Optimal Use Of Limited Colonoscopy Capacity in a Fit-Based Crc Screening Program During Covid-19 Pandemic

Abstract

Aims A second wave of the COVID-19 pandemic may force many health care providers to downscale their services again,including colonoscopies which may impact capacity for colorectal cancer (CRC) screening. This study aimed to determinethe optimal measure to handle these temporary shortages in colonoscopy capacity in the Dutch national CRC screeningprogram to retain as much of the preventive effect of the screening program as possible. Methods We used the MISCAN-Colon model to simulate the Dutch national CRC screening program, providing biennial FITto individuals aged 55-75, under three different scenarios to temporarily reduce required colonoscopy capacity in thesecond half of 2020 and 2021: increase in FIT cut-off value exclusion of specific age-groups, and extension of the screening interval For each scenario, we estimated the impact on required colonoscopy capacity in 2020-2021, long-term CRC incidence,mortality and life years (LYs) lost. Outcomes were compared to a reference scenario without colonoscopy restrictions. Results In 2020 and 2021, the required colonoscopy capacity without any restrictions was 100,300 colonoscopies.Increasing the cut-off, excluding age-groups and extending the screening interval resulted in a reduction of 11,600-27,000,10,800-17,500, and 16,100-49,500 colonoscopies, respectively (Table 1). Increasing the cut-off resulted in 400-900 excessCRC cases and 200-500 excess CRC-related deaths from 2020-2050, while excluding age-groups resulted in 200-600excess CRC cases and 200-500 excess CRC-related deaths. Unexpectedly, extending the screening interval up to 34 months prevented 200-300 more CRC cases and 200-600 more CRC-related deaths, because screening occurred until slightlyhigher ages due to the initial delay. All measures resulted in LYs lost, but extending the screening interval up to 34 monthshad the smallest impact. Abbreviations: CRC, colorectal cancer;LYs, Life Years;μg Hb/g feces, microgram Hemoglobin per gram feces.∗Number between brackets are negative numbers. Conclusions A temporary extension of the screening interval to accommodate reduction in available colonoscopy capacityresults in the smallest impact on the CRC incidence, mortality and LYs lost. (Table Presented).