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@ARTICLE{Heisser:157163,
      author       = {T. Heisser$^*$ and K. Weigl$^*$ and M. Hoffmeister$^*$ and
                      H. Brenner$^*$},
      title        = {{A}ge-specific sequence of colorectal cancer screening
                      options in {G}ermany: {A} model-based critical evaluation.},
      journal      = {PLoS medicine},
      volume       = {17},
      number       = {7},
      issn         = {1549-1676},
      address      = {Lawrence, Kan.},
      publisher    = {PLoS},
      reportid     = {DKFZ-2020-01443},
      pages        = {e1003194 -},
      year         = {2020},
      note         = {#EA:C070#LA:C070#},
      abstract     = {The current organized screening program for colorectal
                      cancer in Germany offers both sexes 5 annual fecal
                      immunochemical tests (FITs) between ages 50 and 54 years,
                      followed by a first screening colonoscopy at age 55 years if
                      all of these FITs were negative. We sought to assess the
                      implications of this approach for key parameters of
                      diagnostic performance.Using a multistate Markov model, we
                      estimated the expected detection rates of advanced neoplasms
                      (advanced adenomas and cancers) and number needed to scope
                      (NNS) to detect 1 advanced neoplasm at a first screening
                      colonoscopy conducted at age 55 after 5 preceding negative
                      FITs and compared them with the corresponding estimates for
                      a first screening colonoscopy at age 55 with no preceding
                      FIT testing. In individuals with 5 consecutive negative FITs
                      undergoing screening colonoscopy at age 55, expected
                      colonoscopy detection rate (NNS) was $3.7\%$ (27) and
                      $0.10\%$ (1,021) for any advanced neoplasm and cancer,
                      respectively, in men, and $2.1\%$ (47) and $0.05\%$ (1,880)
                      for any advanced neoplasm and cancer, respectively, in
                      women. These NNS values for detecting 1 advanced neoplasm
                      are approximately 3-fold higher, and the NNS values for
                      detecting 1 cancer are approximately 8-fold higher, than
                      those for a first screening colonoscopy at age 55 without
                      prior FITs. This study is limited by model simplifying
                      assumptions and uncertainties related to input
                      parameters.Screening colonoscopy at age 55 after 5
                      consecutive negative FITs at ages 50-54, as currently
                      offered in the German cancer early detection program, is
                      expected to have very low positive predictive value. Our
                      results may inform efforts to enhance the design of
                      screening programs.},
      cin          = {C070 / HD01 / C120},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)HD01-20160331 /
                      I:(DE-He78)C120-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32678831},
      doi          = {10.1371/journal.pmed.1003194},
      url          = {https://inrepo02.dkfz.de/record/157163},
}