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Optimal CRC Screening Varies With Age, Family History

Cost-effective screening strategy based on first-degree relatives with CRC, age at diagnosis

FRIDAY, Sept. 16 (HealthDay News) -- The optimal colonoscopy screening strategy for individuals with colorectal cancer (CRC) varies considerably with the number of affected first-degree relatives and their age at diagnosis, according to a study published in the Sept. 15 issue of Cancer.

Janneke A. Wilschut, from the University Medical Center Rotterdam in the Netherlands, and colleagues investigated optimal screening strategies for colonoscopy on the basis of cost-effectiveness analyses among individuals with varying degrees of family history of CRC. The MISCAN-Colon microsimulation model was used to vary the analysis by the age at which screening was started and stopped, and by screening interval. Four risk groups were defined according to the number of affected first-degree relatives, and their age at CRC diagnosis. The optimal screening strategy for all risk groups had an incremental cost-effectiveness ratio of approximately $50,000 per life-year gained.

The investigators found that the optimal strategy for individuals with one first-degree relative older than 50 was an interval of five years, with the optimal age to start screening in this group being 50 years and the optimal age to stop screening being 75 years. For individuals with one first-degree relative 50 years old or younger, the optimal screening interval was four years, with the optimal ages to start and stop screening being 45 and 81 years, respectively. The optimal screening interval for individuals with two or more first-degree relatives older than 50 years was three years, with the optimal ages to start and stop screening being 45 and 81 years, respectively. For individuals with two or more first-degree relatives 50 years or younger, the optimal screening interval was three years, with an age range from starting to stopping of 42 to 84 years.

"The optimal screening strategy varies considerably with the number of affected first-degree relatives and their age of diagnosis," the authors write.

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