Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity

Abstract

Background: In 2014, a national campaign was launched to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018; it is unknown whether there is sufficient colonoscopy capacity to reach this goal. This study estimated the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy and determined whether there was sufficient colonoscopy capacity to meet the need.

Methods: The Microsimulation Screening Analysis-Colon model was used to simulate CRC screening test use in the United States (2014-2040); the implementation of a national screening program in 2014 with FIT or colonoscopy with 80% participation was assumed. The 2012 Survey of Endoscopic Capacity (SECAP) estimated the number of colonoscopies that were performed and the number that could be performed.

Results: If a national screening program started in 2014, by 2024, approximately 47 million FIT procedures and 5.1 million colonoscopies would be needed annually to screen the eligible population with a program using FIT as the primary screening test; approximately 11 to 13 million colonoscopies would be needed annually to screen the eligible population with a colonoscopy-only screening program. According to the SECAP survey, an estimated 15 million colonoscopies were performed in 2012, and an additional 10.5 million colonoscopies could be performed.

Conclusions: The estimated colonoscopy capacity is sufficient to screen 80% of the eligible US population with FIT, colonoscopy, or a mix of tests. Future analyses should take into account the geographic distribution of colonoscopy capacity. Cancer 2016;122:2479-86. © 2016 American Cancer Society.

Keywords: capacity; colonoscopy; colorectal cancer screening.

Figure 1

a. Number of colorectal cancer tests per year before and after start of hypothetical national screening program with FIT* in 2014, by test type *Fecal immunochemical test ^† Fecal occult blood test b. Number of colonoscopies per year, before and after start of a hypothetical national screening program with FIT, by colonoscopy indication

Figure 1

a. Number of colorectal cancer tests per year before and after start of hypothetical national screening program with FIT* in 2014, by test type *Fecal immunochemical test ^† Fecal occult blood test b. Number of colonoscopies per year, before and after start of a hypothetical national screening program with FIT, by colonoscopy indication

Figure 2

a. Number of colorectal cancer tests per year before and after start of a hypothetical national screening program with colonoscopy, by test type *Fecal immunochemical test ^† Fecal occult blood test b. Number of colonoscopies per year, before and after start of a hypothetical national screening program with colonoscopy, by colonoscopy indication

Figure 2

a. Number of colorectal cancer tests per year before and after start of a hypothetical national screening program with colonoscopy, by test type *Fecal immunochemical test ^† Fecal occult blood test b. Number of colonoscopies per year, before and after start of a hypothetical national screening program with colonoscopy, by colonoscopy indication

Figure 3

Predicted colonoscopy use under various modeling scenarios (in millions). FIT = Fecal Immunochemical Test; COL = Colonoscopy; gFOBT = guaiac Fecal Occult Blood Test; FSIG = Flexible Sigmoidoscopy; Opport. = Opportunistic; part = participation. * Annual testing with Hemoccult II. †10-yearly testing with CT colonography. ‡ 5-yearly testing with flexible sigmoidoscopy. Numbers represent sigmoidoscopy and colonoscopy use. § In the scenario with opportunistic screening, we assumed future screening patterns according to age and type of test were similar to those observed in 2013 National Health Interview survey data. The screen rate was increased linearly from approximately 60% to 80% from 2013 to late 2018.