC screening with a colonoscopy within the recommended guidelines was 35%; provider recommendation rate for colonoscopy screening was 34.9%; and never-screened patients would receive a colonoscopy 78% when recommended by a provider. Provider recommendation was the best predictor for receiving a screening colonoscopy (OR 4.19; 95% CI, 1.91-9.22, p < .01).Physician recommendation for colonoscopy is the most effective strategy to promote screening colonoscopy in the US, but only one third of eligible patients recall such counseling.
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Screening colonoscopies for colorectal cancer (CRC) are typically covered without patient cost-sharing, whereas follow-up colonoscopies for positive stool-based screening tests often incur patient costs. The objective of this analysis was to estimate and compare the life-years gained (LYG) per average-risk screening colonoscopy and follow-up colonoscopy after a positive stool-based test to better inform CRC coverage policy and reimbursement decisions. CRC outcomes from screening and follow-up colonoscopies versus no screening were estimated using CRC-AIM in a simulated population of average-risk individuals screened between ages 45-75 years. The LYG/colonoscopy per 1000 individuals was 0.09 for screening colonoscopy and 0.29 for follow-up colonoscopy. 0.01 and 0.04 CRC cases and 0.01 and 0.02 CRC deaths were averted per screening and follow-up colonoscopies, respectively. Coverage policies should be revised to encourage individuals to complete recommended screening processes.
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Colorectal cancer is a significant public health issue all over the world. Screening has been shown effective in improving the survival rate and decreasing the deaths of colorectal cancer. Several organizations have released guidelines for colorectal cancer screening. However, detailed recommendations like the age to begin remain controversial. This paper summarizes the recommended different age groups in initiating the colorectal cancer screening program from a few guidelines and analyzes the reasons for the inconsistency, thus facilitating the drafting of colorectal cancer screening guidelines in China.结直肠癌已成为严重威胁人类健康的重要公共卫生问题之一，筛查可以提升结直肠癌生存率并降低人群死亡率。多个国家相继发布适合本国人群的结直肠癌筛查指南，但不同指南在筛查年龄等问题上尚存争议。本文针对结直肠癌适宜筛查开始年龄进行汇总，分析其产生差异的原因，为我国人群结直肠癌筛查指南的制定提供思路借鉴。.
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Aims Primary colonoscopy and fecal immunochemical testing (FIT) are considered first tier tests for colorectal cancer (CRC) screening. Although colonoscopy is considered the most efficacious test, FIT may achieve higher participation rates. We assessed diagnostic yield of FIT and colonoscopy after the first round of testing in the PICCOLINO study.
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An important new test for colorectal cancer screening was evaluated by Imperiale et al. and reported in the April 4, 2014 New England Journal of Medicine entitled “Multitarget stool DNA testing for colorectal-cancer screening”. This editorial notes the favorable trend in the reduction of colorectal cancer incidence and mortality, and explores the significant issue of suboptimal patient uptake of existing colorectal cancer screening examinations. The findings of the multitarget stool DNA test study are summarized, put into perspective, and the potential interest in this examination is considered. By expanding colorectal cancer screening uptake, the multitarget stool DNA test may further reduce the burden of colorectal cancer.
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Abstract Objectives To assess the potential of an innovative approach to colonoscopy-based screening for colorectal cancer (CRC), by use of a single, low threshold fecal immunochemical test (FIT) as a ‘gateopener’ for screening colonoscopy. Design Simulation study using COSIMO, a validated Markov-based simulation model, in a hypothetical German population. Setting Modelled scenarios included either direct invitation to screening colonoscopy or mailing a single (‘gateopener’) FIT along with an invitation to colonoscopy contingent on a FIT value above a low threshold yielding a 50% positivity rate (i.e., every other pre-test will be positive). The main analyses focused on scenarios assuming identical colonoscopy uptake, resulting from higher adherence to the gateopener FIT than to primary use of colonoscopy and avoidance of colonoscopy in those with below-threshold FIT values. Participants Hypothetical cohorts of 100,000 previously unscreened men and women using screening at different ages and with varying levels of adherence. Interventions Screening colonoscopy without and with preceding gateopener FIT. Main outcome measure Detected and prevented CRC cases and deaths within 10 years. Results Across all ages and both sexes, use of screening colonoscopy contingent on a positive gateopener FIT yielded approximately doubled cancer detection rates as compared to conventional screening. In those spared from undergoing screening colonoscopy due to a negative FIT pretest, numbers needed to screen were 10-times higher as compared to those for individuals with a positive FIT, peaking in more than 2500 and more than 3800 (hypothetically) needed colonoscopies to detect one case of cancer in 50-year-old men and women, respectively. At identical levels of colonoscopy use, gateopener screening resulted in 51-53% and 63-68% more prevented CRC cases and deaths, respectively. Conclusions By directing colonoscopy capacities to those most likely to benefit from it, offer of screening colonoscopy contingent on a ‘gateopener’ low-threshold FIT would substantially enhance efficiency of colonoscopy screening. Summary Box What is already known on this topic Screening colonoscopy as primary examination is inefficient as most of the screened subjects would never develop colorectal cancer even without screening. Efficiency could be enhanced by pre-selecting those most likely to benefit, e.g., by use of a single low-threshold faecal immunochemical test (‘gateopener’ FIT) What this study adds A simulation where only individuals with positive gateopener FIT proceeded to screening colonoscopy resulted in 50% fewer colonoscopies required to detect one case of cancer vs conventional screening colonoscopy. At identical colonoscopy uptake rates, the gateopener approach implied approximately 50% and 70% more prevented colorectal cancer cases and deaths, respectively. Inviting subjects to undergo pre-testing with low-threshold FITs would markedly improve efficiency of colonoscopy-based screening.
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