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Title: Long-Term Impact of the Dutch Colorectal Cancer Screening Program on Cancer Incidence and Mortality—Model-Based Exploration of the Serrated Pathway
Authors: Greuter MJE; Demirel E; Lew JB; Berkhof J; Xu XM; Canfell K; Dekker E; Meijer GA; Coupé VMH
Categories: Cancer Type - Bowel & Colorectal Cancer
Cancer Control, Survivorship, and Outcomes Research - Surveillance
Year: 2016
Journal Title: Cancer Epidemiology, Biomarkers & Prevention
Volume: 25
Issue: 1
Page number start: 135
Page number end: 144
Abstract: Background: We aimed to predict the long-term colorectal cancer incidence, mortality, and colonoscopy demand of the recently implemented Dutch colorectal cancer screening program. Methods: The Adenoma and Serrated pathway to Colorectal Cancer model was set up to simulate the Dutch screening program consisting of biennial fecal immunochemical testing combined with the new Dutch surveillance guidelines, between 2014 and 2044. The impact of screening and surveillance was evaluated under three sets of natural history assumptions differing in the contribution of the serrated pathway to colorectal cancer incidence. In sensitivity analyses, other assumptions concerning the serrated pathway were varied. Model-predicted outcomes were yearly colorectal cancer incidence, mortality, and colonoscopy demand per year. Results: Assuming an aging population, colorectal cancer incidence under 30 years of screening is predicted to decrease by 35% and 31% for a contribution of 0% and 30% of the serrated pathway to colorectal cancer, respectively. For colorectal cancer mortality, reductions are 47% and 45%. In 2044, 110,000 colonoscopies will be required annually assuming no contribution of the serrated pathway (27 per 1,000 individuals in the screening age range). Including the serrated pathway influences predicted screening effectiveness if serrated lesions are neither detected nor treated at colonoscopy, and/or if colorectal cancers arising from serrated lesions have substantially lower survival rates than those arising from adenomas. Conclusions: The Dutch screening program will markedly decrease colorectal cancer incidence and mortality but considerable colonoscopy resources will be required. Impact: Predictions of long-term screening effectiveness are preferably based on both pathways to colorectal cancer to transparently describe the impact of uncertainties regarding the serrated pathway on long-term predictions.
Division: Cancer Research Division
Funding Body: This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine, project DeCoDe (grant 03O-101; to G.A. Meijer). K. Canfell is supported by the National Health and Medical Research Council Australia (CDFs APP1007994 and APP1082989).
DOI: DOI: 10.1158/1055-9965.EPI-15-0592
Appears in Collections:Research Articles

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