This report summarizes estimates of health impact and cost-effectiveness of the impact of offering colorectal cancer screening that were created to assess the relative value of most of the clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP) for the general population. This ranking of clinical prevention priorities is guided by the National Commission on Prevention Priorities (NCPP).

USPSTF Recommendations and screening technologies assessed: This report follows the 2008 recommendation of the USPSTF. The USPSTF most recently updated it colorectal cancer screening recommendation in June 2016.The updated draft recommendation could not be incorporated into this report due to time constraints. Based upon the 2008 recommendation, we assessed screening for colorectal cancer using fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy in adults, from ages 50-75 years. In the 2016 update, the USPSTF de-emphasized evaluation of specific screening strategies due to limited direct evidence with which to compare the net benefit of the strategies. Simulation modeling in support of the USPSTF found small variation in CRC deaths prevented and life years saved among screening strategies. Those simulation modeling results also indicate that screening strategies that produce greater reductions in death and life years lost to cancer generally have higher risk of harms and require more colonoscopies, thereby reducing the differences in net benefits among screening strategies.

In our evaluation of CRC screening, stool-based tests are represented by annual FOBT and direct visualization is represented by sigmoidoscopy every 5 years and colonoscopy every 10 years. We evaluate screening with patient choice of screening strategy in a simulation model that allows patients to select a test with probabilities consistent with observed utilization as described below. In effect, our estimates represent a weighted average of the modeled screening strategies where the weights are the utilization probabilities representative of the US population. The estimates in this report may not reflect current USPSTF recommendations. Readers are advised to check for updated recommendations at https://uspreventiveservicestaskforce.org and https://www.cdc.gov/vaccines/acip/.