Aim: To assess the potential of biomarker triage testing (BM-TT) in the Dutch colorectal cancer (CRC) screening program. Materials & methods: Using the Adenoma and Serrated pathway to Colorectal CAncer model, we simulated fecal immunochemical test (FIT)47-screening and various FIT plus BM-TT screening scenarios in which only individuals with both a positive FIT and BM-TT are referred to colonoscopy. Results: Adding a low polyp sensitivity BM-TT to FIT-screening reduced colonoscopy burden (89-100%) while increasing CRC mortality (27-41%) compared with FIT47-screening only. The FIT plus high polyp sensitivity BM-TT scenarios also decreased colonoscopy burden (71-89%) while hardly affecting CRC mortality (FIT47 0-4% increase, FIT15 2-7% decrease). Conclusion: Adding a BM-TT to FIT-screening considerably reduces colonoscopy burden, but could also decrease screening effectiveness. Combining FIT15 with a high polyp sensitivity BM-TT seems most promising.

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Keywords biomarker test, colorectal cancer screening, screening burden, triage testing
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Journal Journal of Comparative Effectiveness Research
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Greuter, M.J.W, Carvalho, B, Wit, M. (Meike de), Dekker, E, Spaander, M.C.W, Meijer, C.J.L.M, … Coupé, V.M.H. (2020). Can a biomarker triage test reduce colonoscopy burden in fecal immunochemical test screening?. Journal of Comparative Effectiveness Research, 9(8), 563–571. doi:10.2217/cer-2019-0130