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Batty CA, Cauchi M, Lourenço C, Hunter JO, Turner C. Use of the Analysis of the Volatile Faecal Metabolome in Screening for Colorectal Cancer. PLoS One 2015; 10:e0130301. [PMID: 26086914 PMCID: PMC4472922 DOI: 10.1371/journal.pone.0130301] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/19/2015] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of colorectal cancer is an invasive and expensive colonoscopy, which is usually carried out after a positive screening test. Unfortunately, existing screening tests lack specificity and sensitivity, hence many unnecessary colonoscopies are performed. Here we report on a potential new screening test for colorectal cancer based on the analysis of volatile organic compounds (VOCs) in the headspace of faecal samples. Faecal samples were obtained from subjects who had a positive faecal occult blood sample (FOBT). Subjects subsequently had colonoscopies performed to classify them into low risk (non-cancer) and high risk (colorectal cancer) groups. Volatile organic compounds were analysed by selected ion flow tube mass spectrometry (SIFT-MS) and then data were analysed using both univariate and multivariate statistical methods. Ions most likely from hydrogen sulphide, dimethyl sulphide and dimethyl disulphide are statistically significantly higher in samples from high risk rather than low risk subjects. Results using multivariate methods show that the test gives a correct classification of 75% with 78% specificity and 72% sensitivity on FOBT positive samples, offering a potentially effective alternative to FOBT.
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Affiliation(s)
- Claire A Batty
- Dept. Life, Health & Chemical Sciences, The Open University, Walton Hall, Milton Keynes, United Kingdom
| | - Michael Cauchi
- Centre for Biomedical Engineering, Cranfield University, Cranfield, Bedfordshire, United Kingdom
| | - Célia Lourenço
- Dept. Life, Health & Chemical Sciences, The Open University, Walton Hall, Milton Keynes, United Kingdom
| | - John O Hunter
- Gastroenterology Research Dept., Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Claire Turner
- Dept. Life, Health & Chemical Sciences, The Open University, Walton Hall, Milton Keynes, United Kingdom
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102
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Gordon NP, Green BB. Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study. BMC Public Health 2015; 15:546. [PMID: 26062732 PMCID: PMC4462185 DOI: 10.1186/s12889-015-1908-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/04/2015] [Indexed: 12/11/2022] Open
Abstract
Background The one-sample fecal immunochemical test (FIT) is gaining popularity for colorectal cancer (CRC) screening of average-risk people. However, uptake and annual use remain suboptimal. Methods In 2013, we mailed questionnaires to three groups of nonHispanic White, Black, and Latino Kaiser Permanente Northern California (KPNC) members ages 52–76 who received FIT kits in 2010–2012: Continuers did the FIT all 3 years; Converts in 2012, but not 2010 or 2011; and Nonusers in none of the 3 years. The questionnaires covered social influences, perceived CRC risk, reasons for using (Continuers, Converts) or avoiding using (Nonusers) the FIT, and recommendations for improving the kit. Results Continuers (n = 607, response rate 67.5 %), Converts (n = 317, response rate 35.6 %), and Nonusers (n = 215, response rate 21.1 %) did not differ in perceived risk or family history of CRC, but Nonusers were less likely than Continuers and Converts to know someone who had polyps or CRC. Continuers, Converts, and Nonusers did not differ in social network encouragement of CRC screening, but did differ in believing that it was very important that they be screened (88.3 %, 68.4 %, 47.7 %) and that their medical team thought it very important that they be screened (88.6 %, 79.9 %, 53.9 %). Approximately half of Continuers and Converts completed the FIT to please their doctor. Converts were less likely than Continuers to use the FIT to “make sure they were OK” (53.7 % vs. 72.6 %) or “protect their health” (46.1 % vs. 76.4 %). Nearly half of Converts completed the FIT out of guilt. Approximately half of FIT kit users suggested adding a disposable glove, extra paper, and wider-mouth tube to the kit. Nonusers’ reasons for not using the FIT included discomfort, disgust, or embarrassment (59.6 %); thinking it unnecessary (32.9 %); fatalism/fear (15.5 %); and thinking it too difficult to use (14.5 %), but <10 % did not want CRC screening at all. Conclusions Nonusers and irregular users of the FIT are less intrinsically motivated to get CRC screening than long-term users and more averse to preparing their stool sample. Changes to the FIT kit to address discomfort and difficulty factors might improve uptake and continued use. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1908-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, Oakland, CA, 94611, USA.
| | - Beverly B Green
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA. greenb.@ghc.org
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103
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Fedewa SA, Goodman M, Flanders WD, Han X, Smith RA, M Ward E, Doubeni CA, Sauer AG, Jemal A. Elimination of cost-sharing and receipt of screening for colorectal and breast cancer. Cancer 2015; 121:3272-80. [PMID: 26042576 DOI: 10.1002/cncr.29494] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/20/2015] [Accepted: 05/07/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of the cost-sharing provision of the Patient Protection and Affordable Care Act (ACA) was to reduce financial barriers for preventive services, including screening for colorectal cancer (CRC) and breast cancer (BC) among privately and Medicare-insured individuals. Whether the provision has affected CRC and BC screening prevalence is unknown. The current study investigated whether CRC and BC screening prevalence among privately and Medicare-insured adults by socioeconomic status (SES) changed before and after the ACA. METHODS Data obtained from the National Health Interview Survey pertaining to privately and Medicare-insured adults from 2008 (before the ACA) and 2013 (after the ACA) were used. There were 15,786 adults aged 50 to 75 years in the CRC screening analysis and 14,530 women aged ≥40 years in the BC screening analysis. Changes in guideline-recommended screening between 2008 and 2013 by SES were expressed as the prevalence difference (PD) and 95% confidence interval (95% CI) adjusted for demographics, insurance, income, education, body mass index, and having a usual provider. RESULTS Overall, CRC screening prevalence increased from 57.3% to 61.2% between 2008 and 2013 (P<.001). Adjusted CRC screening prevalence during the corresponding period increased in low-income (PD, 5.9; 95% CI, 1.8 to 10.2), least-educated (PD, 7.2; 95% CI, 0.9 to 13.5), and Medicare-insured (PD, 6.2; 95% CI, 1.7 to 10.7) individuals, but not in high-income, most-educated, and privately insured respondents. BC screening remained unchanged overall (70.5% in 2008 vs 70.2% in 2013) and in the low SES groups. CONCLUSIONS Increases in CRC screening prevalence between 2008 and 2013 were confined to respondents with low SES. These findings may in part reflect the ACA's removal of financial barriers.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - W Dana Flanders
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Science, American Cancer Society, Atlanta, Georgia
| | - Elizabeth M Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Department of Epidemiology, Emory University, Atlanta, Georgia
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104
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Brown-Kramer CR, Kiviniemi MT. Affective associations and cognitive beliefs relate to individuals’ decisions to perform testicular or breast self-exams. J Behav Med 2015; 38:664-72. [DOI: 10.1007/s10865-015-9641-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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105
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Disgusted, embarrassed, annoyed: affective associations relate to uptake of colonoscopy screening. Ann Behav Med 2015; 48:112-9. [PMID: 24500079 DOI: 10.1007/s12160-013-9580-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening is lower than desired. Screening decision making research has traditionally focused on benefits and barriers to screening. This study examines the relation of affective associations with screening (feelings and emotions associated with screening) to colonoscopy screening uptake. METHODS Participants were 103 African American community adults. Participants completed a structured interview assessing perceived benefits of and barriers to colonoscopy screening, affective associations with colonoscopy, colonoscopy screening behavior, and intentions for future screening. RESULTS Higher positive and lower negative affective associations with screening were both significant predictors of colonoscopy uptake. Affective associations fully mediated the relation of perceived benefits and barriers to screening uptake. Affective associations were associated with intentions for future screening. CONCLUSIONS Incorporation of affective associations into models of screening decision making and intervention approaches to address screening compliance has utility for advancing our understanding of screening adherence as well as increasing screening rates.
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106
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Patel SG, Lowery JT, Gatof D, Ahnen DJ. Practical opportunities to improve early detection and prevention of colorectal cancer (CRC) in members of high-risk families. Dig Dis Sci 2015; 60:748-61. [PMID: 25698379 DOI: 10.1007/s10620-015-3567-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/28/2015] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) incidence and mortality are steadily declining and CRC screening rates are increasing in the United States. Although this a very good news, several definable groups still have very low screening rates including younger (under age 50) members of high-risk CRC families. This opinion piece describes five strategies that could be incorporated into routine practice to improve identification and guideline-based screening in members of high-risk families. Routine incorporation of a simple family history screening tool and outreach to high-risk family members could substantially improve guideline-based screening in this population. Identification of CRCs and advanced adenomas in the endoscopy suite defines another group of high-risk families for similar outreach. Lynch syndrome families can be identified by testing CRCs and selected adenomas for microsatellite instability or loss of DNA repair protein expression. Finally, selective addition of aspirin to surveillance endoscopy can decrease the risk of new adenomas and CRCs. The rationale for these strategies as well as mechanisms for their implementation and evaluation in clinical practice is described.
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Affiliation(s)
- S G Patel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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107
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Ent MR, Gerend MA. Cognitive dissonance and attitudes toward unpleasant medical screenings. J Health Psychol 2015; 21:2075-84. [PMID: 27535832 DOI: 10.1177/1359105315570986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two studies suggest that cognitive dissonance can lead people to adopt negative attitudes toward beneficial-yet unpleasant-medical screenings. People who thought that they were candidates for an unpleasant medical screening reported less favorable attitudes toward the screening than people who thought that they were ineligible (Study 1). The unpleasantness of a medical screening affected candidates' attitudes toward the screening to a greater extent than non-candidate's attitudes (Study 2). Limitations, including ambiguity regarding the extent to which participants' attitudes were affected specifically by dissonance, are discussed. This preliminary research suggests people attempt to reduce dissonance associated with their anticipated behavior.
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108
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Fernández ME, Savas LS, Wilson KM, Byrd TL, Atkinson J, Torres-Vigil I, Vernon SW. Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border. HEALTH EDUCATION & BEHAVIOR 2015; 42:16-25. [PMID: 24786793 PMCID: PMC4214900 DOI: 10.1177/1090198114529592] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. METHOD Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). RESULTS In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. CONCLUSION CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
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Affiliation(s)
| | - Lara S Savas
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Theresa L Byrd
- Department of Family and Community Medicine, Texas Tech Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - John Atkinson
- University of Texas School of Public Health, Houston, TX, USA
| | - Isabel Torres-Vigil
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA Dorothy I. Height Center for Health Equity & Evaluation Research, University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Sally W Vernon
- University of Texas School of Public Health, Houston, TX, USA
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109
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Plascak JJ, Fisher JL, Paskett ED. Primary care physician supply, insurance type, and late-stage cancer diagnosis. Am J Prev Med 2015; 48:174-178. [PMID: 25441233 PMCID: PMC4302041 DOI: 10.1016/j.amepre.2014.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/09/2014] [Accepted: 08/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Understanding the joint effects of insurance type and primary care physician density on stage at diagnosis is essential to elucidating the healthcare access and late-stage cancer relationship. PURPOSE To determine if the relationship between primary care physician density and odds of late-stage cancer are modified by insurance type at diagnosis. METHODS Case patients were Ohio adults diagnosed between 1996 and 2008 with cancer of one of the following sites: female breast, cervix, colon/rectum, lung/bronchus, melanoma of the skin, oral cavity and pharynx, or prostate (N=376,425). County-level physician density was obtained from the Ohio Department of Health. Multilevel logistic regression models estimated odds ratios of late-stage cancer diagnosis associated with increases in primary care physician density by insurance type. Analyses were conducted in 2014. RESULTS Decreases in late-stage diagnosis of cancers of the breast, prostate, melanoma of the skin, oral cavity and pharynx, or lung/bronchus associated with increases in primary care physician density were strongest among those with private insurance, whereas those with Medicare (prostate, oral cavity and pharynx, lung/bronchus), Medicaid (lung/bronchus), uninsured (prostate), and other/unknown (prostate, oral cavity and pharynx, lung/bronchus) did not benefit as greatly, or experienced significant increases in late-stage cancer diagnosis (other/unknown [female breast], Medicaid [melanoma of the skin], and uninsured [colon/rectum]). CONCLUSIONS As primary care physician density increases, those with private insurance consistently benefit the most in terms of late-stage cancer diagnosis, whereas those with several other insurance types experience flatter decreases or significantly higher odds of late-stage cancer diagnosis.
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Affiliation(s)
- Jesse J Plascak
- Department of Health Services, School of Public Health, The University of Washington, Seattle, Washington.
| | | | - Electra D Paskett
- James Cancer Hospital and Solove Research Institute; Division of Cancer Control and Prevention, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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110
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Dominick GM, Papas MA, Rogers ML, Rakowski W. Classification tree analysis to examine influences on colorectal cancer screening. Cancer Causes Control 2015; 26:443-54. [DOI: 10.1007/s10552-015-0523-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/07/2015] [Indexed: 11/25/2022]
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111
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Ohri N, Rapkin BD, Guha D, Haynes-Lewis H, Guha C, Kalnicki S, Garg M. Predictors of Radiation Therapy Noncompliance in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys 2015; 91:232-8. [DOI: 10.1016/j.ijrobp.2014.09.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/26/2022]
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112
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A randomized controlled trial of two interventions to increase colorectal cancer screening among Hispanics on the Texas-Mexico border. Cancer Causes Control 2014; 26:1-10. [PMID: 25466604 DOI: 10.1007/s10552-014-0472-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second and third leading cause of cancer death for Hispanic men and women, respectively. CRC can be prevented if precursors are detected early and removed and can be successfully treated if discovered early. While one-on-one interventions for increasing CRC screening (CRCS) are recommended, few studies specifically assess the effectiveness of lay health worker (LHW) approaches using different educational materials. PURPOSE To develop and evaluate the effectiveness of two LHW-delivered CRCS interventions known as Vale la Pena (VLP; "It's Worth It!") on increasing CRCS among Hispanics. DESIGN The study design was a cluster randomized controlled trial with two treatment arms. SETTING/PARTICIPANTS Six hundred and sixty five Hispanics 50 years and older were recruited from 24 colonias (neighborhoods) in the Lower Rio Grande Valley of the Texas-Mexico border. INTERVENTION The interventions were a small media print intervention (SMPI) (including DVD and flipchart), and a tailored interactive multimedia intervention (TIMI) delivered on tablet computers. A no intervention group served as the comparison group. Data were collected between 2007 and 2009 and analyzed between 2009 and 2013. MAIN OUTCOME MEASURES Measures assessed CRCS behavior, self-efficacy, knowledge, and other psychosocial constructs related to CRCS and targeted through VLP. RESULTS Among participants reached for follow-up, 18.9 % in the SMPI group, 13.3 % in the TIMI group, and 11.9 % in the comparison group completed CRCS. Intent-to-treat analysis showed that 13.6 % in the SMPI group, 10.2 % in the TIMI group, and 10.8 % in the comparison group completed CRCS. These differences were not statistically significant. CONCLUSION Results indicated that there are no significant differences in CRCS uptake between groups.
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113
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Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
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Clarke N, Sharp L, Osborne A, Kearney PM. Comparison of Uptake of Colorectal Cancer Screening Based on Fecal Immunochemical Testing (FIT) in Males and Females: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 24:39-47. [DOI: 10.1158/1055-9965.epi-14-0774] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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115
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Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Increasing colorectal cancer screening in an overdue population: participation and cost impacts of adding telephone calls to a FIT mailing program. J Community Health 2014; 39:239-47. [PMID: 24499966 DOI: 10.1007/s10900-014-9830-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.
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Affiliation(s)
- Jennifer A Schlichting
- VA Office of Rural Health, Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, USA
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Militello LG, Borders MR, Arbuckle NB, Flanagan ME, Hall NP, Saleem JJ, Doebbeling BN. Persuasive health educational materials for colorectal cancer screening. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/1541931214581130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This paper describes an effort to design and evaluate persuasive educational materials for colorectal cancer (CRC) screening. Although CRC screening is highly effective, screening rates in the US remain low. Educational materials represent one strategy for educating patients about screening options and increasing openness to screening. We developed a one-page brochure, leveraging factual information from the Centers for Disease Control and Prevention (CDC) and national guidelines, and strategies for persuasion from the human factors and behavioral economics literatures. We evaluated the resulting brochure with adults over the age of 50. Findings suggest that the educational brochure increases knowledge of CRC and screening options, and increases openness to screening. Furthermore, no significant difference was found between the new one-page brochure and an existing multi-page Screen for Life brochure recommended by the CDC. We interpret these findings as indication that the more practical and potentially less intimidating one-page brochure is as effective as the existing multi-page Screen for Life brochure.
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Lu H, Huang S, Zhang X, Wang D, Zhang X, Yuan X, Zhang Q, Huang Z. DNA methylation analysis of SFRP2, GATA4/5, NDRG4 and VIM for the detection of colorectal cancer in fecal DNA. Oncol Lett 2014; 8:1751-1756. [PMID: 25202404 PMCID: PMC4156205 DOI: 10.3892/ol.2014.2413] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/18/2014] [Indexed: 01/22/2023] Open
Abstract
Aberrantly methylated genes are increasingly being established as biomarkers for the detection of colorectal cancer (CRC). In the present study, the methylation levels of the secreted frizzled-related protein gene 2 (SFRP2), GATA binding protein 4/5 (GATA4/5), N-Myc downstream-regulated gene 4 (NDRG4) and vimentin (VIM) promoters were evaluated for their use as markers in the noninvasive detection of CRC. Methylation-specific polymerase chain reaction was performed to analyze promoter CpG methylation of SFRP2, GATA4/5, NDRG4 and VIM in the fecal DNA of 56 patients with CRC and 40 individuals exhibiting normal colonoscopy results. Promoter methylation levels of SFRP2, GATA4/5, NDRG4 and VIM in CRC patients were 57.1% (32/56), 42.9% (24/56), 83.9% (47/56), 28.6% (16/56) and 41.1% (23/56), respectively. Furthermore, the specificity of the genes were 90.0% (4/40), 95.0% (2/40), 82.5% (7/40), 97.5% (4/40) and 85.0% (6/40), respectively. The overall sensitivity of detection for fecal DNA with at least one methylated gene was 96.4% (54/56) in CRC patients. By contrast, only 14 of the 40 normal individuals exhibited methylated DNA in the aforementioned promoter regions. Methylation of the SFRP2, GATA4/5, NDRG4 and VIM promoters in fecal DNA is associated with the presence of colorectal tumors. Therefore, the detection of aberrantly methylated DNA in fecal samples may present a promising, noninvasive screening method for CRC.
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Affiliation(s)
- Hongna Lu
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China ; Medical School of Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Shiliang Huang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Xie Zhang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Danping Wang
- Medical School of Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Xuesong Zhang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Xiaogang Yuan
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Qiubo Zhang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Zhigang Huang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, Zhejiang 315040, P.R. China
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Zorzi M, Giorgi Rossi P, Cogo C, Falcini F, Giorgi D, Grazzini G, Mariotti L, Matarese V, Soppelsa F, Senore C, Ferro A. A comparison of different strategies used to invite subjects with a positive faecal occult blood test to a colonoscopy assessment. A randomised controlled trial in population-based screening programmes. Prev Med 2014; 65:70-6. [PMID: 24811759 DOI: 10.1016/j.ypmed.2014.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this parallel randomised controlled trial was to compare compliance with different modalities used to invite patients with a positive immunochemical faecal occult blood test (FIT+) for a total colonoscopy (TC). METHOD FIT+ patients from nine Italian colorectal cancer screening programmes were randomised to be invited for a TC initially by mail or by phone and, for non-compliers, to be recalled by mail, for counselling with a general practitioner, or to meet with a specialist screening practitioner (nurse or healthcare assistant). RESULTS In all, 3777 patients were randomised to different invitation strategies. Compliance with an initial invitation by mail and by phone was similar (86.0% vs. 84.0%, relative risk - RR: 1.02; 95%CI 0.97-1.08). Among non-responders to the initial invitation, compliance with a recall by appointment with a specialist practitioner was 50.4%, significantly higher than with a mail recall (38.1%; RR:1.33; 95%CI 1.01-1.76) or with a face-to-face counselling with the GP (30.8%; RR:1.45;95%CI 1.14-1.87). CONCLUSION Compliance with an initial invitation for a TC by mail and by phone was similar. A personal meeting with a specialist screening practitioner was associated with the highest compliance among non-compliers with initial invitations, while the involvement of GPs in this particular activity seemed less effective.
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Affiliation(s)
- Manuel Zorzi
- Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy.
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Sanitaria Locale di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy.
| | - Carla Cogo
- Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy.
| | - Fabio Falcini
- Unità Operativa di Prevenzione Oncologica, Ospedale Civile G.B. Morgagni L. Pierantoni, AUSL di Forlì, via Forlanini 34, Forlì, Italy.
| | - Daniela Giorgi
- S.C. Epidemiologia e Screening, Azienda Sanitaria Locale 2 di Lucca, via per Sant'Alessio - Monte San Quirico, Lucca, Italy.
| | - Grazia Grazzini
- Screening Unit Cancer Prevention and Research Institute ISPO, via Cosimo il Vecchio 2, Firenze, Italy.
| | - Loretta Mariotti
- Laboratorio Unico di Screening, Azienda Sanitaria Locale 2 di Perugia, via XIV settembre 75, Perugia, Italy.
| | - Vincenzo Matarese
- Unità Operativa di Gastroenterologia, Azienda Ospedaliero-Universitaria S. Anna, Cona-Ferrara, via Moro 8, Cona,FE, Italy.
| | - Fabio Soppelsa
- Dipartimento di Prevenzione, Azienda Sanitaria Locale 1 di Belluno, via S. Andrea 8, Belluno, Italy.
| | - Carlo Senore
- Centro per la Prevenzione Oncologica (CPO), via San Francesco da Paola 31, Torino, Italy.
| | - Antonio Ferro
- Dipartimento di Prevenzione, Azienda Sanitaria Locale 17 di Este Monselice, via Francesconi 2, Este,PD, Italy.
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119
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Shah R, Jones E, Vidart V, Kuppen PJK, Conti JA, Francis NK. Biomarkers for early detection of colorectal cancer and polyps: systematic review. Cancer Epidemiol Biomarkers Prev 2014; 23:1712-28. [PMID: 25004920 DOI: 10.1158/1055-9965.epi-14-0412] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
There is growing interest in early detection of colorectal cancer as current screening modalities lack compliance and specificity. This study systematically reviewed the literature to identify biomarkers for early detection of colorectal cancer and polyps. Literature searches were conducted for relevant papers since 2007. Human studies reporting on early detection of colorectal cancer and polyps using biomarkers were included. Methodologic quality was evaluated, and sensitivity, specificity, and the positive predictive value (PPV) were reported. The search strategy identified 3,348 abstracts. A total of 44 papers, examining 67 different tumor markers, were included. Overall sensitivities for colorectal cancer detection by fecal DNA markers ranged from 53% to 87%. Combining fecal DNA markers increased the sensitivity of colorectal cancer and adenoma detection. Canine scent detection had a sensitivity of detecting colorectal cancer of 99% and specificity of 97%. The PPV of immunochemical fecal occult blood test (iFOBT) is 1.26%, compared with 0.31% for the current screening method of guaiac fecal occult blood test (gFOBT). A panel of serum protein biomarkers provides a sensitivity and specificity above 85% for all stages of colorectal cancer, and a PPV of 0.72%. Combinations of fecal and serum biomarkers produce higher sensitivities, specificities, and PPVs for early detection of colorectal cancer and adenomas. Further research is required to validate these biomarkers in a well-structured population-based study.
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Affiliation(s)
- Reena Shah
- Yeovil District Hospital NHS Trust, Yeovil, United Kingdom.
| | - Emma Jones
- University of Leicester, Leicester, United Kingdom
| | | | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - John A Conti
- Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom. University of Southampton, Southampton, United Kingdom
| | - Nader K Francis
- Yeovil District Hospital NHS Trust, Yeovil, United Kingdom. University of Bristol, Bristol, United Kingdom
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120
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Kaminski MF, Polkowski M, Kraszewska E, Rupinski M, Butruk E, Regula J. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut 2014; 63:1112-9. [PMID: 24385598 PMCID: PMC4078748 DOI: 10.1136/gutjnl-2013-304965] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a model to estimate the likelihood of detecting advanced colorectal neoplasia in Caucasian patients. DESIGN We performed a cross-sectional analysis of database records for 40-year-old to 66-year-old patients who entered a national primary colonoscopy-based screening programme for colorectal cancer in 73 centres in Poland in the year 2007. We used multivariate logistic regression to investigate the associations between clinical variables and the presence of advanced neoplasia in a randomly selected test set, and confirmed the associations in a validation set. We used model coefficients to develop a risk score for detection of advanced colorectal neoplasia. RESULTS Advanced colorectal neoplasia was detected in 2544 of the 35,918 included participants (7.1%). In the test set, a logistic-regression model showed that independent risk factors for advanced colorectal neoplasia were: age, sex, family history of colorectal cancer, cigarette smoking (p<0.001 for these four factors), and Body Mass Index (p=0.033). In the validation set, the model was well calibrated (ratio of expected to observed risk of advanced neoplasia: 1.00 (95% CI 0.95 to 1.06)) and had moderate discriminatory power (c-statistic 0.62). We developed a score that estimated the likelihood of detecting advanced neoplasia in the validation set, from 1.32% for patients scoring 0, to 19.12% for patients scoring 7-8. CONCLUSIONS Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.
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Affiliation(s)
- Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Marcin Polkowski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Ewa Kraszewska
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Maciej Rupinski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | - Jaroslaw Regula
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland
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A large cross-sectional survey investigating the knowledge of cervical cancer risk aetiology and the predictors of the adherence to cervical cancer screening related to mass media campaign. BIOMED RESEARCH INTERNATIONAL 2014; 2014:304602. [PMID: 25013772 PMCID: PMC4075131 DOI: 10.1155/2014/304602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/27/2014] [Indexed: 12/02/2022]
Abstract
Objectives. The aims of this study were to compare the characteristics of women who got a Pap-test during the mass media campaign, carried out in an Italian region by broadcasts advertising, and two years later and to identify the determinants of knowledge of cervical cancer etiology and of the adherence to the mass media campaign. Methods. A cross-sectional survey was carried out through a self-administered questionnaire. Results. A total of 8570 randomly selected women were surveyed, 823 of these had a Pap-test during the mass media campaign period and 7747 two years later. Higher educational level, being not married, and living in urban areas were the main independent characteristics associated with a higher level of knowledge of cervical cancer etiology, although a previous treatment following a Pap smear abnormality was the strongest predictor (OR = 2.88; 95% CI: 2.43–3.41). During the campaign period women had the Pap-test more frequently as a consequence of the mass media campaign (OR = 8.28; 95% CI; 5.51–12.45). Conclusions. Mass media campaign is a useful tool to foster cervical screening compliance; however, its short-term effect suggests repeating it regularly.
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den Hoed CM, Isendoorn K, Klinkhamer W, Gupta A, Kuipers EJ. The societal gain of medical development and innovation in gastroenterology. United European Gastroenterol J 2014; 1:335-45. [PMID: 24917981 DOI: 10.1177/2050640613502337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/29/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gastroenterology has over the past 30 years evolved very rapidly. The societal benefits to which this has led are incompletely determined, yet form a mandate to determine the need for future innovations and further development of the field. A more thorough understanding of societal benefits may help to determine future goals and improve decision making. AIMS The objective of this article is to determine the societal gains of medical innovations in the field of gastroenterology in the past and future, using peptic ulcer disease as an example of past innovation and the implementation of colorectal cancer screening as an illustration of future gains. METHODS Literature searches were performed for data on peptic ulcer and colorectal cancer epidemiology, treatment outcomes, and costs. National and governmental databases in the Netherlands were searched to obtain the input for calculations of quality-adjusted life years (QALYs), health-adjusted life expectancy (HALE), and the corresponding societal benefit. RESULTS Since 1980 the improvements in peptic ulcer treatment have had a limited impact on life expectancy, rising from 83.6 years to 83.7 years, but have led to a yearly gain of 46,000 QALYs, caused by improved quality of life. These developments in the field of peptic ulcer translated into a yearly gain of 1.8 billion to 7.8 billion euros in 2008 compared with the 1980s. Mortality due to colorectal cancer is high, with 21.6 deaths per 100,000 per year in the Netherlands (European Standardized Rate (ESR)). The future implementation of a nationwide call-recall colorectal cancer screening by means of biennial fecal immunochemical testing (FIT) is expected to result in a 50%-80% mortality reduction and thus a gain of an estimated 35,000 life years per year, corresponding to 26,000 QALYs per year. The effects of the implementation of FIT screening can be translated to a future societal gain of 1.0 billion to 4.4 billion euro. CONCLUSIONS The innovations and developments in the field of gastroenterology have led to significant societal gains in the past three decades. This process will continue in the near future as a result of further developments. These calculations provide a template for calculations on the need for specialist training as well as research and implementation of new developments in our field.
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Affiliation(s)
| | | | | | - Anshu Gupta
- Gupta Strategists, Ophemert, the Netherlands
| | - Ernst J Kuipers
- Departments of Gastroenterology and Hepatology ; Departments of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Exploring the validity of the continuum of resistance model for discriminating early from late and non-uptake of colorectal cancer screening: implications for the design of invitation and reminder letters. Int J Behav Med 2014; 20:572-81. [PMID: 22865004 DOI: 10.1007/s12529-012-9254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The continuum of resistance model contends that respondents lie at one end of a continuum and non-respondents at the other with respect to factors demonstrated to impact on screening participation. PURPOSE The aim of this study was to explore the validity of this model for the prediction of participation in colorectal cancer screening. METHOD People aged 50 to 74 years were asked to complete a survey (n = 1,250). Eligible respondents (n = 376, 30 %) were invited to complete a faecal occult blood test (FOBT). The cutoff period for the determination of participation rates was 12 weeks, with a reminder sent at 6 weeks. RESULTS FOBTs were returned by n = 196 people (132 within 6 weeks, 64 following a reminder). Participation was generally influenced by the same variables in both the first 6 weeks and the second 6 weeks, consistent with the continuum of resistance model. These variables were having known someone with bowel cancer and the social cognitive factor, perceptions of barriers to screening. There is a suggestion, however, that other factors may be differentially associated with early, late and non-participants. CONCLUSION Participation in screening appears somewhat consistent with the continuum of resistance model in that early and late participants respond to some of the same factors. This suggests that the same messages are relevant to early, late and non-screeners, but further consideration of what other factors may be influencing discrete stages of readiness to participate is necessary.
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124
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Matro JM, Ruth KJ, Wong YN, McCully KC, Rybak CM, Meropol NJ, Hall MJ. Cost sharing and hereditary cancer risk: predictors of willingness-to-pay for genetic testing. J Genet Couns 2014; 23:1002-11. [PMID: 24794065 DOI: 10.1007/s10897-014-9724-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/09/2014] [Indexed: 12/19/2022]
Abstract
Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost-sharing practices. Little is known about how demographic and psychosocial factors may influence individuals' willingness-to-pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness-to-pay items include intention for: genetic testing only if paid by insurance; testing with self-pay; and amount willing-to-pay ($25-$2,000). Multivariable models examined predictors of willingness-to-pay out-of-pocket (versus only if paid by insurance) and willingness-to-pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two-sided (α = 0.05). Of 385 evaluable participants, a minority (42%) had a personal cancer history, while 56% had ≥1 first-degree relative with colorectal cancer. Overall, 21.3% were willing to have testing only if paid by insurance, and 78.7% were willing-to-pay. Predictors of willingness-to-pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p < 0.05). Subjects willing-to-pay a higher amount were male, more educated, had greater cancer worry, fewer relatives with colorectal cancer, and more positive attitudes toward genetic testing (all p < 0.05). Individuals seeking risk assessment are willing-to-pay out-of-pocket for genetic testing, and anticipate benefits to reducing cancer risk. Identifying factors associated with willingness-to-pay for genetic services is increasingly important as testing is integrated into routine cancer care.
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Affiliation(s)
- Jennifer M Matro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA,
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Abstract
There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the United States, which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 51-75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR = 1.04, 95 % CI 1.01, 1.07), had higher income ($30,000-$60,000, OR = 1.92, 95 % CI 1.29, 2.86; ≥$60,000, OR = 1.80, 95 % CI 1.19, 2.72), a primary care provider (OR = 4.22, 95 % CI 1.33, 13.39), a recent check-up (OR = 2.37, 95 % CI 1.12, 4.99), had been encouraged to be screened (OR = 1.57, 95 % CI 1.11, 2.22), had been recommended by their doctor to be screened (OR = 6.68, 95 % CI 3.87, 11.52), or asked their doctor to order a screening test (OR = 2.24, 95 % CI 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.
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van Dam L, Bretthauer M. Ethical issues in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2014; 28:315-26. [PMID: 24810192 DOI: 10.1016/j.bpg.2014.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 02/07/2023]
Abstract
In many countries, colorectal cancer screening is currently an established population screening program due to the evidence on its reduction of colorectal cancer mortality. There is general consensus that colorectal cancer screening meets the screening criteria as proposed by Wilson and Jungner. However, as for all population screening programs, colorectal cancer screening also has disadvantages and thereby entails ethical issues. There are the general issues concerning the introduction of screening programs (e.g. medicalization, overdiagnosis and overtreatment, information provision to screenees), evaluation of cancer screening programs (e.g. lead time and length bias), chosen screening method (e.g. false-positive and false-negative test results, reduction of all-cause mortality, choice between different screening methods). The different colorectal cancer screening methods and the ethical issues concerning colorectal cancer screening will be discussed in this review.
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Affiliation(s)
- Leonie van Dam
- Department of Gastroenterology and Hepatology, University Medical Centre Rotterdam, The Netherlands; Department of Medical Ethics and Philosophy, University Medical Centre Rotterdam, The Netherlands.
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Oslo, Norway.
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Gimeno Garcia AZ, Hernandez Alvarez Buylla N, Nicolas-Perez D, Quintero E. Public awareness of colorectal cancer screening: knowledge, attitudes, and interventions for increasing screening uptake. ISRN ONCOLOGY 2014; 2014:425787. [PMID: 24729896 PMCID: PMC3963118 DOI: 10.1155/2014/425787] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
Abstract
Colorectal cancer ranks as one of the most incidental and death malignancies worldwide. Colorectal cancer screening has proven its benefit in terms of incidence and mortality reduction in randomized controlled trials. In fact, it has been recommended by medical organizations either in average-risk or family-risk populations. Success of a screening campaign highly depends on how compliant the target population is. Several factors influence colorectal cancer screening uptake including sociodemographics, provider and healthcare system factors, and psychosocial factors. Awareness of the target population of colorectal cancer and screening is crucial in order to increase screening participation rates. Knowledge about this disease and its prevention has been used across studies as a measurement of public awareness. Some studies found a positive relationship between knowledge about colorectal cancer, risk perception, and attitudes (perceived benefits and barriers against screening) and willingness to participate in a colorectal cancer screening campaign. The mentioned factors are modifiable and therefore susceptible of intervention. In fact, interventional studies focused on average-risk population have tried to increase colorectal cancer screening uptake by improving public knowledge and modifying attitudes. In the present paper, we reviewed the factors impacting adherence to colorectal cancer screening and interventions targeting participants for increasing screening uptake.
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Affiliation(s)
- Antonio Z Gimeno Garcia
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain ; Departamento de Gastroenterología, Hospital Universitario de Canarias, Unidad de Endoscopia, Ofra s/n, La Laguna, 38320 Tenerife, Spain
| | - Noemi Hernandez Alvarez Buylla
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
| | - David Nicolas-Perez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
| | - Enrique Quintero
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Unidad de Endoscopia, La Laguna, 38320 Tenerife, Spain
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Cooper CP, Gelb CA, Hawkins NA. How many "Get Screened" messages does it take? Evidence from colorectal cancer screening promotion in the United States, 2012. Prev Med 2014; 60:27-32. [PMID: 24333876 DOI: 10.1016/j.ypmed.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 11/30/2013] [Accepted: 12/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Colorectal cancer screening has been widely promoted in the United States. We investigated the association between reported exposure to screening information during the past year and screening participation and knowledge. METHOD Data from the 2012 HealthStyles Fall survey of U.S. adults were examined using adjusted logistic regression to examine the frequency of exposure to screening information as a predictor of screening participation and knowledge; analyses were limited to participants aged ≥50years with no history of colorectal cancer or polyps (N=1714). RESULTS Nearly half of the participants (44.9%) reported exposure to colorectal cancer screening information during the previous year. The most common sources of screening information were news reports, advertisements, and health care providers. Screening participation and knowledge consistently increased with the reported frequency of exposure to screening information, and these associations generally persisted when demographic variables were controlled. Compared with unexposed participants, significant gains in screening participation were associated with exposure to screening information 2-3 times (Adj. OR=1.84, p=0.001), 4-9 times (Adj. OR=2.00, p=0.001), and ≥10 times (Adj. OR=3.03, p<0.001) in the adjusted model. CONCLUSIONS Increasing public exposure to screening promotion messages may augment screening participation and knowledge.
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Affiliation(s)
| | - Cynthia A Gelb
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Nikki A Hawkins
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Affiliation(s)
- Navkiran K Shokar
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, 9849 Kenworthy Street, El Paso, TX, 79924, USA,
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Lafata JE, Cooper G, Divine G, Oja-Tebbe N, Flocke SA. Patient-physician colorectal cancer screening discussion content and patients' use of colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2014; 94:76-82. [PMID: 24094919 PMCID: PMC3865022 DOI: 10.1016/j.pec.2013.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 08/05/2013] [Accepted: 09/07/2013] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The US Preventive Services Task Force recommends using the 5As (i.e., Assess, Advise, Agree, Assist and Arrange) when discussing preventive services. We evaluate the association of the 5As discussion during primary care office visits with patients' subsequent colorectal cancer (CRC) screening use. METHODS Audio-recordings of n=443 periodic health exams among insured patients aged 50-80 years and due for CRC screening were joined with pre-visit patient surveys and screening use data from an electronic medical record. Association of the 5As with CRC screening was assessed using generalized estimating equations. RESULTS 93% of patients received a recommendation for screening (Advise) and 53% were screened in the following year. The likelihood of screening increased as the number of 5A steps increased: compared to patients whose visit contained no 5A step, those whose visit contained 1-2 steps (OR=2.96 [95% CI 1.16, 7.53]) and 3 or more steps (4.98 [95% CI 1.84, 13.44]) were significantly more likely to use screening. CONCLUSIONS Physician CRC screening recommendations that include recommended 5A steps are associated with increased patient adherence. PRACTICE IMPLICATIONS A CRC screening recommendation (Advise) that also describes patient eligibility (Assess) and provides help to obtain screening (Assist) may lead to improved adherence to CRC screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Virginia Commonwealth University, Richmond, USA; Henry Ford Health System, Detroit, USA.
| | - Greg Cooper
- Case Western Reserve University, Cleveland, USA
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de Castro SS, Cieza A, Cesar CLG. Persons with disabilities, cancer screening and related factors. CIENCIA & SAUDE COLETIVA 2013; 18:3705-14. [PMID: 24263886 DOI: 10.1590/s1413-81232013001200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/10/2012] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to describe persons with disabilities (PwD) being subjected to cancer screening and the relationship between some social variables and inequalities in performing these tests. A cross-sectional study of cancer screening among PwD was conducted in 2007 with 333 participants interviewed in residence in 4 cities of São Paulo. Variables in the practice of cancer screening, disabilities, gender, age, income of main family breadwinner, ethnicity, use of health services, assistance required, private health insurance, and coverage by the family health program were studied. Frequencies, χ²-test, trend χ² percentages and the Odds Ratios (OR) were used for data analysis. 44% of PwD attended at least one cancer screening at the appropriate time. Persons with visual disabilities and with hearing disabilities were subjected to more screening examinations than those with mobility disabilities and women were attended in screening exams more than men. Persons between the ages of 21 and 60 reported cancer screening more frequently than those between 80 and 97 years of age. The outcomes indicate that PwD have different attitudes toward cancer screening according to the type of disability, gender, and age, which were the variables that directly influenced cancer screening exams.
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132
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LoConte NK, Weeth-Feinstein L, Conlon A, Scott S. Engaging health systems to increase colorectal cancer screening: community-clinical outreach in underserved areas of Wisconsin. Prev Chronic Dis 2013; 10:E192. [PMID: 24262024 PMCID: PMC3839589 DOI: 10.5888/pcd10.130180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Colorectal cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related death in Wisconsin. Incidence and mortality rates for colorectal cancer vary by age, race/ethnicity, geography, and socioeconomic status. From 2010 through 2012, the Wisconsin Comprehensive Cancer Control Program awarded grants to 5 regional health systems for the purpose of planning and implementing events to increase colorectal cancer screening rates in underserved communities. Community Context Grantees were chosen for their ability to engage community partners in reaching underserved groups including African American, Hispanic/Latino, Hmong, rural, and uninsured populations in their service areas. Methods Grantees identified target populations for proposed screening events, designated institutional planning teams, engaged appropriate local partner organizations, and created plans for follow-up. All grantees implemented 1 or more colorectal cancer screening events within 6 months of receiving their awards. Events were conducted in 2 phases. Outcomes Participating health systems organized 36 screening events and distributed 633 individual test kits; 506 kits were returned, of which 57 (9%) tested positive for colorectal abnormalities. Of attendees who received screening, 63% were uninsured or underinsured, 55% had no previous screening, 46% were of a racial/ethnic minority group, 22% had a family history of cancer, and 13% were rural residents. This project strengthened partnerships between health systems and local organizations. Interpretation An effective strategy for improving colorectal cancer screening rates, particularly among underserved populations, is to award health systems grants for implementing community-based screening events in conjunction with community partners.
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Affiliation(s)
- Noelle K LoConte
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, CSC K4/548, Madison, WI 53792. E-mail:
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Pepper JK, Brewer NT. Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. Tob Control 2013; 23:375-84. [PMID: 24259045 DOI: 10.1136/tobaccocontrol-2013-051122] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We sought to systematically review the literature on electronic nicotine delivery systems (ENDS, also called electronic cigarettes) awareness, use, reactions and beliefs. DATA SOURCES We searched five databases for articles published between 2006 and 1 July 2013 that contained variations of the phrases 'electronic cigarette', 'e-cigarette' and 'electronic nicotine delivery'. STUDY SELECTION Of the 244 abstracts identified, we excluded articles not published in English, articles unrelated to ENDS, dissertation abstracts and articles without original data on prespecified outcomes. DATA EXTRACTION Two reviewers coded each article for ENDS awareness, use, reactions and beliefs. DATA SYNTHESIS 49 studies met inclusion criteria. ENDS awareness increased from 16% to 58% from 2009 to 2011, and use increased from 1% to 6%. The majority of users were current or former smokers. Many users found ENDS satisfying, and some engaged in dual use of ENDS and other tobacco. No longitudinal studies examined whether ENDS serve as 'gateways' to future tobacco use. Common reasons for using ENDS were quitting smoking and using a product that is healthier than cigarettes. Self-reported survey data and prospective trials suggest that ENDS might help cigarette smokers quit, but no randomised controlled trials with probability samples compared ENDS with other cessation tools. Some individuals used ENDS to avoid smoking restrictions. CONCLUSIONS ENDS use is expanding rapidly despite experts' concerns about safety, dual use and possible 'gateway' effects. More research is needed on effective public health messages, perceived health risks, validity of self-reports of smoking cessation and the use of different kinds of ENDS.
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Affiliation(s)
- Jessica K Pepper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Bae N, Park S, Lim S. Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea. Eur J Oncol Nurs 2013; 18:72-7. [PMID: 24183583 DOI: 10.1016/j.ejon.2013.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/23/2013] [Accepted: 09/03/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE Repeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002-2011) among adults using the Health Belief Model (HBM) after controlling for other covariates. METHODS Data were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis. RESULTS About 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT. CONCLUSIONS Health professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.
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Affiliation(s)
- Nayoung Bae
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
| | - Sunhee Park
- College of Nursing Science, East-West Nursing Research Institute, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 130-071, Republic of Korea.
| | - Sungwon Lim
- National Evidence-based Health Care Collaborating Agency, Seoul, Republic of Korea.
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Thorsen SB, Lundberg M, Villablanca A, Christensen SLT, Belling KC, Nielsen BS, Knowles M, Gee N, Nielsen HJ, Brünner N, Christensen IJ, Fredriksson S, Stenvang J, Assarsson E. Detection of serological biomarkers by proximity extension assay for detection of colorectal neoplasias in symptomatic individuals. J Transl Med 2013; 11:253. [PMID: 24107468 PMCID: PMC3827929 DOI: 10.1186/1479-5876-11-253] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/28/2013] [Indexed: 12/13/2022] Open
Abstract
Background Although the potential of biomarkers to aid in early detection of colorectal cancer (CRC) is recognized and numerous biomarker candidates have been reported in the literature, to date only few molecular markers have been approved for daily clinical use. Methods In order to improve the translation of biomarkers from the bench to clinical practice we initiated a biomarker study focusing on a novel technique, the proximity extension assay, with multiplexing capability and the possible additive effect obtained from biomarker panels. We performed a screening of 74 different biomarkers in plasma derived from a case–control sample set consisting of symptomatic individuals representing CRC patients, patients with adenoma, patients with non-neoplastic large bowel diseases and healthy individuals. Results After statistical evaluation we found 12 significant indicators of CRC and the receiver operating characteristic (ROC) curve of Carcinoembryonic antigen (CEA), Transferrin Receptor-1 (TFRC), Macrophage migration inhibitory factor (MIF), Osteopontin (OPN/SPP1) and cancer antigen 242 (CA242) showed additive effect. This biomarker panel identified CRC patients with a sensitivity of 56% at 90% specificity and thus the performance is sufficiently high to further investigate this combination of five proteins as serological biomarkers for detection of CRC. Furthermore, when applying the indicators to identify early-stage CRC a combination of CEA, TFRC and CA242 resulted in a ROC curve with an area under the curve of 0.861. Conclusions Five plasma protein biomarkers were found to be potential CRC discriminators and three of these were additionally found to be discriminators of early-stage CRC. These explorative data in symptomatic individuals demonstrates the feasibility of the multiplex proximity extension assay for screening of potential serological protein biomarkers and warrants independent analyses in a larger sample cohort, including asymptomatic individuals, to further validate the performances of our CRC biomarker panel.
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Affiliation(s)
- Stine Buch Thorsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
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Salimzadeh H, Eftekhar H, Majdzadeh R, Montazeri A, Delavari A. Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members: a randomized trial. J Behav Med 2013; 37:1019-29. [PMID: 24027014 DOI: 10.1007/s10865-013-9533-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 08/22/2013] [Indexed: 02/04/2023]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world. There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations. The present study was guided by the theoretical concepts of the preventive health model. Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio. The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call. Screening behavior, the main outcome, was assessed 4 months after randomization. A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey. Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up (p's < .001). Moreover, exposure to the theory-based intervention significantly improved self-efficacy, perceived susceptibility, efficacy of screening, social support, and intention to be screened for colorectal cancer, from baseline to 4 months follow-up (p's < .001). The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group (odds ratio = 15.93, 95% CI = 5.57, 45.53). Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report. The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations.
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Affiliation(s)
- Hamideh Salimzadeh
- Digestive Diseases Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Oster C, Zajac I, Flight I, Hart E, Young GP, Wilson C, Turnbull D. Ambivalence and its influence on participation in screening for colorectal cancer. QUALITATIVE HEALTH RESEARCH 2013; 23:1188-1201. [PMID: 23917801 DOI: 10.1177/1049732313501890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, and an ideal target for early detection and prevention through cancer screening. Unfortunately, rates of participation in screening are less than adequate. In this article we explore why people who were offered a fecal immunochemical test for CRC decided to participate or not, and for those who did participate, what influenced them to take action and complete the test. We conducted four focus groups and 30 telephone interviews with 63 people. The main reason people decided to screen was "wanting to know" their CRC status, which operated on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of participants expressed ambivalence about CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced.
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Affiliation(s)
- Candice Oster
- University of Adelaide, Adelaide, South Australia, Australia.
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Chao S, Ying J, Liew G, Marshall W, Liew CC, Burakoff R. Blood RNA biomarker panel detects both left- and right-sided colorectal neoplasms: a case-control study. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:44. [PMID: 23876008 PMCID: PMC3734158 DOI: 10.1186/1756-9966-32-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/17/2013] [Indexed: 12/14/2022]
Abstract
Background Colonoscopy is widely regarded to be the gold standard for colorectal cancer (CRC) detection. Recent studies, however, suggest that the effectiveness of colonoscopy is mostly confined to tumors on the left side of the colon (descending, sigmoid, rectum), and that the technology has poor tumor detection for right-sided (cecum, ascending, transverse) lesions. A minimally invasive test that can detect both left-sided and right-sided lesions could increase the effectiveness of screening colonoscopy by revealing the potential presence of neoplasms in the right-sided “blind spot”. Methods We previously reported on a seven-gene, blood-based biomarker panel that effectively stratifies a patient’s risk of having CRC. For the current study, we assessed the effectiveness of the seven-gene panel for the detection of left- and right-sided CRC lesions. Results were evaluated for 314 patients with CRC (left-sided: TNM I, 65; TNM II, 57; TNM III, 60; TNM IV, 17; unknown, 9. right-sided: TNM I, 28; TNM II, 29; TNM III, 38; TNM IV, 12; unknown, 1 and including two samples with both left and right lesions) and 328 control samples. Blood samples were obtained prior to clinical staging and therapy. Most CRC subjects had localized disease (stages I and II, 58%); regional (stage III) and systemic (stage IV) disease represented 32% and 9%, respectively, of the study population. Results The panel detected left-sided (74%, 154/208) and right-sided (85%, 92/108) lesions with an overall sensitivity of 78% (215/316) at a specificity of 66% (215/328). Treatable cancer (stages I to III) was detected with left-sided lesion sensitivity of 76% (138/182) and right-sided sensitivity of 84% (80/95). Conclusion This seven-gene biomarker panel detected right-sided CRC lesions across all cancer stages with a sensitivity that is at least equal to that for left-sided lesions. This study supports the use of this panel as the basis for a patient-friendly, blood-based test that can be easily incorporated into a routine physical examination in advance of colonoscopy to provide a convenient companion diagnostic and a pre-screening alert, ultimately leading to enhanced CRC screening effectiveness.
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Affiliation(s)
- Samuel Chao
- GeneNews Ltd, 2 East Beaver Creek Road, Building 2, Richmond Hill, Ontario, Canada
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Ahmed NU, Pelletier V, Winter K, Albatineh AN. Factors explaining racial/ethnic disparities in rates of physician recommendation for colorectal cancer screening. Am J Public Health 2013; 103:e91-9. [PMID: 23678899 DOI: 10.2105/ajph.2012.301034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation. METHODS Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates. RESULTS Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income for Blacks. After accounting for the effects of usual source of care, insurance coverage, and education, the disparity reduced and became statistically insignificant. CONCLUSIONS Socioeconomic status and access to health care may explain major racial/ethnic disparities in CRC screening recommendation rates.
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Affiliation(s)
- Nasar U Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
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van Dam L, Korfage IJ, Kuipers EJ, Hol L, van Roon AHC, Reijerink JCIY, van Ballegooijen M, van Leerdam ME. What influences the decision to participate in colorectal cancer screening with faecal occult blood testing and sigmoidoscopy? Eur J Cancer 2013; 49:2321-30. [PMID: 23571149 DOI: 10.1016/j.ejca.2013.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 01/20/2013] [Accepted: 03/03/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Uptake is an important determinant of the effectiveness of population-based screening. Uptake of colorectal cancer (CRC) screening generally remains sub-optimal. AIM To determine factors influencing the decision whether to participate or not among individuals invited for faecal occult blood test (FOBT) or flexible sigmoidoscopy (FS) screening. METHODS A questionnaire was sent to a stratified random sample of individuals aged 50-74, previously invited for a randomised CRC screening trial offering FOBT or FS, and a reference group from the same population not previously invited (screening naïve group). The questionnaire assessed reasons for (non)-participation, individuals' characteristics associated with participation, knowledge, attitudes and level of informed choice. RESULTS The response rate was 75% (n=341/452) for CRC screening participants, 21% (n=676/3212) for non-participants and 38% (n=192/500) for screening-naïve individuals. The main reasons for FOBT and FS participation were acquiring certainty about CRC presence and possible early CRC detection. Anticipated regret and positive attitudes towards CRC screening were strong predictors of actual participation and intention to participate in a next round. The main reason for non-participation in FOBT screening was lack of abdominal complaints. Non-participation in FS screening was additionally influenced by worries about burden. Eighty-one percent of participants and 12% of non-participants made an informed choice on participation. CONCLUSION Only 12% of non-participants made an informed choice not to participate. These results imply that governments and/or organizations offering screening should focus on adequately informing and educating target populations about the harms and benefits of CRC screening. This may impact uptake of CRC screening.
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Affiliation(s)
- L van Dam
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
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Murray DM, Katz ML, Post DM, Pennell ML, Young GS, Tatum CM, Paskett ED. Enhancing cancer screening in primary care: rationale, design, analysis plan, and recruitment results. Contemp Clin Trials 2013; 34:356-63. [PMID: 23357561 PMCID: PMC3601898 DOI: 10.1016/j.cct.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/23/2022]
Abstract
Colorectal cancer (CRC) is the third leading type of cancer and the third leading cause of cancer death in the United States. National policy-making organizations recognize and support a variety of CRC screening strategies among average-risk adults aged 50 and older based on strong evidence showing that screening decreases mortality from CRC and can also reduce the incidence of the disease. The goal of this study was to test a multi-level stepped intervention to increase CRC screening rates. We used a group-randomized trial design where the units of assignment were clinics and the units of observation were eligible patients receiving care at those clinics, with stratified random assignment of clinics to study conditions. The primary analysis was planned as a mixed-model logistic regression to account for the expected positive intraclass correlation associated with clinics. Our recruitment experience reflected the difficulties of conducting research in the real world where changes in economic conditions, staff turnover/layoff, inadequate medical records, and poor acceptance of research can significantly impact study plans. It demonstrated the problems that can emerge when procedures used in the study depart from those used in the pilot work to generate parameter estimates for power analysis. It also demonstrated the importance of allowing for attrition at the group and patient levels so that if recruitment falls short, it is possible to maintain adequate power with only a slight increase in the detectable difference. This experience should assist others planning group-randomized trials, whether in cancer screening or in other areas.
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Affiliation(s)
- David M Murray
- Biostatistics and Bioinformatics Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20892, USA.
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Modiri A, Makipour K, Gomez J, Friedenberg F. Predictors of colorectal cancer testing using the California Health Inventory Survey. World J Gastroenterol 2013; 19:1247-1255. [PMID: 23482920 PMCID: PMC3587481 DOI: 10.3748/wjg.v19.i8.1247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/09/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify key variables associated with colon cancer testing using the 2009 California Health Inventory Survey (CHIS).
METHODS: The CHIS has been conducted biennially since 2001 using a two-stage, geographically stratified random-digit-dial sample design to produce a representative sample of the entire State. For this study we used survey data from 2001-2009 inclusive. We restricted our analysis to White, Black, and Hispanic/Latinos aged 50-80 years. Weighted data was used to calculate the proportion of participants who underwent some form of colon cancer testing (colonoscopy, flexible sigmoidoscopy or fecal occult blood testing) within the previous 5 years stratified by race/ethnicity. For inferential analysis, boot-strapping with replacement was performed on the weighted sample to attain variance estimates at the 95%CI. For mean differences among categories we used t-tests and for comparisons of categorical data we used Pearson’s χ2. Binary logistic regression was used to identify independent variables associated with undergoing some form of testing. Trend analysis was performed to determine rates of testing over the study period stratified by race.
RESULTS: The CHIS database for 2009 had 30 857 unique respondents corresponding to a weighted sample size of 10.6 million Californians. Overall, 63.0% (63.0-63.1) underwent a colon cancer test within the previous 5 years; with 70.5% (70.5%-70.6%) of this subset having undergone colonoscopy. That is 44.5% (44.4%-44.5%) of all individuals 50-80 underwent colonoscopy. By multivariable regression, those tested were more likely to be male (OR = 1.06; 95%CI: 1.06-1.06), Black (OR = 1.30; 95%CI: 1.30-1.31), have a family member with colon cancer (OR = 1.71; 95%CI: 1.70-1.72), and have health insurance (OR = 2.71; 95%CI: 2.70-2.72). Progressive levels above the poverty line were also associated with receiving a test (100%-199%: 1.21; 1.20-1.21), (200%-299%:1.41; 1.40-1.42), (> 300:1.69; 1.68-1.70). The strongest variable was physician recommendation (OR = 3.90; 95%CI: 3.88-3.91). For the Hispanic/Latino group, additional variables associated with testing were success of physician-patient communication (OR = 2.44; 95%CI: 2.40-2.48) and naturalized citizenship status (OR = 1.91; 95%CI: 1.89-1.93). Trend analysis demonstrated increased colon cancer testing for all racial/ethnic subgroups from 2001-2009 although the rate remained considerably lower for the Hispanic/Latino subgroup.
CONCLUSION: Using CHIS we identified California citizens most likely to undergo colon cancer testing. The strongest variable associated with testing for all groups was physician recommendation.
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Katz ML, Heaner S, Reiter P, van Putten J, Murray L, McDougle L, Cegala DJ, Post D, David P, Slater M, Paskett ED. Development of an Educational Video to Improve Patient Knowledge and Communication with Their Healthcare Providers about Colorectal Cancer Screening. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2009.10599097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mira L. Katz
- a College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | - Sarah Heaner
- b College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | - Paul Reiter
- c College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
| | | | - Lee Murray
- e Columbus Neighborhood Health Center, Inc. , Columbus , OH
| | - Leon McDougle
- f College of Medicine , Ohio State University , Columbus , OH , 43210
| | - Donald J. Cegala
- g College of Communications , Ohio State University , Columbus , OH , 43210
| | - Douglas Post
- h College of Medicine , Ohio State University , Columbus , OH , 43210
| | - Prabu David
- i College of Communications , Ohio State University , Columbus , OH , 43210
| | - Michael Slater
- j College of Communications , Ohio State University , Columbus , OH , 43210
| | - Electra D. Paskett
- k College of Public Health and the Comprehensive Cancer Center , Ohio State University , Columbus , OH , 43210
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Sanchez JI, Palacios R, Thompson B, Martinez V, O'Connell MA. Assessing Colorectal Cancer Screening Behaviors and Knowledge among At-Risk Hispanics in Southern New Mexico. ACTA ACUST UNITED AC 2013; 4:15-25. [PMID: 25621179 PMCID: PMC4303072 DOI: 10.4236/jct.2013.46a2003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Colorectal cancer (CRC) mortality rates in New Mexico (NM) continue to be higher than national rates. Hispanic CRC mortality rates in NM surpass those of overall Hispanics in the US. This study was designed to characterize and understand factors contributing to low CRC screening rates in this border region. Methods A CRC Knowledge Assessment Survey (KAS) was administered in either English or Spanish to 247 individuals attending community events throughout southern NM. A subset of these individuals completed an online CRC risk assessment survey managed by the National Cancer Institute (NCI). Data analysis tested for significant differences in knowledge, physician-patient CRC interactions, CRC risk level perception, and screening rates across diverse ethnic and age groups. Results Both CRC knowledge and physician-patient CRC interactions were positively associated with participant screening history. Significant age and ethnic differences for CRC knowledge, physician-patient CRC interactions, and screening history in the NM border sample were also seen. Age-eligible Hispanics (50+) as well as those less than 50 years of age had lower CRC knowledge and were less likely to engage in physician-patient CRC interactions than non-Hispanic Whites (NHWs). The age-eligible Hispanics also reported lower CRC screening rates than their NHW counterparts. Conclusions Low CRC knowledge and limited physician-patient CRC interactions appear to contribute to low screening rates in this NM population. Expanding education and outreach efforts for this border population are essential to promote early CRC detection and thereby decrease overall CRC mortality rates.
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Affiliation(s)
- Janeth I Sanchez
- Plant and Environmental Sciences, New Mexico State University, Las Cruces, New Mexico, USA
| | - Rebecca Palacios
- Public Health Sciences, New Mexico State University, Las Cruces, New Mexico, USA
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Vanessa Martinez
- Plant and Environmental Sciences, New Mexico State University, Las Cruces, New Mexico, USA
| | - Mary A O'Connell
- Plant and Environmental Sciences, New Mexico State University, Las Cruces, New Mexico, USA
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Cole SR, Gregory T, Whibley A, Ward P, Turnbull D, Wilson C, Flight I, Esterman A, Young GP. Predictors of Re-participation in Faecal Occult Blood Test-Based Screening for Colorectal Cancer. Asian Pac J Cancer Prev 2012; 13:5989-94. [DOI: 10.7314/apjcp.2012.13.12.5989] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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146
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Salehi R, Mohammadi M, Emami MH, Salehi AR. Methylation pattern of SFRP1 promoter in stool sample is a potential marker for early detection of colorectal cancer. Adv Biomed Res 2012; 1:87. [PMID: 23946935 PMCID: PMC3724329 DOI: 10.4103/2277-9175.105169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 04/28/2012] [Indexed: 02/06/2023] Open
Abstract
Background: To setup a non-invasive genetic screening method for colorectal cancer, we evaluated the promoter methylation status of secreted frizzled-related protein1 (sfrp1) in stool samples of colorectal cancer with respect to a series of healthy individuals, using methylation-specific polymerase chain reaction. Materials and Methods: In stool samples from 25 patients with colorectal cancer and 25 healthy control subjects, isolated DNA was treated with sodium bisulfite and analyzed by methylation-specific polymerase chain reaction with primers specific for methylated or unmethylated promoter sequences of the SFRP1 gene. Result: Methylation of the SFRP1 promoter was present in the stool DNA of patients with colorectal cancer. A sensitivity of 52% and specificity of 92% were achieved in the detection of colorectal neoplasia. The difference in methylation status of the SFRP1 promoter between the patients with colorectal neoplasia and the control group was statistically highly significant (P = 0.006). Conclusions: The results indicate that this DNA stool test of methylation of the SFRP1 promoter is a sensitive and specific method. It is assumed that the test is potentially useful for the early detection of colorectal cancer.
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Affiliation(s)
- R Salehi
- Department of Genetics and Molecular Biology, and Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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147
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Ferroni E, Camilloni L, Jimenez B, Furnari G, Borgia P, Guasticchi G, Giorgi Rossi P. How to increase uptake in oncologic screening: a systematic review of studies comparing population-based screening programs and spontaneous access. Prev Med 2012; 55:587-96. [PMID: 23064024 DOI: 10.1016/j.ypmed.2012.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/10/2012] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access. METHODS Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions. RESULTS The invitation letter vs no intervention showed significantly more participation (RR=1.60 95%CI 1.33-1.92; RR=1.52 95%CI 1.28-1.82; RR=1.15 95%CI 1.12-1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR=1.74 95%CI 1.25-2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR=0.99 95%CI 0.94-1.05; RR=1.08 95%CI 0.99-1.17, for breast and cervical cancer, respectively). CONCLUSION Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective.
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Affiliation(s)
- E Ferroni
- Laziosanità, Public Health Agency, Lazio Region, Rome, Italy
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148
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Greene P, Mehta P, Yeary KHCK, Bursac Z, Zhang J, Goldsmith G, Henry-Tillman R. Using population data to reduce disparities in colorectal cancer screening, Arkansas, 2006. Prev Chronic Dis 2012; 9:E138. [PMID: 22898236 PMCID: PMC3475514 DOI: 10.5888/pcd9.110256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations. Methods Trained interviewers in 2006 conducted a random-digit–dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status. Results Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice. Conclusion Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.
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Affiliation(s)
- Paul Greene
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham no. 820, Little Rock, AR 72205, USA.
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149
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Simmons RK, Echouffo-Tcheugui JB, Sharp SJ, Sargeant LA, Williams KM, Prevost AT, Kinmonth AL, Wareham NJ, Griffin SJ. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet 2012; 380:1741-8. [PMID: 23040422 PMCID: PMC3607818 DOI: 10.1016/s0140-6736(12)61422-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality. METHODS In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20,184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA(1c)) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. FINDINGS Of 16,047 high-risk individuals in screening practices, 15,089 (94%) were invited for screening during 2001-06, 11,737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184,057 person-years of follow up (median duration 9·6 years [IQR 8·9-9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90-1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75-1·38), cancer (1·08, 0·90-1·30), or diabetes-related mortality (1·26, 0·75-2·10) associated with invitation to screening. INTERPRETATION In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. FUNDING Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.
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Affiliation(s)
| | | | | | | | - Kate M Williams
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - A Toby Prevost
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- King's College London, Department of Primary Care and Public Health Sciences, London, UK
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
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150
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Daly JM, Xu Y, Levy BT. Patients whose physicians recommend colonoscopy and those who follow through. J Prim Care Community Health 2012; 4:83-94. [PMID: 23799714 DOI: 10.1177/2150131912464887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND More than half of eligible individuals are not up-to-date with colon cancer screening. PURPOSE To assess the characteristics of those who received a colonoscopy screening recommendation and those who followed the physician recommendation. METHODS Patient self-administered questionnaire and medical record review in 16 private family physician practices. RESULTS From 8372 patients invited to participate, 685 were enrolled and had a medical record review; 219 (32%) had a colonoscopy recommendation and 86 (39%) received a colonoscopy. Independent factors associated with having a recommendation for colonoscopy were significantly younger in age (odds ratios [OR] = 1.6), higher incomes (annual income ≥$40 000 vs <$40 000; OR = 1.8), physician or nurse discussion about colon cancer tests (OR = 1.6), physical visit in the preceding 26 months (OR = 1.7), distant relative with colon cancer (OR = 2.4), and a medical diagnosis of hyperlipidemia (OR = 2.1). Independent factors associated with following through on colonoscopy after a recommendation were age ≥65 years (OR = 0.3), male patient (OR = 0.4), and feeling that colon cancer screening is very important (OR = 3.2). CONCLUSIONS Socioeconomic factors are associated with receipt of a colonoscopy recommendation. Fewer than one third of patients had documentation of a physician colonoscopy recommendation and of those, less than half followed through.
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Affiliation(s)
- Jeanette M Daly
- Department of Family Medicine, University of Iowa, Iowa City, IA 52242, USA.
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