Effect of Time to Diagnostic Testing for Breast, Cervical, and Colorectal Cancer Screening Abnormalities on Screening Efficacy : A Modeling Study
Menée à l'aide de quatre modèles de microsimulation, cette étude estime le bénéfice, en termes d'années de vie gagnées pour 1 000 examens réalisés, d'une mammographie biennale de dépistage du cancer du sein, d'un dépistage triennal du cancer du col utérin par test Pap et d'un dépistage annuel du cancer colorectal par test FIT, en fonction du délai entre l'examen ou le test de dépistage ayant révélé une anomalie et l'examen de diagnostic (immédiatement, 3, 6 et 12 mois)
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 aged 50-74 years), cervical (women aged 21-65 years), or colorectal (adults aged 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 1000 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 Epidemiology Biomarkers & Prevention , résumé, 2016