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. 2015 Mar;25(3):208-213.e1.
doi: 10.1016/j.annepidem.2014.11.011. Epub 2014 Dec 5.

Colorectal cancer deaths attributable to nonuse of screening in the United States

Reinier G S Meester  1 , Chyke A Doubeni  2 , Iris Lansdorp-Vogelaar  3 , S Lucas Goede  3 , Theodore R Levin  4 , Virginia P Quinn  5 , Marjolein van Ballegooijen  3 , Douglas A Corley  4 , Ann G Zauber  6
Affiliations

Colorectal cancer deaths attributable to nonuse of screening in the United States

Reinier G S Meester et al. Ann Epidemiol. 2015 Mar.

Abstract

Purpose: Screening is a major contributor to colorectal cancer (CRC) mortality reductions in the United States but is underused. We estimated the fraction of CRC deaths attributable to nonuse of screening to demonstrate the potential benefits from targeted interventions.

Methods: The established microsimulation screening analysis colon model was used to estimate the population attributable fraction (PAF) in people aged ≥50 years. The model incorporates long-term patterns and effects of screening by age and type of screening test. PAF for 2010 was estimated using currently available data on screening uptake. PAF was also projected assuming constant future screening rates to incorporate lagged effects from past increases in screening uptake. We also computed PAF using Levin's formula to gauge how this simpler approach differs from the model-based approach.

Results: There were an estimated 51,500 CRC deaths in 2010, about 63% (N ∼ 32,200) of which were attributable to nonscreening. The PAF decreases slightly to 58% in 2020. Levin's approach yielded a considerably more conservative PAF of 46% (N ∼ 23,600) for 2010.

Conclusions: Most of the current United States CRC deaths are attributable to nonscreening. This underscores the potential benefits of increasing screening uptake in the population. Traditional methods of estimating PAF underestimated screening effects compared with model-based approaches.

Keywords: Adenomas; Adenomatous polyps; Colorectal neoplasms; Computer simulation; Epidemiology; Screening and early detection; Secondary prevention.

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Conflict of interest statement

Conflicts of Interest: None of the authors report any conflicts of interest

Figures

Figure 1
Figure 1
Colorectal cancer screening trends* in National Health Interview Survey (NHIS) data and MISCAN. * The red line plots the proportion of U.S. population which had a home FOBT in the previous year, the blue and green lines plot the proportions which had an endoscopy in the previous 5 or 10 years, respectively.
Figure 2
Figure 2. U.S. age-standardized* colorectal cancer (CRC) mortality rates by calendar year in Surveillance Epidemiology and End Results program (SEER) data and MISCAN
* Adjusted to the total 2000 U.S. standard population
Figure 3
Figure 3. Proportion of U.S. colorectal cancer deaths in 2010 attributable to nonuse of screening by two approaches
Figure 4
Figure 4. Projected CRC mortality fractions attributable to nonuse of screening *
* The mortality rates were not standardized for age; future estimates were based on a scenario of constant screen rates of ∼60% after 2010
See this image and copyright information in PMC

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