ArticleMedical decision making : an international journal of the Society for Medical Decision Making2016
Validation of Models Used to Inform Colorectal Cancer Screening Guidelines: Accuracy and Implications.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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Who cites it
38 citing papers in PubMed.
- Validation of Colorectal Cancer Models on Long-term Outcomes from a Randomized Controlled Trial.Medical decision making : an international journal of the Society for Medical Decision Making · 2020Trial
- Modeling in Colorectal Cancer Screening: Assessing External and Predictive Validity of MISCAN-Colon Microsimulation Model Using NORCCAP Trial Results.Medical decision making : an international journal of the Society for Medical Decision Making · 2018Trial
- Trial
- CRC-SPIN version 3.0: an updated policy model for colorectal cancer screening that includes the serrated pathway.Journal of the National Cancer Institute · 2026Article
- Discrete-Event Simulation Modeling Framework for Cancer Interventions and Population Health in R (DESCIPHR): An Open-Source Pipeline.PharmacoEconomics · 2026Article
- The triple effect of colorectal cancer screening: reducing deaths, government spending, and mortality disparities.Journal of the National Cancer Institute · 2026Article
- Benefits, Harms, and Burden of Colorectal Cancer Screening Among Childhood Cancer Survivors Previously Treated With Abdominopelvic Radiation.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Article
- Stress-Testing US Colorectal Cancer Screening Guidelines: Decennial Colonoscopy from Age 45 is Robust to Natural History Uncertainty and Colonoscopy Sensitivity Assumptions.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening.JAMA network open · 2023Article
- Comparison of Simulated Outcomes Between Stool- and Blood-Based Colorectal Cancer Screening Tests.Population health management · 2023Article
- Calibration and Validation of the Colorectal Cancer and Adenoma Incidence and Mortality (CRC-AIM) Microsimulation Model Using Deep Neural Networks.Medical decision making : an international journal of the Society for Medical Decision Making · 2023Article
- Review
- Cost-effectiveness analysis of colorectal cancer screening in Shanghai, China: A modelling study.Preventive medicine reports · 2022Article
- Article
- Sequentially calibrating a Bayesian microsimulation model to incorporate new information and assumptions.BMC medical informatics and decision making · 2022Article
- Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force.JAMA · 2021Article
- Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model.Cancer medicine · 2021Article
- Harms and Benefits of Cancer Screening.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2021Article
- Screening For Colorectal Cancer in the Age of Simulation Models: A Historical Lens.Gastroenterology · 2020Article
- Article
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10 authors.
Funding
Abstract
backgroundMicrosimulation models synthesize evidence about disease processes and interventions, providing a method for predicting long-term benefits and harms of prevention, screening, and treatment strategies. Because models often require assumptions about unobservable processes, assessing a model's predictive accuracy is important.
methodsWe validated 3 colorectal cancer (CRC) microsimulation models against outcomes from the United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial, a randomized controlled trial that examined the effectiveness of one-time flexible sigmoidoscopy screening to reduce CRC mortality. The models incorporate different assumptions about the time from adenoma initiation to development of preclinical and symptomatic CRC. Analyses compare model predictions to study estimates across a range of outcomes to provide insight into the accuracy of model assumptions.
resultsAll 3 models accurately predicted the relative reduction in CRC mortality 10 years after screening (predicted hazard ratios, with 95% percentile intervals: 0.56 [0.44, 0.71], 0.63 [0.51, 0.75], 0.68 [0.53, 0.83]; estimated with 95% confidence interval: 0.56 [0.45, 0.69]). Two models with longer average preclinical duration accurately predicted the relative reduction in 10-year CRC incidence. Two models with longer mean sojourn time accurately predicted the number of screen-detected cancers. All 3 models predicted too many proximal adenomas among patients referred to colonoscopy.
conclusionModel accuracy can only be established through external validation. Analyses such as these are therefore essential for any decision model. Results supported the assumptions that the average time from adenoma initiation to development of preclinical cancer is long (up to 25 years), and mean sojourn time is close to 4 years, suggesting the window for early detection and intervention by screening is relatively long. Variation in dwell time remains uncertain and could have important clinical and policy implications.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.