Charles Meade, MD, Stephanie Hansel, MD, MS
Mayo Clinic, Rochester, MN
Introduction: There are six currently approved screening modalities for colorectal cancer (CRC) as of 2016 United States Preventative Services Task Force guidelines. We sought to model what changes in current screening practice regarding choice between endoscopic and non-endoscopic testing would have to occur to drive a significant (10%) decrease in population-wide endoscopic procedures done as a result of CRC screening.
Methods: Published models of endoscopic procedural rates for all six approved screening methods were integrated with National Health Interview Survey data on screening compliance and reported utilization rates of currently approved screening modalities. A simulated population of 1000 screening-naïve patients was modeled over the guideline recommended period of 25 years (age 50-75). Individuals within the model could choose endoscopic or non-endoscopic screening, but were not allowed crossover between the two groups. Positive non-endoscopic screens were referred for endoscopy and continued on endoscopic screening thereafter. Population-wide total predicted endoscopic procedures were calculated using variables reflecting current screening practices. Choice of endoscopic and non-endoscopic screening within the population was then modified to estimate the increased adoption of non-endoscopic screening that would be necessary to drive an overall 10% reduction in total CRC screening related endoscopic screening procedures.
Results: For a simulated population of 1,000 screening-eligible and screening-naïve adults, screening activity mirroring recent compliance rates and choice of modality type generates approximately 2,612 endoscopic procedures over the population’s screening lifetime. If 20% more screened patients choose non-endoscopic screening relative to current rates and overall rates of screening compliance remain stable then the number of total endoscopic procedures done for CRC screening drops by 10% (2,348).
Discussion: Currently, non-endoscopic approaches to CRC screening represent < 10% of screened patients. Our data shows that if a relatively small increase in utilization of non-endoscopic screening strategies occurs then a significant reduction in the number of endoscopic procedures performed for screening purposes are likely. Such a change in screening practices might be an avenue towards reducing population screening costs, justifying initial screening at a younger age, and improving access to care.
Citation: Charles Meade, MD, Stephanie Hansel, MD, MS. P0222 - HAS ENDOSCOPIC SCREENING FOR COLON AND RECTAL CANCER REACHED AN INFLECTION POINT?. Program No. P0222. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.