Following a negative colonoscopy result at initial screening, regular follow-up with less-invasive screening tools may provide the same life-saving benefit with fewer risks for complication and at a lower cost than rescreening with colonoscopy every 10 years. Researchers used a microsimulation model to assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result.
The model compared several rescreening interventions for persons aged 50 years who had no adenomas or cancer detected on an initial screening colonoscopy. Interventions included no further screening or rescreening with colonoscopy every 10 years, annual screening with fecal occult blood testing or fecal immunochemical testing, or computed tomographic colonography (CTC) every five years. The data showed that compared with no further screening, all rescreening strategies provided approximately the same benefit in life-years as colonoscopy every 10 years, but with fewer complications and at a lower cost.
While life-years saved were similar in all intervention groups, the authors of an accompanying editorial caution that screening reduces colorectal cancer mortality because earlier-stage cancer is less likely to result in death. But highly-sensitive endoscopic screening methods like colonoscopy may be more effective in reducing cancer incidence than FOBT. The editorialists argue that if the study authors had measured for quality-adjusted life-years, they might have reached a different conclusion.
They suggest that most people would likely pay more to never have colorectal cancer at all than to suffer with cancer and survive.