251
|
Gao Y, Wang J, Zhou Y, Sheng S, Qian SY, Huo X. Evaluation of Serum CEA, CA19-9, CA72-4, CA125 and Ferritin as Diagnostic Markers and Factors of Clinical Parameters for Colorectal Cancer. Sci Rep 2018; 8:2732. [PMID: 29426902 PMCID: PMC5807317 DOI: 10.1038/s41598-018-21048-y] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/26/2018] [Indexed: 12/15/2022] Open
Abstract
Blood-based protein biomarkers have recently shown as simpler diagnostic modalities for colorectal cancer, while their association with clinical pathological characteristics is largely unknown. In this study, we not only examined the sensitivity and reliability of single/multiple serum markers for diagnosis, but also assessed their connection with pathological parameters from a total of 279 colorectal cancer patients. Our study shown that glycoprotein carcinoembryonic antigen (CEA) owns the highest sensitivity among single marker in the order of CEA > cancer antigen 72-4 (CA72-4) > cancer antigen 19-9 9 (CA19-9) > ferritin > cancer antigen 125 (CA125), while the most sensitive combined-markers for two to five were: CEA + CA72-4; CEA + CA72-4 + CA125; CEA + CA19-9 + CA72-4 + CA125; and CEA + CA19-9 + CA72-4 + CA125 + ferritin, respectively. We also demonstrated that patients who had positive preoperative serum CEA, CA19-9, or CA72-4 were more likely with lymph node invasion, positive CA125 were prone to have vascular invasion, and positive CEA or CA125 were correlated with perineural invasion. In addition, positive CA19-9, CA72-4, or CA125 was associated with poorly differentiated tumor, while CEA, CA19-9, CA72-4, CA125 levels were positively correlated with pathological tumor-node-metastasis stages. We here conclude that combined serum markers can be used to not only diagnose colorectal cancer, but also appraise the tumor status for guiding treatment, evaluation of curative effect, and prognosis of patients.
Collapse
Affiliation(s)
- Yanfeng Gao
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinping Wang
- Department of Gynecology, the Northwest Women and Children Hospital, Xi'an, China
| | - Yue Zhou
- Department of Statistics, North Dakota State University, North Dakota, 58102, USA
| | - Sen Sheng
- Department of Neurosurgery, Neuroscience Institute, Baylor Scott and White Health, Temple, Texas, 76502, USA
| | - Steven Y Qian
- Department of Pharmaceutical Sciences, North Dakota State University, North Dakota, 58105, USA.
| | - Xiongwei Huo
- Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
252
|
Parihar V, O'Leary C, O'Reagan P. Timed colonoscopy withdrawal, a mandatory quality measure in the era of national screening? Ir J Med Sci 2018; 187:943-945. [PMID: 29411294 DOI: 10.1007/s11845-018-1750-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND A minimum recommended withdrawal time for screening colonoscopy is recommended for by both the US Multi-Society Task Force on Colorectal Cancer and European Society of Gastrointestinal Endoscopy. AIM To characterize the relationship between endoscopists withdrawal time at colonoscopy and polyp detection in a symptomatic cohort of patients as compared to previously untimed withdrawal. METHODS Three experienced medical endoscopists prospectively performed 1079 colonoscopies during a 24-month period in an Irish hospital. Mean withdrawal time and individual polyp detection rate were noted. RESULTS Introduction of mandatory withdrawal time which was monitored and documented was associated with higher polyp detection rate (33 versus 21%, p < 0.005) as compared to previously untimed withdrawal. CONCLUSION Our findings support a monitored colonoscopy withdrawal time of at least 6 min, which correlates with higher colon polyp detection rates in a symptomatic cohort.
Collapse
Affiliation(s)
- Vikrant Parihar
- Gastroenterology Department, Tallaght Hospital, Dublin-24, Ireland
| | - Claire O'Leary
- South Tipperary General Hospital, Clonmel, Co., Tipperary, Ireland.
| | - Paud O'Reagan
- South Tipperary General Hospital, Clonmel, Co., Tipperary, Ireland
| |
Collapse
|
253
|
Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer. Ann Behav Med 2018; 51:694-706. [PMID: 28236077 DOI: 10.1007/s12160-017-9893-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. PURPOSE We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk. METHODS Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention. RESULTS Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08. CONCLUSION Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions. TRIAL REGISTRATION NUMBER ClinicalTrials.gov , NCT01274143.
Collapse
|
254
|
Detection rate and proximal shift tendency of adenomas and serrated polyps: a retrospective study of 62,560 colonoscopies. Int J Colorectal Dis 2018; 33:131-139. [PMID: 29282495 DOI: 10.1007/s00384-017-2951-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from Southern China. METHODS Consecutive patients undergoing colonoscopy from 2004 to 2013 in Guangzhou were included. The proportions of proximal adenomas to advanced adenomas and serrated polyps were compared and potential predictors were evaluated. RESULTS Colonoscopies (n = 62,560) were performed, and 11,427 patients were diagnosed with polyps. Detection rates for adenomas, hyperplastic polyps, and serrated adenomas were 12.0, 2.5, and 0.2 patients per 100 colonoscopies. When comparing the 1st (2004-2008) to the 2nd period (2009-2013), adenoma and serrated polyp detection in proximal and distal colon both increased significantly (proximal colon [adenoma 3.9 vs. 6.1 patients/100 colonoscopies, P < 0.001; serrated polyp 0.4 vs. 1.1 patients/100 colonoscopies, P < 0.001]; distal colon [adenoma 6.6 vs. 7.2 patients/100 colonoscopies, P = 0.003; serrated polyp 1.2 vs. 2.4 patients/100 colonoscopies, P < 0.001]). Advanced adenoma detection increased over these two periods only in proximal colon (1st vs. 2nd period: 1.5 vs. 2.4 patients/100 colonoscopies, P < 0.001), not the distal colon (P = 0.114). Multivariate analyses showed that diagnostic period was an independent predictor for adenoma proximalization (OR = 1.36, 95% CI 1.25-1.48, P < 0.001), but not for advanced adenomas (P = 0.117) or serrated polyps (P = 0.928). CONCLUSIONS Adenomas and serrated polyps were increasingly detected throughout the colon, whereas advanced adenomas were only in proximal colon. A proximal shift tendency detected by colonoscopy was observed for adenomas, but not advanced adenomas or serrated polyps, in Southern China. The screening for proximal polyps should be emphasized and colonoscopy might be a preferred initial screening tool.
Collapse
|
255
|
Woolf SH, Krist AH, Lafata JE, Jones RM, Lehman RR, Hochheimer CJ, Sabo RT, Frosch DL, Zikmund-Fisher BJ, Longo DR. Engaging Patients in Decisions About Cancer Screening: Exploring the Decision Journey Through the Use of a Patient Portal. Am J Prev Med 2018; 54:237-247. [PMID: 29241715 PMCID: PMC7144024 DOI: 10.1016/j.amepre.2017.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Engaging patients to make informed choices is paramount but difficult in busy practices. This study sought to engage patients outside the clinical setting to better understand how they approach cancer screening decisions, including their primary concerns and their preferences for finalizing their decision. METHODS Twelve primary care practices offering patients an online personal health record invited eligible patients to complete a 17-item online interactive module. Among 11,458 registered users, invitations to complete the module were sent to adults aged 50-74 years who were overdue for colorectal cancer screening and to women aged 40-49 years and men aged 55-69 who had not undergone a recent mammogram or prostate-specific antigen test, respectively. RESULTS The module was started by 2,355 patients and completed by 903 patients. Most respondents (76.8%) knew they were eligible for screening. Preferred next steps were talking to the clinician (76.6%), reading/research (28.6%), and consulting trusted friends/family (16.4%). Priority topics included how much screening improves life expectancy, comparative test performance, and the prevalence/health risks of the cancer. Leading fears were getting cancer/delayed detection (79.2%), abnormal results (40.5%), and testing complications (39.1%), the last referring to false test results, medical complications, or unnecessary treatments. Men eligible for prostate-specific antigen screening were more likely than women eligible for mammography to express concerns about testing complications and to prioritize weighing pros and cons over gut feelings (p<0.05). CONCLUSIONS Although this sample was predisposed to screening, most patients wanted help in finalizing their decision. Many wanted to weigh the pros and cons and expressed fears of potential harms from screening. Understanding how patients approach decisions may help design more effective engagement strategies.
Collapse
Affiliation(s)
- Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Elston Lafata
- Department of Health Behavior and Policy, Lineberger Comprehensive Cancer Center and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
| | | | - Camille J Hochheimer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Daniel R Longo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
256
|
Lagoudianakis E, Pappas A, Koronakis N, Tsekouras D, Dallianoudis J, Kontogianni P, Papanikolaou D, Chrysikos J, Karavitis G, Markogiannakis H, Filis K, Manouras A. Lymph Node Harvesting in Colorectal Carcinoma Specimens. TUMORI JOURNAL 2018; 97:74-8. [DOI: 10.1177/030089161109700114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Adequate lymph node evaluation is an important determinant of prognosis in patients with colorectal cancer. Current guidelines recommend evaluation of at least 12 lymph nodes; however, a significant number of patients fail to meet these criteria. Aim To investigate the factors that influence adequate recovery and evaluation of lymph nodes in colorectal cancer Methods We retrospectively analyzed 454 consecutive cases of colorectal cancer surgically treated from September 2000 to September 2006. Univariate and multivariate linear and logistic regression analysis was used to study the effect of various factors in lymph node recovery. Results The number of lymph nodes retrieved ranged from 0 to 62 with a median of 13 nodes. Overall, 189 (41.6%) patients had fewer than 12 nodes removed. Patient age, tumor stage, location and size were associated with lymph node retrieval. Multivariable regression revealed that the aforementioned variables, including gender and hospital type, explained 17% of the observed variance of the lymph node number. Conclusion Patient and tumor characteristics, although important, are only partly responsible for the variation of lymph node yield. Quality of surgical resection and/or the thoroughness of examination of the tissue by the pathologist might explain the wider proportion of this variance. Training in colorectal node evaluation could help to improve the quality of cancer care. Free full text available at www.tumorionline.it
Collapse
Affiliation(s)
- Emmanuel Lagoudianakis
- Second Department of Surgery, 417 NIMTS (Military Veterans' Fund Hospital), Athens, Greece
| | - Apostolos Pappas
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - Nikolaos Koronakis
- Second Department of Surgery, 417 NIMTS (Military Veterans' Fund Hospital), Athens, Greece
| | - Dimitrios Tsekouras
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - John Dallianoudis
- Second Department of Surgery, 417 NIMTS (Military Veterans' Fund Hospital), Athens, Greece
| | - Panagiota Kontogianni
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - Dimitrios Papanikolaou
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - John Chrysikos
- Second Department of Surgery, 417 NIMTS (Military Veterans' Fund Hospital), Athens, Greece
| | - George Karavitis
- Second Department of Surgery, 417 NIMTS (Military Veterans' Fund Hospital), Athens, Greece
| | - Haridimos Markogiannakis
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - Konstantinos Filis
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| | - Andreas Manouras
- First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
| |
Collapse
|
257
|
Arana-Arri E, Imaz-Ayo N, Fernández MJ, Idigoras I, Bilbao I, Bujanda L, Bao F, Ojembarrena E, Gil I, Gutiérrez-Ibarluzea I, Portillo I. Screening colonoscopy and risk of adverse events among individuals undergoing fecal immunochemical testing in a population-based program: A nested case-control study. United European Gastroenterol J 2018; 6:755-764. [PMID: 30083338 DOI: 10.1177/2050640618756105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/01/2018] [Indexed: 12/23/2022] Open
Abstract
Background Screening by means of biennial fecal occult blood test has provided a reduction in overall colorectal cancer mortality. Notwithstanding, we should not underestimate the harms that it can produce. Aim The aim of this article is to identify the independent risk factors of complications after a screening colonoscopy. Methods A six-year, nested case-control study was conducted. Mortality/complications within 30 days after colonoscopy were registered and its predictors identified through logistic regression. Results After 39,254 colonoscopies, the complication rate was 1.0%. Independent predictors were sex (OR 1.68 for men; CI 95% 1.18-2.39), ASA physical status classification system (OR 1.73 for ASA II-III; CI 95% 1.53-3.69), history of abdominal surgery (OR 2.37; CI 95% 1.72-4.08), diverticulosis (OR 2.89; CI 95% 1.94-4.30), inadequate cleansing (OR 29.35; CI 95% 6.52-132.17), detection of advanced neoplasia (AN) (OR 4.92; CI 95% 3.29-7.36), detection of stage I adenocarcinoma (OR 9.44; CI 95% 4.46-20.0), polyps in right colon OR 2.27 CI 95% 1.38-3.74) and complex polypectomy (OR 2.00; CI 95% 1.25-3.20). The logistic model explained 82% of the complications (CI 95% 0.798-0.854, p < 0.001). Conclusions Colonoscopy, with or without removal of a lesion, is an invasive procedure with a non-deniable risk of major complications. Factors like inadequate cleansing or detection of AN are determinants. Therefore, it is vital to know which aspects predict their appearance to implement countermeasures.
Collapse
Affiliation(s)
- Eunate Arana-Arri
- Biocruces Health Research Institute, Barakaldo, Spain.,Cruces University Hospital, Barakaldo, Spain
| | | | | | - Isabel Idigoras
- Biocruces Health Research Institute, Barakaldo, Spain.,Colorectal Cancer Screening Programme Coordination Center, Bilbao, Spain
| | - Isabel Bilbao
- Biocruces Health Research Institute, Barakaldo, Spain.,Colorectal Cancer Screening Programme Coordination Center, Bilbao, Spain
| | - Luis Bujanda
- Biodonostia Health Research Institute, Donostia, Spain.,Donostia University Hospital, Donostia, Spain
| | - Fidencio Bao
- Biocruces Health Research Institute, Barakaldo, Spain.,Urduliz Hospital, Urduliz, Spain
| | - Enrique Ojembarrena
- Biocruces Health Research Institute, Barakaldo, Spain.,Cruces University Hospital, Barakaldo, Spain
| | - Ines Gil
- Biodonostia Health Research Institute, Donostia, Spain.,Donostia University Hospital, Donostia, Spain
| | | | - Isabel Portillo
- Biocruces Health Research Institute, Barakaldo, Spain.,Colorectal Cancer Screening Programme Coordination Center, Bilbao, Spain
| |
Collapse
|
258
|
Abstract
BACKGROUND Nonalcoholic fatty liver disease, the hepatic manifestation of metabolic syndrome, is associated with increased risk of colorectal adenoma, a precursor of colorectal cancer. Because nonalcoholic fatty liver disease and colorectal adenoma share many common risk factors of metabolic syndrome, the association between these 2 pathological findings has been investigated in multiple studies, but the results have been conflicting. OBJECTIVE The present study aimed to assess the relationship between the fatty liver index, a predictor of nonalcoholic fatty liver disease, and the prevalence of colorectal adenomas. DESIGN This is a retrospective observational study. SETTINGS This study was conducted at a single expert center. PATIENTS A total of 2976 consecutive subjects over 40 years of age undergoing routine checkups including abdominal ultrasonography and colonoscopy at Chung-Ang University Hospital Health Care Center were included. MAIN OUTCOME MEASURES The primary outcome measured was the prevalence of colorectal adenomas according to fatty liver index. RESULTS Among these subjects, 932 (31.3%) had colorectal adenoma, 691 (23.2%) had metabolic syndrome, and 1512 (50.8%) had fatty liver on ultrasonography. In multivariate analysis, fatty liver index ≥30 was associated with an increased risk of colorectal adenoma (OR, 1.269; 95% CI, 1.06-1.49; p = 0.008). The fatty liver index-high group (fatty liver index ≥30) had more colorectal adenomas and more advanced colorectal adenomas than the fatty liver index-low group (fatty liver index <30) (p < 0.001 and p = 0.042). The prevalence of colorectal adenomas increased with increasing quartile of fatty liver index (p < 0.05). LIMITATIONS The study was limited by a relatively healthy Asian population. CONCLUSION The high fatty liver index may be a useful predictor of colorectal adenoma. See Video Abstract at http://links.lww.com/DCR/A478.
Collapse
|
259
|
Kastenberg D, Jr WCB, Romeo DP, Kashyap PK, Pound DC, Papageorgiou N, Sainz IFU, Sokach CE, Rex DK. Multicenter, randomized study to optimize bowel preparation for colon capsule endoscopy. World J Gastroenterol 2017; 23:8615-8625. [PMID: 29358870 PMCID: PMC5752722 DOI: 10.3748/wjg.v23.i48.8615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/29/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the cleansing efficacy and safety of a new Colon capsule endoscopy (CCE) bowel preparation regimen.
METHODS This was a multicenter, prospective, randomized, controlled study comparing two CCE regimens. Subjects were asymptomatic and average risk for colorectal cancer. The second generation CCE system (PillCam® COLON 2; Medtronic, Yoqneam, Israel) was utilized. Preparation regimens differed in the 1st and 2nd boosts with the Study regimen using oral sulfate solution (89 mL) with diatrizoate meglumine and diatrizoate sodium solution (“diatrizoate solution”) (boost 1 = 60 mL, boost 2 = 30 mL) and the Control regimen oral sulfate solution (89 mL) alone. The primary outcome was overall and segmental colon cleansing. Secondary outcomes included safety, polyp detection, colonic transit, CCE completion and capsule excretion ≤ 12 h.
RESULTS Both regimens had similar cleansing efficacy for the whole colon (Adequate: Study = 75.9%, Control = 77.3%; P = 0.88) and individual segments. In the Study group, CCE completion was superior (Study = 90.9%, Control = 76.9%; P = 0.048) and colonic transit was more often < 40 min (Study = 21.8%, Control = 4%; P = 0.0073). More Study regimen subjects experienced adverse events (Study = 19.4%, Control = 3.4%; P = 0.0061), and this difference did not appear related to diatrizoate solution. Adverse events were primarily gastrointestinal in nature and no serious adverse events related either to the bowel preparation regimen or the capsule were observed. There was a trend toward higher polyp detection with the Study regimen, but this did not achieve statistical significance for any size category. Mean transit time through the entire gastrointestinal tract, from ingestion to excretion, was shorter with the Study regimen while mean colonic transit times were similar for both study groups.
CONCLUSION A CCE bowel preparation regimen using oral sulfate solution and diatrizoate solution as a boost agent is effective, safe, and achieved superior CCE completion.
Collapse
Affiliation(s)
- David Kastenberg
- Division of Gastroenterology, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | | | - David P Romeo
- Dayton Gastroenterology, Inc., Beavercreek, OH 45540, United States
| | | | - David C Pound
- Indianapolis Gastroenterology and Hepatology, Indianapolis, IN 46237, United States
| | | | | | - Carly E Sokach
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Douglas K Rex
- Indiana University Hospital, Indianapolis, IN 19107, United States
| |
Collapse
|
260
|
Adenoma and Polyp Detection Rates in Colonoscopy according to Indication. Gastroenterol Res Pract 2017; 2017:7207595. [PMID: 29445393 PMCID: PMC5763113 DOI: 10.1155/2017/7207595] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background Adenoma detection rate (ADR) is a validated quality measure for screening colonoscopy, but there are little data for other indications. The distribution of adenomas is not well described for these indications. Aim To describe ADR and the adenoma distribution in the proximal and distal colon based on colonoscopy indication. Methods Outpatient colonoscopies are subdivided by indication. PDR and ADR for the entire colon and for proximal and distal colon. Data were compared using generalized estimating equations to adjust for clustering amongst endoscopists while controlling for patient age and gender. Results 3436 colonoscopies were reviewed (51.2%: men (n = 1759)). Indications are screening 49.2%, surveillance 29.3%, change in bowel habit 8.4%, bleeding 5.8%, colitides 3.0%, pain 2.8%, and miscellaneous 1.5%. Overall ADR was 37% proximal ADR 28%, and distal ADR 17%. PDR and ADR were significantly higher in surveillance than in screening (PDR: 69% versus 51%; ADR: 50% versus 33%; p = 0.0001). Adenomas were more often detected in the proximal than in the distal colon, for all indications. Conclusions Prevalence of polyps and adenomas differs based on colonoscopy indication. Adenoma detection is highest in surveillance and more commonly detected in the proximal colon. For quality assurance, distinct ADR and PDR targets may need to be established for different colonoscopy indications.
Collapse
|
261
|
Clinical Value of CT Colonography Versus Preoperative Colonoscopy in the Surgical Management of Occlusive Colorectal Cancer. AJR Am J Roentgenol 2017; 210:333-340. [PMID: 29261351 DOI: 10.2214/ajr.17.18144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE CT colonography (CTC) has been recognized as a complementary approach to evaluating the entire colon after incomplete colonoscopy (IC) in patients with occlusive colorectal cancer (CRC). The objective of this study is to evaluate changes in preoperative surgical planning after CTC is performed for patients with occlusive CRC and IC in an oncologic hospital. MATERIALS AND METHODS This retrospective study included 65 consecutive patients with occlusive CRC who underwent CTC after IC at our institution from February 2000 to April 2016. CTC examinations and radiology reports were reviewed by an abdominal radiologist. Clinical information was obtained from a review of the electronic medical record. RESULTS CTC contributed to a change in the initial surgical plan of the surgeon for 14 of 65 patients (21.5%). In these 14 patients, CTC detected five synchronous proximal colon polyps (35.7%), five synchronous proximal cancers (35.7%), two imprecise CRC locations (14.3%), one case of proximal colon ischemia (7.1%), and one instance of tumor infiltration of the urinary bladder (7.1%). All CTC findings were confirmed at surgery, and all proximal colon polyps were subsequently confirmed to be advanced adenomas. CONCLUSION The preoperative CTC findings optimized the surgical management plan for 21.5% of patients with occlusive CRC and IC.
Collapse
|
262
|
Colonoscopy overuse in colorectal cancer screening and associated factors in Argentina: a retrospective cohort study. BMC Gastroenterol 2017; 17:162. [PMID: 29246189 PMCID: PMC5732490 DOI: 10.1186/s12876-017-0722-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 12/24/2022] Open
Abstract
Background In recent years, there has been growing concern about the overuse of colonoscopy (CC). Our objective was to evaluate the incidence rate and cumulative probability of having a potentially inadequate CC (PI-CC, e.g. a CC that was performed earlier that recommended) and the association between the report of a hyperplastic polyp in the baseline CC report and the probability of having a PI-CC. Methods A retrospective cohort of adults 50y/o or older with a complete baseline CC between January 1st and December 31st 2005, without reported lesions or with hyperplastic polyps, based on secondary data extracted from the electronic medical record of the Hospital Italiano of Buenos Aires. The outcome consisted of time until a PI-CC, defined as the time measured between basal colonoscopy and a colonoscopy performed earlier than the inter-screening interval recommended by the USPSTF and the USMSTF. Results 389 patients were included. The cumulative probability of receiving a PI-CC over 10 years was 0.29 (95% CI 0.241, 0.342). The incidence rate resulted in 30.91 PI-CC per 1000 person-years (95% CI 25.14, 38). The crude analysis of the association between the outcome and the presence of hyperplastic polyps in the baseline CC, showed a statistically significant difference between both groups (log rank, p 0.036). The multivariate analysis yielded a hazard ratio of 1.67 (95% CI 1.02–2.73). Conclusion We observed that 3 in every 10 patients treated in our health system received a PI-CC during the first ten consecutive years after a normal complete CC. Furthermore, this could be in part attributed to the presence of a hyperplastic polyp in the baseline CC.
Collapse
|
263
|
Lin XH, Luo JC. Fecal immunochemical tests for surveillance of the colorectal neoplasia after polypectomy. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Xi-Hsuan Lin
- National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Gastroenterology & Hepatology Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Jiing-Chyuan Luo
- National Yang-Ming University; School of Medicine; Taipei Taiwan
- Division of Gastroenterology & Hepatology Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| |
Collapse
|
264
|
Ayub K, Ketwaroo G, Abudayyeh S, Ibrahim A, Cole RA, Brumfield-Brown R, Qureshi WA, Rabeneck L, Graham DY. Mechanical colon cleansing for screening colonoscopy: A randomized controlled trial. J Dig Dis 2017; 18:691-697. [PMID: 29160622 DOI: 10.1111/1751-2980.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/21/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Effective screening colonoscopy depends on the quality of colon preparation. This study aimed to compare pulsed irrigation evacuation (PIE), polyethylene glycol (PEG) and sodium phosphate colon preparations. METHODS Outpatients at a VA hospital were randomized using sealed envelopes. Preparations consisted of polyethylene glycol 4L, Fleet sodium phosphate 90 mL with four to six glasses water twice daily and 296 mL of magnesium citrate in the evening with PIE prior to colonoscopy. Colon cleansing was assessed blindly using a five-point scale: 0 (very poor) to 4 (excellent). RESULTS Altogether 391 patients participated in the study (129 in the PEG group, 127 in the sodium phosphate and 135 in the PIE group), with a mean age of 62 years, of whom 75% were men. PIE and sodium phosphate were superior to PEG: median cleansing scored 4 (excellent) versus 3 with PEG (P < 0.01). Inadequate preparations were more common with PEG than PIE (18% vs 5%) (P < 0.01). Side-effects included vomiting: 37% in the sodium phosphate group versus 5% in the PEG and 2% in the PIE groups (P < 0.01). The three preparations were judged intolerable in ≤ 5%. CONCLUSIONS PIE and sodium phosphate are superior to PEG for colon preparations. PIE is the preferred preparation for those at high risk of unsatisfactory preparations or with unsatisfactory traditional preparations.
Collapse
Affiliation(s)
- Kamran Ayub
- Department of Medicine, Silver Cross Hospital, New Lenox, Illinois, USA
| | - Gyanprakash Ketwaroo
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA
| | | | - Abeer Ibrahim
- Department of Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rhonda A Cole
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA
| | - Rosetta Brumfield-Brown
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA
| | - Waqar A Qureshi
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA
| | - Linda Rabeneck
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
265
|
Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
Collapse
|
266
|
Prenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant 2017; 17:2761-2774. [PMID: 28471512 DOI: 10.1111/ajt.14340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 01/25/2023]
Abstract
Colorectal cancer (CRC) is a common malignancy worldwide. Some studies suggest that organ recipients are at a higher risk for CRC than the general population. The underlying transplant indications and their inherent risk factors for CRC may drive the variation in incidence rates that are seen in patients receiving different allografts. Recipients with cystic fibrosis are now recognized as a population at high risk for CRC at a young age. Transplant recipients have high mortality following a CRC diagnosis, even if it is detected at an early stage. Certain types of immunosuppression have been shown to accelerate cancer transformation and may contribute to the more aggressive phenotype seen in organ recipients. Given the high incidence and progressive nature of posttransplant CRC, shorter screening intervals with a modality that can detect early-stage polyps may be essential to prevent mortality. Future research is needed to better elucidate the role of immunosuppression in carcinogenesis. This comprehensive review examines CRC risk, screening, and management specific to organ transplant candidates and recipients.
Collapse
Affiliation(s)
- S Prenner
- Division of Gastroenterology & Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Levitsky
- Division of Gastroenterology & Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
267
|
Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A KASID Multicenter Study. Dig Dis Sci 2017; 62:3138-3148. [PMID: 28936593 DOI: 10.1007/s10620-017-4760-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. AIMS We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. METHODS In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. RESULTS The median size of polyps resected was 10 mm (range 3-60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. CONCLUSION Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
Collapse
|
268
|
Shapiro JA, Bobo JK, Church TR, Rex DK, Chovnick G, Thompson TD, Zauber AG, Lieberman D, Levin TR, Joseph DA, Nadel MR. A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening. Am J Gastroenterol 2017; 112:1728-1735. [PMID: 29016558 PMCID: PMC6077997 DOI: 10.1038/ajg.2017.285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two FITs (InSure FIT and OC FIT-CHEK) for detecting advanced colorectal neoplasia. METHODS The study included 1,006 asymptomatic patients, aged 50-75 years, who were scheduled to receive a screening colonoscopy at gastroenterology practices in the Minneapolis and Indianapolis metropolitan areas. Each participant was asked to complete all three stool tests before their colonoscopy. Each test's performance characteristics were evaluated using the screening colonoscopic results as the reference standard. RESULTS Sensitivity for detecting advanced colorectal neoplasia was highest for InSure FIT (26.3%, 95% confidence interval (CI) 15.9-40.7), followed by OC FIT-CHEK (15.1%, 95% CI 6.7-26.1) and Hemoccult II SENSA (7.4%, 95% CI 1.9-17.0). InSure FIT was statistically significantly more sensitive than both OC FIT-CHEK (absolute difference in sensitivity=11.2%, 95% CI 0.4-24.2) and Hemoccult II SENSA (difference in sensitivity=18.9%, 95% CI 10.2-32.6). Specificities were relatively high for all tests (between 96.8% and 98.6%). CONCLUSIONS Our results suggest that some FITs are more sensitive than the HS-gFOBT Hemoccult II SENSA, but these results need to be confirmed in larger asymptomatic populations. Comparisons between the FITs examined in this study and other FITs are needed to determine the best tests for population screening.
Collapse
Affiliation(s)
- Jean A. Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet K. Bobo
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Timothy R. Church
- Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Douglas K. Rex
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gary Chovnick
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Trevor D. Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann G. Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marion R Nadel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
269
|
Moody L, He H, Pan YX, Chen H. Methods and novel technology for microRNA quantification in colorectal cancer screening. Clin Epigenetics 2017; 9:119. [PMID: 29090038 PMCID: PMC5655825 DOI: 10.1186/s13148-017-0420-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/17/2017] [Indexed: 02/08/2023] Open
Abstract
The screening and diagnosis of colorectal cancer (CRC) currently relies heavily on invasive endoscopic techniques as well as imaging and antigen detection tools. More accessible and reliable biomarkers are necessary for early detection in order to expedite treatment and improve patient outcomes. Recent studies have indicated that levels of specific microRNA (miRNA) are altered in CRC; however, measuring miRNA in biological samples has proven difficult, given the complicated and lengthy PCR-based procedures used by most laboratories. In this manuscript, we examine the potential of miRNA as CRC biomarkers, summarize the methods that have commonly been employed to quantify miRNA, and focus on novel strategies that can improve or replace existing technology for feasible implementation in a clinical setting. These include isothermal amplification techniques that can potentially eliminate the need for specialized thermocycling equipment. Additionally, we propose the use of near-infrared (NIR) probes which can minimize autofluorescence and photobleaching and streamline quantification without tedious sample processing. We suggest that novel miRNA quantification tools will be necessary to encourage new discoveries and facilitate their translation to clinical practice.
Collapse
Affiliation(s)
- Laura Moody
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 472 Bevier Hall, MC-182, 905 South Goodwin Avenue, Urbana, IL 61801 USA
| | - Hongshan He
- Department of Chemistry, Eastern Illinois University, Charleston, IL 62910 USA
| | - Yuan-Xiang Pan
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 472 Bevier Hall, MC-182, 905 South Goodwin Avenue, Urbana, IL 61801 USA.,Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 472 Bevier Hall, MC-182, 905 South Goodwin Avenue, Urbana, IL 61801 USA.,Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, IL 61801 USA
| | - Hong Chen
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 472 Bevier Hall, MC-182, 905 South Goodwin Avenue, Urbana, IL 61801 USA.,Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 472 Bevier Hall, MC-182, 905 South Goodwin Avenue, Urbana, IL 61801 USA
| |
Collapse
|
270
|
Doroudi M, Schoen RE, Pinsky PF. Early detection versus primary prevention in the PLCO flexible sigmoidoscopy screening trial: Which has the greatest impact on mortality? Cancer 2017; 123:4815-4822. [PMID: 28976536 DOI: 10.1002/cncr.31034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/10/2017] [Accepted: 05/18/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Screening for colorectal cancer (CRC) with flexible sigmoidoscopy (FS) has been shown to reduce CRC mortality. The current study examined whether the observed mortality reduction was due primarily to the prevention of incident CRC via removal of adenomatous polyps or to the early detection of cancer and improved survival. METHODS The Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial randomized 154,900 men and women aged 55 to 74 years. Individuals underwent FS screening at baseline and at 3 or 5 years versus usual care. CRC-specific survival was analyzed using Kaplan-Meier curves and proportional hazards modeling. The authors estimated the percentage of CRC deaths averted by early detection versus primary prevention using a model that applied intervention arm survival rates to CRC cases in the usual-care arm and vice versa. RESULTS A total of 1008 cases of CRC in the intervention arm and 1291 cases of CRC in the usual-care arm were observed. Through 13 years of follow-up, there was no significant difference noted between the trial arms with regard to CRC-specific survival for all CRC (68% in the intervention arm vs 65% in the usual-care arm; P =.16) or proximal CRC (68% vs 62%, respectively; P = .11) cases; however, survival in distal CRC cases was found to be higher in the intervention arm compared with the usual-care arm (77% vs 66%; P<.0001). Within each arm, symptom-detected cases had significantly worse survival compared with screen-detected cases. Overall, approximately 29% to 35% of averted CRC deaths were estimated to be due to early detection and 65% to 71% were estimated to be due to primary prevention. CONCLUSIONS CRC-specific survival was similar across arms in the PLCO trial, suggesting a limited role for early detection in preventing CRC deaths. Modeling suggested that approximately two-thirds of avoided deaths were due to primary prevention. Future CRC screening guidelines should emphasize primary prevention via the identification and removal of precursor lesions. Cancer 2017;123:4815-22. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Maryam Doroudi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| |
Collapse
|
271
|
Detection Rate, Anatomic Sites, and Pathologic Types of Colorectal Cancer During Colonoscopy Procedures. Surg Laparosc Endosc Percutan Tech 2017; 27:394-399. [DOI: 10.1097/sle.0000000000000456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
272
|
Guivatchian T, Koeppe ES, Baker JR, Moisa C, Demerath M, Foor-Pessin C, Chey WD, Eswaran SL, Kolars JC, Menees SB, Rajala M, Rice MD, Rizk R, Rubenstein JH, Sharma P, Todisco A, Stoffel EM. Family history in colonoscopy patients: feasibility and performance of electronic and paper-based surveys for colorectal cancer risk assessment in the outpatient setting. Gastrointest Endosc 2017; 86:684-691. [PMID: 28174125 DOI: 10.1016/j.gie.2017.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Family history is crucial in stratifying patients' risk for colorectal cancer (CRC). Previous risk assessment tools developed for use in clinic or endoscopy settings have demonstrated suboptimal specificity for identifying patients with hereditary cancer syndromes. Our aim was to test the feasibility and performance of 2 family history surveys (paper and electronic) in individuals presenting for outpatient colonoscopy. METHODS Patients presenting for outpatient colonoscopy at a tertiary care center were asked to complete a 5-question paper risk assessment survey (short paper survey) either alone or in conjunction with a second, comprehensive electronic family risk assessment survey (comprehensive tablet survey). Each subject's survey results, along with the electronic medical record, were reviewed, and 10 high-risk criteria and PREMM1,2,6 model scores (a predictive model for carrying a Lynch syndrome-associated gene mutation) were used to identify patients warranting genetic evaluation for suspected hereditary cancer syndromes. RESULTS Six hundred patients completed the short paper survey (cohort 1), with an additional 100 patients completing both the short paper and comprehensive tablet survey (cohort 2). Using 10 high-risk criteria and/or a PREMM1,2,6 score ≥5%, we identified 10% and 9% of patients as high risk for CRC in cohorts 1 and 2, respectively. Of the 69 high-risk subjects, 23 (33%) underwent genetic evaluations and 7 (10%) carried germline mutations associated with cancer predisposition. Both patients and endoscopists reported the tools were user-friendly and helpful for CRC risk stratification. CONCLUSIONS Systematic assessment of family history in colonoscopy patients is feasible and can help endoscopists identify high-risk patients who would benefit from genetic evaluation.
Collapse
Affiliation(s)
- Tannaz Guivatchian
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Erika S Koeppe
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Jason R Baker
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Cristina Moisa
- Comprehensive Cancer Center, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Matthew Demerath
- Comprehensive Cancer Center, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Caitlin Foor-Pessin
- Division of Gastroenterology, Department of Internal Medicine, University of Rochester, Rochester, New York, USA
| | - William D Chey
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Shanti L Eswaran
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Joseph C Kolars
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Stacy B Menees
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Michael Rajala
- Division of Gastroenterology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael D Rice
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Rafat Rizk
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Pratima Sharma
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Andrea Todisco
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
| |
Collapse
|
273
|
Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data. Dig Dis Sci 2017; 62:2719-2727. [PMID: 28836087 DOI: 10.1007/s10620-017-4722-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Machine learning tools identify patients with blood counts indicating greater likelihood of colorectal cancer and warranting colonoscopy referral. AIMS To validate a machine learning colorectal cancer detection model on a US community-based insured adult population. METHODS Eligible colorectal cancer cases (439 females, 461 males) with complete blood counts before diagnosis were identified from Kaiser Permanente Northwest Region's Tumor Registry. Control patients (n = 9108) were randomly selected from KPNW's population who had no cancers, received at ≥1 blood count, had continuous enrollment from 180 days prior to the blood count through 24 months after the count, and were aged 40-89. For each control, one blood count was randomly selected as the pseudo-colorectal cancer diagnosis date for matching to cases, and assigned a "calendar year" based on the count date. For each calendar year, 18 controls were randomly selected to match the general enrollment's 10-year age groups and lengths of continuous enrollment. Prediction performance was evaluated by area under the curve, specificity, and odds ratios. RESULTS Area under the receiver operating characteristics curve for detecting colorectal cancer was 0.80 ± 0.01. At 99% specificity, the odds ratio for association of a high-risk detection score with colorectal cancer was 34.7 (95% CI 28.9-40.4). The detection model had the highest accuracy in identifying right-sided colorectal cancers. CONCLUSIONS ColonFlag® identifies individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II), flags colorectal tumors 180-360 days prior to usual clinical diagnosis, and is more accurate at identifying right-sided (compared to left-sided) colorectal cancers.
Collapse
|
274
|
Age-adapted Variation in Screening Interval of Fecal Immunochemical Test May Improve its Participation and Colonoscopy Acceptance. J Clin Gastroenterol 2017; 51:825-830. [PMID: 27824639 DOI: 10.1097/mcg.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS We determined appropriate intervals for administering the fecal immunochemical test (FIT) and performance outcomes in an Asian national colorectal cancer (CRC) screening program. BACKGROUND The optimal interval for FIT in CRC screening is unclear, especially in Asian populations. STUDY Between January 2009 and December 2015, 13,480 individuals aged 50 years or older with an initial negative FIT result underwent 2 rounds of FIT screening at intervals of 1 (annual group, 5333), 2 (biennial group, 7363), or 3 years (triennial group, 784). Positive rates of FIT, colonoscopy acceptance, colonoscopy findings, and detection rates for CRC and advanced neoplasia were compared according to FIT intervals. RESULTS The overall positivity rate of FIT in the second screening round was significantly higher in men and in older subjects than in the entire sample. Younger subjects were less likely to undergo annual FIT (36.0% vs. 46.4%, P<0.001). The colonoscopy acceptance rate was decreased in the biennial and triennial groups compared with an annual group among younger subjects (odds ratio, 0.56; 95% confidence interval, 0.33-0.95 for the biennial group vs. odds ratio, 0.19; 95% confidence interval, 0.03-1.37 for the triennial group). Detection rates for CRC and advanced neoplasia in the second round were significantly higher and accompanied by increased FIT screening intervals in older, but not younger subjects. CONCLUSIONS Age-adapted variation in FIT screening intervals, such as annual screening for elderly subjects and biennial screening for younger subject, may improve FIT participation and colonoscopy acceptance.
Collapse
|
275
|
Ashktorab H, Kupfer SS, Brim H, Carethers JM. Racial Disparity in Gastrointestinal Cancer Risk. Gastroenterology 2017; 153:910-923. [PMID: 28807841 PMCID: PMC5623134 DOI: 10.1053/j.gastro.2017.08.018] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/25/2017] [Accepted: 08/05/2017] [Indexed: 12/13/2022]
Abstract
Cancer from the gastrointestinal tract and its associated excretory organs will occur in more than 300,000 Americans in 2017, with colorectal cancer responsible for >40% of that burden; there will be more than 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to the incidence and mortality of these cancers exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in non-Hispanic whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among blacks. Liver cancer has been most frequent among Asian/Pacific Islanders, chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene-environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas, and colorectum show the highest rates among blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socioeconomic and health care access, treatment, and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biologic and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.
Collapse
Affiliation(s)
- Hassan Ashktorab
- Department of Medicine, Howard University, Washington, District of Columbia; Cancer Center, Howard University, Washington, District of Columbia
| | - Sonia S Kupfer
- Section of Gastroenterology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, District of Columbia
| | - John M Carethers
- Division of Gastroenterology, Department of Internal Medicine, Department of Human Genetics and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
276
|
|
277
|
Metabolic reprogramming of the premalignant colonic mucosa is an early event in carcinogenesis. Oncotarget 2017; 8:20543-20557. [PMID: 28423551 PMCID: PMC5400525 DOI: 10.18632/oncotarget.16129] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States. There is an increasing need for the identification of biomarkers of pre-malignant and early stage CRC to improve risk-stratification and screening recommendations. In this study, we investigated the possibility of metabolic and mitochondrial reprogramming early in the pre-malignant colorectal field. Methods Rectal biopsies were taken from 81 patients undergoing screening colonoscopy, and gene expression of metabolic and mitochondrial markers were assessed using real time quantitative PCR. Validation studies were performed in two different animal models of colon carcinogenesis: Pirc rats and AOM-treated rats. Results We found evidence of a Warburg effect in the normal-appearing rectal mucosa of patients harboring precancerous lesions elsewhere in the colon compared to control patients, with a significant increase in HIF1a, SLC2A1 (referred to as GLUT1), PKM2, and LDHA. We also found evidence of early mitochondrial changes in the colorectal field of patients harboring pre-cancerous lesions, with significantly increased mitochondrial gene expression of DRP1 (fission), OPA1 (fusion), PGC1-a (biogenesis), UCP2 (uncoupling) and mtND1 (copy number). Similar results were observed in the two different animal models. Conclusions These results demonstrate for the first time evidence of early Warburg-like metabolic changes as well as changes in mitochondrial function, dynamics and mtDNA copy number in endoscopically normal premalignant colorectal mucosal field. These findings provide an opportunity for the development of metabolic biomarkers that could be used for improving screening recommendations and risk-stratification. This also provides a potential target for novel chemopreventive strategies in the pre-malignant colorectal field.
Collapse
|
278
|
Sjöström O, Lindholm L, Tavelin B, Melin B. Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer. Fam Cancer 2017; 15:543-51. [PMID: 26935832 PMCID: PMC5010828 DOI: 10.1007/s10689-016-9867-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012-0.5299) and 0.11 (CI 95 % 0.0014-0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.
Collapse
Affiliation(s)
- Olle Sjöström
- Department of Radiation Sciences, Oncology, Unit of Research, Education and Development-Östersund, Umeå University, Umeå, Sweden.
| | - Lars Lindholm
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Björn Tavelin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| |
Collapse
|
279
|
Sjöström O, Lindholm L, Melin B. Colonoscopic surveillance - a cost-effective method to prevent hereditary and familial colorectal cancer. Scand J Gastroenterol 2017; 52:1002-1007. [PMID: 28587529 DOI: 10.1080/00365521.2017.1327615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Approximately 20-30% of all colorectal cancer (CRC) cases may have a familial contribution. The family history of CRC can be prominent (e.g., hereditary colorectal cancer (HCRC)) or more moderate (e.g., familial colorectal cancer (FCRC)). For family members at risk, colonoscopic surveillance is a well-established method to prevent both HCRC and FCRC, although the evidence for the exact procedures of the surveillance is limited. Surveillance can come at a high price if individuals are frequently examined, as this may result in unnecessary colonoscopies in relation to actual risk for CRC. This study analyses the cost-effectiveness of a surveillance programme implemented in the Northern Sweden Health Care Region. METHODS The study includes 259 individuals prospectively recorded in the colonoscopic surveillance programme registry at the Cancer Prevention Clinic, Umeå University Hospital. We performed a cost-utility analysis with a contrafactual design: we compared observed costs and loss of quality-adjusted life years (QALYs) due to CRC with the surveillance programme to an expected outcome without surveillance. The main measure was the incremental cost-effectiveness ratio (ICER) between surveillance and non-surveillance. Scenario analysis was used to explore uncertainty. RESULTS The ICER between surveillance and non-surveillance in the base model was 3596€/QALY. The ICER varied from -4620€ in the best-case scenario to 33,779€ in the worst-case scenario. CONCLUSION Colonoscopic surveillance is a very cost-effective method to prevent HCRC and FCRC compared to current thresholds for cost-effectiveness and other cancer preventive interventions.
Collapse
Affiliation(s)
- Olle Sjöström
- a Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden
| | - Lars Lindholm
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Beatrice Melin
- a Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden
| |
Collapse
|
280
|
Kim NH, Lee MY, Park JH, Park DI, Sohn CI, Choi K, Jung YS. A Combination of Fecal Immunochemical Test Results and Iron Deficiency Anemia for Detection of Advanced Colorectal Neoplasia in Asymptomatic Men. Yonsei Med J 2017; 58:910-917. [PMID: 28792133 PMCID: PMC5552644 DOI: 10.3349/ymj.2017.58.5.910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A substantial proportion of patients with colorectal cancer (CRC) present with iron deficiency anemia (IDA), and fecal immunochemical test (FIT) has proven to be an effective method for detecting the majority of CRC cases. A combination strategy of FIT results and IDA may be useful for risk stratification for detecting advanced colorectal neoplasia (ACRN). We compared the prevalence of ACRN among four groups stratified by FIT results and the presence of IDA. MATERIALS AND METHODS A cross-sectional study was performed on asymptomatic male participants who underwent both FIT and colonoscopy between 2010 and 2014 as part of a comprehensive health screening program in Korea. RESULTS Of 17236 participants, 522 (3.0%) showed positive FIT results and 26 (0.2%) had IDA. The mean age of the study participants was 40.8 years. The participants were classified into four groups: positive FIT result/IDA (G1, n=7), positive FIT result/no IDA (G2, n=515), negative FIT result/IDA (G3, n=19), and negative FIT result/no IDA (G4, n=16695). The prevalences of ACRN in G1, G2, G3, and G4 were 28.6, 13.4, 5.3, and 1.5%, respectively (p<0.001) and those of CRC were 28.6, 1.6, 0.0, and 0.01%, respectively (p<0.001). Subjects with positive FIT results and IDA had an increased risk of ACRN and CRC in both group aged <50 and ≥50 years. CONCLUSION Subjects with positive FIT results and IDA had an increased risk of ACRN. Our results suggest that a combination strategy of FIT and IDA may be helpful in selecting and prioritizing asymptomatic men for colonoscopy.
Collapse
Affiliation(s)
- Nam Hee Kim
- Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyuyong Choi
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
281
|
Long-Term Colorectal Cancer Incidence After Negative Colonoscopy in the State of Utah: The Effect of Family History. Am J Gastroenterol 2017; 112:1439-1447. [PMID: 28695908 DOI: 10.1038/ajg.2017.193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Colonoscopy is widely recommended for colorectal cancer (CRC) screening, but evidence to guide the optimal frequency of repeat screening examination is limited. We examined the duration and magnitude of the risk of developing CRC, following a negative colonoscopy in those at average risk and those with a first-degree family history of CRC. METHODS A cohort of Utah residents aged 50-80 years who had a negative colonoscopy between 1 January 2001 and 31 December 2011 was identified using the Utah Population Database. Patients were followed from the time of the index colonoscopy until diagnosis of CRC, death, migration out of state, repeat colonoscopy, or end of the study period. CRC incidence after the index colonoscopy was compared with that of the state population by standardized incidence ratios (SIRs). RESULTS A cohort of 131,349 individuals at average risk with a negative colonoscopy was identified. Compared with the state population, a negative colonoscopy was associated with SIRs of 0.15 (95% confidence interval (CI): 0.08-0.23) at 1 year, 0.26 (95% CI: 0.19-0.32) at 2-5 years, 0.33 (95% CI: 0.22-0.43) at 5-6 years, and 0.60 (95% CI: 0.44-0.76) at 7-10 years for CRC following the index colonoscopy. In a secondary analysis involving only patients with a first-degree relative with CRC, patients had a significantly lower incidence of CRC only for the first 5 years of follow-up (SIR 0.39, 95% CI: 013-0.64). There was also a difference in the risk of proximal (SIR 0.72, 95% CI: 0.45-0.98) and distal (SIR 0.51, 95% CI: 0.30-0.72) colon cancers at 7-10 years following a negative colonoscopy. CONCLUSIONS The risk of developing CRC remains decreased for at least 10 years following the performance of a negative colonoscopy. However, the lower incidence of CRC in those with a family history of CRC differed in magnitude and timing being limited primarily to the first 5 years of follow-up and of lesser magnitude than that in the overall cohort.
Collapse
|
282
|
Skinner CS, Ahn C, Halm EA, Bishop WP, McCallister K, Sanders JM, Farrell D, Santini N, Singal AG. Recommendation of colorectal cancer testing among primary care patients younger than 50 with elevated risk. Prev Med 2017; 102:20-23. [PMID: 28625419 PMCID: PMC5557096 DOI: 10.1016/j.ypmed.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 01/09/2023]
Abstract
In the era of precision medicine, efforts are needed to identify and tailor screening recommendations among elevated-risk patients. Individuals younger than 50years are an important target population, as they comprise 15% of colorectal (CRC) cases and often present with more advanced disease than their 50+ counterparts. In this large study, 2470 patients ages 25-49 used a tablet-based program that assessed risks, matched risks with screening guidelines, and generated tailored printed guideline-concordant recommendations for patients and their providers. The tablet-based program identified 121 (4.9%) patients with risk factors warranting screening before age 50. Likelihood of risk warranting screening was greater for ages 40-49 than <40years (OR: 2.38), females than males (OR: 1.82), and African Americans (OR: 1.69) and non-Hispanic Whites (OR: 2.89) compared to Hispanics. Most common risk factors were family history of polyps (23.1%), personal history of inflammatory bowel disease (19.8%), and combined family history of CRC+polyps (18.2%). Receipt of guideline-concordant screening within 6months of identification was low, including only 5.3% of those who needed colonoscopy and 13.3% for whom colonoscopy or FIT was recommended. Although elevated-risk patients younger than 50years can be readily identified, more than notification is necessary to facilitate screening participation.
Collapse
Affiliation(s)
- Celette Sugg Skinner
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
| | - Chul Ahn
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Ethan A Halm
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Wendy Pechero Bishop
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Katharine McCallister
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Joanne M Sanders
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - David Farrell
- People Designs, 1304 Broad St, Durham, NC 27705, USA
| | - Noel Santini
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Parkland Health & Hospital System, 5201 Harry Hines Blvd., Dallas, TX 75235. USA
| | - Amit G Singal
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; Department of Internal Medicine, Division of Digestive & Liver Diseases, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| |
Collapse
|
283
|
Ye D, Huang Q, Li Q, Jiang X, Mamat M, Tang M, Wang J, Chen K. Comparative Evaluation of Preliminary Screening Methods for Colorectal Cancer in a Mass Program. Dig Dis Sci 2017. [PMID: 28634645 DOI: 10.1007/s10620-017-4648-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) has been widely used in preliminary screening for colorectal cancer (CRC). The high-risk factor questionnaire (HRFQ) and quantitative risk-assessment method (QRAM) are recommended for estimating the risk of CRC qualitatively and quantitatively in China. AIM We aimed to prospectively compare the diagnostic values of CRC preliminary screening methods to identify which method is preferable as a screening strategy. METHODS Individuals aged 40-74 years old were enrolled in a mass CRC screening program from January 1, 2007 to December 31, 2014, in Jiashan County, Zhejiang Province, China. FIT of two stool specimens at 1-week intervals was performed by laboratory personnel and face-to-face interviews were conducted by trained investigators. Screening data in the program were linked to a CRC surveillance and registry system, and CRC cases reported in the system were regarded as true patients. RESULTS A total of 96,043 subjects were included. The sensitivity and specificity of FIT for detecting CRC cases were 75.49% (95% CI 69.84-80.39) and 90.36% (95% CI 90.17-90.54), respectively. QRAM was more sensitive (p < 0.001) and less specific (p < 0.001) than HRFQ. The sensitivity and specificity of FIT along with HRFQ were 86.56% (95% CI 81.81-90.22) and 81.37% (95% CI 81.12-81.62), and those of FIT along with QRAM were 88.93% (95% CI 84.47-92.23) and 73.95% (95% CI 73.67-74.23). CONCLUSIONS Our findings suggest that CRC preliminary screening with FIT and QRAM in parallel has high sensitivity and satisfactory specificity, and is a useful strategy in mass screening programs.
Collapse
Affiliation(s)
- Ding Ye
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Qiuchi Huang
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Qilong Li
- Jiashan Institute of Cancer Prevention and Treatment, Jiaxing, 314100, China
| | - Xiyi Jiang
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Mayila Mamat
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Mengling Tang
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Jianbing Wang
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China
| | - Kun Chen
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China.
| |
Collapse
|
284
|
Seo IK, Kim BJ, Kim B, Choi CH, Kim JW, Kim JG, Chang SK, Kang H. Abdominal fat distribution measured using computed tomography is associated with an increased risk of colorectal adenoma in men. Medicine (Baltimore) 2017; 96:e8051. [PMID: 28906398 PMCID: PMC5604667 DOI: 10.1097/md.0000000000008051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A few studies have shown inconsistent results regarding the association between the visceral fat proportion and colorectal adenomas. We aimed to investigate the association between abdominal fat distribution measured by computed tomography (CT) and colon adenoma.A total of 336 participants underwent physical examination, blood tests, colonoscopy, and abdominal computed tomography at Chung-Ang University Hospital. The associations between the obesity indicies (body mass index, visceral fat area (VFA), subcutaneous fat area (SFA), VFA-to-SFA ratio (VFA/SFA), and colorectal adenomas were evaluated.Of 309 subjects, 119 patients (38.5%) had colorectal adenoma. Mean age and fasting plasma glucose were higher in the patients with colorectal adenoma (P < .05, respectively). The mean VFA (153.3 cm vs 131.4 cm, P < .01) and VFA/SFA (1.07 vs 0.92, P < .05) were higher in the adenoma group than in the nonadenoma group. Males had higher mean VFA and VFA/SFA (P < .001). The mean VFA, SFA, and VFA/SFA were not associated with the location, size, number, and advancement of colorectal adenoma. In multivariate analysis, colorectal adenoma was significantly associated with VFA rather than VFA/SFA. In addition, colorectal adenoma was significantly associated with VFA rather than VFA/SFA in the men. The VFA, SFA, and VFA/SFA were not associated with colorectal adenoma in the women.The VFA measured by using a CT scan was positively associated with the presence of colorectal adenoma, especially in men. Furthermore, average risk men with large visceral fat volume should be examined carefully in screening colonoscopy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
285
|
Siba Y, Culpepper-Morgan J, Schechter M, Alatevi E, Jallow S, Onaghise J, Sey A, Ozick L, Sabbagh R. A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study. Ann Gastroenterol 2017; 30:518-525. [PMID: 28845107 PMCID: PMC5566772 DOI: 10.20524/aog.2017.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/27/2017] [Indexed: 12/22/2022] Open
Abstract
Background Controversy exists as to whether disparities in colorectal cancer (CRC) outcomes in African Americans (AAs) are best resolved by screening at age 45 or by proper use of existing guidelines. In 2004, an aggressive colonoscopy-based CRC screening program was implemented throughout New York City. Our goal was to determine the effect of that program on CRC outcomes in our mostly AA population. Methods CRC cases entered into Harlem Hospital’s tumor registry from January 1992 to December 2011 were divided into two cohorts: 1992-2003, the pre-intensive screening era (PSE), and 2004-2011, the intensive screening era (ISE). Each cohort was reviewed for demographics, indication for colonoscopy, tumor location, tumor stage, and mortality. Multivariate analysis was applied to the pooled cohorts to determine factors associated with survival. Results Inclusion criteria were met by 379 patients: 207 PSE and 172 ISE. Racial distribution, gender, age at presentation, and tumor location were not different during the two eras. Over 75% of patients were AA. During the ISE, 84% were insured compared to 34% in the PSE (P<0.0001). Fewer patients died during the ISE (21%) than during the PSE (67%) (P<0.0001). The ISE patients were diagnosed with earlier stages of CRC compared to the PSE. Increased survival was associated with being insured (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.30-2.81), distal tumors (HR 1.43, 95%CI 1.05-1.95), and being female (HR 1.36, 95%CI 1.01-1.850). Conclusions A multifaceted program reduced CRC outcome disparities in a poor AA community. Aggressive implementation of current colonoscopy screening guidelines still has unrealized potential to reduce CRC mortality disparities in AAs.
Collapse
Affiliation(s)
- Yahuza Siba
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Joan Culpepper-Morgan
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Menachem Schechter
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Eric Alatevi
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Sainabou Jallow
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Jude Onaghise
- Department of Medicine, Harlem Hospital Center, Columbia University Medical Center, New York (Eric Alatevi, Sainabou Jallow, Jude Onaghise), USA
| | - Albert Sey
- Department of Hospitalist Medicine, Ashtabula County Medical Center, Ohio (Albert Sey), USA
| | - Lisa Ozick
- Department of Medicine, Division of Gastroenterology, Harlem Hospital Center, Columbia University Medical Center, New York (Yahuza Siba, Joan Culpepper-Morgan, Menachem Schechter, Lisa Ozick), USA
| | - Raja Sabbagh
- Department of Surgery, Harlem Hospital Center, Columbia University Medical Center, New York (Raja Sabbagh), USA
| |
Collapse
|
286
|
The more from East-Asian, the better: risk prediction of colorectal cancer risk by GWAS-identified SNPs among Japanese. J Cancer Res Clin Oncol 2017; 143:2481-2492. [PMID: 28849422 DOI: 10.1007/s00432-017-2505-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/16/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the difference of genetic predisposition for CRC between ethnicities; however, many genetic traits common to colorectal cancer have been identified. This study investigated whether more SNPs identified in GWAS in East Asian population could improve the risk prediction of Japanese and explored possible application of genetic risk groups as an instrument of the risk communication. METHODS 558 Patients histologically verified colorectal cancer and 1116 first-visit outpatients were included for derivation study, and 547 cases and 547 controls were for replication study. Among each population, we evaluated prediction models for the risk of CRC that combined the genetic risk group based on SNPs from GWASs in European-population and a similarly developed model adding SNPs from GWASs in East Asian-population. We examined whether adding East Asian-specific SNPs would improve the discrimination. RESULTS Six SNPs (rs6983267, rs4779584, rs4444235, rs9929218, rs10936599, rs16969681) from 23 SNPs by European-based GWAS and five SNPs (rs704017, rs11196172, rs10774214, rs647161, rs2423279) among ten SNPs by Asian-based GWAS were selected in CRC risk prediction model. Compared with a 6-SNP-based model, an 11-SNP model including Asian GWAS-SNPs showed improved discrimination capacity in Receiver operator characteristic analysis. A model with 11 SNPs resulted in statistically significant improvement in both derivation (P = 0.0039) and replication studies (P = 0.0018) compared with six SNP model. We estimated cumulative risk of CRC by using genetic risk group based on 11 SNPs and found that the cumulative risk at age 80 is approximately 13% in the high-risk group while 6% in the low-risk group. CONCLUSION We constructed a more efficient CRC risk prediction model with 11 SNPs including newly identified East Asian-based GWAS SNPs (rs704017, rs11196172, rs10774214, rs647161, rs2423279). Risk grouping based on 11 SNPs depicted lifetime difference of CRC risk. This might be useful for effective individualized prevention for East Asian.
Collapse
|
287
|
Shukla R, Salem M, Hou JK. Use and barriers to chromoendoscopy for dysplasia surveillance in inflammatory bowel disease. World J Gastrointest Endosc 2017; 9:359-367. [PMID: 28874956 PMCID: PMC5565501 DOI: 10.4253/wjge.v9.i8.359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/13/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
Abstract
Traditionally, patients with inflammatory bowel disease (IBD) have been thought to be at increased risk of developing colitis-associated colorectal cancer. Although there are recent data suggesting that rates of colitis-associated cancer in IBD patients is declining, current guidelines still recommend regular dysplasia surveillance for early detection and prevention of neoplasia in patients with IBD. White-light endoscopy with random biopsies has been the traditional approach for dysplasia detection; however, newer technologies and approaches have emerged. One method, dye-based chromoendoscopy, has the potential to detect more dysplasia. However, longitudinal data to showing a benefit in morbidity or mortality from the use of chromoendoscopy are still lacking. Many societies have included recommendation on the use of chromoendoscopy with targeted biopsies as a method of surveillance for colitis - associated colorectal cancer. This narrative review seeks to outline data on dysplasia detection as well as barriers to the implementation of dye-based chromoendoscopy for the prevention and early detection of colitis-associated colorectal cancer.
Collapse
|
288
|
Tsai MH, Xirasagar S, de Groen PC. Persisting Racial Disparities in Colonoscopy Screening of Persons with a Family History of Colorectal Cancer. J Racial Ethn Health Disparities 2017; 5:737-746. [DOI: 10.1007/s40615-017-0418-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 12/24/2022]
|
289
|
Suemoto CK, Ueda P, Beltrán-Sánchez H, Lebrão ML, Duarte YA, Wong R, Danaei G. Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries. J Gerontol A Biol Sci Med Sci 2017; 72:410-416. [PMID: 27522061 DOI: 10.1093/gerona/glw166] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/25/2016] [Indexed: 12/24/2022] Open
Abstract
Background Existing mortality prediction models for older adults have been each developed using a single study from the United States or Western Europe. We aimed to develop and validate a 10-year mortality prediction model for older adults using data from developed and developing countries. Methods We used data from five cohorts, including data from 16 developed and developing countries: ELSA (English Longitudinal Study of Aging), HRS (Health and Retirement Study), MHAS (Mexican Health and Aging Study), SABE-Sao Paulo (The Health, Well-being and Aging), and SHARE (Survey on Health, Ageing and Retirement in Europe). 35,367 older adults were split into training (two thirds) and test (one third) data sets. Baseline predictors included age, sex, comorbidities, and functional and cognitive measures. We performed an individual participant data meta-analysis using a sex-stratified Cox proportional hazards model, with time to death as the time scale. We validated the model using Harrell's C statistic (discrimination) and the estimated slope between observed and predicted 10-year mortality risk across deciles of risk (calibration). Results During a median of 8.6 years, 8,325 participants died. The final model included age, sex, diabetes, heart disease, lung disease, cancer, smoking, alcohol use, body mass index, physical activity, self-reported health, difficulty with bathing, walking several blocks, and reporting date correctly. The model showed good discrimination (Harrell's C = 0.76) and calibration (slope = 1.005). Models for developed versus developing country cohorts performed equally well when applied to data from developing countries. Conclusion A parsimonious mortality prediction model using data from multiple cohorts in developed and developing countries can be used to predict mortality in older adults in both settings.
Collapse
Affiliation(s)
- Claudia Kimie Suemoto
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of Geriatrics, University of Sao Paulo Medical School, Brazil
| | - Peter Ueda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences and California Center for Population Research, Fielding School of Public Health, UCLA, Los Angeles
| | | | - Yeda Aparecida Duarte
- Department of Medical Surgical Nursing, School of Nursing, University of Sao Paulo, Brazil
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, University of Texas, Galveston
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
290
|
High-risk family colorectal cancer screening service in Ireland: Critical review of clinical outcomes. Cancer Epidemiol 2017; 50:30-38. [PMID: 28783501 DOI: 10.1016/j.canep.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/02/2017] [Accepted: 07/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND We present the 15-year experience of a family colorectal cancer screening service in Ireland with emphasis on real life experience and outcomes. METHODS Questionnaires were used to assess family cancer history and assign patients to risk categories; 'Moderate Risk', HNPCC, (suspected) genetic syndrome (non-HNPCC), 'Low Risk'. Screening was by full colonoscopy. We report neoplastic yield, examining effect of risk category, age, gender, and index colonoscopy findings. RESULTS Between 1998 and 2013, 2242 individuals were referred; 57.3% female, 42.7% male, median age 46 years (range9-85yrs). Median follow up time was 7.9yrs (range 0.5-15.3yrs). Follow up data after exclusion (non-compliance, known CRC) was available in 1496 (66.7%): 'Moderate risk' 785 (52.5%), HNPCC 256 (17.1%), (suspected) genetic syndrome (non-HNPCC) 85 (5.7%), 'Low Risk' 370 (24.7%). Screening was performed in 1025(68.5%) patients; colonoscopy data available for 993 (96.9%); total 1914 colonoscopies. At index colonoscopy, 178 (18.0%) patients had adenomas; 56 (5.5%) advanced adenoma. During the entire study period, 240 (24.2%) had an adenoma; 69 (7.0%) advanced adenoma. Cancers were diagnosed on screening in 2 patients. Older age and male gender were associated with higher adenoma detection rate; p<0.001, p=0.01, respectively. Risk category did not affect adenoma yield. Adenoma and advanced adenoma detection at index colonoscopy were associated with detection of same at follow up screening; p<0.001. CONCLUSION Male gender and age (>50) were the core identifiable risk factors for neoplasia at screening colonoscopy in this family screening setting. Our results would support less intensive surveillance in younger patients (<50), particularly where index colonoscopy is normal.
Collapse
|
291
|
The Impact of Family History on the Risk of Colorectal Neoplasia and Screening Practices. Clin Gastroenterol Hepatol 2017; 15:1204-1206. [PMID: 28433780 DOI: 10.1016/j.cgh.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023]
|
292
|
Colonoscopy and Flexible Sigmoidoscopy in Colorectal Cancer Screening and Surveillance. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
293
|
Vasan V, Brewington C. The Role of CT Colonography as a Screening Tool for Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
294
|
Training and competency in endoscopic mucosal resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
295
|
Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153:307-323. [PMID: 28600072 DOI: 10.1053/j.gastro.2017.05.013] [Citation(s) in RCA: 446] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
Collapse
Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| |
Collapse
|
296
|
Abstract
Colorectal cancer (CRC) contributes a major burden of cancer mortality in the United States. There are multiple effective screening approaches that can reduce CRC mortality. These approaches are supported by different levels of evidence, and each has its own advantages and disadvantages. Implementing a systematic approach to screening that addresses the multiple steps involved in the screening process is essential to improving population-level CRC screening. Offering patients stool-based screening is important for increasing screening uptake. However, programs that offer stool testing must support the population health infrastructure needed to promote adherence to repeat testing and follow-up of abnormal tests.
Collapse
Affiliation(s)
- Alison T Brenner
- Cecil G Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA.
| | - Michael Dougherty
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 4182 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-6134, USA
| | - Daniel S Reuland
- Division of General Internal Medicine, Department of Medicine, University of North Carolina, 725 Martin Luther King Jr Boulevard, CB# 7590, Chapel Hill, NC 27599-7590, USA
| |
Collapse
|
297
|
Yang HJ, Choi S, Park SK, Jung YS, Choi KY, Park T, Kim JY, Park DI. Derivation and validation of a risk scoring model to predict advanced colorectal neoplasm in adults of all ages. J Gastroenterol Hepatol 2017; 32:1328-1335. [PMID: 28012211 DOI: 10.1111/jgh.13711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Little is known about how to include adults < 50 years in colonoscopy screening. This study aimed to derive a risk-scoring model incorporating laboratory indicators for metabolic risks to predict advanced colorectal neoplasia (ACN) in asymptomatic Korean adults both younger and older than 50 years. METHODS In this cross-sectional study, 70 812 consecutive adult recipients of a screening colonoscopy in a single health check-up center in Korea between 2003 and 2012 were enrolled. A risk score model was developed using multiple logistic regression model and internally validated. RESULTS Overall prevalence of ACN was 1.4% (956/70 812). A 15-point score model was developed to comprise age, sex, family history of colorectal cancer, smoking, body mass index, serum levels of fasting glucose, low-density lipoprotein cholesterol, and carcinoembryonic antigen. Based on the score, the validation cohort could be categorized into five risk groups (low, borderline, moderate, high, and very high) with an ACN prevalence of 0.7%, 1.3%, 2.7%, 6.6%, and 13.2%, respectively. Compared with the borderline risk group, the low-risk group showed a 50.3% reduced risk of ACN. Meanwhile, the moderate, high, and very high risk groups showed 2, 5, and 10-fold increased risk of ACN. The score showed significantly superior discriminative power than the Asian-Pacific colorectal screening score (P = 0.003). CONCLUSIONS Our scoring model based on both clinical and laboratory risk factors is useful for the prediction of ACN. This score may be used to include adults < 50 years in colonoscopy screening.
Collapse
Affiliation(s)
- Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungkyoung Choi
- Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yong Choi
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taesung Park
- Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea.,Department of Statistics, Seoul National University, Seoul, Korea
| | - Ji Yeon Kim
- Comprehensive Health Care Center, Korea Cancer Center Hospital, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
298
|
Extracolonic Findings at Screening CT Colonography: Prevalence, Benefits, Challenges, and Opportunities. AJR Am J Roentgenol 2017; 209:94-102. [DOI: 10.2214/ajr.17.17864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
299
|
Ishaq S, Siau K, Harrison E, Tontini GE, Hoffman A, Gross S, Kiesslich R, Neumann H. Technological advances for improving adenoma detection rates: The changing face of colonoscopy. Dig Liver Dis 2017; 49:721-727. [PMID: 28454854 DOI: 10.1016/j.dld.2017.03.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/06/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
Worldwide, colorectal cancer is the third commonest cancer. Over 90% follow an adenoma-to-cancer sequence over many years. Colonoscopy is the gold standard method for cancer screening and early adenoma detection. However, considerable variation exists between endoscopists' detection rates. This review considers the effects of different endoscopic techniques on adenoma detection. Two areas of technological interest were considered: (1) optical technologies and (2) mechanical technologies. Optical solutions, including FICE, NBI, i-SCAN and high definition colonoscopy showed mixed results. In contrast, mechanical advances, such as cap-assisted colonoscopy, FUSE, EndoCuff and G-EYE™, showed promise, with reported detections rates of up to 69%. However, before definitive recommendations can be made for their incorporation into daily practice, further studies and comparison trials are required.
Collapse
Affiliation(s)
- Sauid Ishaq
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom; Birmingham City University, Birmingham, United Kingdom; St. George's University, Grenada, West Indies.
| | - Keith Siau
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom
| | - Elizabeth Harrison
- Gastroenterology Department, Dudley Group Hospitals, Dudley, United Kingdom
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato, Italy
| | - Arthur Hoffman
- Department of Internal Medicine and Gastroenterology, St. Marienkrankenhaus Frankfurt, Frankfurt, Germany
| | - Seth Gross
- Division of Gastroenterology, NYU Langone Medical Center, New York, NY, USA
| | - Ralf Kiesslich
- Department of Internal Medicine and Gastroenterology, St. Marienkrankenhaus Frankfurt, Frankfurt, Germany
| | - Helmut Neumann
- Interventional Endoscopy Center, University Hospital Mainz, Germany
| |
Collapse
|
300
|
Bloch MB, Yavin E, Nissan A, Ariel I, Kenett R, Brass D, Rubinstein A. The effect of linker type and recognition peptide conjugation chemistry on tissue affinity and cytotoxicity of charged polyacrylamide. J Control Release 2017; 257:102-117. [DOI: 10.1016/j.jconrel.2016.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/27/2016] [Accepted: 06/26/2016] [Indexed: 12/16/2022]
|