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Ladabaum U, Mannalithara A, Schoen RE, Dominitz JA, Lieberman D. Projected Impact and Cost-Effectiveness of Novel Molecular Blood-Based or Stool-Based Screening Tests for Colorectal Cancer. Ann Intern Med 2024. [PMID: 39467291 DOI: 10.7326/annals-24-00910] [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: 10/30/2024] Open
Abstract
BACKGROUND Cell-free DNA blood tests (cf-bDNA) and next-generation stool tests could change colorectal cancer (CRC) screening. OBJECTIVE To estimate the clinical and economic impacts of novel CRC screening tests. DESIGN Cost-effectiveness analysis using MOSAIC (Model of Screening and Surveillance for Colorectal Cancer). DATA SOURCES Published data. TARGET POPULATION Average-risk persons. TIME HORIZON Ages 45 to 100 years. PERSPECTIVE Health sector. INTERVENTION Novel versus established CRC screening tests. OUTCOME MEASURES Incidence and mortality of CRC, quality-adjusted life-years (QALYs), costs. RESULTS OF BASE-CASE ANALYSIS For colonoscopy every 10 years, annual fecal immunochemical test (FIT), and triennial next-generation multitarget stool DNA, FIT-RNA, cf-bDNA (Guardant Shield), or cf-bDNA (Freenome), the relative rates (RRs) and 95% uncertainty intervals (UIs) versus no screening for CRC incidence were 0.21 (0.19 to 0.22), 0.29 (0.27 to 0.31), 0.33 (0.32 to 0.36), 0.32 (0.30 to 0.34), 0.58 (0.55 to 0.61) and 0.58 (0.55 to 0.60), respectively; the RRs for CRC death were 0.19 (0.17 to 0.20), 0.25 (0.23 to 0.27), 0.28 (0.27 to 0.30), 0.28 (0.26 to 0.30), 0.44 (0.42 to 0.47), and 0.46 (0.44 to 0.49), respectively. The cf-bDNA test (Shield; list price $1495) cost $89 600 ($74 800 to $102 300) per QALY gained versus no screening; alternatives were less costly and more effective. RESULTS OF SENSITIVITY ANALYSIS Incremental costs exceeded incremental benefits when novel test intervals were shortened to 2 or 1 years. The cf-bDNA test matched FIT's impact on CRC mortality at 1.35 (1.30 to 1.40)-fold FIT's uptake rate, assuming equal colonoscopy follow-up. If persons who accept colonoscopy or stool tests shifted to cf-bDNA, CRC deaths increased. This adverse effect was overcome if every 3 such substitutions were counterbalanced by cf-bDNA uptake by 2 or more persons refusing alternatives, assuming equal colonoscopy follow-up. LIMITATION Longitudinal test-specific participation patterns are unknown. CONCLUSION First-generation cf-bDNA tests may deliver net benefit or harm, depending on the balance between achieving screening in persons who decline alternatives versus substituting cf-bDNA for more effective alternatives. PRIMARY FUNDING SOURCE The Gorrindo Family Fund.
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Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology and Department of Medicine, Stanford University School of Medicine, Stanford, California (U.L., A.M.)
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology and Department of Medicine, Stanford University School of Medicine, Stanford, California (U.L., A.M.)
| | - Robert E Schoen
- Division of Gastroenterology, Hepatology and Nutrition, and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (R.E.S.)
| | - Jason A Dominitz
- Veterans Administration Puget Sound Health Care System, Seattle; and Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (J.A.D.)
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Sciences University, Portland, Oregon (D.L.)
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Worthington J, Kelly A, Lew JB, Ge H, Vasica C, Broun K, Canfell K, Feletto E. Longitudinal screening adherence in the Australian National Bowel Cancer Screening Program from 2006 to 2022. Prev Med 2024; 186:108095. [PMID: 39122018 DOI: 10.1016/j.ypmed.2024.108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Australia's National Bowel Cancer Screening Program (NBCSP) offers two-yearly screening to 50-74-year-olds for the prevention and early detection of colorectal cancer (CRC). Internationally, detailed reporting of participation across multiple screening rounds - also known as longitudinal adherence - is becoming more common, but remains limited in Australia. We described the longitudinal screening adherence of individuals by age and sex invited to the NBCSP at least once, and quantified longitudinal adherence among individuals who received four NBCSP invitations. METHODS We obtained aggregate national data for individuals who received at least one NBCSP invitation between 1 August 2006 and 31 March 2022. We described screening adherence patterns including longitudinal adherence among individuals who received four invitations, and evaluated prior longitudinal adherence and adherence at most recent invitation as predictors of future participation. RESULTS Over the study period, 8.5 million individuals were invited to screen in the NBCSP; 51.9% of these individuals screened at least once. Of the >2.5 million individuals who received four invitations, 23.3% consistently screened, 38.3% never screened, and 38.3% inconsistently screened. The longitudinal adherence at the fourth invitation round for individuals who previously returned none, one, two, or three of their previous three invitations was 9.5%, 37.4%, 70.1% and 88.8%, respectively. Both longitudinal adherence and adherence at the most recent invitation were significant predictors of future participation. CONCLUSION Our study is the first detailed report of longitudinal adherence to the NBCSP in >2 screening rounds. These insights into long-term behaviours can inform planning for interventions to improve screening participation.
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Affiliation(s)
- Joachim Worthington
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia.
| | - Anna Kelly
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Jie-Bin Lew
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Han Ge
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
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3
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Priego-Parra BA, Triana-Romero A, Inurreta-Vásquez A, Laffitte-García H, Violante-Hernández GA, Jiménez-Rodríguez SS, Martínez-Pérez GP, Meixueiro-Daza A, Grube-Pagola P, Remes-Troche JM. Colorectal cancer screening program implementation: biennial adherence and participation patterns. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:354-361. [PMID: 38862361 DOI: 10.1016/j.rgmxen.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/26/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION AND AIM Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. MATERIALS AND METHODS A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. RESULTS A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). CONCLUSIONS In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone.
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Affiliation(s)
- B A Priego-Parra
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.
| | - A Triana-Romero
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Inurreta-Vásquez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - H Laffitte-García
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G A Violante-Hernández
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - S S Jiménez-Rodríguez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G P Martínez-Pérez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Meixueiro-Daza
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - P Grube-Pagola
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - J M Remes-Troche
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
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Priego-Parra B, Triana-Romero A, Inurreta-Vásquez A, Laffitte-García H, Violante-Hernández G, Jiménez-Rodríguez S, Martínez-Pérez G, Meixueiro-Daza A, Grube-Pagola P, Remes-Troche J. Implementación de un programa de tamizaje organizado para cáncer colorrectal: Adherencia bienal y patrones de participación. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2024; 89:354-361. [DOI: 10.1016/j.rgmx.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
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5
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Arevalo M, Sutton SK, Abdulla R, Christy SM, Meade CD, Roetzheim RG, Gwede CK. Longitudinal adherence to annual colorectal cancer screening among Black persons living in the United States enrolled in a community-based randomized trial. Cancer 2024; 130:1684-1692. [PMID: 38150285 PMCID: PMC11009071 DOI: 10.1002/cncr.35169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND This study examined repeat colorectal cancer screening rates at 12 and 24 months as part of a randomized intervention trial among Black persons living in the United States and factors associated with screening adherence. METHODS Participants completed a survey assessing demographics and Preventive Health Model (PHM) factors (e.g., self efficacy, susceptibility) and received either a culturally targeted photonovella plus free fecal immunochemical test (FIT) kits (intervention group) or a standard educational brochure plus free FIT kits (comparison group). FIT return was assessed at 6, 12, and 24 months. Descriptive statistics summarized patterns of repeat screening. Logistic regression models assessed FIT uptake overtime, and demographic and PHM factors associated with screening adherence. RESULTS Participants (N = 330) were U.S.-born (93%), non-Hispanic (97%), and male (52%). Initial FIT uptake within 6 months of enrollment was 86.6%, and subsequently dropped to 54.5% at 12 months and 36.6% at 24 months. Higher FIT return rates were observed for the brochure group at 24 months (51.5% vs 33.3% photonovella, p = .023). Multiple patterns of FIT kit return were observed: 37% completed FIT at all three time points (full adherence), 22% completed two of three (partial adherence), 29% completed one of three (partial adherence), and 12% did not return any FIT kits (complete nonadherence). Predictors of full adherence were higher levels of education and self-efficacy. CONCLUSIONS Full adherence to repeat screening was suboptimal. Most participants had partial adherence (one or two of three) to annual FIT screening. Future studies should focus on strategies to support repeat FIT screening.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Rania Abdulla
- NTRO Non-Therapeutic Research Office, Moffitt Cancer Center, Tampa, FL, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Richard G. Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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6
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Worthington J, Sun Z, Fu R, Lew JB, Chan KKW, Li Q, Eskander A, Hui H, McLoughlin K, Caruana M, Peacock S, Yong JHE, Canfell K, Feletto E, Malagón T. COVID-related disruptions to colorectal cancer screening, diagnosis, and treatment could increase cancer Burden in Australia and Canada: A modelling study. PLoS One 2024; 19:e0296945. [PMID: 38557758 PMCID: PMC10984523 DOI: 10.1371/journal.pone.0296945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/20/2023] [Indexed: 04/04/2024] Open
Abstract
COVID-19 disrupted cancer control worldwide, impacting preventative screening, diagnoses, and treatment services. This modelling study estimates the impact of disruptions on colorectal cancer cases and deaths in Canada and Australia, informed by data on screening, diagnosis, and treatment procedures. Modelling was used to estimate short- and long-term effects on colorectal cancer incidence and mortality, including ongoing impact of patient backlogs. A hypothetical mitigation strategy was simulated, with diagnostic and treatment capacities increased by 5% from 2022 to address backlogs. Colorectal cancer screening dropped by 40% in Canada and 6.3% in Australia in 2020. Significant decreases to diagnostic and treatment procedures were also observed in Australia and Canada, which were estimated to lead to additional patient wait times. These changes would lead to an estimated increase of 255 colorectal cancer cases and 1,820 colorectal cancer deaths in Canada and 234 cases and 1,186 deaths in Australia over 2020-2030; a 1.9% and 2.4% increase in mortality, respectively, vs a scenario with no screening disruption or diagnostic/treatment delays. Diagnostic and treatment capacity mitigation would avert 789 and 350 deaths in Canada and Australia, respectively. COVID-related disruptions had a significant impact on colorectal cancer screening, diagnostic, and treatment procedures in Canada and Australia. Modelling demonstrates that downstream effects on disease burden could be substantial. However, backlogs can be managed and deaths averted with even small increases to diagnostic and treatment capacity. Careful management of resources can improve patient outcomes after any temporary disruption, and these results can inform targeted approaches early detection of cancers.
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Affiliation(s)
| | - Zhuolu Sun
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jie-Bin Lew
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | - Kelvin K. W. Chan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Harriet Hui
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | | | - Michael Caruana
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- BC Cancer Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia, Canada
| | | | - Karen Canfell
- The Daffodil Centre, Kings Cross, New South Wales, Australia
| | | | - Talía Malagón
- Department of Oncology, McGill University, Montréal, Canada
- St Mary’s Research Centre, Montréal West Island CIUSSS, Montréal, Canada
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Montalvan-Sanchez EE, Beas R, Karkash A, Godoy A, Norwood DA, Dougherty M. Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer. Gastroenterology Res 2024; 17:41-51. [PMID: 38463144 PMCID: PMC10923253 DOI: 10.14740/gr1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
The significant global burden of colorectal cancer accentuates disparities in access to preventive healthcare in most low- and middle-income countries (LMICs) as well as large sections of underserved populations within high-income countries. The barriers to colorectal cancer screening in economically transitioning Latin America are multiple. At the same time, immigration from these countries to the USA continues to increase. This case highlights the delays in diagnosis experienced by a recent immigrant from a country with no established colorectal cancer screening program, to an immigrant population in the USA with similar poor screening coverage. We discuss common challenges faced by Latinos in their home countries and the USA, as well as strategies that could be implemented to improve screening coverage in US immigrant populations.
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Affiliation(s)
| | - Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ahmad Karkash
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ambar Godoy
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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8
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de Jonge L, Riggi E, van Duuren LA, Toes-Zoutendijk E, Campari C, Sassatelli R, Arrigoni A, Orione L, Lansdorp-Vogelaar I, Senore C. Risk prediction for advanced neoplasia using longitudinal adherence measures to fecal immunochemical test-based colorectal cancer screening programs. Prev Med 2023; 170:107488. [PMID: 36931473 DOI: 10.1016/j.ypmed.2023.107488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/12/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Patterns of longitudinal adherence may predict advanced neoplasia (AN) detection in subsequent rounds of colorectal cancer (CRC) screening. However, after more than five rounds, it is important to obtain a simplified measure. The aim was to determine the best simplified measure of longitudinal adherence to predict AN detection in CRC screening. METHODS Individuals with four invitations from a Dutch Fecal immunochemical testing (FIT-)based pilot study and two Italian FIT-based CRC screening programs were included. We calculated AN detection in the fourth round, stratified by prior adherence. Five simplified measures were compared to full information (permutations) using chi-squared goodness-of-fit: adherence previous invitation, consistency, frequency, frequency + adherence previous invitation, and proportion of invitations covered. RESULTS AN detection in the fourth round was highly dependent on prior adherence behavior. For inconsistent adherence, detection in the fourth round was strongly dependent on frequency and time since last participation. The performance of the simplified measures to capture this variation differed considerably. 'Adherence previous invitation' scored worst in predicting AN detection. 'Frequency+adherence previous invitation' had lowest chi-squared goodness-of-fit. DISCUSSION The simplified measure 'frequency+adherence previous invitation' is the best measure to reflect patterns of longitudinal adherence and could be used to emphasize to individuals the importance of CRC screening.
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Affiliation(s)
- L de Jonge
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Emilia Riggi
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Luuk A van Duuren
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Cinzia Campari
- Screening Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Arrigo Arrigoni
- Diagnostic and Interventional Digestive Endoscopy, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Lorenzo Orione
- Screening organisation and evaluation Unit, ASL CN1, Cuneo, Italy
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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Alrubaiy L, Al-Rubaye A, Alrudainy W, Al-Hawaz MH, Mahmoud RA, Saunders BP. Colonoscopy Colorectal Cancer Screening Programme in Southern Iraq: Challenges, Knowledge Gaps and Future Potential. J Pers Med 2023; 13:jpm13020173. [PMID: 36836407 PMCID: PMC9964669 DOI: 10.3390/jpm13020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Data on current colorectal cancer screening practices in Iraq are limited. This study aimed to better understand the current colorectal cancer screening practice and perceived barriers. The project also aimed to use UK expertise to introduce Bowel Cancer Screening Programme (BCSP) in Basra, Iraq. The study consisted of two parts: A pre-visit online survey of clinicians to test the project's feasibility. A public survey was conducted to understand and gauge the general knowledge and perceived barriers to having colorectal cancer screening. The second phase included a short visit to Basra and the delivery of a multidisciplinary meeting for bowel screening colonoscopists. Fifty healthcare providers completed the survey. Basra has no established bowel cancer screening programme, let alone the country. Opportunistic colonoscopy surveillance is done on an ad hoc base. A total of 350 individuals completed the public survey. The survey showed that more than 50% of participants were not familiar with the concept of a BCSP and less than 25% were aware of "red flag" symptoms of bowel cancer. The short visit to Basra included a roundtable discussion and delivered a training workshop for screening colonoscopists using UK training materials in conjunction with the Iraqi Medical Association. Feedback from the course was extremely positive. Several potential barriers were identified to participate in BCSP. The study highlighted potential barriers, including a lack of public awareness and insufficient training resources to be addressed in future screening programmes. The study has identified several potential areas for future collaboration to support the development of a BCSP centre in Basra.
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Affiliation(s)
- Laith Alrubaiy
- Gastroenterology Department, Swansea University Medical School, Swansea SA8 2PP, UK
- Correspondence: ; Tel.: +44-7809670683
| | - Ali Al-Rubaye
- Medical Research Unit, Basra Health Directorate, Basra 289, Iraq
| | | | | | - Raja A. Mahmoud
- Public Health Department, Al-Zahraa Medical College, Basra 289, Iraq
| | - Brian P. Saunders
- Bowel Cancer Screening for North West London, St Mark’s Hospital, Watford Road, London HA1 3UJ, UK
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10
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van Wifferen F, Greuter MJE, Lissenberg-Witte BI, Carvalho B, Meijer GA, Dekker E, Campari C, Garcia M, Rabeneck L, Lansdorp-Vogelaar I, Senore C, Coupé VMH, Segnan N, McCarthy S, Puricelli-Perin DM, Portillo I, Jahn B. Guidance for setting international standards on reporting longitudinal adherence to stool-based colorectal cancer screening. Prev Med 2022; 164:107187. [PMID: 35963311 DOI: 10.1016/j.ypmed.2022.107187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/01/2022] [Accepted: 08/05/2022] [Indexed: 11/26/2022]
Abstract
Longitudinal adherence to colorectal cancer (CRC) screening is reported using different summarizing measures, which hampers international comparison. We provide evidence to guide recommendations on which longitudinal adherence measure to report. Using adherence data over four stool-based CRC screening rounds in three countries, we calculated six summarizing adherence measures; adherence over all rounds, adherence per round, rescreening, full programme adherence (yes/no), regularity (never/inconsistent/consistent screenees) and number of times participated. For each measure, we calculated the accuracy in capturing the observed adherence patterns. Using the ASCCA model, we predicted screening effectiveness when using summarizing measures as model input versus the observed adherence patterns. Adherence over all rounds in the Italian, Spanish and Dutch cohorts was 64.9%, 42.8% and 61.5%, respectively, and the proportion of consistent screenees was 50.9%, 26.3% and 45.7%. Number of times participated and regularity were most accurate and resulted in similar model-predicted screening effectiveness as simulating the observed adherence patterns of Italy, Spain and the Netherlands (mortality reductions: 24.4%, 16.9% and 23.5%). Adherence over all rounds and adherence per round were least accurate. Screening effectiveness was overestimated when using adherence over all rounds (mortality reductions: 26.8%, 19.4% and 25.7%) and adherence per round (mortality reductions: 26.8%, 19.5% and 25.9%). To conclude, number of times participated and regularity were most accurate and resulted in similar model-predicted screening effectiveness as using the observed adherence patterns. However they require longitudinal data. To facilitate international comparison of CRC screening programme performance, consensus on an accurate adherence measure to report should be reached.
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Affiliation(s)
- Francine van Wifferen
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Marjolein J E Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gerrit A Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Cinzia Campari
- Screening Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Montse Garcia
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Linda Rabeneck
- Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), University of Toronto, Canada
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Carlo Senore
- SSD Epidemiology, screening unit - CPO, University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | | | - Nereo Segnan
- Centre for Cancer Prevention, CPO, Piedmonte, Turin, Italy
| | - Sharon McCarthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Isabel Portillo
- Osakidetza Basque Health Service, Basque Country Colorectal Cancer Screening Programme, 48011 Bilbao, Spain; Biocruces Health Research Institute, Cancer Biomarker Area, 48903 Barakaldo, Spain
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer Zentrum 1, A-6060 Hall in Tirol, Austria
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11
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Brändle K, Bulliard JL. Measuring longitudinal adherence to screening needs international standards. Breast 2022; 67:129. [PMID: 36210239 PMCID: PMC9982305 DOI: 10.1016/j.breast.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
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12
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Ding L, Greuter MJ, Van Hal G, de Bock GH. Reply to: Measuring longitudinal adherence to screening needs international standards. Breast 2022; 67:130. [PMID: 36202721 PMCID: PMC9982303 DOI: 10.1016/j.breast.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
- Lilu Ding
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Marcel J.W. Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | - Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium,Center for Cancer Detection (CvKO) in Flanders, Belgium
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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13
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Segnan N, Dekker E, Doria-Rose VP, Senore C, Rabeneck L, Lansdorp-Vogelaar I. Comparing Colorectal Cancer Screening Outcomes in the International Cancer Screening Network: A Consortium Proposal. Gastroenterology 2022; 162:668-674. [PMID: 34687738 DOI: 10.1053/j.gastro.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Nereo Segnan
- Centre for Cancer Prevention, CPO Piemonte, Torino, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, US National Cancer Institute, Bethesda, Maryland
| | - Carlo Senore
- Centre for Cancer Prevention, CPO Piemonte, Torino, Italy
| | - Linda Rabeneck
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada and, University of Toronto, Toronto, Ontario, Canada
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus Medical Center, University Medical Centre, Rotterdam, the Netherlands
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14
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Troisi J, Tafuro M, Lombardi M, Scala G, Richards SM, Symes SJK, Ascierto PA, Delrio P, Tatangelo F, Buonerba C, Pierri B, Cerino P. A Metabolomics-Based Screening Proposal for Colorectal Cancer. Metabolites 2022; 12:metabo12020110. [PMID: 35208185 PMCID: PMC8878838 DOI: 10.3390/metabo12020110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is a high incidence disease, characterized by high morbidity and mortality rates. Early diagnosis remains challenging because fecal occult blood screening tests have performed sub-optimally, especially due to hemorrhoidal, inflammatory, and vascular diseases, while colonoscopy is invasive and requires a medical setting to be performed. The objective of the present study was to determine if serum metabolomic profiles could be used to develop a novel screening approach for colorectal cancer. Furthermore, the study evaluated the metabolic alterations associated with the disease. Untargeted serum metabolomic profiles were collected from 100 CRC subjects, 50 healthy controls, and 50 individuals with benign colorectal disease. Different machine learning models, as well as an ensemble model based on a voting scheme, were built to discern CRC patients from CTRLs. The ensemble model correctly classified all CRC and CTRL subjects (accuracy = 100%) using a random subset of the cohort as a test set. Relevant metabolites were examined in a metabolite-set enrichment analysis, revealing differences in patients and controls primarily associated with cell glucose metabolism. These results support a potential use of the metabolomic signature as a non-invasive screening tool for CRC. Moreover, metabolic pathway analysis can provide valuable information to enhance understanding of the pathophysiological mechanisms underlying cancer. Further studies with larger cohorts, including blind trials, could potentially validate the reported results.
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Affiliation(s)
- Jacopo Troisi
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Theoreo srl, Via degli Ulivi 3, 84090 Montecorvino Pugliano, Italy; (M.L.); (G.S.)
- Correspondence: or (J.T.); (B.P.)
| | - Maria Tafuro
- Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055 Portici, Italy; (M.T.); (C.B.); (P.C.)
| | - Martina Lombardi
- Theoreo srl, Via degli Ulivi 3, 84090 Montecorvino Pugliano, Italy; (M.L.); (G.S.)
| | - Giovanni Scala
- Theoreo srl, Via degli Ulivi 3, 84090 Montecorvino Pugliano, Italy; (M.L.); (G.S.)
- Hosmotic srl, Via R. Bosco 178, 80069 Vico Equense, Italy
| | - Sean M. Richards
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, University of Tennessee College of Medicine, 960 East Third Street, Suite 100, 902 McCallie Avenue, Chattanooga, TN 37403, USA; (S.M.R.); (S.J.K.S.)
- Department of Biology, Geology and Environmental Sciences, University of Tennessee at Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, USA
| | - Steven J. K. Symes
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, University of Tennessee College of Medicine, 960 East Third Street, Suite 100, 902 McCallie Avenue, Chattanooga, TN 37403, USA; (S.M.R.); (S.J.K.S.)
- Department of Chemistry and Physics, University of Tennessee at Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, USA
| | - Paolo Antonio Ascierto
- Istituto Nazionale Tumori Fondazione Pascale IRCCS, 80131 Napoli, Italy; (P.A.A.); (P.D.); (F.T.)
| | - Paolo Delrio
- Istituto Nazionale Tumori Fondazione Pascale IRCCS, 80131 Napoli, Italy; (P.A.A.); (P.D.); (F.T.)
| | - Fabiana Tatangelo
- Istituto Nazionale Tumori Fondazione Pascale IRCCS, 80131 Napoli, Italy; (P.A.A.); (P.D.); (F.T.)
| | - Carlo Buonerba
- Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055 Portici, Italy; (M.T.); (C.B.); (P.C.)
| | - Biancamaria Pierri
- Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055 Portici, Italy; (M.T.); (C.B.); (P.C.)
- Correspondence: or (J.T.); (B.P.)
| | - Pellegrino Cerino
- Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, 80055 Portici, Italy; (M.T.); (C.B.); (P.C.)
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15
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Bulliard JL. Time to use measures of longitudinal adherence in cancer screening programmes. Int J Cancer 2021; 149:248-249. [PMID: 33834483 DOI: 10.1002/ijc.33582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jean-Luc Bulliard
- Centre for Primary Care and Public Health (unisanté), Lausanne, Switzerland
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