Optimizing Initial Screening for Colorectal Cancer Detection with Adherence Behavior
Management Science · 2025 · Sarah Yini Gao、Yan He、Ruijie Zhang、Zhichao Zheng、Shao Wei Lam、Emile Tan
中文摘要
结直肠癌(CRC)检测的两阶段筛查项目通常包括第一阶段检测,评估粪便样本中的粪便血红蛋白(f-Hb)浓度,检测结果为阳性者将被建议接受第二阶段诊断性检测(结肠镜检查)。我们考察第一阶段检测的设计——特别是用于报告检测结果的 f-Hb 阈值的选择——以期在筛查有效性(CRC 与息肉检出)和效率(结肠镜检查成本)之间取得平衡,同时考虑到并非所有个体都会随访接受结肠镜检查。我们提出一个将贝叶斯说服与信息回避相结合的信息设计模型来解决这一问题。该模型应用于新加坡结直肠癌筛查项目的设计,并利用来自多个来源的数据进行校准,其中包括一项在新加坡对 3,920 名受访者开展的全国性调查。我们的研究结果表明,在某些条件下,使用单一阈值可使随访依从性最大化,而显示精确的 f-Hb 读数则可优化检出有效性。与现行做法相比,将阈值提高至 39 μg/g 可多检出 21% 的结直肠癌和息肉病例,减少 27% 的结肠镜检查,并将终身结直肠癌风险降低 11%。在筛查成本方面,这一调整将使公共医疗支出平均减少 2,000 万新元,个人支出平均减少 1,200 万新元。为第一阶段检测选择合适的阈值,可以显著提升筛查有效性,同时高效管理结肠镜检查需求。目前普遍采用的以较低阈值实现高灵敏度的做法,可能导致过多不必要的结肠镜检查以及随访依从性下降。
Abstract
Two-stage screening programs for colorectal cancer (CRC) detection typically involve a first-stage test that evaluates fecal-hemoglobin (f-Hb) concentration in stool samples, with positive results leading to a recommended second-stage diagnostic test (colonoscopy). We explore the design of the first-stage test—specifically the selection of f-Hb cutoffs to report test outcomes—to balance screening effectiveness (CRC and polyp detection) and efficiency (colonoscopy costs), considering that not all individuals follow up with a colonoscopy. We propose an information design model that integrates Bayesian persuasion with information avoidance to address this issue. The model is applied to the design of Singapore’s CRC screening program and calibrated using data from multiple sources, including a nationwide survey of 3,920 respondents in Singapore. Our findings indicate that under certain conditions, using a single cutoff maximizes follow-up adherence, whereas showing exact f-Hb readings optimizes detection effectiveness. Raising the cutoff to 39 $\mu \text{g}/\text{g}$, as compared with the current practice, could detect 21% more CRC and polyp cases, reduce colonoscopies by 27%, and lower lifetime CRC risk by 11%. This adjustment would reduce public healthcare expenditure by S$20 million and individual spending by S$12 million on average in screening costs. Choosing appropriate cutoffs for the first-stage test can significantly enhance the screening effectiveness while efficiently managing colonoscopy demands. The prevalent practice of using lower cutoffs to achieve high sensitivity may lead to excessive unnecessary colonoscopies and reduced follow-up adherence.