In a study reported in the Journal of Clinical Oncology, Yeh et al found that childhood cancer survivors who received abdominopelvic radiation, who are at increased risk of developing colorectal cancer, can benefit from early screening to reduce the risk of colorectal cancer and associated mortality.
Study Details
The study used data from the Childhood Cancer Survivor Study and published studies to develop models for evaluating the effects of colorectal cancer screening among 5-year survivors who received abdominopelvic radiation; screening strategies included colonoscopy, multitarget stool DNA (mtsDNA), and fecal immunochemical testing (FIT) at various intervals, starting at age 25 to 45 years.
Key Findings
At age 45 years, survivors had a cumulative colorectal cancer risk of 0.6%, representing a relative risk 3.3 times that of average-risk individuals. In the absence of screening, it was estimated that 75 per 1,000 survivors would be diagnosed with colorectal cancer in their lifetime and 30 would die from the disease. Screening was estimated to avoid 47 to 73 cases colorectal cancer cases and 23 to 29 colorectal cancer deaths per 1,000 survivors.
Based on average-risk burden-to-benefit risk benchmarks, the optimal screening strategies were: colonoscopy every 10 years starting at age 30 years; mtsDNA every 3 years starting at age 30 years; and FIT every 3 years starting at age 25 years and then annually starting at 45 years. For these three strategies, incremental cost-effectiveness ratios (U.S. dollars) were $146,000/quality adjusted life-year gained (QALYG), $166,000/QALYG, and $123,000/QALYG, respectively.
The investigators concluded: “Early initiation of screening with colonoscopy or stool-based tests may substantially reduce [colorectal cancer] incidence and early mortality among survivors treated with abdominopelvic [radiation therapy], with reasonable burden-to-benefit trade-offs, and be considered cost-effective. These findings can facilitate clinician-survivor discussions on [colorectal cancer] screening and inform guideline refinements.”
Jennifer M. Yeh, PhD, of Boston Children’s Hospital, Harvard Medical School, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by the American Cancer Society and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
