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  • COST-EFFECTIVENESS  (3)
  • 1
    Keywords: CANCER ; DIAGNOSIS ; POPULATION ; RISK ; COST-EFFECTIVENESS ; COLON-CANCER ; UNITED-STATES ; sensitivity ; colorectal neoplasms ; SERVICES TASK-FORCE ; colonography ; OCCULT BLOOD-TEST ; ADVANCED ADENOMAS ; natural history
    Abstract: The sojourn time of preclinical colorectal cancer is a critical parameter in modeling effectiveness and cost-effectiveness of colorectal cancer screening. For ethical reasons, it cannot be observed directly, and available estimates are based mostly on relatively small historic data sets that do not include differentiation by age and sex. The authors derived sex- and age-specific estimates (age groups: 55-59, 60-64, 65-69, 70-74, 75-79, and more or equal 80 years) of mean sojourn time, combining data from the German national screening colonoscopy registry (based on 1.88 million records) and data from population-based cancer registries (population base: 37.9 million people) for the years 2003-2006. Estimates of mean sojourn time were similar for both sexes and all age groups and ranged from 4.5 years (95% confidence interval: 4.1, 4.8) to 5.8 years (95% confidence interval: 5.3, 6.3) for the subgroups assessed. Sensitivity analyses indicated that mean sojourn time might be approximately 1.5 years longer if colorectal cancer prevalence in nonparticipants of screening colonoscopy is 20% lower than prevalence in participants or 1 year shorter if it exceeds the prevalence in participants by 20%. This study provides, for the first time, precise estimates of sojourn time by age and sex, and it suggests that sojourn times are remarkably consistent across age groups and in both sexes.
    Type of Publication: Journal article published
    PubMed ID: 21984657
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  • 2
    Keywords: CANCER ; Germany ; screening ; incidence ; POPULATION ; RISK ; PATIENT ; colon ; ADENOMAS ; PROGRESSION ; DESIGN ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COST-EFFECTIVENESS ; RATES ; LINE ; EVOLUTION ; MALIGNANT TRANSFORMATION ; NATIONWIDE ; CARRIERS ; INDIVIDUALS ; SERIES ; PREVALENCE ; REGISTRY ; RE ; INCREASE ; TRANSITION ; colonoscopy ; CANCER INCIDENCE ; GUT ; REGISTRIES ; colorectal ; - ; GRADIENT ; LARGE-INTESTINE ; POLYPS ; SCREENING COLONOSCOPY ; adenoma ; YOUNGER
    Abstract: Objectives: To derive age and sex specific estimates of transition rates from advanced adenomas to colorectal cancer by combining data of a nationwide screening colonoscopy registry and national data on colorectal cancer ( CRC) incidence. Design: Registry based study. Setting: National screening colonoscopy programme in Germany. Patients: Participants of screening colonoscopy in 2003 and 2004 ( n = 840 149). Main outcome measures: Advanced adenoma prevalence, colorectal cancer incidence, annual and 10 year cumulative risk of developing CRC among carriers of advanced adenomas according to sex and age ( range 55 - 80+ years). Results: The age gradient is much stronger for CRC incidence than for advanced adenoma prevalence. As a result, projected annual transition rates from advanced adenomas to CRC strongly increase with age ( from 2.6% in age group 55 - 59 years to 5.6% in age group 〉= 80 years among women, and from 2.6% in age group 55 - 59 years to 5.1% in age group 〉= 80 years among men). Projections of 10 year cumulative risk increase from 25.4% at age 55 years to 42.9% at age 80 years in women, and from 25.2% at age 55 years to 39.7% at age 80 years in men. Conclusions: Advanced adenoma transition rates are similar in both sexes, but there is a strong age gradient for both sexes. Our estimates of transition rates in older age groups are in line with previous estimates derived from small case series in the pre-colonoscopy era independent of age. However, our projections for younger age groups are considerably lower. These findings may have important implications for the design of CRC screening programmes
    Type of Publication: Journal article published
    PubMed ID: 17591622
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  • 3
    Keywords: CANCER ; POPULATION ; COST-EFFECTIVENESS ; ENDOSCOPY ; LARGE-INTESTINE ; POLYPS ; sex ; OCCULT BLOOD-TEST ; STOOL DNA ; SOJOURN TIME
    Abstract: Background: Most colorectal cancers (CRC) develop from adenomas. Knowledge of the natural history of colorectal adenomas, which is not directly observable for ethical reasons, is crucial for designing cost-effective CRC screening strategies. Methods: We derived transition rates from carriage of nonadvanced adenoma to carriage of advanced adenoma to carriage of CRC by sex and age in birth cohort analyses among 3,593,420 participants in the German screening colonoscopy program in 2003-2010. Results: Transition rates from advanced adenoma to CRC carriage were similar in men and women, but monotonically and significantly increased with age. Estimated annual transition percentages [(95% confidence interval (CI)] in age groups 55-59, 60-64, 65-69, 70-74, and 75-79 years were 2.6 (2.4-2.9), 3.1 (2.8-3.3), 3.8 (3.5-4.1), 5.1 (4.8-5.5), and 5.2 (4.6-5.8) among men, and 2.5 (2.2-2.7), 2.7 (2.4-3.0), 3.8 (3.5-4.1), 5.0 (4.5-5.4), and 5.6 (4.9-6.3) among women. Estimated annual transitions from carriage of nonadvanced to carriage of advanced adenoma were in a narrow range from 3.6% to 4.7% for all age and sex groups. Conclusions: Despite low annual transition rates, cumulative transition rates from advanced adenoma to CRC carriage are expected to exceed by 60%, 50%, and 40% for age intervals 55-80, 65-80, and 70-80 years, respectively, in both sexes. Cumulative transition rates from nonadvanced adenoma to CRC carriage are expected to be close to 30% for age interval 55-80 years, but less than 2% for age interval 75-80 years. Impact: Our results enhance the empirical basis for modeling CRC screening strategies.
    Type of Publication: Journal article published
    PubMed ID: 23632815
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