Zgraggen, Armin;
Stoffel, Sandro Tiziano;
Barbier, Michaela Carla;
Marbet, Urs Albert;
(2022)
Colorectal cancer surveillance by colonoscopy in a prospective, population-based long-term Swiss screening study – outcomes, adherence, and costs.
Zeitschrift für Gastroenterologie
, 60
(5)
pp. 761-778.
10.1055/a-1796-2471.
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Abstract
BACKGROUND: The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time. METHODS: In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively. RESULTS: 1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30-9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1'934'521 per 1'000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals. CONCLUSION: Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals.
| Type: | Article |
|---|---|
| Title: | Colorectal cancer surveillance by colonoscopy in a prospective, population-based long-term Swiss screening study – outcomes, adherence, and costs |
| Location: | Germany |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1055/a-1796-2471 |
| Publisher version: | http://doi.org/10.1055/a-1796-2471 |
| Language: | English |
| Additional information: | © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
| Keywords: | Adenoma, Cohort Studies, Colonoscopy, Colorectal Neoplasms, Early Detection of Cancer, Female, Humans, Male, Mass Screening, Prospective Studies, Retrospective Studies, Risk Factors, Switzerland |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10149048 |
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