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We systematically evaluated the benefit\u2010harm trade\u2010offs of various screening strategies differing by screening test (colonoscopy or iFOBT), interval (iFOBT: annual\/biennial; colonoscopy: 10\u2010yearly) and age at start (30, 35, 40, 45, 50 and 55\u2009years) and end of screening (65, 70 and 75\u2009years) offered to individuals identified with familial CRC risk in Germany. A Markov\u2010state\u2010transition model was developed and used to estimate health benefits (CRC\u2010related deaths avoided, life\u2010years gained [LYG]), potential harms (eg, associated with additional colonoscopies) and incremental harm\u2010benefit ratios (IHBR) for each strategy. Both benefits and harms increased with earlier start and shorter intervals of screening. When screening started before age 50, 32\u201036 CRC\u2010related deaths per 1000 persons were avoided with colonoscopy and 29\u201034 with iFOBT screening, compared to 29\u201031 (colonoscopy) and 28\u201030 (iFOBT) CRC\u2010related deaths per 1000 persons when starting age 50 or older, respectively. For iFOBT screening, the IHBRs expressed as additional colonoscopies per LYG were one (biennial, age 45\u201065 vs no screening), four (biennial, age 35\u201065), six (biennial, age 30\u201070) and 34 (annual, age 30\u201054; biennial, age 55\u201075). Corresponding IHBRs for 10\u2010yearly colonoscopy were four (age 55\u201065), 10 (age 45\u201065), 15 (age 35\u201065) and 29 (age 30\u201070). Offering screening with colonoscopy or iFOBT to individuals with familial CRC risk before age 50 is expected to be beneficial. Depending on the accepted IHBR threshold, 10\u2010yearly colonoscopy or alternatively biennial iFOBT from age 30 to 70 should be recommended for this target group.<\/jats:p>","DOI":"10.1002\/ijc.34747","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T19:48:55Z","timestamp":1696535335000},"page":"516-529","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long\u2010term benefits and harms of early colorectal cancer screening in German individuals with familial cancer risk"],"prefix":"10.1002","volume":"154","author":[{"given":"Gaby","family":"Sroczynski","sequence":"first","affiliation":[{"name":"Department of Public Health, Health Services Research, and Health Technology Assessment UMIT TIROL\u2014University for Health Sciences and Technology  Hall in Tirol Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1ra R.","family":"Hallsson","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Services Research, and Health Technology Assessment UMIT TIROL\u2014University for Health Sciences and Technology  Hall in Tirol Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolai","family":"M\u00fchlberger","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Services Research, and Health Technology Assessment UMIT TIROL\u2014University for Health Sciences and Technology  Hall in Tirol Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beate","family":"Jahn","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Services Research, and Health Technology Assessment UMIT TIROL\u2014University for Health Sciences and Technology  Hall in Tirol Austria"},{"name":"Division of Health Technology Assessment ONCOTYROL\u2014Center for Personalized Cancer Medicine  Innsbruck Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Rehms","sequence":"additional","affiliation":[{"name":"Department of Medical Information Processing, Biometry, and Epidemiology Ludwig\u2010Maximilians Universit\u00e4t  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Medical Information Processing, Biometry, and Epidemiology Ludwig\u2010Maximilians Universit\u00e4t  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Crispin","sequence":"additional","affiliation":[{"name":"Department of Medical Information Processing, Biometry, and Epidemiology Ludwig\u2010Maximilians Universit\u00e4t  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doris","family":"Lindoerfer","sequence":"additional","affiliation":[{"name":"Department of Medical Information Processing, Biometry, and Epidemiology Ludwig\u2010Maximilians Universit\u00e4t  Munich Germany"},{"name":"Chronobiology and Health, Department of Sport and Health Sciences Technical University of Munich  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Mansmann","sequence":"additional","affiliation":[{"name":"Department of Medical Information Processing, Biometry, and Epidemiology Ludwig\u2010Maximilians Universit\u00e4t  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6425-7671","authenticated-orcid":false,"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Services Research, and Health Technology Assessment UMIT TIROL\u2014University for Health Sciences and Technology  Hall in Tirol Austria"},{"name":"Division of Health Technology Assessment ONCOTYROL\u2014Center for Personalized Cancer Medicine  Innsbruck Austria"},{"name":"Department of Epidemiology Harvard T. 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