ArticleGastroenterology2019
Cost-Effectiveness and National Effects of Initiating Colorectal Cancer Screening for Average-Risk Persons at Age 45 Years Instead of 50 Years.
Article in Gastroenterology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients.International journal of colorectal disease · 2024Pooled it
- AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review.Gastroenterology · 2023Guideline
- Treatment stratification and prognosis assessment using circulating tumor DNA in locally advanced rectal cancer: A systematic review and meta-analysis.Cancer medicine · 2023Pooled it
- Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023Guideline
- Pooled it
- A risk scoring system to predict the individual incidence of early-onset colorectal cancer.BMC cancer · 2022Pooled it
- Risk of Colorectal Cancer in Patients With Irritable Bowel Syndrome: A Meta-Analysis of Population-Based Observational Studies.Frontiers in medicine · 2022Pooled it
- Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis.Gastroenterology · 2021Pooled it
- NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020.Journal of the National Comprehensive Cancer Network : JNCCN · 2020Guideline
- A preliminary study of further attempt at the development, testing and application of an auxiliary equipment for electronic colonoscopy.Scientific reports · 2024Trial
- Shaping the future of early-onset colorectal cancer prevention.Nature reviews. Cancer · 2026Review
- The Association of FIT-Based Colorectal Cancer Screening with Earlier Disease Detection: The Romanian Experience.Cancers · 2026Article
- Rethinking Colorectal Cancer Screening: Culturally Tailored Navigation for Mailed FIT Kits in 45- to 49-Year-Olds.Journal of general internal medicine · 2026Article
- Development and External Validation of a Large Language Model-Based Clinical Decision-Support System for Colonoscopy Surveillance Intervals.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Early-onset colorectal cancer: a comprehensive review reframing hypotheses and defining research priorities.International journal of colorectal disease · 2026Review
- Combination of fecal SDC2 methylation with serum CEA/CA72-4 in screening of colorectal cancer and precancerous lesions.Clinics (Sao Paulo, Brazil) · 2026Article
- Knowledge and Awareness of Cancer Screening Among the Public in Saudi Arabia: A Cross-Sectional Study.Cureus · 2026Article
- The Evolution of Value-Based Care: Why Cost-Effectiveness Matters in Gastroenterology.ACG case reports journal · 2025Article
- Insights from age-stratified endoscopic detection metrics support initiating colorectal cancer screening at age 45.BMC gastroenterology · 2025Article
- Knowledge, attitudes, and practices of liver cancer screening among high-risk populations in China.BMC public health · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
BACKGROUND &
aimsThe American Cancer Society has recommended initiating colorectal cancer (CRC) screening at age 45 years instead of 50 years. We estimated the cost effectiveness and national effects of adopting this recommendation.
methodsWe compared screening strategies and alternative resource allocations in a validated Markov model. We based national projections on screening participation rates by age and census data.
resultsScreening colonoscopy initiation at age 45 years instead of 50 years in 1000 persons averted 4 CRCs and 2 CRC deaths, gained 14 quality-adjusted life-years (QALYs), cost $33,900/QALY gained, and required 758 additional colonoscopies. These 758 colonoscopies could instead be used to screen 231 currently unscreened 55-year-old persons or 342 currently unscreened 65-year-old persons, through age 75 years. These alternatives averted 13-14 CRC cases and 6-7 CRC deaths and gained 27-28 discounted QALYs while saving $163,700-$445,800. Improving colonoscopy completion rates after abnormal results from a fecal immunochemical test yielded greater benefits and savings. Initiation of fecal immunochemical testing at age 45 years instead of 50 years cost $7700/QALY gained. Shifting current age-specific screening rates to 5 years earlier could avert 29,400 CRC cases and 11,100 CRC deaths over the next 5 years but would require 10.7 million additional colonoscopies and cost an incremental $10.4 billion. Improving screening rates to 80% in persons who are 50-75 years old would avert nearly 3-fold more CRC deaths at one third the incremental cost.
conclusionsIn a Markov model analysis, we found that starting CRC screening at age 45 years is likely to be cost effective. However, greater benefit, at lower cost, could be achieved by increasing participation rates for unscreened older and higher-risk persons.
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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.