1010 Disease-Associated Enterotypes and Metabotypes in Families With Pediatric Inflammatory Bowel Disease

Abstract

BACKGROUND: Colorectal cancer (CRC) screening is cost-effective in adults of age 5075 years, but is currently used by only 58% of the eligible adults in the United States (US). The National Colorectal Cancer Roundtable, a national coalition of public, private and voluntary organizations, recently launched an initiative to increase US CRC screening rates to 80% by 2018. We evaluated the potential public health benefits of achieving this goal. METHODS: We simulated the 1980-2030 US population 50-100 years of age using microsimulation modeling (MISCAN-colon). Population estimates were obtained from the US Census Bureau, past CRC incidence and mortality estimates were based on Surveillance Epidemiology and End Results program data, and test-specific historical screening was based on 1987-2013 National Health Interview Survey data. The effects of increasing screening rates from 58% in 2013 to 80% in 2018, by screening previously unscreened adults, were compared to a scenario in which the screening rate remained at approximately 60%. We examined the influence of detection and removal of adenoma and early cancers on new CRC cases and deaths per year during short-term follow-up (to 2020) and extended followup (to 2030). The outcomes of interest in our analysis were cancer incidence and mortality rates, and absolute number of cancer cases and deaths. RESULTS: Increasing screening rates from 58% to 80% by 2018 would initially increase CRC incidence, but would subsequently reduce CRC incidence by 17% and CRC mortality by 19% during short-term followup (to 2020). Increasing screening uptake to 80% would reduce CRC incidence and mortality rates by a total of 22% and 33%, respectively, by 2030. The estimated effects on incidence and mortality rates would translate in approximately 43,000 new CRC cases and 21,000 CRC deaths averted per year by 2030, and a total of 278,000 cases and 203,000 deaths averted from 2013 through 2030 ( Figure). CONCLUSION: Considerable reductions in CRC incidence and mortality and the avoidance of over 200,000 CRC deaths through 2030 are projected to result if the uptake of CRC screening in the US increases from the current 58% to 80% by 2018. This underscores the potential gains of public health efforts targeted to screening underutilization.