Fig. 1

Overview of the MOCCAS study. * FIT = faecal immunochemical test, consisting of the OC-sensor® (Eiken Chemical Co., Tokyo, Japan) and FOB Gold® (Sentinel, Milan, Italy). ASCCA = Adenoma and Serrated pathway to Colorectal Cancer. Individuals with an indication for surveillance colonoscopy are selected and invited to participate. After oral consent the home stool collection kit is sent to the individuals home address. The test results of Cologuard® (Exact Sciences, Madison, WI, USA) and FIT will be compared to the findings described in the colonoscopy and pathology report in order to yield the test performances. This will then feed the ASCCA model for the simulation of different surveillance strategies. The tissue of lesions removed during the surveillance colonoscopy will be used for molecular analysis of progression biomarkers to define high risk adenomas. This alternative, molecular-based intermediate endpoint will impact the test performances and thus the ASCCA modelling. By adding identified risk factors to the obtained test performance data, new sensitivity data will be acquired and used to repeat the model simulations of surveillance strategies