The Dutch screening programme
In 2014, the Netherlands has started with the implementation of a colorectal cancer (CRC) screening programme consisting of biennial faecal immunochemical testing (FIT) screening in individuals aged 55 to 75 years. We aimed to evaluate the long-term impact of this programme on CRC incidence, mortality and colonoscopy demand. For this purpose, we developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that describes the development of colorectal polyps to CRC. The model satisfactorily reproduces the Dutch age- and sex-specific polyp prevalence as reported in a Dutch trial and Dutch CRC incidence and mortality rates.
Long-term impact of the programme
We showed that the Dutch CRC screening programme will decrease CRC incidence by roughly 35% and CRC mortality by roughly 45%. To achieve this reduction, 110,000 colonoscopies will be required annually by 2044. However, the number of yearly incident CRC cases after thirty years of screening will be comparable to that before the implementation of screening, due to ageing of the population. This indicates that facilities for CRC patients need to be maintained at the same level. Furthermore, results of this study are informative for steering colonoscopy capacity to meet the expected demand.
The potential of CTC and MRC screening
We also used the ASCCA model to evaluate the potential of other screening modalities in terms of cost-effectiveness. We compared several strategies of CT colonography (CTC) and MR colonography (MRC) to no screening, colonoscopy screening and FIT screening. To our knowledge, this is the first study to assess the potential of MRC as a screening tool for CRC. Our model predicted that all imaging strategies are cost-effective compared to no screening. CTC strategies with two, three and five screening rounds were even cost-saving. Although MRC strategies led to similar health gains as CTC strategies with an equal number of screening rounds, the incremental cost-effectiveness ratios for MRC strategies were higher, which was mainly due to the higher costs per test. When taking three rounds of colonoscopy screening as the comparator, CTC or MRC screening with four or five screening rounds were cost-effective alternatives. However, imaging cannot compete with FIT screening in terms of cost-effectiveness.
Greuter MJE, de Klerk CM, Meijer GA, Dekker E, Coupé VMH. Screening for Colorerectal Cancer With Fecal Immunochemical Testing With and Without Postpolypectomy Surveillance Colonoscopy: A Cost-Effectiveness Analysis. Ann Intern Med. 2017. [Epub ahead of print]
Greuter MJ, Berkhof J, Canfell K, Lew JB, Dekker E, Coupé VM. Resilience of a FIT screening programme against screening fatigue: a modelling study. BMC Public Health. 2016;16(1):1009.
Greuter MJ, Berkhof J, Fijneman RJA et al. The Potential of Imaging Techniques as a Screening Tool for Colorectal Cancer: a Cost-Effectiveness Analysis. Br. J. Radiol. 2016;89(1063):20150910.
Greuter MJ, Demirel E, Lew JB et al. Long-term Impact of the Dutch Colorectal Cancer Screening Programme on Cancer Incidence and Mortality – Model-based Exploration of the Serrated Pathway. Cancer Epidemiol Biomarkers Prev. 2015;25(1):1-10.
Greuter MJ, Xu XM, Lew, JB et al. Modeling the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA). Risk Anal. 2014;34(5):889-910.