How long does it take until the effects of endoscopic screening on colorectal cancer mortality are fully disclosed?: a Markov model study.
Int J Cancer
; 143(11): 2718-2724, 2018 12 01.
Article
em En
| MEDLINE
| ID: mdl-29978478
ABSTRACT
A recent randomized trial has suggested persisting protection from colorectal cancer (CRC) incidence and mortality of a single flexible sigmoidoscopy for up to 17 years and possibly beyond. We performed a simulation study to explore the time course and magnitude of protection provided by screening colonoscopy against CRC death over 25 years. Using data from the German national screening colonoscopy registry, a multistate Markov model was set up based on the adenoma-carcinoma pathway to estimate cumulative CRC mortality when different proportions of the population have a single screening colonoscopy at age 55, or two screening colonoscopies at ages 55 and 65. Cumulative CRC mortality continuously increased with age and reached 2.6 and 1.7% at age 80 in the absence of screening for men and women, respectively. A single colonoscopy at age 55, even with limited uptake, would lead to much lower cumulative mortality (0.7% for men and 0.5% for women at age 80 under 100% uptake). Relative mortality reduction continued to increase over more than 10 years and reached the maximum around 12-13 years after screening. Absolute risk reduction steadily increased throughout follow-up and more than half of the total risk reduction would occur between 15-25 years. A repeat colonoscopy 10 years later further enhanced the effects and cumulative mortality remained at 0.1-0.2% under 100% uptake. Even a single (once-only) screening colonoscopy has the potential to prevent most of CRC mortalities. Protective effects are expected to be long-lasting and to become fully manifest after more than two decades from screening.
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1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Health_economic_evaluation
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Cancer
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Alemanha