Abstract
Background & Aims: Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at “average” risk for the development of colorectal cancer. Methods: We used 1988–1995 California Cancer Registry data to compare the cost-effectiveness of two 35-year colorectal cancer screening interventions among Asians, blacks, Latinos, and Whites. Results: Average annual age-specific colorectal cancer incidence rates were highest in blacks and lowest in Latinos. Screening beginning at age 50 was most cost-effective in blacks and least cost-effective in Latinos (measured as dollars spent per year of life saved), using annual fecal occult blood testing (FOBT) combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. A 35-year screening program beginning in blacks at age 42, whites at age 44, or Asians at age 46 was more cost-effective than screening Latinos beginning at age 50. Conclusions: Colorectal cancer screening programs beginning at age 50, using either FOBT and flexible sigmoidoscopy or colonoscopy in each racial or ethnic group, are within the $40,000–$60,000 per year of life saved upper cost limit considered acceptable for preventive strategies. Screening is most cost-effective in blacks because of high age-specific colorectal cancer incidence rates.GASTROENTEROLOGY 2001;120:848-856
Highlights
Background & AimsColorectal cancer screening beginning at age 50 is recommended for all Americans considered at “average” risk for the development of colorectal cancer
Colorectal cancer screening programs beginning at age 50, using either fecal occult blood testing (FOBT) and flexible sigmoidoscopy or colonoscopy in each racial or ethnic group, are within the $40,000 –$60,000 per year of life saved upper cost limit considered acceptable for preventive strategies
Colorectal cancer screening allows the detection of asymptomatic cancers that are more amenable to curative therapy, and allows the removal of adenomas that could subsequently develop into invasive cancer
Summary
Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at “average” risk for the development of colorectal cancer. Methods: We used 1988 – 1995 California Cancer Registry data to compare the cost-effectiveness of two 35-year colorectal cancer screening interventions among Asians, blacks, Latinos, and Whites. Results: Average annual agespecific colorectal cancer incidence rates were highest in blacks and lowest in Latinos. Screening beginning at age 50 was most cost-effective in blacks and least cost-effective in Latinos (measured as dollars spent per year of life saved), using annual fecal occult blood testing (FOBT) combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. A 35-year screening program beginning in blacks at age 42, whites at age 44, or Asians at age 46 was more cost-effective than screening Latinos beginning at age
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