Figures and data in Projected long-term effects of colorectal cancer screening disruptions following the COVID-19 pandemic

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Pedro Nascimento de Lima

Rosita van den Puttelaar

Anne I Hahn

Matthias Harlass

Nicholson Collier

Jonathan Ozik

Ann G Zauber

Iris Lansdorp-Vogelaar

Carolyn M Rutter

(2023)
Projected long-term effects of colorectal cancer screening disruptions following the COVID-19 pandemic

eLife 12:e85264.

https://doi.org/10.7554/eLife.85264
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Figures
Tables
Additional files

2 figures, 4 tables and 4 additional files

Figures

Figure 1 with 1 supplement

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Screening benefits lost due to disruptions by cohort and scenario.

Notes: Each dot represents the estimated life-years lost per 1000 individuals or life-days lost from one model under the high sensitivity scenario. Results are ordered from highest to lowest …

Figure 1—figure supplement 1

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Estimated loss of life in minor disruption scenarios.

Notes: Each dot represents the estimated life-years lost per 1000 individuals or life-days lost from one model under the high sensitivity scenario. Results are ordered from highest to lowest …

Figure 2 with 1 supplement

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Life-years gained (LYG) in high- vs. low-sensitivity scenarios.

Notes: Each dot represents one scenario considered in this study. The horizontal axis displays the number of LYG estimated in that scenario under a high colonoscopy sensitivity scenario. The …

Figure 2—figure supplement 1

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Life-years lost in high- vs. low-sensitivity scenarios.

Notes: Each dot represents one scenario considered in this study. The horizontal axis displays the number of life-years lost due to disruptions (LYL) estimated in that scenario under a high …

Tables

Table 1

Study cohorts and scenarios.

Cohort	No-disruption counterfactual	CRC screening disruption scenario
Cohort	No-disruption counterfactual	Description	Label
Unscreened 50-year-olds (U50)	Decennial COL from age 50 to 70	Short-term delays of [d] months^*	U50 \| C[d]m
	Decennial COL from age 50 to 70	Long-term delay (COL at age 65 and 75)	U50 \| C@65
	Annual FIT from age 50 to 75	Short-term delays^*	U50 \| F[d]m
Unscreened 60-year-olds (U60)	Decennial COL from age 60 to 70	Short-term delays^*	U60 \| C[d]m
	Decennial COL from age 60 to 70	Long-term delay (COL at age 65 and 75)	U60 \| C@65
	Annual FIT from age 60 to 75	Short-term delays^*	U60 \| F[d]m
COL-adherent 60-year-olds (C60)	Decennial COL from age 50 to 70	Short-term delays^*	C60 \| C[d]m
		Switch to annual FIT and short-term delays	C60 \| F[d]m
		Long-term delay (COL at age 65 and 75)	C60 \| C@65
		Discontinue screening	C60 \| U
FIT-adherent 60-year-olds (F60)	Annual FIT from age 50 to 75	Short-term delays^*	F60 \| F[d]m
FIT-adherent 60-year-olds (F60)	Annual FIT from age 50 to 75	Discontinue screening	F60 \| U
FIT-semi-adherent 60-year-olds (f60)	Biannual FIT from age 50 to 56, annual FIT from age 60 to 75	Short-term delays^*	f60 \| F[d]m
FIT-semi-adherent 60-year-olds (f60)		Discontinue screening	f60 \| U
Unscreened 70-year-olds (U70)	COL at age 70	Short-term delays^*	U70 \| C[d]m
	COL at age 70	Long-term delay (COL at age 75)	U70 \| C@75
	Annual FIT from age 70 to 75	Short-term delays	U70 \| F[d]m
COL-adherent 70-year-olds (C70)	Decennial COL from age 50 to 70	Short-term delays^*	C70 \| C[d]m
		Switch to annual FIT and short-term delays	C70 \| F[d]m
		Long-term delay Perform COL at age 75	C70 \| C@75
		Discontinue screening	C70 \| U
FIT-adherent 70-year-olds (F70)	Annual FIT from age 50 to 75	Short-term delays^*	F70 \| F[d]m
FIT-adherent 70-year-olds (F70)	Annual FIT from age 50 to 75	Discontinue screening	F70 \| U

Notes: This table presents the scenarios considered in this study. Each scenario corresponds to a combination of a population cohort, indicated by their age during the first COVID-19 lockdowns (March 2020), a pre-pandemic, and a post-pandemic screening regimen. The scenarios aim to represent possible combinations of screening regimens followed in the United States. The first letter in the scenario code represents screening before the pandemic and the second letter represents screening after the pandemic.
*

Delays of 3, 9, and 18 months. Letter d stands for the number of months of delays.

Table 2

Per lesion test sensitivity and specificity.

	Sensitivity*				Specificity†
Test	Adenoma1–5 mm	Adenoma6–9 mm	Adenoma ≥10 mm	Preclinical cancer	Specificity†
Colonoscopy, high sensitivity‡	0.75	0.85	0.95	0.95	0.86
Colonoscopy, low sensitivity§	0.55	0.70	0.90	0.95	0.86
FIT¶
MISCAN	0.00	0.114	0.159	0.62565/0.886	0.97
CRC-SPIN	0.05	0.15	0.22	*0.74	0.97

Notes: This table presents the assumed test characteristics. We simulated two colonoscopy sensitivity scenarios seeking to represent a range of colonoscopy sensitivity of gastroenterologists in the United States.
*

Sensitivity is for lesions within reach of the scope. We assume the same test characteristics for follow-up and surveillance colonoscopy as for screening colonoscopy.
†

For FIT, the lack of specificity reflects detection of bleeding from other causes. We assume other-cause bleeding is independent of adenoma status. For colonoscopy, the lack of specificity reflects detection of non-adenomatous lesions, but specificity is handled in post-processing in cost-effectiveness analyses. Since this study does not consider burden outcomes, specificity is not considered in this paper. Specificity values were obtained from Lin et al., 2021.
‡

Baseline scenarios used in Zauber et al., 2008.
§

In line with low-sensitivity scenarios compatible with Rutter et al., 2022.
¶

CRC-SPIN uses per-person test sensitivity for stool-based tests that are based on the size of the most advanced lesion. To account for the likelihood that a person with multiple adenomas is more likely than a person with only one to have a positive stool test, MISCAN uses lesion-based sensitivities instead of person-based sensitivities. Lesion-based sensitivities were derived by calibrating the person-based sensitivities to the number of people having one or more small/medium/large adenomas or cancers detected by stool-based testing with diagnostic colonoscopy, divided by those having one or more small/medium/large adenomas or cancers detected by colonoscopy screening.

Table 3

CRC surveillance intervals.

Finding at second-most recent colonoscopy^*^†	Finding at first-most recent colonoscopy^*^†	Interval^‡ to next colonoscopy, years
No prior colonoscopy	Normal colonoscopy	See note below§
	1–2 adenomas <10 mm	7
	3–4 adenomas <10 mm	3
	10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1
Normal colonoscopy	Normal colonoscopy	10
	1–2 adenomas <10 mm	7
	3–4 adenomas <10 mm	3
	5–10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1
1–2 adenomas <10 mm	Normal colonoscopy	10
	1–2 adenomas <10 mm	7
	3–4 adenomas <10 mm	3
	5–10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1
3–4 adenomas <10 mm	Normal colonoscopy	10
	1–2 adenomas <10 mm	7
	3–4 adenomas <10 mm	3
	5–10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1
5–10 adenomas <10 mm	Normal colonoscopy	5
or	1–2 adenomas <10 mm	5
any adenoma ≥10 mm	3–4 adenomas <10 mm	3
	5–10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1
>10 adenomas of any size	Normal colonoscopy	5
	1–2 adenomas <10 mm	5
	3–4 adenomas <10 mm	3
	5–10 adenomas <10 mm or any adenoma ≥10 mm	3
	>10 adenomas	1

*

A normal colonoscopy is one in which no adenomas, SSPs (not currently simulated), or CRC is detected.
†

This table omits the case where CRC is detected at a screening, diagnostic, or surveillance colonoscopy because the CISNET CRC models do not simulate detailed events following CRC diagnosis.
‡

The Multi-Society Task Force provides a range for some intervals (e.g. the interval for 3–4 adenomas <10 mm is 3–5 years). In such cases, we selected the shortest intervals provided.
§

A person whose first screening or diagnostic colonoscopy is normal does not enter surveillance but instead resumes screening with the original modality 10 years after the normal colonoscopy. The exception to the 10-year waiting period is when the first colonoscopy is a screening colonoscopy with an x-year interval, where x>10. In that case, the next colonoscopy is in x years.

Table 4

Projected life-years (LY) per 1000 individuals.

Scenario	Model	No screening	Screening without disruptions		Screening with disruptions		Loss due to disruptions
Scenario	Model	LY[a]	LY[b]	LYG[b-a]	LY[c]	LYG[c-a]	LY[b-c]	% LYG loss[(b-c)/b]
U50 \| C3m	CRCSPIN	31,595	31,893	299	31,892	297	2	1
U50 \| C3m	MISCAN	31,222	31,494	273	31,491	270	3	1
U50 \| C9m	CRCSPIN	31,595	31,893	299	31,890	295	3	1
U50 \| C9m	MISCAN	31,222	31,494	273	31,490	268	5	2
U50 \| C18m	CRCSPIN	31,595	31,893	299	31,886	291	7	2
U50 \| C18m	MISCAN	31,222	31,494	273	31,488	266	6	2
U50 \| C@65	CRCSPIN	31,595	31,893	299	31,766	172	127	43
U50 \| C@65	MISCAN	31,222	31,494	273	31,390	169	104	38
U50 \| F3m	CRCSPIN	31,595	31,866	271	31,865	270	1	0
U50 \| F3m	MISCAN	31,222	31,483	261	31,481	259	1	1
U50 \| F9m	CRCSPIN	31,595	31,866	271	31,862	268	3	1
U50 \| F9m	MISCAN	31,222	31,483	261	31,480	258	2	1
U50 \| F18m	CRCSPIN	31,595	31,866	271	31,858	264	7	3
U50 \| F18m	MISCAN	31,222	31,483	261	31,478	256	5	2
U60 \| C3m	CRCSPIN	23,336	23,557	221	23,560	224	-3	-1
U60 \| C3m	MISCAN	23,114	23,309	195	23,304	190	5	3
U60 \| C9m	CRCSPIN	23,336	23,557	221	23,555	219	2	1
U60 \| C9m	MISCAN	23,114	23,309	195	23,301	187	8	4
U60 \| C18m	CRCSPIN	23,336	23,557	221	23,547	211	10	4
U60 \| C18m	MISCAN	23,114	23,309	195	23,296	182	14	7
U60 \| C@65	CRCSPIN	23,336	23,557	221	23,512	176	45	20
U60 \| C@65	MISCAN	23,114	23,309	195	23,267	153	42	21
U60 \| F3m	CRCSPIN	23,336	23,528	191	23,529	193	-2	-1
U60 \| F3m	MISCAN	23,114	23,291	177	23,288	174	3	1
U60 \| F9m	CRCSPIN	23,336	23,528	191	23,525	189	2	1
U60 \| F9m	MISCAN	23,114	23,291	177	23,285	171	6	3
U60 \| F18m	CRCSPIN	23,336	23,528	191	23,519	183	8	4
U60 \| F18m	MISCAN	23,114	23,291	177	23,280	166	11	6
C60 \| C3m	CRCSPIN	23,243	23,541	298	23,541	299	0	0
C60 \| C3m	MISCAN	23,077	23,320	243	23,318	241	2	1
C60 \| C9m	CRCSPIN	23,242	23,541	298	23,541	299	0	0
C60 \| C9m	MISCAN	23,077	23,319	243	23,317	240	2	1
C60 \| C18m	CRCSPIN	23,242	23,541	298	23,540	298	0	0
C60 \| C18m	MISCAN	23,077	23,320	243	23,317	239	3	1
C60 \| F3m	CRCSPIN	23,242	23,541	298	23,532	289	9	3
C60 \| F3m	MISCAN	23,077	23,320	243	23,310	233	10	4
C60 \| F9m	CRCSPIN	23,243	23,541	298	23,532	289	9	3
C60 \| F9m	MISCAN	23,077	23,319	243	23,310	233	9	4
C60 \| F18m	CRCSPIN	23,243	23,541	298	23,532	289	9	3
C60 \| F18m	MISCAN	23,077	23,320	243	23,309	232	11	4
C60 \| C@65	CRCSPIN	23,243	23,541	298	23,538	295	3	1
C60 \| C@65	MISCAN	23,077	23,320	243	23,308	231	11	5
C60 \| U	CRCSPIN	23,243	23,541	298	23,435	192	106	36
C60 \| U	MISCAN	23,077	23,320	243	23,195	118	125	51
F60 \| F3m	CRCSPIN	23,307	23,579	272	23,576	269	3	1
F60 \| F3m	MISCAN	23,144	23,377	234	23,377	233	0	0
F60 \| F9m	CRCSPIN	23,306	23,578	272	23,575	269	3	1
F60 \| F9m	MISCAN	23,143	23,376	234	23,376	234	0	0
F60 \| F18m	CRCSPIN	23,307	23,578	272	23,573	267	5	2
F60 \| F18m	MISCAN	23,143	23,377	234	23,376	233	1	0
F60 \| U	CRCSPIN	23,307	23,579	272	23,467	160	111	41
F60 \| U	MISCAN	23,143	23,376	234	23,283	141	93	40
f60 \| F3m	CRCSPIN	23,314	23,562	249	23,560	247	2	1
f60 \| F3m	MISCAN	23,136	23,355	219	23,353	217	2	1
f60 \| F9m	CRCSPIN	23,314	23,563	249	23,559	245	4	1
f60 \| F9m	MISCAN	23,136	23,355	219	23,352	216	3	1
f60 \| F18m	CRCSPIN	23,313	23,562	249	23,556	242	6	3
f60 \| F18m	MISCAN	23,136	23,355	219	23,350	214	5	2
f60 \| U	CRCSPIN	23,313	23,562	249	23,419	105	143	58
f60 \| U	MISCAN	23,134	23,353	219	23,203	68	150	69
U70 \| C3m	CRCSPIN	15,973	16,102	128	16,099	126	3	2
U70 \| C3m	MISCAN	15,748	15,866	117	15,857	108	9	8
U70 \| C9m	CRCSPIN	15,973	16,102	128	16,094	120	8	6
U70 \| C9m	MISCAN	15,748	15,866	117	15,852	103	14	12
U70 \| C18m	CRCSPIN	15,973	16,102	128	16,086	113	16	12
U70 \| C18m	MISCAN	15,748	15,866	117	15,845	97	21	18
U70 \| C@75	CRCSPIN	15,973	16,102	128	16,052	79	50	39
U70 \| C@75	MISCAN	15,748	15,866	117	15,815	66	51	43
U70 \| F3m	CRCSPIN	15,973	16,069	95	16,067	93	2	2
U70 \| F3m	MISCAN	15,748	15,840	92	15,833	85	7	8
U70 \| F9m	CRCSPIN	15,973	16,069	95	16,063	90	5	6
U70 \| F9m	MISCAN	15,748	15,840	92	15,830	81	10	11
U70 \| F18m	CRCSPIN	15,973	16,069	95	16,058	84	11	12
U70 \| F18m	MISCAN	15,748	15,840	92	15,824	76	16	17
C70 \| C3m	CRCSPIN	15,683	15,968	285	15,968	285	0	0
C70 \| C3m	MISCAN	15,590	15,824	234	15,823	234	1	0
C70 \| C9m	CRCSPIN	15,683	15,968	285	15,968	285	0	0
C70 \| C9m	MISCAN	15,590	15,824	234	15,823	233	1	0
C70 \| C18m	CRCSPIN	15,684	15,969	285	15,968	285	0	0
C70 \| C18m	MISCAN	15,589	15,824	234	15,822	233	2	1
C70 \| C@75	CRCSPIN	15,683	15,968	285	15,968	285	0	0
C70 \| C@75	MISCAN	15,590	15,824	234	15,819	229	5	2
C70 \| F3m	CRCSPIN	15,683	15,968	285	15,964	281	5	2
C70 \| F3m	MISCAN	15,590	15,824	234	15,818	228	6	3
C70 \| F9m	CRCSPIN	15,683	15,968	285	15,964	281	4	1
C70 \| F9m	MISCAN	15,590	15,824	234	15,817	228	7	3
C70 \| F18m	CRCSPIN	15,683	15,968	285	15,964	281	4	2
C70 \| F18m	MISCAN	15,589	15,824	234	15,817	227	7	3
C70 \| U	CRCSPIN	15,683	15,968	285	15,930	247	38	13
C70 \| U	MISCAN	15,581	15,815	234	15,726	146	89	38
F70 \| F3m	CRCSPIN	15,764	16,024	259	16,023	259	0	0
F70 \| F3m	MISCAN	15,676	15,902	226	15,902	226	0	0
F70 \| F9m	CRCSPIN	15,765	16,024	259	16,023	259	1	0
F70 \| F9m	MISCAN	15,677	15,903	226	15,903	225	1	0
F70 \| F18m	CRCSPIN	15,766	16,025	259	16,024	258	1	0
F70 \| F18m	MISCAN	15,677	15,903	226	15,903	226	0	0
F70 \| U	CRCSPIN	15,764	16,024	259	15,990	226	33	13
F70 \| U	MISCAN	15,677	15,903	226	15,873	196	30	13

Notes: Outcomes calculated over the lifetime of a cohort of 1000 average-risk, CRC-free individuals with age at pandemic defined in the scenario description. The scenario column describes colorectal cancer screening disruption scenarios, as presented in Table 1. Life-years (LY) and Life-years gained (LYG) are computed over the remaining lifespan of individuals starting at the beginning of 2020. All values refer to cohort-level estimates – that is, the expected LY of an average-risk person. This table presents results assuming high colonoscopy sensitivity. Supplementary file 1 presents additional results for the low colonoscopy sensitivity scenario, and Supplementary files 2 and 3 present CRC cases and deaths outcomes.