Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.
We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.
Projecting the status quo (2023-2032), deaths per 100 K people increase from 87.5 to 115.4, and CRC progressions per 100 K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100 K people, with cumulative prevented 7 K deaths and 9 K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100 K with no effect on progression, totaling 35 K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100 K, or 41 K and 7 K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681 K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100 K people, or 54 K and 30 K cumulatively.
Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.

Copyright © 2023. Published by Elsevier Inc.