Abstract
Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices. Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to follow-up for breast, cervical, and colorectal cancers was increased. Estimates were based on four independently developed microsimulation models that each simulated the life course of adults eligible for breast (women ages 50–74 years), cervical (women ages 21–65 years), or colorectal (adults ages 50–75 years) cancer screening. We assumed screening based on biennial mammography for breast cancer, triennial Papanicolaou testing for cervical cancer, and annual fecal immunochemical testing for colorectal cancer. For each cancer type, we simulated diagnostic testing immediately and at 3, 6, and 12 months after an abnormal screening exam. Results: We found declines in screening benefit with longer times to diagnostic testing, particularly for breast cancer screening. Compared to immediate diagnostic testing, testing at 3 months resulted in reduced screening benefit, with fewer undiscounted life years gained per 1,000 screened (breast: 17.3%, cervical: 0.8%, colorectal: 2.0% and 2.7%, from two colorectal cancer models), fewer cancers prevented (cervical: 1.4% fewer, colorectal: 0.5% and 1.7% fewer, respectively), and, for breast and colorectal cancer, a less favorable stage distribution. Conclusions: Longer times to diagnostic testing after an abnormal screening test can decrease screening effectiveness, but the impact varies substantially by cancer type. Impact: Understanding the impact of time to diagnostic testing on screening effectiveness can help inform quality improvement efforts. Cancer Epidemiol Biomarkers Prev; 27(2); 158–64. 2017 AACR.
| Original language | English |
|---|---|
| Pages (from-to) | 158-164 |
| Number of pages | 7 |
| Journal | Cancer Epidemiology Biomarkers and Prevention |
| Volume | 27 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1 Feb 2018 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2017 American Association for Cancer Research.
Funding
We used four independently developed models to simulate detection of and death from breast, cervical, and colorectal cancers. Each of these models is supported by the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET; ref. 5). This study was conducted as part of the NCI-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). The overall aim of PROSPR is to conduct multisite, coordinated, transdisciplinary research to evaluate and improve cancer screening processes. The 10 PROSPR Research Centers reflect the diversity of U.S. delivery system organizations. NCI PROSPR: U54 CA163261 (C.M. Rutter); U54 CA164336 (J.J. Kim, N.G. Campos, S. Sy); U54 CA163262 (R.G.S. Meester, C.A. Doubeni, D.A. Corley, I. Lansdorp-Vogelaar, A.G. Zauber); U54 CA163303 (O. Algoz, M.A. Ergun, B.L. Sprague, N. Stout, A. Trentham-Dietz); NCI CISNET: U01 CA199335 (C.M. Rutter, R.G.S. Meester, A.G. Zauber, I. Lansdorp-Vogelaar); U01 CA199218 (O. Algoz, M.A. Ergun, B.L. Sprague, N. Stout, A. Trentham-Dietz); U54 CA163307 (A.N.A. Tosteson); P30 CA014520 (A. Trentham-Dietz); P30 CA008748 (A.G. Zauber).
| Funders | Funder number |
|---|---|
| CISNET | |
| National Cancer Institute's Cancer Intervention and Surveillance Modeling Network | |
| National Cancer Institute | U54CA163261 |
| Center for International Studies, University of Southern California | P30 CA008748, U01 CA199335, U01 CA199218, U54 CA163307, P30 CA014520 |
| Society for Psychical Research | U54 CA164336, U54 CA163262, U54 CA163261, U54 CA163303 |
