英国医学杂志》关于结直肠癌筛查的快速建议对人群的影响:微观模拟分析。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Luuk A van Duuren, Jean-Luc Bulliard, Ella Mohr, Rosita van den Puttelaar, Ekaterina Plys, Karen Brändle, Douglas A Corley, Florian Froehlich, Kevin Selby, Iris Lansdorp-Vogelaar
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引用次数: 0

摘要

目的:2019 年,《英国医学杂志》(BMJ)的一项快速建议建议不要对 15 年 CRC 预测风险低于 3% 的成年人进行结直肠癌(CRC)筛查。我们以瑞士为例,估算了这一建议在人群中的影响:设计:我们预测了瑞士健康调查中所有受访者的 CRC 风险。我们得出了基于风险的筛查开始年龄分布,假设在 25 岁到 70 岁之间每 5 年计算一次预测风险,当风险超过 3% 时开始筛查。接下来,MISCAN-Colon 微观模拟模型评估了基于该风险起始年龄的两年一次的粪便免疫化学检验(FIT)筛查。作为对比,我们模拟了根据年龄和性别启动筛查的情况:结果:仅在预测风险超过 3% 时才开始筛查意味着分别有 82% 和 90% 的女性和男性不会在 65 岁和 60 岁之前开始筛查。与从 50 岁开始筛查相比,这将减少 43%-57% 的检查次数,减少 8%-16% 的 CRC 死亡预防率,减少 19%-33% 的寿命延长率。当预测风险超过 3% 时,对 65 岁以上女性和 60 岁以上男性进行筛查与仅进行筛查的效果相似:使用推荐的风险预测工具,BMJ 快速建议对人群的影响与仅根据年龄和性别启动筛查的影响相似。它将使筛查启动时间延迟 10-15 年。虽然筛查负担减半,但与 50 岁开始筛查相比,筛查的益处将大幅减少。这表明,开始进行 CRC 筛查的 3% 风险阈值可能过高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Population-level impact of the BMJ Rapid Recommendation for colorectal cancer screening: a microsimulation analysis.

Objective: In 2019, a BMJ Rapid Recommendation advised against colorectal cancer (CRC) screening for adults with a predicted 15-year CRC risk below 3%. Using Switzerland as a case study, we estimated the population-level impact of this recommendation.

Design: We predicted the CRC risk of all respondents to the population-based Swiss Health Survey. We derived the distribution of risk-based screening start age, assuming predicted risk was calculated every 5 years between ages 25 and 70 and screening started when this risk exceeded 3%. Next, the MISCAN-Colon microsimulation model evaluated biennial faecal immunochemical test (FIT) screening with this risk-based start age. As a comparison, we simulated screening initiation based on age and sex.

Results: Starting screening only when predicted risk exceeded 3% meant 82% of women and 90% of men would not start screening before age 65 and 60, respectively. This would require 43%-57% fewer tests, result in 8%-16% fewer CRC deaths prevented and yield 19%-33% fewer lifeyears gained compared with screening from age 50. Screening women from age 65 and men from age 60 had a similar impact as screening only when predicted risk exceeded 3%.

Conclusion: With the recommended risk prediction tool, the population impact of the BMJ Rapid Recommendation would be similar to screening initiation based on age and sex only. It would delay screening initiation by 10-15 years. Although halving the screening burdens, screening benefits would be reduced substantially compared with screening initiation at age 50. This suggests that the 3% risk threshold to start CRC screening might be too high.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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