Extending intervals may help accommodate COVID-19-related colonoscopy reductions
In the wake of a COVID-19 wave, extending screening intervals may be the best way to accommodate the reduction in available colonoscopy capacity with the smallest impact on the incidence of colorectal cancer, according to study results.
In her presentation at the European Society of Gastrointestinal Endoscopy (ESGE) Days 2021, Lucie de Jonge, from Erasmus MC University Medical Center in The Netherlands, said that the Dutch national CRC screening program was disrupted during the first wave of COVID-19 between March and May of 2020.
“At the restart of the program, there was 35% of regular colonoscopy capacity available, and by September, we were almost back at 100%,” she said. “However, a second wave and more disruptions are expected. Therefore, the aim of this study was to find the best strategy to temporarily decrease colonoscopy demand based on long-term impact.”
Researchers used the MISCAN-Colon model to simulate the Dutch national CRC screening program, which normally provides biennial fecal immunochemical testing to individuals aged 55 to 75 years with a cut-off of 47 µg HB/g. They estimated the reduction in colonoscopy demand in the second half of 2020 and 2021, long-term CRC incidence, mortality and impact on life years lost in three different scenarios; increase the fecal immunochemical test (FIT) cut-off value to 60 µg HB/g, skipping individuals aged 63 or 65 years and extending the screening interval to 28 to 36 months. They compared these outcomes with a reference scenario without any colonoscopy restrictions.
Investigators determined that the required capacity for 2020 and 2021 without any restrictions was 100,300 colonoscopies.
Increasing the FIT cut-off resulted in a reduction of between 11,600 and 27,000 colonoscopies, However, it also resulted in in 400 to 900 excess CRC cases and 200 to 500 excess CRC-related deaths from 2020 to 2050.
Excluding age groups resulted in 10,800 to 17,500 fewer colonoscopies, but 200 to 600 excess CRC cases and 200 to 500 excess CRC-related deaths.
Extending intervals resulted in 16,100 to 49,500 fewer colonoscopies. Specifically, extending the screening interval up to 34 months prevented 200 to 300 more CRC cases and 200 to 600 CRC-related deaths. Although every strategy resulted in more life years lost, a 34-month interval had the smallest impact, and researchers did not see a drastic increase in life years lost until the interval was increased to 36 months.
“Temporarily increasing the screening interval had the smallest impact on the long term,” de Jonge said. “If extra reduction is necessary, increasing the cut-off value could be considered.”