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@ARTICLE{Heisser:170568,
      author       = {T. Heisser$^*$ and R. Cardoso$^*$ and F. Guo$^*$ and T.
                      Moellers$^*$ and M. Hoffmeister$^*$ and H. Brenner$^*$},
      title        = {{S}trongly {D}ivergent {I}mpact of {A}dherence {P}atterns
                      on {E}fficacy of {C}olorectal {C}ancer {S}creening: {T}he
                      {N}eed to {R}efine {A}dherence {S}tatistics.},
      journal      = {Clinical and translational gastroenterology},
      volume       = {12},
      number       = {9},
      issn         = {2155-384X},
      address      = {London},
      publisher    = {Nature Publ. Group},
      reportid     = {DKFZ-2021-02019},
      pages        = {e00399},
      year         = {2021},
      note         = {#EA:C070#LA:C070#},
      abstract     = {The performance of colorectal cancer (CRC) screening
                      programs depends on the adherence to screening offers.
                      However, identical adherence levels may result from varying
                      patterns of the population's screening behavior. We
                      quantified the effects of different adherence patterns on
                      the long-term performance of CRC screening for annual fecal
                      immunochemical testing and screening colonoscopy at 10-year
                      intervals.Using a multistate Markov model, we simulated
                      scenarios where, while at the same overall adherence level,
                      a certain proportion of the population adheres to all
                      screening offers (selective adherence) or the entire
                      population uses the screening offers at some point(s) of
                      time, albeit not in the recommended frequency (sporadic
                      adherence). Key outcomes for comparison were the numbers of
                      prevented CRC cases and prevented CRC deaths after 50
                      simulated years.For screening with annual fecal
                      immunochemical testing at adherence levels of $10\%-50\%,$
                      ratios of prevented CRC cases (CRC deaths) resulting from a
                      sporadic vs a selective pattern ranged from 1.8 to 4.4
                      (1.9-5.3) for men and from 1.7 to 3.6 (1.8-4.4) for women,
                      i.e., up to 4-5 times more CRC cases and deaths were
                      prevented when the population followed a sporadic instead of
                      a selective adherence pattern. Comparisons of simulated
                      scenarios for screening colonoscopy revealed similar
                      patterns.Over a lifelong time frame, large numbers of
                      irregular screening attendees go along with much larger
                      preventive effects than small numbers of perfectly adhering
                      individuals. In clinical practice, efforts to reach as many
                      people as possible at least sporadically should be
                      prioritized over efforts to maximize adherence to repeat
                      screening offers.},
      cin          = {C070 / C120 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      I:(DE-He78)HD01-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34506306},
      doi          = {10.14309/ctg.0000000000000399},
      url          = {https://inrepo02.dkfz.de/record/170568},
}