CRC screening: when to stop?

  • Cenin DR & al.
  • Clin Gastroenterol Hepatol
  • 22 May 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A simulation suggests ages at which biennial fecal immunochemical test (FIT) for colorectal cancer (CRC) can stop in some patient groups.

Why this matters

  • Guidelines generally suggest screening between ages 50 years and 74 years, but they do not account for population heterogeneity.
  • The new model incorporates age, sex, comorbidity status, and screening history.

Study design

  • Microsimulation model (MISCAN-Colon).
  • The model looked at individual cohorts and compared with harms and benefits of screening of an average-health population that underwent perfect screening since age 50 years.
  • Stop ages were those that granted a similar benefit to 1 more screen at age 74-76 years in the healthy group.
  • The model assumed that the setting was Canada.
  • Funding: Cancer Care Ontario

Key results

  • Some individuals could benefit from screening until 76-90 years, including those without comorbidity, those who are screening naïve, or whose last colonoscopy was 15 years ago and have no severe comorbidities.
  • Women with no comorbid conditions and who had not been previously screened could undergo an initial screening through age 90 years. Men with similar characteristics could through age 88 years.
  • Individuals with severe comorbidities and most to perfect prior FIT screening history can stop screening at age 66 years or younger.

Limitations

  • Simulation.