Impact of COVID-19 on colorectal cancer screening in England

Research questions What is the impact of pausing screening for colorectal cancer (CRC), on disease incidence and mortality in England? What is the most effective and cost-effective scenario for CRC screening restart? Background CRC screening in England comprises repeated testing with the Faecal Immunochemical Test for all individuals aged 60-74. When the Covid-19 epidemic started, the screening program was paused to ensure patient safety. While FIT screening has currently been resumed, it is likely that there will be more pauses of CRC screening in the future conditional on the epidemiological situation in the country. Aims and objectives The aims of this project are (1) to explore the impact of CRC screening interruption on the clinical burden of CRC and (2) to compare alternative scenarios for screening restart in England. The objectives: To synthesise a population representative to England by age, sex, ethnicity, deprivation and underlying disease & screening status. To develop the model structure to enable short pauses in screening to be evaluated. To evaluate the impact of screening pauses of different lengths on CRC incidence and mortality To evaluate different scenarios for screening restart, in order to identify the optimal scenario in terms of effectiveness and cost-effectiveness. Methods The Microsimulation Model in Cancer of the Bowel (MiMiC-Bowel) will be used. This model was developed in R software in 2019 to inform decisions for the UK National Screening Committee (UK NSC) and has been used to assess risk stratified CRC screening strategies in England. The project will require two key adjustments to MiMiC-Bowel. Firstly, model cycle length will be reduced from 1 year to 1 month to enable short screening pauses to be evaluated. Secondly, the model will be adapted to represent the current population of England, including their underlying disease status and previous screening history. The number of additional CRC cases and deaths will be predicted for different durations of pauses to the screening programme (ranging from three to 12 months). Predictions will be categorised by cancer stage at diagnosis, age and sex. The relative merits, including effectiveness, cost-effectiveness and capacity requirements, of different options for restarting the CRC screening programme will be evaluated. This will compare: (a) Omitting screening invitations due during the pause entirely; (b) Postponing screening for everyone by the duration of the pause; and (c) Catching up screening in all who missed it over the next year. Timelines for delivery: 6 months from December 1st 2020. Anticipated impact and dissemination This project will allow evidence-based decision making around prioritisation of capacity for the screening programme versus other parts of the NHS. The study has interest and support from the UK National Screening Committee and Cancer Research UK and will be disseminated to these and other stakeholders via the project report and online workshops. A peer-reviewed publication will disseminate the research throughout the scientific community. PPI workshops will be held to enable patient input on project planning, project results and dissemination strategies.