TY  - JOUR
AU  - Zaika, Viktor
AU  - Prakash, Meher K
AU  - Cheng, Chih-Yuan
AU  - Schlander, Michael
AU  - Lang, Brian M
AU  - Beerenwinkel, Niko
AU  - Sonnenberg, Amnon
AU  - Krupka, Niklas
AU  - Misselwitz, Benjamin
AU  - Poleszczuk, Jan
TI  - Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study.
JO  - PLOS ONE
VL  - 19
IS  - 5
SN  - 1932-6203
CY  - San Francisco, California, US
PB  - PLOS
M1  - DKFZ-2024-01118
SP  - e0304374 -
PY  - 2024
AB  - Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.
KW  - Humans
KW  - Colonoscopy
KW  - Middle Aged
KW  - Adenoma: diagnosis
KW  - Aged
KW  - Early Detection of Cancer: methods
KW  - Adult
KW  - Colorectal Neoplasms: diagnosis
KW  - Male
KW  - Female
KW  - Aged, 80 and over
KW  - Patient Compliance
KW  - Time Factors
KW  - Computer Simulation
KW  - Mass Screening: methods
KW  - Young Adult
LB  - PUB:(DE-HGF)16
C6  - pmid:38787836
C2  - pmc:PMC11125540
DO  - DOI:10.1371/journal.pone.0304374
UR  - https://inrepo02.dkfz.de/record/290491
ER  -