Abstract
Objective
The COVID-19 pandemic forced colorectal cancer (CRC) screening programs to downscale their colonoscopy capacity. In this study, we assessed strategies to deal with temporary restricted colonoscopy capacity in a FIT-based CRC screening program while aiming to retain the maximum possible preventive effect of the screening program.
Design
We simulated the Dutch national CRC screening program inviting individuals between ages 55 and 75 for biennial FIT using the MISCAN-Colon model including the 3-month disruption in the first half of 2020 due to the COVID-19 pandemic. For the second half of 2020 and 2021, we simulated three different strategies for the total target population: 1) increasing the FIT cut-off, 2) skipping one screening for specific screening ages, and 3) extending the screening interval. We estimated the impact on required colonoscopy capacity in 2020–2021 and life years (LYs) lost in the long-term.
Results
Increasing the FIT cut-off, skipping screening ages and extending the screening interval resulted in a maximum reduction of 25,100 (-17.0%), 16,100(-10.9%) and 19,000 (-12.9%) colonoscopies, respectively. Modelling an increased FIT cut-off, the number of LYs lost ranged between 1,400 and 4,400. Skipping just a single screening age resulted in approximately 2,700 LYs lost and this was doubled in case of skipping two screening ages. Extending the screening interval up to 34 months had the smallest impact on LYs lost (up to 1,100 LYs lost).
Conclusion
This modelling study shows that to anticipate on restricted colonoscopy capacity, temporarily extending the screening interval retains the maximum possible preventive effect of the CRC screening program.
Funder
rijksinstituut voor volksgezondheid en milieu
Publisher
Public Library of Science (PLoS)
Reference33 articles.
1. Impact of the COVID-19 pandemic on faecal immunochemical test-based colorectal cancer screening programmes in Australia, Canada, and the Netherlands: a comparative modelling study;L de Jonge;Lancet Gastroenterol Hepatol,2021
2. The impact of episodic screening interruption: COVID-19 and population-based cancer screening in Canada;JHE Yong;Journal of medical screening,2020
3. The value of models in informing resource allocation in colorectal cancer screening: the case of the Netherlands;F van Hees;Gut,2015
4. Real-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels;E Toes-Zoutendijk;Gastroenterology,2017
5. Dekker E, van Leerdam ME, Hazewinkel Y, Sanduleanu S, Vasen HF, Lansdorp-Vogelaar I. Nederlandse richtlijn coloscopie surveillance. 2016.