A new economic evaluation study published in JAMA Network Open provides crucial guidance on when to discontinue colorectal cancer screening, offering a personalized approach based on individual patient characteristics and screening history.
The research, which validated the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model against real-world data from three integrated U.S. healthcare systems, reveals that optimal stopping ages for screening vary significantly depending on multiple factors, including sex, comorbidity status, and previous screening results.
Impact of Individual Characteristics on Screening Benefits
The study found that patients with lower comorbidity status benefit from extended screening ages due to longer life expectancy. Surprisingly, despite women having a lower CRC risk than men, the research showed that colorectal cancer screening at older ages is more cost-effective in females.
For women aged 76 without comorbidities and a negative colonoscopy result from 10 years prior, one additional colonoscopy cost $38,226 per quality-adjusted life-year gained (QALYG). This figure increased dramatically to $1,689,945 per QALYG for 90-year-old women with similar characteristics, demonstrating the diminishing returns of screening with advancing age.
Screening Modalities and Optimal Stopping Ages
The analysis examined various screening scenarios, including fecal immunochemical tests (FIT), colonoscopy, and combinations of both. The optimal stopping ages showed considerable variation:
- Colonoscopy: Ranging from younger than 76 to 86 years
- FIT screening: Ranging from younger than 76 to 88 years
These ranges reflect the need for individualized screening strategies rather than a one-size-fits-all approach.
Data-Driven Insights
The study analyzed two significant subcohorts:
- 25,974 adults (54.7% aged 76-80 years) with a negative colonoscopy result 10 years prior
- 118,269 adults (90.5% aged 76-80 years) with a negative FIT result from the previous year
The research demonstrated that screening benefits and cost-effectiveness decreased with:
- Advanced age
- Male sex
- Higher comorbidity levels
- Recent negative screening results
Clinical Implications for Practice
These findings have significant implications for clinical practice, suggesting that healthcare providers should consider multiple factors when deciding when to discontinue CRC screening. The research supports a more nuanced approach to screening decisions in older adults, potentially leading to more efficient resource utilization and reduced unnecessary procedures.
The researchers emphasize that personalizing CRC screening based on individual risk factors after age 75 could significantly improve screening efficiency while reducing potential harms. This approach aligns with the growing trend toward precision medicine and individualized healthcare decisions.
