Individuals with cystic fibrosis are at increased risk of colorectal cancer compared with the general population, and risk is higher among those who received an organ transplant.
Dr Andrea Gini and colleagues from the Netherlands performed a cost-effectiveness analysis to determine optimal colorectal cancer screening strategies for patients with cystic fibrosis.
The team adjusted the existing Microsimulation Screening Analysis-Colon model to reflect increased colorectal cancer risk and lower life expectancy in patients with cystic fibrosis.
Modeling was performed separately for individuals who never received an organ transplant and patients who had received an organ transplant.
The researchers modeled 76 colonoscopy screening strategies that varied the age range and screening interval.
The optimal screening strategy was determined based on a willingness to pay threshold of $100,000 per life-year gained.
Colonoscopy every 5 years prevented
79% of deaths from colorectal cancer
Sensitivity and supplementary analyses were performed, including fecal immunochemical test as an alternative test, earlier ages of transplantation, and increased rates of colonoscopy complications, to assess if optimal screening strategies would change.
The team of researchers found that a colonoscopy every 5 years, starting at an age of 40 years, was the optimal colonoscopy strategy for patients with cystic fibrosis who never received an organ transplant.
The team noted that this strategy prevented 79% of deaths from colorectal cancer.
Among patients with cystic fibrosis who had received an organ transplant, optimal colonoscopy screening should start at an age of 30 or 35 years, depending on the patient’s age at time of transplantation.
Annual fecal immunochemical test screening was predicted to be cost-effective for patients with cystic fibrosis.
However, the level of accuracy of the fecal immunochemical test in this population is not clear.
Dr Gini's team concludes, "Using a Microsimulation Screening Analysis-Colon model, we found screening of patients with cystic fibrosis for colorectal cancer to be cost effective."
"Because of the higher risk of colorectal cancer in these patients, screening should start at an earlier age with a shorter screening interval."
"The findings of this study may be limited by restricted evidence available for patients with cystic fibrosis."