Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand
Issued Date
2023-10-01
Resource Type
ISSN
00917435
eISSN
10960260
Scopus ID
2-s2.0-85171732867
Pubmed ID
37660758
Journal Title
Preventive Medicine
Volume
175
Rights Holder(s)
SCOPUS
Bibliographic Citation
Preventive Medicine Vol.175 (2023)
Suggested Citation
Wongseree P., Hasgul Z., Leerapan B., Iramaneerat C., Phisalprapa P., Jalali M.S. Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand. Preventive Medicine Vol.175 (2023). doi:10.1016/j.ypmed.2023.107694 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90240
Title
Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand
Other Contributor(s)
Abstract
Background: Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand. Methods: We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination. Results: Projecting the status quo (2023−2032), deaths per 100K people increase from 87.5 to 115.4, and CRC progressions per 100K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100K people, with cumulative prevented 7K deaths and 9K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100K with no effect on progression, totaling 35K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100K, or 41K and 7K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100K people, or 54K and 30K cumulatively. Conclusion: Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.