Purpose: Colonoscopy is effective in finding, detecting, and removing adenomatous polyps and detecting early stage colorectal cancer (CRC). US colonoscopy rates remain low. Strategies to increase colonoscopy rates resource intense. This study determines age groups for which additional screening colonoscopies would yield the greatest population health benefit.
Method: Population health benefit of additional colonoscopies on hypothetical cohort of 1 million average-risked 40 year olds analyzed by Markov simulation model. Transition probabilities estimated from vital and cancer statistics and published data on polyp progression.
Result: In cohort of one-million 40-year olds aging over time, an additional 100,000 screening colonoscopies in 55-59 year age group yields greatest reduction in total number of colorectal cancer deaths, 2,340 fewer for females (95% CI, 1,170 to 3,580) and 1,930 for males (1,080 to 2,760). An additional 100,000 screening colonoscopies in 50-54 year age group yields greatest gains in total life expectancy, 0.030 years for females (0.007 to 0.037) and 0.022 years for males (0.003 to 0.031). An additional 100,000 screening colonoscopies in 60-64 year age group yields greatest absolute reduction in the lifetime probability of developing CRC, 0.55% for females (0.55% to 0.56%) and 0.50% for males (0.49% to 0.50%), and dying from CRC, for 0.23% females (0.12% to 0.36%) and 0.19% for males (0.11% to 0.28%).
Conclusion: In an era of limited resources, efforts to increase CRC screening with colonoscopy should focus on narrow age bands for greatest population health efficiency. Additional colonoscopies for pre-Medicare eligible age groups may yield greatest population benefit.
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