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Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force
Open accessAbstract
Importance: The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations. Objective: To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF. Design, Setting, and Participants: Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer. Exposures: Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed. Main Outcome and Measures: Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies. Results: Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer. Conclusions and Relevance: This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.
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“The sensitivity of colonoscopy for the detection of intestinal adenomas larger than 1 cm and CRC is estimated at 95%[22,68].”
From Risk factors, prevention and screening of colorectal cancer: A rising problem (2025) · cites this paper as [68]
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Şenol, S., Kuşak, M., Uzunoglu, K., Gün, M., & Bıdıl, M. G. (2025) · Diagnostics · doi:10.3390/diagnostics15131717
“Its incidence and mortality rates are declining due to the development of screening meth-ods [1,2], of which colonoscopy is the most sensitive and is recommended by the most recent guidelines [3,4].”
de Lima, P. N., Bartholomew, L. K., May, F. P., Coronado, G. D., & Rutter, C. M. (2025) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djaf202
“…and better reach representing better preparation (95% reaching the cecum) as assumed in analyses that informed USPSTF CRC screening guidelines; 17 and lower-quality colonoscopy with reduced detection rates (0.55 for 1-5mm adenomas and 0.70 for 6-9mm adenomas) and lower cecal intubation rates…”
InfluentialSelf-citationEpidemiology of Colon Cancer Screening in a Safety-Net Setting
Mahapatra, E., Kee, R. A., Shim, K., Rowell, C., Trick, W. E., & Goldberg, D. N. (2025) · AJPM Focus · doi:10.1016/j.focus.2025.100403
Cost-Effectiveness of Colorectal Cancer Screening in the Dominican RepublicPreprint
Agyekum, A. A., Wagner, S., Pineda, K. M. D., de la Cruz, D. M., Crew, K., Hur, C., & Pumpalova, Y. S. (2025) · Research Square · doi:10.21203/rs.3.rs-7829020/v1
van Duuren, L. A., Bulliard, J., Harlass, M., Plys, E., Corley, D. A., Froehlich, F., Selby, K. J., & Lansdorp‐Vogelaar, I. (2025) · American Journal of Epidemiology · doi:10.1093/aje/kwaf214
“24,32 Hereafter, the terms efficient and efficiency frontier include both efficient and near-efficient strategies.”
InfluentialSelf-citationChanging paradigms in colorectal cancer screening
Basu, P. S. (2025) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djaf267
Gatwood, J. D., Gomez-Espinosa, E., Fusco, N., Stempniewicz, N., & Singer, D. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.128015
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“26 This framework incorporates numerous factors, including initial and end age, screening frequency, modality, number of life-years gained, colorectal cancer cases and deaths averted, lifetime colonoscopies required, and potential harms associated with different CRC screening strategies.”
InfluentialTaksler, G. B., Le, P., Hu, B., Alberts, J. L., Flynn, A. J., & Rothberg, M. B. (2022) · Figshare · doi:10.6084/m9.figshare.21384096
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Zhu, M., Zhong, X., Liao, T., Peng, X., Lei, L., Peng, J., & Cao, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26687351
Zhu, M., Zhong, X., Liao, T., Peng, X., Lei, L., Peng, J., & Cao, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26687357
Breekveldt, E. C. H., Toes‐Zoutendijk, E., de Jonge, L., Spaander, M. C. W., Dekker, E., van Kemenade, F. J., van Vuuren, A. J., Ramakers, C. R. B., Nagtegaal, I. D., van Leerdam, M. E., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26570632
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Philipson, T., Durie, T., Cong, Z., & Fendrick, A. M. (2024) · Figshare · doi:10.6084/m9.figshare.26608866
Ko, L. K., Jang, S. H., Rodriguez, E. A., Buta, M., Ibarra, G., & Reuland, D. (2024) · Figshare · doi:10.6084/m9.figshare.27124174
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Current status and future directions of colorectal cancer screening: can colonoscopy be replaced?
Elsaid, A. (2025) · Journal of Stem Cell Research & Therapeutics · doi:10.15406/jsrt.2025.10.00208
Endoscopic screening for colorectal cancer: efficacy versus effectiveness
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Evaluation of colorectal cancer screening practices in Rhode Island, 2011–2021
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Metadata
- Authors
- Knudsen, A. B., Rutter, C. M., Peterse, E. F. P., Lietz, A. P., Seguin, C. L., Meester, R. G. S., Perdue, L. A., Lin, J. S., Siegel, R. L., Doria-Rose, V. P., Feuer, E. J., Zauber, A. G., Kuntz, K. M., & Lansdorp-Vogelaar, I.
- Affiliations
- Harvard University (US)
- RAND Corporation (US)
- Erasmus MC (NL)
- Massachusetts General Hospital (US)
- Kaiser Permanente (US)
- American Cancer Society (US)
- National Cancer Institute (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Minnesota (US)
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
- Corresponding author
- Knudsen, Amy B.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2021-05-18
- Volume
- 325
- Issue
- 19
- Pages
- 1998
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC8409520
- OpenAlex
- W3162019711
- Cited by
- 327
- References
- 40
- Citations by year
- 2026: 44 · 2025: 70 · 2024: 76 · 2023: 63 · 2022: 55 · 2021: 16
- FWCI
- 19.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- Kaiser Permanente
- Agency for Healthcare Research and Quality
- National Cancer Institute (U01CA199335, U01CA253913, P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- colorectal cancer screening, screening guidelines, life-years gained, fecal immunochemical test, flexible sigmoidoscopy, computed tomography colonography, screening frequency, screening age, efficiency ratio, USPSTF recommendations, average-risk population, microsimulation model, cost-effectiveness, colorectal cancer incidence
- MeSH terms
- Adult, Aged, Aged, 80 and over, Colonoscopy, Female, Humans, Life Expectancy, Male, Middle Aged, Occult Blood, Risk, Sensitivity and Specificity, Sex Factors, Sigmoidoscopy, Tomography, X-Ray Computed, Colorectal Neoplasms, Models, Statistical, Cohort Studies, Early Detection of Cancer
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