
Dr. Knudsen, a Senior Scientist at the MGH Institute for Technology Assessment and an Assistant Professor at Harvard Medical School, has expertise in decision science. Her research focus is on development and application of data analytics and simulation models to address important questions pertaining to cancer prevention and opioid misuse reduction. Recognized nationally for her leadership in decision science and colorectal cancer screening, Dr. Knudsen's research has significantly influenced national colorectal cancer screening policies. This includes contributions to the Centers for Medicare and Medicaid Services’ National Coverage Determinations for colorectal cancer screening tests and the screening recommendations of both the US Preventive Services Task Force and the American Cancer Society.
Notably, Dr. Knudsen developed one of the three colorectal cancer models funded by the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET), a consortium of independent research teams focused on evaluating cancer-control policies.
Dr. Knudsen received a BS with Distinction in policy analysis from Cornell University and a PhD in Health Policy from Harvard University. While at Harvard, Amy was the recipient of a Cancer Prevention Training Grant from the National Cancer Institute (NCI) and a Dissertation Completion Fellowship from Harvard University. She completed a NCI-funded post-doctoral fellowship in the Dana-Farber/Harvard Cancer Center Program in Cancer Outcomes Research Training (PCORT). She has worked for health-economics consulting firms where she developed decision-analytic models to assess the lifetime health and economic consequences of obesity and the benefits of weight loss.
Dr. Knudsen’s career goal is to improve cancer outcomes by identifying the most effective and cost-effective options for prevention, screening, and treatment. Her research focuses on the use of disease simulation models to inform cancer control policies. Her work to date has focused on colorectal cancer, the second most common cause of cancer death in the US. She developed and programmed a computer model, SimCRC, that simulates the natural history of colorectal cancer among the US population over time and incorporates the effects of prevention, screening, and treatment interventions. SimCRC has been used to inform both state- and national screening coverage decisions and guidelines. Dr. Knudsen’s research aims to evaluate how existing and emerging screening methodologies can best be used to minimize the burden of colorectal cancer.
Selected Publications
Goddard, Katrina A B; Feuer, Eric J; Mandelblatt, Jeanne S; Meza, Rafael; Holford, Theodore R; Jeon, Jihyoun; Lansdorp-Vogelaar, Iris; Gulati, Roman; Stout, Natasha K; Howlader, Nadia; Knudsen, Amy B; Miller, Daniel; Caswell-Jin, Jennifer L; Schechter, Clyde B; Etzioni, Ruth; Trentham-Dietz, Amy; Kurian, Allison W; Plevritis, Sylvia K; Hampton, John M; Stein, Sarah; Sun, Liyang P; Umar, Asad; Castle, Philip E
Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020 Journal Article
In: JAMA Oncol, 2024, ISSN: 2374-2445.
@article{pmid39636625,
title = {Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020},
author = {Katrina A B Goddard and Eric J Feuer and Jeanne S Mandelblatt and Rafael Meza and Theodore R Holford and Jihyoun Jeon and Iris Lansdorp-Vogelaar and Roman Gulati and Natasha K Stout and Nadia Howlader and Amy B Knudsen and Daniel Miller and Jennifer L Caswell-Jin and Clyde B Schechter and Ruth Etzioni and Amy Trentham-Dietz and Allison W Kurian and Sylvia K Plevritis and John M Hampton and Sarah Stein and Liyang P Sun and Asad Umar and Philip E Castle},
doi = {10.1001/jamaoncol.2024.5381},
issn = {2374-2445},
year = {2024},
date = {2024-12-01},
journal = {JAMA Oncol},
abstract = {IMPORTANCE: Cancer mortality has decreased over time, but the contributions of different interventions across the cancer control continuum to averting cancer deaths have not been systematically evaluated across major cancer sites.nnOBJECTIVE: To quantify the contributions of prevention, screening (to remove precursors [interception] or early detection), and treatment to cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.nnDESIGN, SETTING, AND PARTICIPANTS: In this model-based study using population-level cancer mortality data, outputs from published models developed by the Cancer Intervention and Surveillance Modeling Network were extended to quantify cancer deaths averted through 2020. Model inputs were based on national data on risk factors, cancer incidence, cancer survival, and mortality due to other causes, and dissemination and effects of prevention, screening (for interception and early detection), and treatment. Simulated or modeled data using parameters derived from multiple birth cohorts of the US population were used.nnINTERVENTIONS: Primary prevention via smoking reduction (lung), screening for interception (cervix and colorectal) or early detection (breast, cervix, colorectal, and prostate), and therapy (breast, colorectal, lung, and prostate).nnMAIN OUTCOMES AND MEASURES: The estimated cumulative number of cancer deaths averted with interventions vs no advances.nnRESULTS: An estimated 5.94 million cancer deaths were averted for breast, cervical, colorectal, lung, and prostate cancers combined. Cancer prevention and screening efforts averted 8 of 10 of these deaths (4.75 million averted deaths). The contribution of each intervention varied by cancer site. Screening accounted for 25% of breast cancer deaths averted. Averted cervical cancer deaths were nearly completely averted through screening and removal of cancer precursors as treatment advances were modest during the study period. Averted colorectal cancer deaths were averted because of screening and removal of precancerous polyps or early detection in 79% and treatment advances in 21%. Most lung cancer deaths were avoided by smoking reduction (98%) because screening uptake was low and treatment largely palliative before 2014. Screening contributed to 56% of averted prostate cancer deaths.nnCONCLUSIONS AND RELEVANCE: Over the past 45 years, cancer prevention and screening accounted for most cancer deaths averted for these causes; however, their contribution varied by cancer site according to these models using population-level cancer mortality data. Despite progress, efforts to reduce the US cancer burden will require increased dissemination of effective interventions and new technologies and discoveries.},
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van den Puttelaar, Rosita; de Lima, Pedro Nascimento; Knudsen, Amy B; Rutter, Carolyn M; Kuntz, Karen M; de Jonge, Lucie; Escudero, Fernando Alarid; Lieberman, David; Zauber, Ann G; Hahn, Anne I; Inadomi, John M; Lansdorp-Vogelaar, Iris
In: Gastroenterology, vol. 167, no. 2, pp. 368–377, 2024, ISSN: 1528-0012.
@article{pmid38552671b,
title = {Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening With a Blood Test That Meets the Centers for Medicare \& Medicaid Services Coverage Decision},
author = {Rosita van den Puttelaar and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and Karen M Kuntz and Lucie de Jonge and Fernando Alarid Escudero and David Lieberman and Ann G Zauber and Anne I Hahn and John M Inadomi and Iris Lansdorp-Vogelaar},
doi = {10.1053/j.gastro.2024.02.012},
issn = {1528-0012},
year = {2024},
date = {2024-07-01},
journal = {Gastroenterology},
volume = {167},
number = {2},
pages = {368--377},
abstract = {BACKGROUND \& AIMS: A blood-based colorectal cancer (CRC) screening test may increase screening participation. However, blood tests may be less effective than current guideline-endorsed options. The Centers for Medicare \& Medicaid Services (CMS) covers blood tests with sensitivity of at least 74% for detection of CRC and specificity of at least 90%. In this study, we investigate whether a blood test that meets these criteria is cost-effective.nnMETHODS: Three microsimulation models for CRC (MISCAN-Colon, CRC-SPIN, and SimCRC) were used to estimate the effectiveness and cost-effectiveness of triennial blood-based screening (from ages 45 to 75 years) compared to no screening, annual fecal immunochemical testing (FIT), triennial stool DNA testing combined with an FIT assay, and colonoscopy screening every 10 years. The CMS coverage criteria were used as performance characteristics of the hypothetical blood test. We varied screening ages, test performance characteristics, and screening uptake in a sensitivity analysis.nnRESULTS: Without screening, the models predicted 77-88 CRC cases and 32-36 CRC deaths per 1000 individuals, costing $5.3-$5.8 million. Compared to no screening, blood-based screening was cost-effective, with an additional cost of $25,600-$43,700 per quality-adjusted life-year gained (QALYG). However, compared to FIT, triennial stool DNA testing combined with FIT, and colonoscopy, blood-based screening was not cost-effective, with both a decrease in QALYG and an increase in costs. FIT remained more effective (+5-24 QALYG) and less costly (-$3.2 to -$3.5 million) than blood-based screening even when uptake of blood-based screening was 20 percentage points higher than uptake of FIT.nnCONCLUSION: Even with higher screening uptake, triennial blood-based screening, with the CMS-specified minimum performance sensitivity of 74% and specificity of 90%, was not projected to be cost-effective compared with established strategies for colorectal cancer screening.},
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Pineda-Antunez, Carlos; Seguin, Claudia; van Duuren, Luuk A; Knudsen, Amy B; Davidi, Barak; de Lima, Pedro Nascimento; Rutter, Carolyn; Kuntz, Karen M; Lansdorp-Vogelaar, Iris; Collier, Nicholson; Ozik, Jonathan; Alarid-Escudero, Fernando
Emulator-Based Bayesian Calibration of the CISNET Colorectal Cancer Models Journal Article
In: Med Decis Making, vol. 44, no. 5, pp. 543-553, 2024, ISSN: 1552-681X.
@article{pmid38858832,
title = {Emulator-Based Bayesian Calibration of the CISNET Colorectal Cancer Models},
author = {Carlos Pineda-Antunez and Claudia Seguin and Luuk A van Duuren and Amy B Knudsen and Barak Davidi and Pedro Nascimento de Lima and Carolyn Rutter and Karen M Kuntz and Iris Lansdorp-Vogelaar and Nicholson Collier and Jonathan Ozik and Fernando Alarid-Escudero},
doi = {10.1177/0272989X241255618},
issn = {1552-681X},
year = {2024},
date = {2024-07-01},
urldate = {2024-07-01},
journal = {Med Decis Making},
volume = {44},
number = {5},
pages = {543-553},
abstract = {PURPOSE: To calibrate Cancer Intervention and Surveillance Modeling Network (CISNET)\'s SimCRC, MISCAN-Colon, and CRC-SPIN simulation models of the natural history colorectal cancer (CRC) with an emulator-based Bayesian algorithm and internally validate the model-predicted outcomes to calibration targets.nnMETHODS: We used Latin hypercube sampling to sample up to 50,000 parameter sets for each CISNET-CRC model and generated the corresponding outputs. We trained multilayer perceptron artificial neural networks (ANNs) as emulators using the input and output samples for each CISNET-CRC model. We selected ANN structures with corresponding hyperparameters (i.e., number of hidden layers, nodes, activation functions, epochs, and optimizer) that minimize the predicted mean square error on the validation sample. We implemented the ANN emulators in a probabilistic programming language and calibrated the input parameters with Hamiltonian Monte Carlo-based algorithms to obtain the joint posterior distributions of the CISNET-CRC models\' parameters. We internally validated each calibrated emulator by comparing the model-predicted posterior outputs against the calibration targets.nnRESULTS: The optimal ANN for SimCRC had 4 hidden layers and 360 hidden nodes, MISCAN-Colon had 4 hidden layers and 114 hidden nodes, and CRC-SPIN had 1 hidden layer and 140 hidden nodes. The total time for training and calibrating the emulators was 7.3, 4.0, and 0.66 h for SimCRC, MISCAN-Colon, and CRC-SPIN, respectively. The mean of the model-predicted outputs fell within the 95% confidence intervals of the calibration targets in 98 of 110 for SimCRC, 65 of 93 for MISCAN, and 31 of 41 targets for CRC-SPIN.nnCONCLUSIONS: Using ANN emulators is a practical solution to reduce the computational burden and complexity for Bayesian calibration of individual-level simulation models used for policy analysis, such as the CISNET CRC models. In this work, we present a step-by-step guide to constructing emulators for calibrating 3 realistic CRC individual-level models using a Bayesian approach.nnHIGHLIGHTS: We use artificial neural networks (ANNs) to build emulators that surrogate complex individual-based models to reduce the computational burden in the Bayesian calibration process.ANNs showed good performance in emulating the CISNET-CRC microsimulation models, despite having many input parameters and outputs.Using ANN emulators is a practical solution to reduce the computational burden and complexity for Bayesian calibration of individual-level simulation models used for policy analysis.This work aims to support health decision scientists who want to quantify the uncertainty of calibrated parameters of computationally intensive simulation models under a Bayesian framework.},
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Lima, Pedro Nascimento De; Puttelaar, Rosita Van Den; Knudsen, Amy B; Hahn, Anne I; Kuntz, Karen M; Ozik, Jonathan; Collier, Nicholson; Alarid-Escudero, Fernando; Zauber, Ann G; Inadomi, John M; Lansdorp-Vogelaar, Iris; Rutter, Carolyn M
Characteristics of a cost-effective blood test for colorectal cancer screening Journal Article
In: J Natl Cancer Inst, 2024, ISSN: 1460-2105.
@article{pmid38845072,
title = {Characteristics of a cost-effective blood test for colorectal cancer screening},
author = {Pedro Nascimento De Lima and Rosita Van Den Puttelaar and Amy B Knudsen and Anne I Hahn and Karen M Kuntz and Jonathan Ozik and Nicholson Collier and Fernando Alarid-Escudero and Ann G Zauber and John M Inadomi and Iris Lansdorp-Vogelaar and Carolyn M Rutter},
doi = {10.1093/jnci/djae124},
issn = {1460-2105},
year = {2024},
date = {2024-06-01},
journal = {J Natl Cancer Inst},
abstract = {BACKGROUND: Blood-based biomarker tests can potentially change the landscape of colorectal cancer (CRC) screening. We characterize the conditions under which blood test screening would be as effective and cost-effective as annual fecal immunochemical testing (FIT) or decennial colonoscopy.nnMETHODS: We used the three CISNET-Colon models to compare scenarios of no screening, annual FIT, decennial colonoscopy, and a blood test meeting CMS coverage criteria (74% CRC sensitivity and 90% specificity). We varied the sensitivity to detect CRC (74%-92%), advanced adenomas (AAs, 10%-50%), screening interval (1-3 years), and test cost ($25-$500). Primary outcomes included quality-adjusted life-years gained (QALYG) from screening and costs for an US average-risk 45-year-old cohort.nnRESULTS: Annual FIT yielded 125-163 QALYG per 1,000 at a cost of $3,811-5,384 per person, whereas colonoscopy yielded 132-177 QALYG at a cost of $5,375-7,031 per person. A blood test with 92% CRC sensitivity and 50% AA sensitivity yielded 117-162 QALYG if used every three years and 133-173 QALYG if used every year but would not be cost-effective if priced above $125 per test. If used every three years, a $500 blood test only meeting CMS coverage criteria yielded 83-116 QALYG, at a cost of $8,559-9,413 per person.nnCONCLUSION: Blood tests that only meet CMS coverage requirements should not be recommended to patients who would otherwise undergo screening by colonoscopy or FIT due to lower benefit. Blood tests need higher AA sensitivity (above 40%) and lower costs (below $125) to be cost-effective.},
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van den Puttelaar, Rosita; de Lima, Pedro Nascimento; Knudsen, Amy B; Rutter, Carolyn M; Kuntz, Karen M; de Jonge, Lucie; Escudero, Fernando Alarid; Lieberman, David; Zauber, Ann G; Hahn, Anne I; Inadomi, John M; Lansdorp-Vogelaar, Iris
In: Gastroenterology, 2024, ISSN: 1528-0012.
@article{pmid38552671,
title = {Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening With a Blood Test That Meets the Centers for Medicare \& Medicaid Services Coverage Decision},
author = {Rosita van den Puttelaar and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and Karen M Kuntz and Lucie de Jonge and Fernando Alarid Escudero and David Lieberman and Ann G Zauber and Anne I Hahn and John M Inadomi and Iris Lansdorp-Vogelaar},
doi = {10.1053/j.gastro.2024.02.012},
issn = {1528-0012},
year = {2024},
date = {2024-03-01},
journal = {Gastroenterology},
abstract = {BACKGROUND \& AIMS: A blood-based colorectal cancer (CRC) screening test may increase screening participation. However, blood tests may be less effective than current guideline-endorsed options. The Centers for Medicare \& Medicaid Services (CMS) covers blood tests with sensitivity of at least 74% for detection of CRC and specificity of at least 90%. In this study, we investigate whether a blood test that meets these criteria is cost-effective.nnMETHODS: Three microsimulation models for CRC (MISCAN-Colon, CRC-SPIN, and SimCRC) were used to estimate the effectiveness and cost-effectiveness of triennial blood-based screening (from ages 45 to 75 years) compared to no screening, annual fecal immunochemical testing (FIT), triennial stool DNA testing combined with an FIT assay, and colonoscopy screening every 10 years. The CMS coverage criteria were used as performance characteristics of the hypothetical blood test. We varied screening ages, test performance characteristics, and screening uptake in a sensitivity analysis.nnRESULTS: Without screening, the models predicted 77-88 CRC cases and 32-36 CRC deaths per 1000 individuals, costing $5.3-$5.8 million. Compared to no screening, blood-based screening was cost-effective, with an additional cost of $25,600-$43,700 per quality-adjusted life-year gained (QALYG). However, compared to FIT, triennial stool DNA testing combined with FIT, and colonoscopy, blood-based screening was not cost-effective, with both a decrease in QALYG and an increase in costs. FIT remained more effective (+5-24 QALYG) and less costly (-$3.2 to -$3.5 million) than blood-based screening even when uptake of blood-based screening was 20 percentage points higher than uptake of FIT.nnCONCLUSION: Even with higher screening uptake, triennial blood-based screening, with the CMS-specified minimum performance sensitivity of 74% and specificity of 90%, was not projected to be cost-effective compared with established strategies for colorectal cancer screening.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Peters, Mary Linton B; Eckel, Andrew; Seguin, Claudia L; Davidi, Barak; Howard, David H; Knudsen, Amy B; Pandharipande, Pari V
Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations Journal Article
In: JCO Oncol Pract, vol. 20, iss. 2, pp. 278-290, 2024, ISSN: 2688-1535.
@article{pmid38086003,
title = {Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations},
author = {Mary Linton B Peters and Andrew Eckel and Claudia L Seguin and Barak Davidi and David H Howard and Amy B Knudsen and Pari V Pandharipande},
doi = {10.1200/OP.23.00495},
issn = {2688-1535},
year = {2024},
date = {2024-02-01},
urldate = {2024-02-01},
journal = {JCO Oncol Pract},
volume = {20},
issue = {2},
pages = {278-290},
abstract = {PURPOSE: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease.nnMETHODS: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including and , , , Lynch syndrome, , , and . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency. Screening included MRI with follow-up EUS in a subset of patients. Costs of tests were based on Medicare reimbursement for MRI, EUS, fine-needle aspiration biopsy, and pancreatectomy. Cancer-related cost by stage of disease and phase of treatment was based on the literature. For each high-risk population, we performed an incremental cost-effectiveness analysis, assuming a willingness-to-pay (WTP) threshold of $100,000 US dollars (USD) per quality-adjusted life year (QALY) gained.nnRESULTS: For men with relative risk (RR) 12.33 () and RR 28 (), annual screening was cost-effective, starting at age 55 and 40 years, respectively. For women, screening was only cost-effective for those with RR 28 (), with annual screening starting at age 45 years.nnCONCLUSION: Combined MRI/EUS screening may be a cost-effective approach for the highest-risk populations (among mutations considered, those with RR \>12). However, for those with moderate risk (RR, 5-12), screening would only be cost-effective at higher WTP thresholds (eg, $200K USD/QALY) or with once-only screening.},
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Knudsen, Amy B; Trentham-Dietz, Amy; Kim, Jane J; Mandelblatt, Jeanne S; Meza, Rafael; Zauber, Ann G; Castle, Philip E; Feuer, Eric J
Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening Journal Article
In: JAMA Netw Open, vol. 6, no. 11, pp. e2344698, 2023, ISSN: 2574-3805.
@article{pmid37991759,
title = {Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening},
author = {Amy B Knudsen and Amy Trentham-Dietz and Jane J Kim and Jeanne S Mandelblatt and Rafael Meza and Ann G Zauber and Philip E Castle and Eric J Feuer},
doi = {10.1001/jamanetworkopen.2023.44698},
issn = {2574-3805},
year = {2023},
date = {2023-11-01},
journal = {JAMA Netw Open},
volume = {6},
number = {11},
pages = {e2344698},
abstract = {IMPORTANCE: Increased use of recommended screening could help achieve the Cancer Moonshot goal of reducing US cancer deaths.nnOBJECTIVE: To estimate the number of cancer deaths that could be prevented with a 10-percentage point increase in the use of US Preventive Services Task Force (USPSTF)-recommended screening.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023. This study simulated contemporary cohorts of US adults eligible for lung, colorectal, breast, and cervical cancer screening.nnEXPOSURES: Annual low-dose computed lung tomography among eligible adults aged 50 to 80 years; colonoscopy every 10 years among adults aged 45 to 75 years; biennial mammography among female adults aged 40 to 74 years; and triennial cervical cytology screening among female adults aged 21 to 29 years, followed by human papillomavirus testing every 5 years from ages 30 to 65 years.nnMAIN OUTCOMES AND MEASURES: Estimated number of cancer deaths prevented with a 10-percentage point increase in screening use, assuming screening commences at the USPSTF-recommended starting age and continues throughout the lifetime. Outcomes were presented 2 ways: (1) per 100 000 and (2) among US adults in 2021; and they were expressed among the target population at the age of screening initiation. For lung cancer, estimates were among those who will also meet the smoking eligibility criteria during their lifetime. Harms from increased uptake were also reported.nnRESULTS: A 10-percentage point increase in screening use at the age that USPSTF recommended screening commences was estimated to prevent 226 lung cancer deaths (range across models within the cancer site, 133-332 deaths), 283 (range, 263-313) colorectal cancer deaths, 82 (range, 61-106) breast cancer deaths, and 81 (1 model; no range available) cervical cancer deaths over the lifetimes of 100 000 persons eligible for screening. These rates corresponded with an estimated 1010 (range, 590-1480) lung cancer deaths prevented, 11 070 (range, 10 280-12 250) colorectal cancer deaths prevented, 1790 (range, 1330-2310) breast cancer deaths prevented, and 1710 (no range available) cervical cancer deaths prevented over the lifetimes of eligible US residents at the recommended age to initiate screening in 2021. Increased uptake was also estimated to generate harms, including 100 000 (range, 45 000-159 000) false-positive lung scans, 6000 (range, 6000-7000) colonoscopy complications, 300 000 (range, 295 000-302 000) false-positive mammograms, and 348 000 (no range available) colposcopies over the lifetime.nnCONCLUSIONS AND RELEVANCE: In this decision analytical model study, a 10-percentage point increase in uptake of USPSTF-recommended lung, colorectal, breast, and cervical cancer screening at the recommended starting age was estimated to yield important reductions in cancer deaths. Achieving these reductions is predicated on ensuring equitable access to screening.},
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van den Berg, Danica M N; de Lima, Pedro Nascimento; Knudsen, Amy B; Rutter, Carolyn M; Weinberg, David; and, Iris Lansdorp-Vogelaar
NordICC Trial Results in Line With Expected Colorectal Cancer Mortality Reduction After Colonoscopy: A Modeling Study Journal Article
In: Gastroenterology, vol. 165, no. 4, pp. 1077–1079.e2, 2023, ISSN: 1528-0012.
@article{pmid37454978b,
title = {NordICC Trial Results in Line With Expected Colorectal Cancer Mortality Reduction After Colonoscopy: A Modeling Study},
author = {Danica M N van den Berg and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and David Weinberg and Iris Lansdorp-Vogelaar and },
doi = {10.1053/j.gastro.2023.06.035},
issn = {1528-0012},
year = {2023},
date = {2023-10-01},
journal = {Gastroenterology},
volume = {165},
number = {4},
pages = {1077--1079.e2},
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Seguin, Claudia L; Davidi, Barak; Peters, Mary Linton B; Eckel, Andrew; Harisinghani, Mukesh G; Goiffon, Reece J; Knudsen, Amy B; Pandharipande, Pari V
Ultrasound Surveillance of Small, Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level Journal Article
In: J Am Coll Radiol, vol. 20, no. 10, pp. 1031-1041, 2023, ISSN: 1558-349X.
@article{pmid37406750c,
title = {Ultrasound Surveillance of Small, Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},
author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},
doi = {10.1016/j.jacr.2023.05.015},
issn = {1558-349X},
year = {2023},
date = {2023-10-01},
urldate = {2023-10-01},
journal = {J Am Coll Radiol},
volume = {20},
number = {10},
pages = {1031-1041},
abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to 5 years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \<3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With 10 years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},
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van den Berg, Danica M N; de Lima, Pedro Nascimento; Knudsen, Amy B; Rutter, Carolyn M; Weinberg, David; and, Iris Lansdorp-Vogelaar
NordICC trial results in line with expected colorectal cancer mortality reduction after colonoscopy: a modelling study Journal Article
In: Gastroenterology, 2023, ISSN: 1528-0012.
@article{pmid37454978,
title = {NordICC trial results in line with expected colorectal cancer mortality reduction after colonoscopy: a modelling study},
author = {Danica M N van den Berg and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and David Weinberg and Iris Lansdorp-Vogelaar and },
doi = {10.1053/j.gastro.2023.06.035},
issn = {1528-0012},
year = {2023},
date = {2023-07-01},
journal = {Gastroenterology},
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pubstate = {published},
tppubtype = {article}
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