Age-specific sequence of colorectal cancer screening options in Germany: A model-based critical evaluation

Autoři: Thomas Heisser aff001;  Korbinian Weigl aff001;  Michael Hoffmeister aff001;  Hermann Brenner aff001
Působiště autorů: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany aff001;  Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany aff002;  German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany aff003;  Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany aff004
Vyšlo v časopise: Age-specific sequence of colorectal cancer screening options in Germany: A model-based critical evaluation. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003194
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003194



The current organized screening program for colorectal cancer in Germany offers both sexes 5 annual fecal immunochemical tests (FITs) between ages 50 and 54 years, followed by a first screening colonoscopy at age 55 years if all of these FITs were negative. We sought to assess the implications of this approach for key parameters of diagnostic performance.

Methods and findings

Using a multistate Markov model, we estimated the expected detection rates of advanced neoplasms (advanced adenomas and cancers) and number needed to scope (NNS) to detect 1 advanced neoplasm at a first screening colonoscopy conducted at age 55 after 5 preceding negative FITs and compared them with the corresponding estimates for a first screening colonoscopy at age 55 with no preceding FIT testing. In individuals with 5 consecutive negative FITs undergoing screening colonoscopy at age 55, expected colonoscopy detection rate (NNS) was 3.7% (27) and 0.10% (1,021) for any advanced neoplasm and cancer, respectively, in men, and 2.1% (47) and 0.05% (1,880) for any advanced neoplasm and cancer, respectively, in women. These NNS values for detecting 1 advanced neoplasm are approximately 3-fold higher, and the NNS values for detecting 1 cancer are approximately 8-fold higher, than those for a first screening colonoscopy at age 55 without prior FITs. This study is limited by model simplifying assumptions and uncertainties related to input parameters.


Screening colonoscopy at age 55 after 5 consecutive negative FITs at ages 50–54, as currently offered in the German cancer early detection program, is expected to have very low positive predictive value. Our results may inform efforts to enhance the design of screening programs.

Klíčová slova:

Adenomas – Cancer detection and diagnosis – Cancer screening – Colorectal cancer – Death rates – German people – Neoplasms – colonoscopy


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