101
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Howard R, Machado-Aranda D. Frailty as a Predictor of Colonoscopic Procedural Risk: Robust Associations from Fragile Patients. Dig Dis Sci 2018; 63:3159-3160. [PMID: 29934724 PMCID: PMC6309660 DOI: 10.1007/s10620-018-5172-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Ryan Howard
- Department of Surgery, Surgical Education Office, University of Michigan, 1500 E Medical Center Drive, 2110 Taubman Center, SPC 5346, Ann Arbor, MI, 48109-5346, USA
| | - David Machado-Aranda
- Department of Surgery, Division of Acute Care Surgery, University of Michigan, 1500 E Medical Center Drive, 1C421-UH, SPC 5033, Ann Arbor, MI, 48109-5033, USA.
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102
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Lacy BE, Spiegel B. Introduction to the 80% by 2018 Special Issue. Am J Gastroenterol 2018; 113:1737-1738. [PMID: 30377308 PMCID: PMC6768627 DOI: 10.1038/s41395-018-0387-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Brennan Spiegel
- 2Division of Gastroenterology, Cedars‐Sinai Medical Center, Los Angeles, CA, USA
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103
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Creating and Implementing a National Public Health Campaign: The American Cancer Society's and National Colorectal Cancer Roundtable's 80% by 2018 Initiative. Am J Gastroenterol 2018; 113:1739-1741. [PMID: 30413821 PMCID: PMC6768590 DOI: 10.1038/s41395-018-0384-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022]
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104
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Dubé C. Organized Screening Is Better Than Opportunistic Screening at Decreasing the Burden of Colorectal Cancer in the United States. Gastroenterology 2018; 155:1302-1304. [PMID: 30300613 DOI: 10.1053/j.gastro.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Catherine Dubé
- Department of Medicine, University of Ottawa and Cancer Care Ontario, Toronto, Ontario, Canada.
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105
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Levin TR, Corley DA, Jensen CD, Schottinger JE, Quinn VP, Zauber AG, Lee JK, Zhao WK, Udaltsova N, Ghai NR, Lee AT, Quesenberry CP, Fireman BH, Doubeni CA. Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large Community-Based Population. Gastroenterology 2018; 155:1383-1391.e5. [PMID: 30031768 PMCID: PMC6240353 DOI: 10.1053/j.gastro.2018.07.017] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. METHODS We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after (through 2015) implementation of organized screening outreach, from 2007 through 2008 (primarily annual fecal immunochemical testing and colonoscopy), in a large community-based population. Among screening-eligible individuals 51-75 years old, we calculated annual up-to-date status for cancer screening (by fecal test, sigmoidoscopy, or colonoscopy), CRC incidence, cancer stage distributions, and incidence-based mortality. RESULTS Initiation of organized CRC screening significantly increased the up-to-date status of screening, from 38.9% in 2000 to 82.7% in 2015 (P < .01). Higher rates of screening were associated with a 25.5% reduction in annual CRC incidence between 2000 and 2015, from 95.8 to 71.4 cases/100,000 (P < .01), and a 52.4% reduction in cancer mortality, from 30.9 to 14.7 deaths/100,000 (P < .01). Increased screening was initially associated with increased CRC incidence, due largely to greater detection of early-stage cancers, followed by decreases in cancer incidence. Advanced-stage CRC incidence rates decreased 36.2%, from 45.9 to 29.3 cases/100,000 (P < .01), and early-stage CRC incidence rates decreased 14.5%, from 48.2 to 41.2 cases/100,000 (P < .04). CONCLUSIONS Implementing an organized CRC screening program in a large community-based population rapidly increased screening participation to the ≥80% target set by national organizations. Screening rates were sustainable and associated with substantial decreases in CRC incidence and mortality within short time intervals, consistent with early detection and cancer prevention.
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Affiliation(s)
- Theodore R. Levin
- Kaiser Permanente Medical Center, Walnut Creek, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Joanne E. Schottinger
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Virginia P. Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Nirupa R. Ghai
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alexander T. Lee
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Bruce H. Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chyke A. Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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106
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Bakhai S, Ahluwalia G, Nallapeta N, Mangat A, Reynolds JL. Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care. BMJ Open Qual 2018; 7:e000400. [PMID: 30397662 PMCID: PMC6203033 DOI: 10.1136/bmjoq-2018-000400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2018] [Accepted: 09/22/2018] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50–75 years, from a baseline rate of 50%–70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan–Do–Study–Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas. We developed a process flow map to optimise opportunities to improve CRC screening. We performed eight PDSA cycles. The major components of interventions included: (1) leveraging health information technology; (2) optimising team work, (3) education to patient, physicians and IMC staff, (4) use of patient navigator for tracking FIT completion and (5) interactive workshops for the staff and physicians to learn motivational interview techniques. The outcome measure included CRC screening rates with either FIT or colonoscopy. The process measures included FIT order and completion rates. Data were analysed using a statistical process control and run charts. Four hundred and seven patients visiting the IMC were offered FIT, and 252 (62%) completed the test. Twenty-two (8.7%) of patients were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. We achieved 75% CRC screening with FIT or colonoscopy within 12 months and exceeded our goal. Successful strategies included engaging the leadership, the front-line staff and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening. We were able to sustain a CRC screening rate of 75% during the 6-month postproject period. Sustainable annual FIT is required for successful CRC screening.
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Affiliation(s)
- Smita Bakhai
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Gaurav Ahluwalia
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Naren Nallapeta
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Amanpreet Mangat
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jessica L Reynolds
- Department of Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
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107
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Myers RE, Stello B, Daskalakis C, Sifri R, González ET, DiCarlo M, Johnson MB, Hegarty SE, Shaak K, Rivera A, Gordils-Molina L, Petrich A, Careyva B, de-Ortiz R, Diaz L. Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients. Cancer Epidemiol Biomarkers Prev 2018; 28:384-391. [PMID: 30333221 DOI: 10.1158/1055-9965.epi-18-0260] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/22/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Effective strategies are needed to raise colorectal cancer screening rates among Hispanics. METHODS We surveyed and randomized 400 Hispanic primary care patients either to a Decision Support and Navigation Intervention (DSNI) Group (n = 197) or a Standard Intervention (SI) Group (n = 203). Both groups received a colorectal cancer screening kit [bilingual informational booklet, fecal immunochemical stool blood test (SBT), and colonoscopy screening instructions]. The DSNI Group received a telephone contact from a patient navigator. The navigator clarified screening test preference and likelihood of test performance, helped to develop a screening plan, and provided guidance through test performance. An endpoint telephone survey and medical chart review were completed. Multivariable analyses were conducted to assess 12-month screening adherence, change in decision stage, and knowledge and perceptions. RESULTS Screening adherence was significantly higher in the DSNI Group than the SI Group [OR, 4.8; 95% confidence interval (CI), 3.1-7.6]. The DSNI Group, compared with the SI Group, also displayed higher SBT screening [OR, 4.2; 95% CI, 2.6-6.7), higher colonoscopy screening (OR, 8.8; 95% CI, 4.1-18.7), and greater forward change in screening decision stage (OR, 4.9; 95% CI, 2.6-9.5). At endpoint, study groups did not differ in screening knowledge or perceptions. CONCLUSIONS The DSNI had a greater positive impact on colorectal cancer screening outcomes than the SI. IMPACT Health system implementation of DSNI strategies may help to reduce Hispanic colorectal cancer screening disparities in primary care.
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Affiliation(s)
- Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Brian Stello
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Constantine Daskalakis
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randa Sifri
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Sarah E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kyle Shaak
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Alicia Rivera
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Anett Petrich
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Beth Careyva
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Liselly Diaz
- Lehigh Valley Health Network, Allentown, Pennsylvania
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108
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Alsayid M, Singh MH, Issaka R, Laleau V, Day L, Lee J, Allison J, Somsouk M. Yield of Colonoscopy After a Positive Result From a Fecal Immunochemical Test OC-Light. Clin Gastroenterol Hepatol 2018; 16:1593-1597.e1. [PMID: 29660528 PMCID: PMC6151285 DOI: 10.1016/j.cgh.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/14/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about its ability to detect CRC in large average-risk populations. METHODS We performed a retrospective cohort study of patients (50-75 years old) in the San Francisco Health Network who were screened for CRC by OC-Light FIT from August 2010 through June 2015. Patients with a positive result were referred for colonoscopy. We used electronic health records to identify participants with positive FIT results, and collected results from subsequent colonoscopies and pathology analyses. The FIT positive rate was calculated by dividing the number of positive FIT results by the total number of FIT tests completed. The primary outcome was the positive rate from OC-Light FIT and yield of neoplasms at colonoscopy. Secondary outcomes were findings from first vs subsequent rounds of testing, and how these varied by sex and race. RESULTS We collected result from 35,318 FITs, performed on 20,886 patients; 2930 patients (8.3%) had a positive result, and 1558 patients completed the follow-up colonoscopy. A positive result from the FIT identified patients with CRC with a positive predictive value of 3.0%, and patients with advanced adenoma with a positive predictive value of 20.8%. The FIT positive rate was higher during the first round of testing (9.4%) compared to subsequent rounds (7.4%) (P < .01). The yield of CRC in patients with a positive result from the first round of the FIT was 3.7%, and decreased to 1.8% for subsequent rounds (P = .02). CONCLUSIONS In a retrospective analysis of patients in a diverse safety-net population who underwent OC-Light FIT for CRC screening, we found that approximately 3% of patients with a positive result from a FIT to have CRC and approximately 21% to have advanced adenoma.
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Affiliation(s)
- Muhammad Alsayid
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | | | - Rachel Issaka
- Clinical Research & Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Victoria Laleau
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Lukejohn Day
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Jeffrey Lee
- Kaiser Permanente Division of Research, Vallejo, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - James Allison
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Kaiser Permanente Division of Research, Vallejo, California
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California.
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109
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Ghai NR, Jensen CD, Corley DA, Doubeni CA, Schottinger JE, Zauber AG, Lee AT, Contreras R, Levin TR, Lee JK, Quinn VP. Colorectal Cancer Screening Participation Among Asian Americans Overall and Subgroups in an Integrated Health Care Setting with Organized Screening. Clin Transl Gastroenterol 2018; 9:186. [PMID: 30242160 PMCID: PMC6155113 DOI: 10.1038/s41424-018-0051-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 01/01/2023] Open
Abstract
Background Screening reduces colorectal cancer deaths, but <50% of Asian Americans are screening up-to-date according to surveys, with variability across Asian subgroups. We examined colorectal cancer screening participation among Asian Americans overall and Asian subgroups in a large integrated health care system with organized screening. Methods Data were electronically accessed to characterize screening in 2016 for Asians overall and subgroups relative to the National Colorectal Cancer Roundtable target of ≥80% screening and compared with non-Hispanic whites. Screening up-to-date was defined as a colonoscopy with 10 years, a sigmoidoscopy within 5 years, or a fecal immunochemical test (FIT) completed in 2016. Results Among 436,398 patients, 69,826 (16.0%) were Asian, of whom 79.8% were screening up-to-date vs. 77.6% of non-Hispanic whites (p < 0.001). Almost all subgroups met the 80% target: Chinese (83.3%), Vietnamese (82.4%), Korean (82.1%), other Asian (80.3%), Filipino (78.7%), Asian Indian (79.6%), and Japanese (79.0%). Among Asians overall and non-Hispanic whites, 50.6% and 48.4% of members were up-to-date with screening by colonoscopy, and 28.0% and 28.2% were up-to-date by FIT, respectively. Across Asian subgroups, colonoscopy most frequently accounting for being screening up-to-date (range: 47.4–59.7%), followed by FIT (range: 21.6–31.5%). Conclusions In an organized screening setting, there were minimal differences in screening participation among Asian subgroups and almost all met the 80% screening target, despite differences in language preference. Screening test type differences across subgroups suggest possible preferences in screening modality, which can inform future research into tailored education or outreach.
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Affiliation(s)
- Nirupa R Ghai
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA.
| | - Christopher D Jensen
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Douglas A Corley
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, The Perelman School of Medicine at the University of Pennsylvania, 51N 39th Street, Andrew Mutch Building, 7th Floor, Philadelphia, PA, 19104, USA
| | - Joanne E Schottinger
- Kaiser Permanente Southern California Regional Offices, 393 East Walnut Street, Pasadena, CA, 91188, USA
| | - Ann G Zauber
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2063A, New York, NY, 10017, USA
| | - Alexander T Lee
- Southern California Permanente Medical Group, Kaiser Permanente Woodland Hills, 5601 De Soto Ave, Woodland Hills, CA, 91365, USA
| | - Richard Contreras
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA
| | - Theodore R Levin
- Kaiser Permanente Medical Center, 1425 South Main Street, Walnut Creek, CA, 94596, USA
| | - Jeffrey K Lee
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Virginia P Quinn
- Kaiser Foundation Health Plan, Department of Regional Clinical Effectiveness, 393 East Walnut Street, Pasadena, CA, 91188, USA
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Dillon M, Flander L, Buchanan DD, Macrae FA, Emery JD, Winship IM, Boussioutas A, Giles GG, Hopper JL, Jenkins MA, Ait Ouakrim D. Family history-based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios. PLoS Med 2018; 15:e1002630. [PMID: 30114221 PMCID: PMC6095490 DOI: 10.1371/journal.pmed.1002630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/29/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Australian National Bowel Cancer Screening Programme (NBCSP) was introduced in 2006. When fully implemented, the programme will invite people aged 50 to 74 to complete an immunochemical faecal occult blood test (iFOBT) every 2 years. METHODS AND FINDINGS To investigate colorectal cancer (CRC) screening occurring outside of the NBCSP, we classified participants (n = 2,480) in the Australasian Colorectal Cancer Family Registry (ACCFR) into 3 risk categories (average, moderately increased, and potentially high) based on CRC family history and assessed their screening practices according to national guidelines. We developed a microsimulation to compare hypothetical screening scenarios (70% and 100% uptake) to current participation levels (baseline) and evaluated clinical outcomes and cost for each risk category. The 2 main limitations of this study are as follows: first, the fact that our cost-effectiveness analysis was performed from a third-party payer perspective, which does not include indirect costs and results in overestimated cost-effectiveness ratios, and second, that our natural history model of CRC does not include polyp sojourn time, which determines the rate of cancerous transformation. Screening uptake was low across all family history risk categories (64%-56% reported no screening). For participants at average risk, 18% reported overscreening, while 37% of those in the highest risk categories screened according to guidelines. Higher screening levels would substantially reduce CRC mortality across all risk categories (95 to 305 fewer deaths per 100,000 persons in the 70% scenario versus baseline). For those at average risk, a fully implemented NBCSP represented the most cost-effective approach to prevent CRC deaths (AUS$13,000-16,000 per quality-adjusted life year [QALY]). For those at moderately increased risk, higher adherence to recommended screening was also highly cost-effective (AUS$19,000-24,000 per QALY). CONCLUSION Investing in public health strategies to increase adherence to appropriate CRC screening will save lives and deliver high value for money.
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Affiliation(s)
- Mary Dillon
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Systems Analysis Laboratory, Department of Mathematics and System Analysis, Aalto University, Aalto, Finland
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel D. Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
- Genomic Medicine and the University of Melbourne Department of Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Finlay A. Macrae
- Colorectal Medicine and Genetics, and the University of Melbourne Department of Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Ingrid M. Winship
- Genomic Medicine and the University of Melbourne Department of Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alex Boussioutas
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Epidemiology and Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea
| | - Mark A. Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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111
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Hassan C, Kaminski MF, Repici A. How to Ensure Patient Adherence to Colorectal Cancer Screening and Surveillance in Your Practice. Gastroenterology 2018; 155:252-257. [PMID: 29964039 DOI: 10.1053/j.gastro.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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Adherence to colorectal cancer screening measured as the proportion of time covered. Gastrointest Endosc 2018; 88:323-331.e2. [PMID: 29477302 PMCID: PMC6050149 DOI: 10.1016/j.gie.2018.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) screening can reduce CRC incidence and mortality, but measuring screening adherence over time is challenging. We examined adherence using a novel measure characterizing the proportion of time covered (PTC) by screening tests. METHODS Eligible patients were age 50 to 60 years and followed at a large, safety-net health care system between January 2010 and September 2014. We estimated PTC as the number of days up to date with screening divided by the number of days from cohort entry until study end, CRC diagnosis, or death. We estimated mean and median PTC and used least-significant difference tests to assess differences in adherence by patient characteristics. RESULTS Of 18,257 patients, most were non-Hispanic black (40.5%) or Hispanic (34.9%) and/or female (62.4%). Approximately 40% (n = 7559) were never screened during the study period; the remaining 10,698 patients completed 19,105 screening examinations (14,481 fecal immunochemical tests [FITs], 4393 colonoscopies, 94 sigmoidoscopies, and 137 barium enemas). Overall, the mean PTC was 29.1% (95% confidence interval [CI], 28.6%-29.5%). Among those who completed at least one screening test (n = 10,698), the mean PTC was 49.0% (95% CI, 48.5%-49.5%). The most common reasons for non-adherence were lack of repeat FIT and no diagnostic colonoscopy after abnormal results for the FIT. The mean PTC increased with the number of primary care visits (0 visits, 21%; 1 visit, 29%; 2-3 visits, 35%; ≥4 visits, 37%; all P < .05). CONCLUSIONS PTC provides a reliable estimate of screening adherence, capturing breakdowns in the CRC screening process amenable to intervention. Repeat FIT and diagnostic colonoscopy are important intervention targets that may increase adherence in underserved populations.
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113
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Holt BA, Mac QD, Kwong GA. Nanosensors to Detect Protease Activity In Vivo for Noninvasive Diagnostics. J Vis Exp 2018. [PMID: 30059042 DOI: 10.3791/57937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Proteases are multi-functional enzymes that specialize in the hydrolysis of peptide-bonds and control broad biological processes including homeostasis and allostasis. Moreover, dysregulated protease activity drives pathogenesis and is a functional biomarker of diseases such as cancer; therefore, the ability to detect protease activity in vivo may provide clinically relevant information for biomedical diagnostics. The goal of this protocol is to create nanosensors that probe for protease activity in vivo by producing a quantifiable signal in urine. These protease nanosensors consist of two components: a nanoparticle and substrate. The nanoparticle functions to increase circulation half-life and substrate delivery to target disease sites. The substrate is a short peptide sequence (6-8 AA), which is designed to be specific to a target protease or group of proteases. The substrate is conjugated to the surface of the nanoparticle and is terminated by a reporter, such as a fluorescent marker, for detection. As dysregulated proteases cleave the peptide substrate, the reporter is filtered into urine for quantification as a biomarker of protease activity. Herein we describe construction of a nanosensor for matrix metalloproteinase 9 (MMP9), which is associated with tumor progression and metastasis, for detection of colorectal cancer in a mouse model.
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Affiliation(s)
- Brandon Alexander Holt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech College of Engineering and Emory School of Medicine
| | - Quoc D Mac
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech College of Engineering and Emory School of Medicine
| | - Gabriel A Kwong
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech College of Engineering and Emory School of Medicine; Parker H. Petit Institute of Bioengineering and Bioscience; Institute for Electronics and Nanotechnology, Georgia Tech; Integrated Cancer Research Center, Georgia Tech; The Georgia Immunoengineering Consortium, Emory University and Georgia Tech;
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114
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Singal AG, Corley DA, Kamineni A, Garcia M, Zheng Y, Doria-Rose PV, Quinn VP, Jensen CD, Chubak J, Tiro J, Doubeni CA, Ghai NR, Skinner CS, Wernli K, Halm EA. Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States. Am J Gastroenterol 2018; 113:746-754. [PMID: 29487413 PMCID: PMC6476786 DOI: 10.1038/s41395-018-0023-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 01/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study's objective was to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac FOBT (gFOBT) or fecal immunochemical test (FIT). METHODS We performed a multi-center retrospective cohort study among people who completed a FOBT between January 2010 and December 2011 to characterize repeat screening patterns over the subsequent 3 years. We studied at 4 large health care delivery systems in the United States. Logistic regression analyses were used to identify factors associated with repeat screening patterns. We included individuals aged 50-71 years who completed an index FOBT and had at least 3 years of follow-up. We excluded people with a history of CRC, colonoscopy within 10 years or flexible sigmoidoscopy within 5 years before the index test, or positive index stool test. Consistent screening was defined as repeat FOBT within every 15 months and inconsistent screening as repeat testing at least once during follow-up but less than consistent screening. RESULTS Among 959,857 eligible patients who completed an index FIT or gFOBT, 344,103 had three years of follow-up and met inclusion criteria. Of these, 46.6% had consistent screening, 43.4% inconsistent screening, and 10% had no repeat screening during follow-up. Screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Higher consistent screening proportions were observed in health systems with screening outreach and in-reach programs, whereas the safety-net health system, which uses opportunistic clinic-based screening, had the lowest consistent screening. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities. CONCLUSIONS Adherence with annual FOBT screening is highly variable across healthcare delivery systems. Settings with more organized screening programs performed better than those with opportunistic screening, but evidence-based interventions are needed to improve CRC screening adherence in all settings.
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Affiliation(s)
- Amit G. Singal
- University of Texas Southwestern Medical Center, Dallas TX
| | | | | | | | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle WA
| | | | | | | | | | - Jasmin Tiro
- University of Texas Southwestern Medical Center, Dallas TX
| | | | | | | | | | - Ethan A. Halm
- University of Texas Southwestern Medical Center, Dallas TX
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115
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Preston MA, Mays GP, Bursac Z, Thomas BR, Laryea J, Tilford JM, Odlum M, Smith SA, Henry-Tillman RS. Insurance coverage mandates: Impact of physician utilization in moderating colorectal cancer screening rates. Am J Surg 2018; 215:1004-1010. [PMID: 29555083 DOI: 10.1016/j.amjsurg.2018.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/27/2018] [Indexed: 12/26/2022]
Abstract
Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997-2014) using a multivariate logistic framework. Key variables of interest were HiM, CRC screening status, and physician utilization. The adjusted average marginal effects from the DDD model indicate that physician utilization increased the probability of being "up-to-date" vs. non-compliance by 9.9% points (p = 0.007), suggesting that an estimated 8.85 million additional age-eligible persons would receive a CRC screening with HiM and routine physician visits. Routine physician visits and mandates that lower out-of-pocket expenses constitute an effective approach to increasing CRC screenings for persons ready to take advantage of such policies.
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Affiliation(s)
- Michael A Preston
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
| | - Glen P Mays
- University of Kentucky, Department of Health Management & Policy, College of Public Health, 111 Washington Avenue #201, Lexington, KY 40536-003, USA.
| | - Zoran Bursac
- University of TN Health Science Center, Center for Population Sciences, Department of Preventive Medicine, 66 N Pauline St., Suite 307, Memphis, TN 38163, USA.
| | - Billy R Thomas
- University of Arkansas for Medical Sciences, Department of Pediatrics Neonatology, College of Medicine, 4301 West Markham Street, Little Rock, AR 72205-7199, USA.
| | - Jonathan Laryea
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
| | - J Mick Tilford
- University of Arkansas for Medical Sciences, Department of Health Policy & Management, College of Public Health, 4301 West Markham Street, Little Rock, AR 72205-7199, USA.
| | - Michelle Odlum
- Columbia University, School of Nursing, 617 West 168th Street, Rm 225, New York, NY 10032, USA.
| | - Sharla A Smith
- University of Kansas School of Medicine-Wichita, Department of Preventive Medicine & Public Health, 1010 N. Kansas Street, Wichita, KS 67214, USA.
| | - Ronda S Henry-Tillman
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
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116
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Khan Z, Darr U, Khan MA, Nawras M, Khalil B, Abdel-Aziz Y, Alastal Y, Barnett W, Sodeman T, Nawras A. Improving Internal Medicine Residents' Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study. JMIR MEDICAL EDUCATION 2018; 4:e10. [PMID: 29535080 PMCID: PMC5871737 DOI: 10.2196/mededu.9635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/11/2018] [Accepted: 02/11/2018] [Indexed: 08/10/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. OBJECTIVE The objective of our study was to assess the improvement in internal medicine residents' CRC screening knowledge via a pilot approach using a smartphone app. METHODS We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents' knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. RESULTS A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. CONCLUSIONS In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents' knowledge about CRC screening.
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Affiliation(s)
- Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Umar Darr
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Muhammad Ali Khan
- Department of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mohamad Nawras
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Basmah Khalil
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Yousef Abdel-Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Yaseen Alastal
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
| | - William Barnett
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Thomas Sodeman
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
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117
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Alcalá HE, Mitchell EM, Keim-Malpass J. Heterogeneous impacts: adverse childhood experiences and cancer screening. Cancer Causes Control 2018; 29:343-351. [PMID: 29411203 DOI: 10.1007/s10552-018-1007-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with higher odds of cancer in adulthood. One potential explanation for this association is the impact of ACEs on cancer screening. To address this shortcoming, this study examined how ACEs were associated with current compliance and ever use of prostate, breast, cervical, and colorectal cancer screening. METHODS Data from the 2014 Kansas Behavioral Risk Factor Surveillance System were used (n = 11,794). Logistic regressions were used to calculate odds of cancer screening behaviors from each of nine different ACE items and a count of ACEs. RESULTS Individual ACE items were associated with lower odds of compliance with PSA screening, clinical breast exam, and pap test guidelines. Certain ACEs were associated with increased odds of compliance with colorectal cancer screening guidelines among women and lower odds of compliance among men. ACEs were associated with ever screening for PSA and ever use of colonoscopy or sigmoidoscopy among men and women. Physical abuse was most consistently associated with cancer screening, across outcomes. CONCLUSIONS Most significant associations showed that specific ACEs were associated with lower odds of cancer screening. Therefore, efforts should be made to promote screening among those with histories of ACEs.
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Affiliation(s)
- Héctor E Alcalá
- Department of Family, Population and Preventive Medicine; Program in Public Health, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - Emma M Mitchell
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
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Riehman KS, Stephens RL, Henry-Tanner J, Brooks D. Evaluation of Colorectal Cancer Screening in Federally Qualified Health Centers. Am J Prev Med 2018; 54:190-196. [PMID: 29198834 DOI: 10.1016/j.amepre.2017.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Screening for colorectal cancer in average-risk adults is recommended beginning at age 50 years and continuing until age 75 years. This study was conducted to provide evidence for the effectiveness of an American Cancer Society grant program promoting colorectal cancer screening by implementing evidence-based interventions proven to increase screening rates. METHODS Analysis compared colorectal cancer screening rates in 77 grant-funded federally qualified health centers between 2013 and 2015 to those of a sample of 77 nonfunded federally qualified health centers selected using a genetic matching technique. The Uniform Data System from 2013 to 2015 provided data used in the analysis performed in 2016. RESULTS Funded grantees differed significantly from nongrantees on several indicators at baseline. Genetic matching resulted in good-quality matched samples. Both matched samples increased colorectal cancer screening rates over time. Grantees increased their colorectal cancer screening rates significantly more than nongrantees, especially between 2013 and 2014, where funded federally qualified health centers increased by 9% and nonfunded federally qualified health centers increased by 3%. Across the 3 years, increases were 12% and 9%, respectively. CONCLUSIONS The findings suggest grant funding was effective in promoting improvements in colorectal cancer screening rates in funded federally qualified health centers, and these improvements exceed those of nonfunded federally qualified health centers. Funding that results in targeted, intensive efforts supported by technical assistance and accountability for data and reporting, can result in improved system policies and practices that, in turn, can increase screening rates among uninsured and underserved populations.
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Affiliation(s)
- Kara S Riehman
- American Cancer Society, Statistics and Evaluation Center, Intramural Research, Atlanta, Georgia.
| | - Robert L Stephens
- American Cancer Society, Statistics and Evaluation Center, Intramural Research, Atlanta, Georgia
| | | | - Durado Brooks
- American Cancer Society, Prevention and Early Detection, Cancer Control Sciences, Atlanta, Georgia
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119
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Naidu H, Jacobson BC. Patients and Providers Are Amenable to Fecal Immunochemical Testing by Digital Rectal Exam. J Patient Exp 2018; 5:236-237. [PMID: 30214932 PMCID: PMC6134536 DOI: 10.1177/2374373517753176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fecal immunochemical testing (FIT) for colorectal cancer (CRC) requires patients to return samples for processing, after having a spontaneously passed stool at home. This results in low completion rates (only 50% in our institution). Using stool obtained during an office-based digital rectal exam (DRE-FIT) could improve compliance, but it is not known whether patients and providers would find this option acceptable. Surveys were given to 100 physicians and 118 patients at our institution. We found that 68% of patients and 88% of providers approved of DRE-FIT making this a potentially effective way to improve CRC screening compliance.
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Affiliation(s)
- Harini Naidu
- Department of Gastroenterology, Boston Medical Center, Boston, MA, USA
| | - Brian C Jacobson
- Department of Gastroenterology, Boston Medical Center, Boston, MA, USA
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120
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Joseph DA, Johnson CJ, White A, Wu M, Coleman MP. Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5037-5058. [PMID: 29205308 PMCID: PMC6191027 DOI: 10.1002/cncr.30882] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period. METHODS Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000. RESULTS There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods. CONCLUSIONS There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chris J. Johnson
- Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, ID
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michel P. Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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121
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White A, Joseph D, Rim SH, Johnson CJ, Coleman MP, Allemani C. Colon cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5014-5036. [PMID: 29205304 PMCID: PMC6152891 DOI: 10.1002/cncr.31076] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/08/2017] [Accepted: 09/21/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the first CONCORD study (2008), 5-year survival for patients diagnosed with colon cancer between 1990 and 1994 in the United States was among the highest in the world (60%), but there were large racial disparities in most participating states. The CONCORD-2 study (2015) enabled the examination of survival trends between 1995 and 2009 for US states by race and stage. METHODS The authors analyzed data from 37 state population-based cancer registries, covering approximately 80% of the US population, for patients who were diagnosed with colon cancer between 2001 and 2009 and were followed through 2009. Survival up to 5 years was corrected for background mortality (net survival) using state-specific and race-specific life tables and age-standardized using the International Cancer Survival Standard weights. Survival is presented by race (all, black, white), stage, state, and calendar period (2001-2003 and 2004-2009) to account for changes in methods used to collect stage. RESULTS Five-year net survival increased by 0.9%, from 63.7% between 2001 and 2003 to 64.6% between 2004 and 2009. More black than white patients were diagnosed with distant-stage disease between 2001 and 2003 (21.5% vs 17.2%) and between 2004 and 2009 (23.3% vs 18.8%). Survival improved for both blacks and whites, but 5-year net survival was 9-10% lower for blacks than for whites both between 2001 and 2003 (54.7% vs 64.5%) and between 2004 and 2009 (56.6% vs 65.4%). The absolute difference between blacks and whites decreased by only 1% during the decade. CONCLUSIONS Five-year net survival from colon cancer increased slightly over time. Survival among blacks diagnosed between 2004 and 2009 had still not reached the level of that among whites diagnosed between 1990 and 1994, some 15 to 20 years earlier. These findings suggest a need for more targeted efforts to improve screening and to ensure timely, appropriate treatment, especially for blacks, to reduce this large and persistent disparity in survival. Cancer 2017;123:5014-36. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sun Hee Rim
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michel P. Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Şahin MK, Aker S. Family Physicians' Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:908-913. [PMID: 27193411 DOI: 10.1007/s13187-016-1047-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess family physicians' knowledge, attitudes, and practices toward colorectal cancer (CRC) screening. The population in this cross-sectional study consisted of 290 family physicians working in Samsun, Turkey, contacted between 15 June and 15 July 2015 and agreeing to participate. A questionnaire prepared by the authors on the basis of the relevant literature was applied at face-to-face interviews. The first part of the questionnaire inquired into sociodemographic information, while the second contained questions evaluating family physicians' knowledge, attitudes, and practices toward CRC screening. Physicians completed the questionnaire in approximately 10 min. 65.9 % of the family physicians in the study were men. Mean age of the participants was 43.40 ± 6.54 years, and mean number of years in service was 18.43 ± 6.42. The average number of patients seen by physicians on a daily basis was 51-99. CRC screening was performed by 83.1 % of physicians. The fecal occult blood test (FOBT) was recommended at the correct frequency by 30.7 % of physicians and colonoscopy by 11.7 %. A further 68.6 % of physicians followed no CRC guideline. Only 3.8 % of those reporting using a guideline were able to name it. The great majority of physicians in this study apply CRC screening. However, family physicians lack sufficient information concerning the ages at which screening tests should be started and concluded and how frequently they should be performed. They also do not attach sufficient importance to CRC guidelines. This results in excessive demand for screening tests.
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Affiliation(s)
- Mustafa Kürşat Şahin
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey.
| | - Servet Aker
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey
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124
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Mahon SM. Colorectal cancer screening: Using evidence-based guidelines. Nurse Pract 2017; 42:18-26. [PMID: 28926493 DOI: 10.1097/01.npr.0000524663.78727.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Colorectal cancer is the third most common cancer diagnosed in men and women. There are multiple options for prevention and early detection. Evidence-based guidelines are available to select the best option based on personal and family history. NPs should utilize these guidelines in clinical practice to select the appropriate screening for their patients.
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Affiliation(s)
- Suzanne M Mahon
- Suzanne M. Mahon is a professor at the Department of Internal Medicine, Division of Hematology/Oncology and professor of adult nursing at Saint Louis University, School of Nursing, St. Louis, Mo
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125
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Selby K, Baumgartner C, Levin TR, Doubeni CA, Zauber AG, Schottinger J, Jensen CD, Lee JK, Corley DA. Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review. Ann Intern Med 2017; 167:565-575. [PMID: 29049756 PMCID: PMC6178946 DOI: 10.7326/m17-1361] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. PURPOSE To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). DATA SOURCES English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. STUDY SELECTION Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. DATA EXTRACTION Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type. DATA SYNTHESIS Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of -7.4 percentage points (95% CI, -19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). LIMITATION More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. CONCLUSION Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient. PRIMARY FUNDING SOURCE National Cancer Institute. (PROSPERO: CRD42016048286).
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Affiliation(s)
- Kevin Selby
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Christine Baumgartner
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Theodore R Levin
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Chyke A Doubeni
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Ann G Zauber
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Joanne Schottinger
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Christopher D Jensen
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Jeffrey K Lee
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
| | - Douglas A Corley
- From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California
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126
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Rogers CR, Robinson CD, Arroyo C, Obidike OJ, Sewali B, Okuyemi KS. Colorectal Cancer Screening Uptake's Association With Psychosocial and Sociodemographic Factors Among Homeless Blacks and Whites. HEALTH EDUCATION & BEHAVIOR 2017; 44:928-936. [PMID: 28978252 DOI: 10.1177/1090198117734284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants ( N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.
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Affiliation(s)
| | | | | | | | - Barrett Sewali
- 5 Uganda National Expanded Programme on Immunisation, Kampala, Uganda, Africa
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Arafa MA, Farhat KH. Recent diagnostic procedures for colorectal cancer screening: Are they cost-effective? Arab J Gastroenterol 2017; 18:136-139. [PMID: 28988790 DOI: 10.1016/j.ajg.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/27/2017] [Indexed: 12/28/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. Reduction in mortality rates in some countries worldwide are most likely ascribed to CRC screening and/or improved treatments. We reviewed the most relevant articles which discuss the cost-effectiveness of colorectal cancer screening procedures, in particular, the recent ones through the last eight years. The effectiveness of screening estimated by discounted life years gained (LYGs) compared to no screening, differed considerably between the studies. Despite these differences, all studies consistently emphasized that screening for CRC was cost-effective compared with no screening for each of the recognized screening strategies. Newer technologies for colorectal cancer screening, including computed tomographic colonography (CTC), faecal DNA test, and Pillcam Colon are less invasive and accurate, however, they are not cost-effective, as their cost was higher than all other established screening strategies. When compliance and adherence to such new techniques are increased more than the established strategies they would be more cost-effective particularly CTC.
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Affiliation(s)
- Mostafa Ahmed Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim Hamda Farhat
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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128
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Wallace MB. New Strategies to Improve Polypectomy During Colonoscopy. Gastroenterol Hepatol (N Y) 2017; 13:1-12. [PMID: 29249913 PMCID: PMC5721691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the United States, colorectal cancer (CRC) is the second-leading cause of cancer-related deaths. The most effective strategy for prevention of CRC is to screen for and remove precancerous polyps. There are various ways to screen for CRC. In the United States, the most common method is colonoscopy. Polyps are classified primarily through pathology. Size is the primary risk factor for malignancy. In general, the bigger the polyp, the greater the risk for malignancy. There are 3 basic options for removal: standard polypectomy; advanced resection techniques, known as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD); and surgical removal. In the past 10 years, the use of surgical removal has significantly decreased. Noninvasive, nonmalignant polyps can be removed endoscopically. EMR and ESD are very effective and achieve similar clinical outcomes. Both procedures begin with a submucosal injection. The submucosal lift is one of the most significant advances that have been made in polypectomy. Traditionally, the approach to achieving a submucosal lift has relied on the use of a saline solution. Saline is inexpensive and widely available, but it dissipates quickly. Various viscous agents have been added to saline to maintain mucosal lifting throughout the procedure. Although most are effective, they are used off-label. The only solution approved by the US Food and Drug Administration for the submucosal lift procedure is Eleview. In a clinical trial, Eleview decreased the mean total injected volume and the mean total injected volume per lesion as compared with saline. Other advances in polypectomy techniques include the use of cold snare polypectomy and high-definition colonoscopes. The quality of the colonoscopy can also be improved if a physician knows and monitors his or her adenoma detection rate.
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Affiliation(s)
- Michael B Wallace
- Professor of Medicine Department of Gastroenterology and Hepatology Mayo Clinic Jacksonville, Florida
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129
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Colonoscopy and sigmoidoscopy use among older adults in different countries: A systematic review. Prev Med 2017; 103:33-42. [PMID: 28739489 DOI: 10.1016/j.ypmed.2017.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/24/2017] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
Screening for colorectal cancer (CRC) by colonoscopy and sigmoidoscopy has been demonstrated to be effective in reducing CRC incidence and mortality, and they are increasingly employed as screening tests and for diagnostic purposes in many countries. We conducted a systematic review to provide up-to-date estimates on the utilization of lower gastrointestinal endoscopy (colonoscopy and sigmoidoscopy) in the general average-risk population in different countries. PubMed and Web of Science were searched for relevant articles published between 1 September 2008 and 31 October 2016. A total of 23 studies from the US and 20 studies from other countries were included in this review. Estimates from the US were highest, continued to increase over the past decade and reached 62% for colonoscopy use within 10years in people aged 50-75years in 2012. Endoscopy use in other countries was substantially lower (12-44% for lifetime colonoscopy use and 13-30% for recent colonoscopy use), except for Germany, where 55% of the screening-eligible population reported colonoscopy utilization within the previous 10years in 2008-2011. Both lifetime and recent endoscopy use increased with age and peaked at approximately 70-75years. Although several European and Asian countries have started to collect endoscopy utilization data through periodic national health surveys, more data are still much needed from non-US countries. With the implementation of CRC screening programs in an increasing number of countries, especially European countries, an increase in endoscopy use and subsequent reduction in CRC incidence and mortality in the years to come might be expected in those countries.
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Becker EA, Buscemi J, Fitzgibbon ML, Watson K, Matthews KL, Winn RA. Society of Behavioral Medicine (SBM) position statement: SBM supports the National Colorectal Cancer Roundtable's (NCCRT) call to action to reach 80 % colorectal cancer screening rates by 2018. Transl Behav Med 2017; 6:306-8. [PMID: 27357000 DOI: 10.1007/s13142-015-0364-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Society of Behavioral Medicine (SBM) urges stakeholders to support the National Colorectal Cancer Roundtable's (NCCRT) initiative 80 % by 2018. Colorectal cancer (CRC) is largely preventable with early detection of pre-cancerous polyps but CRC screening is underutilized, especially among the underserved. In response to low screening rates, this initiative sets an important goal of a population screening rate of 80 % in adults ages 50 and older by the year 2018. It is estimated that this screening rate could prevent more than 20,000 CRC deaths per year within 15 years. The initiative takes a multilevel approach to improving screening rates and includes recommendations for clinicians, health care organizations, insurers, policymakers, and researchers.
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Affiliation(s)
- Elizabeth A Becker
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Joanna Buscemi
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Kameron L Matthews
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert A Winn
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
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Burke C, Kaul V, Pohl H. Polyp Resection and Removal Procedures: Insights From the 2017 Digestive Disease Week. Gastroenterol Hepatol (N Y) 2017; 13:1-24. [PMID: 29070970 PMCID: PMC5635426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Colorectal cancer (CRC) is an important public health issue not only because of its high incidence but also for its high mortality rate. When CRC is diagnosed at an early stage, the 5-year relative survival rate reaches 89.9%. However, only 39% of patients with CRC are diagnosed at this stage. Screening decreases both the incidence of CRC and the number of CRC-related deaths. There are several options available for screening, and colonoscopy is one of the most common methods utilized in the United States. Screening colonoscopy is associated with durable protection from CRC. However, it has become increasingly apparent in recent years that polyp detection and resection have not been completely effective in clinical practice. Because the protective benefit of colonoscopy is variable, quality benchmarks have been established to improve its clinical effectiveness. The adenoma detection rate (ADR) directly correlates with the incidence and mortality of postcolonoscopy (or interval) CRCs. It is now routine to remove large polyps (≥20 mm) using advanced techniques for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Recent studies have helped identify which colorectal lesions are at higher risk of invasive cancer and would benefit from a complete en bloc resection. Such data may guide endoscopists in making a decision on whether to use ESD or EMR for removal of large lesions. An increased number of studies have reported on the efficacy and safety of cold snare resection, even for larger polyps. These data suggest that cold snare resection may be as effective, and perhaps safer, than hot snare resection for polyps up to 1 to 2 cm in size. However, data on the threshold for cold snare resection and the value of submucosal injectates are still lacking. Use of submucosal injection is generally preferred for larger polyps, particularly those located in the proximal colon, where the colonic wall is thinner.
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Affiliation(s)
- Carol Burke
- Vice Chair, Department of Gastroenterology and Hepatology Director of the Center for Colon Polyp and Cancer Prevention Cleveland Clinic Cleveland, Ohio
| | - Vivek Kaul
- Segal-Watson Professor of Medicine, Chief, Division of Gastroenterology & Hepatology Center for Advanced Therapeutic Endoscopy University of Rochester Medical Center Rochester, New York
| | - Heiko Pohl
- Associate Professor of Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire Department of Gastroenterology, Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Department of Gastroenterology, VA Medical Center White River Junction, Vermont
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Skyrud KD, Myklebust TÅ, Bray F, Eriksen MT, de Lange T, Larsen IK, Møller B. How Many Deaths from Colorectal Cancer Can Be Prevented by 2030? A Scenario-Based Quantification of Risk Factor Modification, Screening, and Treatment in Norway. Cancer Epidemiol Biomarkers Prev 2017; 26:1420-1426. [PMID: 28626069 DOI: 10.1158/1055-9965.epi-17-0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Colorectal cancer mortality can be reduced through risk factor modification (adherence to lifestyle recommendations), screening, and improved treatment. This study estimated the potential of these three strategies to modify colorectal cancer mortality rates in Norway.Methods: The potential reduction in colorectal cancer mortality due to risk factor modification was estimated using the software Prevent, assuming that 50% of the population in Norway-who do not adhere to the various recommendations concerning prevention of smoking, physical activity, body weight, and intake of alcohol, red/processed meat, and fiber-started to follow the recommendations. The impact of screening was quantified assuming implementation of national flexible sigmoidoscopy screening with 50% attendance. The reduction in colorectal cancer mortality due to improved treatment was calculated assuming that 50% of the linear (positive) trend in colorectal cancer survival would continue to persist in future years.Results: Risk factor modification would decrease colorectal cancer mortality by 11% (corresponding to 227 prevented deaths: 142 men, 85 women) by 2030. Screening and improved treatment in Norway would reduce colorectal cancer mortality by 7% (149 prevented deaths) and 12% (268 prevented deaths), respectively, by 2030. Overall, the combined effect of all three strategies would reduce colorectal cancer mortality by 27% (604 prevented deaths) by 2030.Conclusions: Risk factor modification, screening, and treatment all have considerable potential to reduce colorectal cancer mortality by 2030, with the largest potential reduction observed for improved treatment and risk factor modification.Impact: The estimation of these health impact measures provides useful information that can be applied in public health decision-making. Cancer Epidemiol Biomarkers Prev; 26(9); 1420-6. ©2017 AACR.
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Affiliation(s)
- Katrine Damgaard Skyrud
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway.
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Morten Tandberg Eriksen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Inger Kristin Larsen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
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133
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Lin SC, McKinley D, Sripipatana A, Makaroff L. Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication. Cancer 2017; 123:4185-4192. [PMID: 28708933 DOI: 10.1002/cncr.30855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. METHODS Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. RESULTS Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. CONCLUSIONS The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.
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Affiliation(s)
- Sue C Lin
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Duane McKinley
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
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Reuland DS, Brenner AT, Hoffman R, McWilliams A, Rhyne RL, Getrich C, Tapp H, Weaver MA, Callan D, Cubillos L, Urquieta de Hernandez B, Pignone MP. Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:967-974. [PMID: 28505217 PMCID: PMC5710456 DOI: 10.1001/jamainternmed.2017.1294] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Colorectal cancer (CRC) screening is underused, especially among vulnerable populations. Decision aids and patient navigation are potentially complementary interventions for improving CRC screening rates, but their combined effect on screening completion is unknown. OBJECTIVE To determine the combined effect of a CRC screening decision aid and patient navigation compared with usual care on CRC screening completion. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, data were collected from January 2014 to March 2016 at 2 community health center practices, 1 in North Carolina and 1 in New Mexico, serving vulnerable populations. Patients ages 50 to 75 years who had average CRC risk, spoke English or Spanish, were not current with recommended CRC screening, and were attending primary care visits were recruited and randomized 1:1 to intervention or control arms. INTERVENTIONS Intervention participants viewed a CRC screening decision aid in English or Spanish immediately before their clinician encounter. The decision aid promoted screening and presented colonoscopy and fecal occult blood testing as screening options. After the clinician encounter, intervention patients received support for screening completion from a bilingual patient navigator. Control participants viewed a food safety video before the encounter and otherwise received usual care. MAIN OUTCOMES AND MEASURES The primary outcome was CRC screening completion within 6 months of the index study visit assessed by blinded medical record review. RESULTS Characteristics of the 265 participants were as follows: their mean age was 58 years; 173 (65%) were female, 164 (62%) were Latino; 40 (15%) were white non-Latino; 61 (23%) were black or of mixed race; 191 (78%) had a household income of less than $20 000; 101 (38%) had low literacy; 75 (28%) were on Medicaid; and 91 (34%) were uninsured. Intervention participants were more likely to complete CRC screening within 6 months (68% vs 27%); adjusted-difference, 40 percentage points (95% CI, 29-51 percentage points). The intervention was more effective in women than in men (50 vs 21 percentage point increase, interaction P = .02). No effect modification was observed across other subgroups. CONCLUSIONS AND RELEVANCE A patient decision aid plus patient navigation increased the rate of CRC screening completion in compared with usual care invulnerable primary care patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02054598.
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Affiliation(s)
- Daniel S Reuland
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Alison T Brenner
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Richard Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City5University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City6Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Robert L Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque8University of New Mexico Comprehensive Cancer Center, Albuquerque
| | - Christina Getrich
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque9Department of Anthropology, University of Maryland, College Park
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Mark A Weaver
- Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill10Department of Biostatistics, University of North Carolina, Chapel Hill
| | - Danelle Callan
- University of New Mexico Comprehensive Cancer Center, Albuquerque
| | - Laura Cubillos
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | | | - Michael P Pignone
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill2Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill11Department of Internal Medicine, University of Texas Dell Medical School, Austin
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135
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Nguyen E, Mehta S, Yates SW, Schrader MK, Martin MC. Colon Cancer Screening in Concierge Practice. South Med J 2017; 110:408-411. [PMID: 28575898 DOI: 10.14423/smj.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. METHODS We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the average rate of Medicare Advantage plans reported by our Independent Physician Association (IPA) in 2015 and national health plans reported by the National Committee for Quality Assurance in 2014. RESULTS The CEM had a CRC screening rate of 90.2%, which was significantly higher than local IPA Medicare Advantage plans (63.3%) and National Committee for Quality Assurance national plans (57.7%-66.5%). CEM members were significantly more likely than were IPA members to undergo screening (odds ratio 1.425, 95% confidence interval 1.348-1.507, P < 0.0001). CONCLUSIONS These results suggest that the CEM practice strategy and processes increase CRC screening rates.
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Affiliation(s)
- Elizabeth Nguyen
- From the Texas College of Osteopathic Medicine, Fort Worth, and the Center for Executive Medicine, Plano, Texas
| | - Shivani Mehta
- From the Texas College of Osteopathic Medicine, Fort Worth, and the Center for Executive Medicine, Plano, Texas
| | - Scott W Yates
- From the Texas College of Osteopathic Medicine, Fort Worth, and the Center for Executive Medicine, Plano, Texas
| | - M Keith Schrader
- From the Texas College of Osteopathic Medicine, Fort Worth, and the Center for Executive Medicine, Plano, Texas
| | - Michael C Martin
- From the Texas College of Osteopathic Medicine, Fort Worth, and the Center for Executive Medicine, Plano, Texas
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136
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Decrease in Incidence of Colorectal Cancer Among Individuals 50 Years or Older After Recommendations for Population-based Screening. Clin Gastroenterol Hepatol 2017; 15:903-909.e6. [PMID: 27609707 PMCID: PMC5337450 DOI: 10.1016/j.cgh.2016.08.037] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence of colorectal cancer (CRC) in the United States is increasing among adults younger than 50 years, but incidence has decreased among older populations after population-based screening was recommended in the late 1980s. Blacks have higher incidence than whites. These patterns have prompted suggestions to lower the screening age for average-risk populations or in blacks. At the same time, there has been controversy over whether reductions in CRC incidence can be attributed to screening. We examined age-related and race-related differences in CRC incidence during a 40-year time period. METHODS We determined the age-standardized incidence of CRC from 1975 through 2013 by using the population-based Surveillance, Epidemiology, and End Results (SEER) program of cancer registries. We calculated incidence for 5-year age categories (20-24 years through 80-84 years and 85 years or older) for different time periods (1975-1979, 1980-1984, 1985-1989, 1990-1994, 1995-1999, 2000-2004, 2005-2009, and 2010-2013), tumor subsite (proximal colon, descending colon, and rectum), and stages at diagnosis (localized, regional, and distant). Analyses were stratified by race (white vs black). RESULTS There were 450,682 incident cases of CRC reported to the SEER registries during the entire period (1975-2013). Overall incidence was 75.5/100,000 white persons and 83.6/100,000 black persons. CRC incidence peaked during 1980 through 1989 and began to decrease in 1990. In whites and blacks, the decreases in incidence between the time periods of 1980-1984 and 2010-2013 were limited to the screening-age population (ages 50 years or older). Between these time periods, there was 40% decrease in incidence among whites compared with 26% decrease in incidence among blacks. Decreases in incidence were greater for cancers of the distal colon and rectum, and reductions in these cancers were greater among whites than blacks. CRC incidence among persons younger than 50 years decreased slightly between 1975-1979 and 1990. However, among persons 20-49 years old, CRC incidence increased from 8.3/100,000 persons in 1990-1994 to 11.4/100,000 persons in 2010-2013; incidence rates in younger adults were similar for whites and blacks. CONCLUSIONS On the basis of an analysis of the SEER cancer registries from 1975 through 2013, CRC incidence decreased only among individuals 50 years or older between the time periods of 1980-1984 and 2010-2013. Incidence increased modestly among individuals 20-49 years old between the time periods of 1990-1994 and 2010-2013. The decision of whether to recommend screening for younger populations requires a formal analysis of risks and benefits. Our observed trends provide compelling evidence that screening has had an important role in reducing CRC incidence.
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Mansinho A, Boni V, de Miguel M, Calvo E. The future of oncology therapeutics. Expert Rev Anticancer Ther 2017; 17:563-565. [PMID: 28504011 DOI: 10.1080/14737140.2017.1331131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- André Mansinho
- a Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria , Oncology Department , Lisbon , Portugal.,b START Madrid , Oncology Phase I Unit, Centro Integral Oncológico Clara Campal , Madrid , Spain
| | - Valentina Boni
- b START Madrid , Oncology Phase I Unit, Centro Integral Oncológico Clara Campal , Madrid , Spain
| | - María de Miguel
- b START Madrid , Oncology Phase I Unit, Centro Integral Oncológico Clara Campal , Madrid , Spain
| | - Emiliano Calvo
- b START Madrid , Oncology Phase I Unit, Centro Integral Oncológico Clara Campal , Madrid , Spain
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Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A. Colorectal cancer statistics, 2017. CA Cancer J Clin 2017; 67:177-193. [PMID: 28248415 DOI: 10.3322/caac.21395] [Citation(s) in RCA: 2800] [Impact Index Per Article: 400.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the United States. Every 3 years, the American Cancer Society provides an update of CRC incidence, survival, and mortality rates and trends. Incidence data through 2013 were provided by the Surveillance, Epidemiology, and End Results program, the National Program of Cancer Registries, and the North American Association of Central Cancer Registries. Mortality data through 2014 were provided by the National Center for Health Statistics. CRC incidence rates are highest in Alaska Natives and blacks and lowest in Asian/Pacific Islanders, and they are 30% to 40% higher in men than in women. Recent temporal patterns are generally similar by race and sex, but differ by age. Between 2000 and 2013, incidence rates in adults aged ≥50 years declined by 32%, with the drop largest for distal tumors in people aged ≥65 years (incidence rate ratio [IRR], 0.50; 95% confidence interval [95% CI], 0.48-0.52) and smallest for rectal tumors in ages 50 to 64 years (male IRR, 0.91; 95% CI, 0.85-0.96; female IRR, 1.00; 95% CI, 0.93-1.08). Overall CRC incidence in individuals ages ≥50 years declined from 2009 to 2013 in every state except Arkansas, with the decrease exceeding 5% annually in 7 states; however, rectal tumor incidence in those ages 50 to 64 years was stable in most states. Among adults aged <50 years, CRC incidence rates increased by 22% from 2000 to 2013, driven solely by tumors in the distal colon (IRR, 1.24; 95% CI, 1.13-1.35) and rectum (IRR, 1.22; 95% CI, 1.13-1.31). Similar to incidence patterns, CRC death rates decreased by 34% among individuals aged ≥50 years during 2000 through 2014, but increased by 13% in those aged <50 years. Progress against CRC can be accelerated by increasing initiation of screening at age 50 years (average risk) or earlier (eg, family history of CRC/advanced adenomas) and eliminating disparities in high-quality treatment. In addition, research is needed to elucidate causes for increasing CRC in young adults. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:177-193. © 2017 American Cancer Society.
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Affiliation(s)
- Rebecca L Siegel
- Strategic Director, Surveillance Information Services, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Director, Screening and Risk Factor Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Dennis J Ahnen
- Professor, Division of Gastroenterology, School of Medicine, University of Colorado, Aurora, CO
| | - Reinier G S Meester
- Epidemiologist, Department of Public Health, Erasmus University, Rotterdam, the Netherlands
| | - Afsaneh Barzi
- Assistant Professor of Clinical Medicine, Department of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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139
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Weir HK, Li C, Henley SJ, Joseph D. Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012). Cancer Epidemiol Biomarkers Prev 2017; 26:736-742. [PMID: 28003180 PMCID: PMC5851447 DOI: 10.1158/1055-9965.epi-16-0702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States.Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars.Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss.Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups.Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR.
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Affiliation(s)
- Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Chunyu Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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140
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Winawer SJ, Zauber AG. Can post-polypectomy surveillance be less intensive? Lancet Oncol 2017; 18:707-709. [PMID: 28457710 DOI: 10.1016/s1470-2045(17)30305-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Sidney J Winawer
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York 10065-6007, NY, USA.
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York 10065-6007, NY, USA
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141
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Muller CJ, Robinson RF, Smith JJ, Jernigan MA, Hiratsuka V, Dillard DA, Buchwald D. Text message reminders increased colorectal cancer screening in a randomized trial with Alaska Native and American Indian people. Cancer 2017; 123:1382-1389. [PMID: 28001304 PMCID: PMC5384860 DOI: 10.1002/cncr.30499] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Alaska Native and American Indian people (AN/AIs) have a high incidence of colorectal cancer (CRC) and CRC-related mortality. Screening can prevent death from CRC, but screening rates are low in racially and ethnically diverse populations. The authors conducted a randomized controlled trial using text messaging to increase CRC screening among unscreened AN/AIs in a tribal health care system in Anchorage, Alaska. METHODS The intervention entailed up to 3 text messages sent 1 month apart. The authors randomized 2386 AN/AIs aged 40 to 75 years who were eligible for CRC screening to the intervention or usual-care control conditions. Screening status was ascertained from electronic health records 3 months and 6 months after the last text message. Hazard ratios (HRs) were estimated to evaluate the effectiveness of the intervention, stratified by age and sex. RESULTS The intervention increased CRC screening for AN/AIs aged 50 to 75 years (HR, 1.42; 95% confidence interval [95% CI], 0.97-2.09) and aged 40 to 49 years (HR, 1.24; 95% CI, 0.95-1.62). Within both age groups, the HRs were higher for women (HR, 1.69 [95% CI, 1.02-2.80] and HR, 1.37 [95% CI, 1.01-1.88]) compared with men (HR, 1.09 [95% CI, 0.59-1.99] and HR, 0.90 [95% CI, 0.54-1.53]). Interaction analysis yielded P values of .55 and .09, respectively, for age and sex. CONCLUSIONS A simple text messaging intervention was found to increase CRC screening rates in AN/AIs, a group with high CRC morbidity and mortality. Text messaging may be a cost-effective means of reducing CRC screening disparities in AN/AIs and other populations. Cancer 2017;123:1382-1389. © 2016 American Cancer Society.
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Affiliation(s)
- Clemma J Muller
- Partnerships for Native Health, Washington State University, Seattle, Washington
| | - Renee F Robinson
- Southcentral Foundation, Anchorage, Alaska
- United States Public Health Service, Indian Health Service, Region X, Southcentral Foundation
| | | | - Meghan A Jernigan
- Partnerships for Native Health, Washington State University, Seattle, Washington
| | | | | | - Dedra Buchwald
- Partnerships for Native Health, Washington State University, Seattle, Washington
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142
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Muller CJ, Robinson RF, Smith JJ, Jernigan MA, Hiratsuka V, Dillard DA, Buchwald D. Text message reminders increased colorectal cancer screening in a randomized trial with Alaska Native and American Indian people. Cancer 2017. [PMID: 28001304 DOI: 10.1002/cncr.3049930499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Alaska Native and American Indian people (AN/AIs) have a high incidence of colorectal cancer (CRC) and CRC-related mortality. Screening can prevent death from CRC, but screening rates are low in racially and ethnically diverse populations. The authors conducted a randomized controlled trial using text messaging to increase CRC screening among unscreened AN/AIs in a tribal health care system in Anchorage, Alaska. METHODS The intervention entailed up to 3 text messages sent 1 month apart. The authors randomized 2386 AN/AIs aged 40 to 75 years who were eligible for CRC screening to the intervention or usual-care control conditions. Screening status was ascertained from electronic health records 3 months and 6 months after the last text message. Hazard ratios (HRs) were estimated to evaluate the effectiveness of the intervention, stratified by age and sex. RESULTS The intervention increased CRC screening for AN/AIs aged 50 to 75 years (HR, 1.42; 95% confidence interval [95% CI], 0.97-2.09) and aged 40 to 49 years (HR, 1.24; 95% CI, 0.95-1.62). Within both age groups, the HRs were higher for women (HR, 1.69 [95% CI, 1.02-2.80] and HR, 1.37 [95% CI, 1.01-1.88]) compared with men (HR, 1.09 [95% CI, 0.59-1.99] and HR, 0.90 [95% CI, 0.54-1.53]). Interaction analysis yielded P values of .55 and .09, respectively, for age and sex. CONCLUSIONS A simple text messaging intervention was found to increase CRC screening rates in AN/AIs, a group with high CRC morbidity and mortality. Text messaging may be a cost-effective means of reducing CRC screening disparities in AN/AIs and other populations. Cancer 2017;123:1382-1389. © 2016 American Cancer Society.
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Affiliation(s)
- Clemma J Muller
- Partnerships for Native Health, Washington State University, Seattle, Washington
| | - Renee F Robinson
- Southcentral Foundation, Anchorage, Alaska
- United States Public Health Service, Indian Health Service, Region X, Southcentral Foundation
| | | | - Meghan A Jernigan
- Partnerships for Native Health, Washington State University, Seattle, Washington
| | | | | | - Dedra Buchwald
- Partnerships for Native Health, Washington State University, Seattle, Washington
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143
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Diagnostic Accuracy of Methylated SEPT9 for Blood-based Colorectal Cancer Detection: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2017; 8:e216. [PMID: 28102859 PMCID: PMC5288600 DOI: 10.1038/ctg.2016.66] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022] Open
Abstract
Objectives: More convenient and effective blood-based methods are believed to increase colorectal cancer (CRC) detection adoption. The effectiveness of methylated SPET9 for CRC detection has been reviewed in the newly published recommendation statement by US Preventive Services Task Force (USPSTF), while detailed instructions were not provided, which may be a result of insufficient evidence. Therefore, more evidence is needed to assist practitioners to thoroughly understand the utilization of this special maker. Methods: Based on the standard method, a systematic review and meta-analysis was performed. Quadas-2 was used to assess the methodological quality of studies. Relevant studies were searched and screened from PubMed, Embase and other literature databases up to June 1, 2016. Pooled sensitivity, specificity and diagnostic odds ratio were summarized by bivariate mixed effect model and area under the curve (AUC) was estimated by hierarchical summary receiver operator characteristic curve. Results: 25 studies were included for analysis. The pooled sensitivity, specificity and AUC were 0.71, 0.92 and 0.88, respectively. Among the various methods and assays, Epipro Colon 2.0 with 2/3 algorithm was the most effective in colorectal cancer detection. Positive ratio of mSEPT9 was higher in advanced CRC (45% in I, 70% in II, 76% in III, 79% in IV) and lower differentiation (31% in high, 73% in moderate, 90% in low) tissue. However, this marker has poor ability of identifying precancerous lesions according to current evidence. Conclusions: mSEPT9 is a reliable blood-based marker in CRC detection, particularly advanced CRC. Epipro Colon 2.0 with 2/3 algorithm is currently the optimal method and assay to detect CRC.
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144
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Terlizzi J, Zheng A, Fuzesi S, Beekley A, Moleski S, Phillips B, Isenberg G, Goldstein S. Polyp Detection Rates among Body Mass Index Categories at First Screening Colonoscopy. Am Surg 2017. [DOI: 10.1177/000313481708300125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the United States, obesity is an epidemic and colorectal cancer is the second deadliest cancer for men and women. A link between obesity and colorectal adenomas and carcinoma has been suggested but not proven. We sought out to determine if obesity was associated with increased rates of polyp formation. All patients undergoing a first screening colonoscopy by one of the participating endoscopists at Thomas Jefferson University Hospital from January 2012 to March 2015 were considered for the study. Their demographics, body mass index (BMI), and colonoscopy findings were recorded at the time of the procedure and prospectively maintained in our database. The final pathologic diagnosis was recorded for each participant as it became available. A total of 758 subjects were included. Of these, 22 per cent had a BMI <25 kg/m2, 29 per cent had a BMI between 25 and 29.9 kg/m2, and 49 per cent had a BMI of at least 30 kg/m2. Overall, 21.9 per cent of the participants were found to have at least one adenomatous polyp. The polyp detection rates were 24.4 per cent in the group with a BMI less than 25, 20.5 per cent in the overweight group, and 21.6 per cent in the obese group. Our study included 56 super obese individuals with a BMI ≥45 kg/m2. About 17.9 per cent of subjects in the super obese group had an adenomatous polyp. There were no differences in the incidence of adenomatous polyps between BMI categories in our study.
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Affiliation(s)
- Joseph Terlizzi
- Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, Pennsylvania
- Laser Surgery Care, New York, New York
| | - Andrew Zheng
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah Fuzesi
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alec Beekley
- Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Stephanie Moleski
- Thomas Jefferson University Hospital, Department of Gastroenterology, Philadelphia, Pennsylvania
| | - Benjamin Phillips
- Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Gerald Isenberg
- Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, Pennsylvania
| | - Scott Goldstein
- Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, Pennsylvania
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145
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Feng X, Tan X, Alenzi EO, Rai P, Chang J. Spatial and temporal variations of screening for breast and colorectal cancer in the United States, 2008 to 2012. Medicine (Baltimore) 2016; 95:e5656. [PMID: 28002335 PMCID: PMC5181819 DOI: 10.1097/md.0000000000005656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cancer screening tests are important tools to combat cancer-related morbidity and mortality. There is limited up-to-date research on spatial and temporal variations of colorectal and breast cancer screening in the United States.County-level data of cancer screening adherence rates were generated from 2008 to 2012 Behavioral Risk Factor Surveillance System. We performed the univariate local indicators for spatial analyses (LISA) for the geographic differences of screening adherence rate and the differential LISA for the change of screening adherence rate from 2008 to 2012.In the univariate LISA, low-to-low clusters were consistently identified in counties of New Mexico, Wyoming, and Mississippi (P < 0.05) for both screenings. In the differential LISA, we found low-to-low clusters in Indiana counties (P < 0.05) for mammography screening, which implied that counties with a below-average difference in mammography adherence were surrounded by counties of below-average difference in adherence rates. A high-to-high cluster was also identified in the southern Appalachian counties for mammography screening (P < 0.05). No obvious spatial pattern was found for the colorectal cancer screening adherence rate across the United States.We found low-to-low clusters over time in adherence to screening guidelines for both cancer types in New Mexico, Wyoming, and Mississippi, and clusters of potential decrease in adherence to mammography screening guideline in counties of Indiana. The study also showed improvement on mammography screening clustered in southern Appalachia. The methodology adopted in this study identified areas with clusters of consistent low adherence to screening and a decrease in adherence, which implies that further research and intervention is warranted.
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Affiliation(s)
- Xue Feng
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV
| | - Xi Tan
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV
| | - Ebtihag O. Alenzi
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV
| | - Pragya Rai
- Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV
| | - Jongwha Chang
- University of Texas at El Paso, School of Pharmacy, El Paso, TX
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146
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Han Y, Lu S, Yu F, Liu X, Sun H, Wang J, Zhu X, Lu H, Yue H, Wang J, Lin J, Zhou C, Tang H, Peng Z. A comparative analysis and guidance for individualized chemotherapy of stage II and III colorectal cancer patients based on pathological markers. Sci Rep 2016; 6:37240. [PMID: 27845412 PMCID: PMC5109035 DOI: 10.1038/srep37240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022] Open
Abstract
Adjuvant chemotherapy is considered the standard of care for patients with colorectal cancer after curative resection. Although current guidelines provide clear instructions for chemotherapy for stage II high-risk and stage III colorectal cancer, it is insufficient to individualize therapy. We analyzed the outcomes of 902 patients with colorectal cancer treated with or without chemotherapy in our hospital. We found Chinese survival benefit for chemotherapy was consistent with current guidelines. Moreover, our data added to the evidence that chemotherapy might be used for elderly patients with stage II high-risk colorectal cancer. Pathological markers could predict response to individualize therapy in a convenient, fast and inexpensive way. We compared survivals of patients with stage II high-risk and stage III colorectal cancer with chemotherapy in different pathological markers expression, and furthermore used 458 colon adenocarcinoma samples from The Cancer Genome Atlas to verify our preliminary results. We confirmed TOPIIα, EGFR and P170 may be sufficiently predictive markers to individualize chemotherapy. FOLFOX was the optimal adjuvant chemotherapy for patients with stage II high-risk and stage III colorectal cancer when TOPIIα was positive or EGFR or P170 was negative.
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Affiliation(s)
- Yang Han
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Su Lu
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Fudong Yu
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Xisheng Liu
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Huimin Sun
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Jingtao Wang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Xingwu Zhu
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Huijun Lu
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Hao Yue
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Jing Wang
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Jun Lin
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Chongzhi Zhou
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Huamei Tang
- Department of Pathology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
| | - Zhihai Peng
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 20080, China
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147
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Williams CD, Grady WM, Zullig LL. Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening. J Natl Compr Canc Netw 2016; 14:1479-1485. [PMID: 27799515 PMCID: PMC5117951 DOI: 10.6004/jnccn.2016.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/31/2016] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening.
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Affiliation(s)
- Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham, NC, USA
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - William M. Grady
- Clinical Research Division, Fred Hutchison Cancer Research Center, University of Washington, Seattle, Washington, USA
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
| | - Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
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148
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Mehta SJ, Jensen CD, Quinn VP, Schottinger JE, Zauber AG, Meester R, Laiyemo AO, Fedewa S, Goodman M, Fletcher RH, Levin TR, Corley DA, Doubeni CA. Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System. J Gen Intern Med 2016; 31:1323-1330. [PMID: 27412426 PMCID: PMC5071288 DOI: 10.1007/s11606-016-3792-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/16/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. OBJECTIVE To examine the association between race/ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. DESIGN Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004-2013). SUBJECTS A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004-2006), 654,633 during the first 3 years after implementation (2007-2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation. INTERVENTION A comprehensive system-wide long-term effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. MAIN MEASURES Differences over time and by race/ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ethnicity categories included non-Hispanic white, non-Hispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. KEY RESULTS From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results. CONCLUSIONS In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.
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Affiliation(s)
- Shivan J Mehta
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Ann G Zauber
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Reinier Meester
- Erasmus University Medical Center (Erasmus MC), Rotterdam, Netherlands
| | - Adeyinka O Laiyemo
- Division of Gastroenterology, Howard University College of Medicine, Washington, DC, USA
| | - Stacey Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA
| | | | | | | | | | - Chyke A Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Gates 2 Pavilion, Philadelphia, PA, 19104, USA.
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149
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Zhu X, Shrubsole MJ, Ness RM, Hibler EA, Cai Q, Long J, Chen Z, Li G, Jiang M, Hou L, Kabagambe EK, Zhang B, Smalley WE, Edwards TL, Giovannucci EL, Zheng W, Dai Q. Calcium/magnesium intake ratio, but not magnesium intake, interacts with genetic polymorphism in relation to colorectal neoplasia in a two-phase study. Mol Carcinog 2016; 55:1449-57. [PMID: 26333203 PMCID: PMC4775445 DOI: 10.1002/mc.22387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 12/20/2022]
Abstract
Some studies suggest that the calcium to magnesium ratio intakes modify the associations of calcium or magnesium with risk of colorectal adenoma, adenoma recurrence, and cancer. Parathyroid hormone (PTH) plays a key role in the regulation of homeostasis for both calcium and magnesium. We hypothesized that polymorphisms in PTH and 13 other genes may modify the association between the calcium/magnesium intake ratio and colorectal neoplasia risk. We conducted a two-phase study including 1336 cases and 2891 controls from the Tennessee Colorectal Polyp Study. In Phase I, we identified 19 SNPs that significantly interacted with the calcium/magnesium intake ratio in adenoma risk. In Phase II, rs11022858 in PTH was replicated. In combined analysis of phases I and II, we found high calcium/magnesium intake ratio tended to be associated with a reduced risk of colorectal adenoma (P for trend, 0.040) among those who carried the TT genotype in rs11022858. In stratified analyses, calcium intake (≥ 1000 mg/d) was significantly associated with 64% reduced adenoma risk (OR = 0.36 (95% CI : 0.18-0.74)) among those homozygous for the minor allele (TT genotype) (P for trend, 0.012), but not associated with risk in other genotypes (CC/TC). Conversely, we found that highest magnesium intake was significantly associated with 27% reduced risk (OR = 0.73 (95% CI : 0.54-0.97)) of colorectal adenoma (P for trend, 0.026) among those who possessed the CC/TC genotypes, particularly among those with the TC genotype, whereas magnesium intake was not linked to risk among those with the TT genotype. These findings, if confirmed, will help for the development of personalized prevention strategies for colorectal cancer. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Xiangzhu Zhu
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Martha J Shrubsole
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Reid M Ness
- Department of Medicine, Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elizabeth A Hibler
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Qiuyin Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jirong Long
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zhi Chen
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Guoliang Li
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ming Jiang
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
| | - Edmond K Kabagambe
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bing Zhang
- Department of Biomedical informatics, Vanderbilt University, Nashville, Tennessee
| | - Walter E Smalley
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Department of Medicine, Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd L Edwards
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edward L Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Wei Zheng
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Qi Dai
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Geriatric, Research, Education and Clinical Center (GRECC), Nashville, Tennessee.
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
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150
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Voltaggio L, Cimino-Mathews A, Bishop JA, Argani P, Cuda JD, Epstein JI, Hruban RH, Netto GJ, Stoler MH, Taube JM, Vang R, Westra WH, Montgomery EA. Current concepts in the diagnosis and pathobiology of intraepithelial neoplasia: A review by organ system. CA Cancer J Clin 2016; 66:408-36. [PMID: 27270763 DOI: 10.3322/caac.21350] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Answer questions and earn CME/CNE In this report, a team of surgical pathologists has provided a review of intraepithelial neoplasia in a host of (but not all) anatomic sites of interest to colleagues in various medical specialties, namely, uterine cervix, ovary, breast, lung, head and neck, skin, prostate, bladder, pancreas, and esophagus. There is more experience with more readily accessible sites (such as the uterine cervix and skin) than with other anatomic sites, and the lack of uniform terminology, together with divergent biology in various sites, makes it difficult to paint a unifying, relevant portrait. The authors' aim was to provide a framework from which to move forward as we care for patients with such precancerous lesions. CA Cancer J Clin 2016;66:408-436. © 2016 American Cancer Society.
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Affiliation(s)
- Lysandra Voltaggio
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ashley Cimino-Mathews
- Assistant Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Justin A Bishop
- Associate Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Pedram Argani
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan D Cuda
- Assistant Professor of Dermatology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jonathan I Epstein
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
- Professor of Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD
| | - Ralph H Hruban
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - George J Netto
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark H Stoler
- Professor of Pathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA
| | - Janis M Taube
- Associate Professor of Dermatology and Pathology, Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Russell Vang
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - William H Westra
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Elizabeth A Montgomery
- Professor of Pathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
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