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

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 determine the optimal measure to handle these temporary shortages in colonoscopy capacity in the Dutch national CRC screening program 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 FIT to individuals aged 55-75, under three different scenarios to temporarily reduce required colonoscopy capacity in the second half of 2020 and 2021:

1. increase in FIT cut-off value

2. exclusion of specific age-groups, and

3. 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 excess CRC cases and 200-500 excess CRC-related deaths from 2020-2050, while excluding age-groups resulted in 200-600 excess 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 slightly higher ages due to the initial delay. All measures resulted in LYs lost, but extending the screening interval up to 34 months had the smallest impact.

Table 1

	Reduction in colonoscopy demand 2020-2021	Excess CRC incidence 2020-2050	Excess CRC-related deaths 2020-2050	LYs lost 2020-2050
Increasing the cut-off value: 50-70 µg/g feces	11,600 - 27,000	400 - 900	200 - 500	2,100 - 4,800
Excluding age-groups: 55-, 63-year-olds, or both 63- and 65-year-olds	7,900 - 17,500	200 - 600	200 - 500	2,800 - 5,700
Extending the screening interval: 28-36 months	16,100 - 49,500	(200)* - 400	(600)* - (200)*	900 - 5,200

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 capacity results in the smallest impact on the CRC incidence, mortality and LYs lost.

Citation: de Jonge L, van de Schootbrugge-Vandermeer HJ, Breekveldt ECH et al. OP86 OPTIMAL USE OF LIMITED COLONOSCOPY CAPACITY IN A FIT-BASED CRC SCREENING PROGRAM DURING COVID-19 PANDEMIC. Endoscopy 2021; 53: S37.

Publication History

Article published online:
19 March 2021