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Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

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  • Marjolein J. E. Greuter
  • Xiang‐Ming Xu
  • Jie‐Bin Lew
  • Evelien Dekker
  • Ernst J. Kuipers
  • Karen Canfell
  • Gerrit A. Meijer
  • Veerle M. H. Coupé

Abstract

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.

Suggested Citation

  • Marjolein J. E. Greuter & Xiang‐Ming Xu & Jie‐Bin Lew & Evelien Dekker & Ernst J. Kuipers & Karen Canfell & Gerrit A. Meijer & Veerle M. H. Coupé, 2014. "Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)," Risk Analysis, John Wiley & Sons, vol. 34(5), pages 889-910, May.
    • Handle: RePEc:wly:riskan:v:34:y:2014:i:5:p:889-910
    DOI: 10.1111/risa.12137
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    1. David H. Howard & Florence K. Tangka & Laura C. Seeff & Lisa C. Richardson & Donatus U. Ekwueme, 2009. "The impact of detection and treatment on lifetime medical costs for patients with precancerous polyps and colorectal cancer," Health Economics, John Wiley & Sons, Ltd., vol. 18(12), pages 1381-1393, December.
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    1. Beate Jahn & Jovan Todorovic & Marvin Bundo & Gaby Sroczynski & Annette Conrads-Frank & Ursula Rochau & Gottfried Endel & Ingrid Wilbacher & Nikoletta Malbaski & Niki Popper & Jagpreet Chhatwal & Dan , 2019. "Budget Impact Analysis of Cancer Screening: A Methodological Review," Applied Health Economics and Health Policy, Springer, vol. 17(4), pages 493-511, August.

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