Colorectal cancer–screening models commonly assume 100% adherence, which is inconsistent with real-world experience. The influence of adherence to initial stool-based screening [fecal immunochemical test (FIT), multitarget stool DNA (mt-sDNA)] and follow-up colonoscopy (after a positive stool test) on colorectal cancer outcomes was modeled using the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model. Average-risk individuals without diagnosed colorectal cancer at age 40 undergoing annual FIT or triennial mt-sDNA screening from ages 50 to 75 were simulated. Primary analyses incorporated published mt-sDNA (71%) or FIT (43%) screening adherence, with follow-up colonoscopy adherence ranging from 40% to 100%. Secondary analyses simulated 100% adherence for stool-based screening and colonoscopy follow-up (S1), published adherence for stool-based screening with 100% adherence to colonoscopy follow-up (S2), and published adherence for both stool-based screening and colonoscopy follow-up after positive mt-sDNA (73%) or FIT (47%; S3). Outcomes were life-years gained (LYG) and colorectal cancer incidence and mortality reductions (per 1,000 individuals) versus no screening. Adherence to colonoscopy follow-up after FIT had to be 4%–13% higher than mt-sDNA to reach equivalent LYG. The theoretical S1 favored FIT versus mt-sDNA (LYG 316 vs. 297; colorectal cancer incidence reduction 68% vs. 64%; colorectal cancer mortality reduction 76% vs. 72%). The more realistic S2 and S3 favored mt-sDNA versus FIT (S2: LYG 284 vs. 245, colorectal cancer incidence reduction 61% vs. 50%, colorectal cancer mortality reduction 69% vs. 59%; S3: LYG 203 vs. 113, colorectal cancer incidence reduction 43% vs. 23%, colorectal cancer mortality reduction 49% vs. 27%, respectively). Incorporating realistic adherence rates for colorectal cancer screening influences modeled outcomes and should be considered when assessing comparative effectiveness. Prevention Relevance: Adherence rates for initial colorectal cancer screening by FIT or mt-sDNA and for colonoscopy follow-up of a positive initial test influence the comparative effectiveness of these screening strategies. Using adherence rates based on published data for stool-based testing and colonoscopy follow-up yielded superior outcomes with an mt-sDNA versus FIT-screening strategy.

中文翻译：

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患者依从性对基于粪便的结直肠癌筛查和结肠镜检查在临床结果呈阳性后的影响

结直肠癌筛查模型通常假定 100% 的依从性，这与现实世界的经验不一致。使用结直肠癌和腺瘤发病率和死亡率显微模拟模型。模拟了在 40 岁时未确诊结直肠癌的平均风险个体在 50 至 75 岁期间接受年度 FIT 或三年一次的 mt-sDNA 筛查。初步分析纳入了已发表的 mt-sDNA (71%) 或 FIT (43%) 筛查依从性，随访结肠镜检查依从性范围为 40% 至 100%。二次分析模拟 100% 依从粪便筛查和结肠镜检查随访 (S1)，发表了基于粪便筛查的依从性，结肠镜检查随访 100% 的依从性 (S2)，并发表了阳性 mt-sDNA (73%) 或 FIT (47%; S3) 后基于粪便筛查和结肠镜检查随访的依从性). 结果是获得的生命年数 (LYG) 和结直肠癌发病率和死亡率的降低（每 1,000 人）与未筛查相比。FIT 后对结肠镜检查的依从性必须比 mt-sDNA 高 4%–13% 才能达到等效的 LYG。理论 S1 有利于 FIT 与 mt-sDNA（LYG 316 与 297；结直肠癌发病率降低 68% 与 64%；结直肠癌死亡率降低 76% 与 72%）。更现实的 S2 和 S3 有利于 mt-sDNA 与 FIT（S2：LYG 284 与 245，结直肠癌发病率降低 61% 与 50%，结直肠癌死亡率降低 69% 与 59%；S3：LYG 203 与 113 , 结直肠癌发病率分别降低 43% 和 23%，结直肠癌死亡率分别降低 49% 和 27%）。结合结直肠癌筛查的实际依从率会影响模型结果，在评估比较有效性时应予以考虑。预防相关性：通过 FIT 或 mt-sDNA 进行结直肠癌初始筛查的依从率以及对阳性初始检测进行结肠镜检查随访的依从率会影响这些筛查策略的比较有效性。使用基于粪便测试和结肠镜检查随访的已发表数据的依从率，mt-sDNA 与 FIT 筛查策略相比产生了更好的结果。结合结直肠癌筛查的实际依从率会影响模型结果，在评估比较有效性时应予以考虑。预防相关性：通过 FIT 或 mt-sDNA 进行结直肠癌初始筛查的依从率以及对阳性初始检测进行结肠镜检查随访的依从率会影响这些筛查策略的比较有效性。使用基于粪便测试和结肠镜检查随访的已发表数据的依从率，mt-sDNA 与 FIT 筛查策略相比产生了更好的结果。结合结直肠癌筛查的实际依从率会影响模型结果，在评估比较有效性时应予以考虑。预防相关性：通过 FIT 或 mt-sDNA 进行结直肠癌初始筛查的依从率以及对阳性初始检测进行结肠镜检查随访的依从率会影响这些筛查策略的比较有效性。使用基于粪便测试和结肠镜检查随访的已发表数据的依从率，mt-sDNA 与 FIT 筛查策略相比产生了更好的结果。通过 FIT 或 mt-sDNA 进行结直肠癌初始筛查的依从率以及对阳性初始测试进行结肠镜检查随访的依从率会影响这些筛查策略的比较有效性。使用基于粪便测试和结肠镜检查随访的已发表数据的依从率，mt-sDNA 与 FIT 筛查策略相比产生了更好的结果。通过 FIT 或 mt-sDNA 进行结直肠癌初始筛查的依从率以及对阳性初始测试进行结肠镜检查随访的依从率会影响这些筛查策略的比较有效性。使用基于粪便测试和结肠镜检查随访的已发表数据的依从率，mt-sDNA 与 FIT 筛查策略相比产生了更好的结果。