Too Good to Be True? Evaluation of Colonoscopy Sensitivity Assumptions Used in Policy Models
- RAND Corp., Santa Monica, CA (United States)
- RAND Corp., Santa Monica, CA (United States); Argonne National Lab. (ANL), Lemont, IL (United States)
- Kaiser Permanente, San Francisco, CA (United States)
- Argonne National Lab. (ANL), Lemont, IL (United States); Univ. of Chicago, IL (United States)
Background: Models can help guide colorectal cancer screening policy. Although models are carefully calibrated and validated, there is less scrutiny of assumptions about test performance. Methods: We examined the validity of the CRC-SPIN model and colonoscopy sensitivity assumptions. Standard sensitivity assumptions, consistent with published decision analyses, assume sensitivity equal to 0.75 for diminutive adenomas (<6 mm), 0.85 for small adenomas (6–10 mm), 0.95 for large adenomas (≥10 mm), and 0.95 for preclinical cancer. We also selected adenoma sensitivity that resulted in more accurate predictions. Targets were drawn from the Wheat Bran Fiber study. In the study, we examined how well the model predicted outcomes measured over a three-year follow-up period, including the number of adenomas detected, the size of the largest adenoma detected, and incident colorectal cancer. Results: Using standard sensitivity assumptions, the model predicted adenoma prevalence that was too low (42.5% versus 48.9% observed, with 95% confidence interval 45.3%–50.7%) and detection of too few large adenomas (5.1% versus 14.% observed, with 95% confidence interval 11.8%–17.4%). Predictions were close to targets when we set sensitivities to 0.20 for diminutive adenomas, 0.60 for small adenomas, 0.80 for 10- to 20-mm adenomas, and 0.98 for adenomas 20 mm and larger. Conclusions: Colonoscopy may be less accurate than currently assumed, especially for diminutive adenomas. Alternatively, the CRC-SPIN model may not accurately simulate onset and progression of adenomas in higher-risk populations. Impact: Misspecification of either colonoscopy sensitivity or disease progression in high-risk populations may affect the predicted effectiveness of colorectal cancer screening. When possible, decision analyses used to inform policy should address these uncertainties.
- Research Organization:
- Argonne National Laboratory (ANL), Argonne, IL (United States)
- Sponsoring Organization:
- USDOE; National Institutes of Health (NIH); National Cancer Institute (NCI)
- Grant/Contract Number:
- AC02-06CH11357
- OSTI ID:
- 1869935
- Journal Information:
- Cancer Epidemiology, Biomarkers and Prevention, Journal Name: Cancer Epidemiology, Biomarkers and Prevention Journal Issue: 4 Vol. 31; ISSN 1055-9965
- Publisher:
- American Association for Cancer Research (AACR)Copyright Statement
- Country of Publication:
- United States
- Language:
- English
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