Cp. Theuer et al., Racial and ethnic colorectal cancer patterns affect the cost-effectivenessof colorectal cancer screening in the United States, GASTROENTY, 120(4), 2001, pp. 848-856
Background&Aims: Colorectal cancer screening beginning at age 50 is recomme
nded for all Americans considered at "average" risk for the development of
colorectal cancer. Methods: We used 1988-1995 California Cancer Registry da
ta to compare the cost-effectiveness of two 35-year colorectal cancer scree
ning interventions among Asians, blacks, Latinos, and Whites. Results: Aver
age annual age-specific colorectal cancer incidence rates were highest in b
lacks and lowest in Latinos. Screening beginning at age 50 was most cost-ef
fective in blacks and least cost-effective in Latinos (measured as dollars
spent per year of life saved), using annual fecal occult blood testing (FOB
T) combined with flexible sigmoidoscopy every 5 years and using colonoscopy
every 10 years. A 35-year screening program beginning in blacks at age 42,
whites at age 44, or Asians at age 46 was more cost-effective than screeni
ng Latinos beginning at age 50, Conclusions: Colorectal cancer screening pr
ograms beginning at age 50, using either FOBT and flexible sigmoidoscopy or
colonoscopy in each racial or ethnic group, are within the $40,000-$60,000
per year of life saved upper cost limit considered acceptable for preventi
ve strategies. Screening is most cost-effective in blacks because of high a
ge-specific colorectal cancer incidence rates.