What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

AIM： To identify a cost-effective strategy of second primary colorectal cancer （CRC） screening for cancer survivors in Korea using a decision-analytic model. METHODS： A Markov model estimated the clinical and economic consequences of a simulated 50-year- old male cancer survivors＇ cohort, and we compared the results of eight screening strategies： no screening, fecal occult blood test （FOBT） annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years （COL10）, every 5 years （COL5）, and every 3 years （COL3）. We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost- effectiveness ratio （ICER）. RESULTS： In the base-case analysis, the non-dominat- ed strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life- year saved （LYS）, and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in can- cer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was tess than $7400/LYS regardless of screening compliance. CONCLUSION： Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Risk of second primary lung cancer in patients with thyroid cancer:a meta-analysis based on big population studies

Background:Previous studies have revealed that the number of cancer survivors developing a second primary malignancy is increasing,especially among thyroid cancer patients,and lung cancer is still the main cause of cancer death.Therefore,we aimed to investigate the risk of second primary lung cancer(SPLC)in patients with thyroid cancer.Methods:We searched the PubMed,Web of Science,Embase,and Scopus databases up to November 24,2021,for relevant research and merged the standardized incidence ratios(SIRs)and 95%confidence intervals(95%CIs)to evaluate the risk of developing SPLC in patients with thyroid cancer.Results:Fourteen studies involving 1,480,816 cases were included in our meta-analysis.The pooled result demonstrated that thyroid cancer patients may have a higher risk of SPLC than the general population(SIR=1.21,95%CI:1.07-1.36,P<0.01,I^(2)=81%,P<0.01).Subgroup analysis stratified by sex indicated that female patients may have a markedly higher risk of SPLC than male patients(SIR=1.65,95%CI:1.40-1.94,P<0.01,I^(2)=75%,P<0.01).Conclusions:Thyroid cancer patients are more likely to develop SPLC than the general population,especially women.However,other risk factors must be investigated,and more prospective studies are needed to confirm our results.Registration:International Prospective Register of Systematic Reviews:No.CRD42021285399.