Figure 1. Natural History of Disease as Modeled by the Microsimulation Screening Analysis and Simulation Model of Colorectal Cancer Models (Text Description)

Figure 1 depicts a natural history of disease model. The text at the top of the figure reads "Screening." Beneath it, in brackets, are "Adenoma States" and "Preclinical Cancer States." To the right, not in brackets, is "Clinical Cancer States." These three items each head a column of text boxes.

On the left side of the figure is a text box that reads "No lesion." An arrow points from this box to the uppermost text box in the column below "Adenoma States"; this box reads "Adenoma ≤5 mm". Below this box is another text box labeled "Adenoma 6-9 mm" and below that, a third labeled "Adenoma ≥10 mm." Arrows pointing downward connect the top, middle, and bottom box in this column.

An arrow points from the box labeled "Adenoma 6-9 mm" to the uppermost text box in the column below "Preclinical Cancer States"; this box reads "Preclinical stage I". Below it are a column of text boxes that read from top to bottom, "Preclinical stage II," "Preclinical stage III," and "Preclinical stage IV." Arrows pointing downward connect the boxes in this column.

An arrow points from the box labeled "Preclinical stage I" to the uppermost text box in the column below "Clinical Cancer States"; this box reads "Clinical stage I". An arrow points from the box labeled "Preclinical stage II" to the second text box in the column below "Clinical Cancer States"; this box reads "Clinical stage II". An arrow points from the box labeled "Preclinical stage III" to the third text box in the column below "Clinical Cancer States"; this box reads "Clinical stage III". An arrow points from the box labeled "Preclinical stage IV" to the bottom text box in the column below "Clinical Cancer States"; this box reads "Clinical stage IV". Arrows pointing downward also connect the boxes in this column.

Arrows from Clinical stages I through IV all point to one box that reads "Death from colorectal cancer."

Note: The opportunity to intervene in the natural history through screening is noted.

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