Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis

Table 1 Model-estimated benefits and burden of colorectal cancer screening starting at age 45 vs 50 per 1000 screened over a lifetime[27]

Screening test	Age of start and stop	Life years gained	Number of colonoscopies	Recommendable?
Colonoscopy every 10 yr	45-75	429	5646	Yes
	50-75	404	4836	No
CTC every 5 yr	45-75	390	2666	Yes
	50-75	368	2430	No
Flexible sigmoidoscopy every 5 yr	45-75	403	3761	Yes
	50-75	380	3426	No
FIT every year	45-75	403	2698	Yes
	50-75	377	2402	No
HSgFOBT every year	45-75	403	3364	No
	50-75	377	2956	No
mt-sDNA every 3 yr	45-75	376	2640	No
	50-75	350	2331	No

The model predicted better suitability for fecal immunochemical testing over high sensitivity guaiac fecal occult blood testing (HSgFOBT) because the latter has higher false positive rates (nonsteroidal anti-inflammatory drugs causing upper gastrointestinal bleeding, red meat, dietary peroxidases contained in fruits and vegetables). Thus, it increases the number of unnecessary colonoscopies. However, HSgFOBT is less expensive, making it an attractive option in low-resource settings. Colonoscopy every 10 years from the age of 45 to 75 years provides the greatest reduction of mortality and incidence, as well as more life-years gained and deaths averted, with twice as many colonoscopies as stool-based tests. CTC: Computed tomography colonoscopy; FIT: Fecal immunochemical testing; HSgFOBT: High sensitivity guaiac fecal occult blood testing; mt-sDNA: Multitarget stool DNA.