Initiating colonoscopy every 10 years (Colo10) at age 45 years or an annual fecal immunochemical test (FIT) at 40 years is cost-effective for several body mass index (BMI) and sex groups, in accordance with a report published online Aug. 4 in Clinical Gastroenterology & Hepatology.
Aaron Yeoh, M.D., from the Stanford University School of Medicine in California, and colleagues compared colorectal cancer (CRC) screening starting at age 45 or 40 versus 50 years and/or shortening screening intervals among men and women with a body mass index (BMI) which range from normal to grade III obesity. Screening strategies included Colo10, colonoscopy every five years (Colo5), or annual FIT.
The researchers discovered that sex-specific total CRC deaths were similar for persons with overweight and obesity I to III without screening, reflecting the counterbalance of increased CRC risk by lower life span with increasing BMI. Colo10 starting at 45 years or FIT starting at 40 years were cost-effective at a threshold of $100,000/quality-adjusted life-year (QALY) gained for several BMI/sex groups. Among men with obesity II and III only, Colo10 starting at 40 years was cost-effective at $93,300 and $80,400/QALY gained, respectively. The preference was always for shifting Colo10 to a youthful starting age instead of Colo5 starting at later ages. In a sensitivity analysis, results were robust.
“Our findings have implications for CRC screening in obese persons specifically, and also generalizable lessons for CRC screening tailored to risk,” the authors write.
One author disclosed financial ties to the biotechnology and medical device industries.
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