Benefits, harms, and burden of colorectal cancer screening among childhood cancer survivors previously treated with abdominopelvic radiation

Childhood cancer survivors (CCSs) treated with abdominopelvic radiation (RT) are at increased risk of colorectal cancer (CRC), yet adherence to Children’s Oncology Group screening guidelines remains low. A CRC simulation model using data from the Childhood Cancer Survivor Study and published studies evaluated CRC screening among 5-year survivors, starting at age 25-45 years. At age 45 years, survivors had a 0.6% cumulative CRC risk (relative risk, 3.3 versus average-risk individuals). Without screening, an estimated 75 per 1,000 survivors would be diagnosed with CRC in their lifetime, and 30 would die from CRC. Screening averted 47-73 cases and 23-29 CRC deaths per 1,000. Based on average-risk burden-to-benefit ratios, the optimal strategies by modality were colonoscopy every 10 years starting at age 30 years, multitargeted stool DNA every 3 years starting and age 30 years, and FIT every 3 years starting at age 25 years. ICERs in USD per quality-adjusted life-year gained were 146,000; 166,000; and 123.000; respectively. The authors conclude that early initiation of screening may substantially reduce CRC incidence and early mortality among CCSs treated with abdominopelvic RT, with reasonable burden-to-benefit trade-offs, and be considered cost-effective.