Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force

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Table 2. Test Characteristics Used in the Microsimulation Screening Analysis and Simulation Model of Colorectal Cancer Models^a

Test Characteristic	Base-Case Value	Sensitivity Analysis
Test Characteristic	Base-Case Value	Best-Case Value	Worst-Case Value
Hemoccult II
Specificity, %	98.0	99.0	95.0
Sensitivity for adenomas ≤5 mm, %^b	2.0	1.0	5.0
Sensitivity for adenomas 6—9 mm, %	5.0	13.7	5.0
Sensitivity for adenomas ≥10 mm, %	12.0	27.5	8.9
Sensitivity for cancer, %	40.0	50.0	25.0
Reach	Whole colorectum	Not varied	Not varied
Mortality rate	0	Not varied	Not varied
Hemoccult SENSA
Specificity, %	92.5	95.0	90.0
Sensitivity for adenomas ≤5 mm, %^b	7.5	5.0	10.0
Sensitivity for adenomas 6—9 mm, %	12.4	26.2	10.0
Sensitivity for adenomas ≥10 mm, %	23.9	49.4	17.7
Sensitivity for cancer, %	70.0	87.0	50.0
Reach	Whole colorectum	Not varied	Not varied
Mortality rate	0	Not varied	Not varied
Fecal immunochemical test
Specificity, %	95.0	98.0	92.5
Sensitivity for adenomas ≤5 mm, %^b	5.0	2.0	7.5
Sensitivity for adenomas 6—9 mm, %	10.1	24.0	7.5
Sensitivity for adenomas ≥10 mm, %	22.0	48.0	16.0
Sensitivity for cancer, %	70.0	87.0	50.0
Reach	Whole colorectum	Not varied	Not varied
Mortality rate	0	Not varied	Not varied
Sigmoidoscopy (within reach)
Specificity, %	92.0	Not varied	Not varied
Sensitivity for adenomas ≤5 mm, %	75.0	79.0	70.0
Sensitivity for adenomas 6—9 mm, %	85.0	92.0	80.0
Sensitivity for adenomas ≥10 mm, %	95.0	99.0	92.0
Sensitivity for cancer, %^c	95.0	99.0	92.0
Reach cm	80 (to sigmoid–descending junction), 40 (to splenic flexure)	100 (to sigmoid–descending junction), 80 (to splenic flexure)	60 (to sigmoid—descending junction), 30 (to splenic flexure)
Mortality rate	0	Not varied	Not varied
Colonoscopy (within reach)
Specificity, %	90.0	Not varied	Not varied
Sensitivity for adenomas ≤5 mm, %	75.0	79.0	70.0
Sensitivity for adenomas 6—9 mm, %	85.0	92.0	80.0
Sensitivity for adenomas ≥10 mm, %	95.0	99.0	92.0
Sensitivity for cancer, %	95.0	99.0	92.0
Reach cm	95 (to end of cecum), remaining 5 between rectum and cecum	Not varied	Not varied
Mortality rate	1 per 10 000	Not varied	Not varied

a. Data obtained from reference 29.
b. We assume that small adenomas do not bleed and cannot be detected by fecal occult blood tests (FOBTs). The sensitivity of FOBTs for adenomas ≤5 mm is based on the false-positive rate (that is, 1 – specificity).
c. The sensitivity of sigmoidoscopy for colorectal cancer over the whole colorectum is 72% with the Microsimulation Screening Analysis model and 61% with the Simulation Model of Colorectal Cancer.

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Table 2. Test Characteristics Used in the Microsimulation Screening Analysis and Simulation Model of Colorectal Cancer Modelsa

Table 2. Test Characteristics Used in the Microsimulation Screening Analysis and Simulation Model of Colorectal Cancer Models^a