1
|
Buja A, De Luca G, Zorzi M, Bovo E, Mocellin S, Trevisiol C, Bronte V, Guzzinati S, Rugge M. Thirty-two-year trends of cancer incidence by sex and cancer site in the Veneto Region from 1987 to 2019. Front Public Health 2024; 11:1267534. [PMID: 38259775 PMCID: PMC10800396 DOI: 10.3389/fpubh.2023.1267534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Background This observational study considers the sex-specific incidence of the most incident cancers as recorded in the population-based Veneto Regional Cancer Registry over a period of more than 30 years (1987-2019). Methods The Veneto Regional Cancer Registry collected data for the time interval 1987-2019. Significant changes in incidence trends calculated on age-standardized incidence rates (Annual Percent Change-APC) were identified by join point regression analysis. Results Overall, the incidence trend for all cancers decreased in males and remained stable in females. In nine cancer sites, the incidence trends showed consistent differences by sex (oral cavity, esophagus, colon rectum and anus, liver, larynx, lung, cutaneous malignant melanoma, bladder, and thyroid gland). Other malignancies did not show significant sex-related differences (stomach, pancreas, biliary tract, kidney/urinary tract, central nervous system, multiple myeloma, non-Hodgkin lymphoma, and leukemia). Conclusion In the period 1987-2019, this study revealed sex-related differences in cancer incidence trends. Over time, cancer incidence remained higher in males, with a decreasing epidemiological impact, plausibly resulting from prevention campaigns against environmental cancer risk factors, as tobacco and alcohol. Conversely, a significant decrease was not observed in the incidence trend in females. These findings contribute essential insights for profiling the epidemiological map of cancer in a large Italian population, allowing comparison with other European cancer epidemiology studies and providing updated data supporting sex-related primary and secondary cancer prevention strategies.
Collapse
Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe De Luca
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum, and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology – DISCOG, University of Padova, Padua, Italy
| | - Chiara Trevisiol
- Soft-Tissue, Peritoneum, and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | | | | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
- Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| |
Collapse
|
2
|
Wang L, Tu Y, Chen L, Zhang Y, Pan X, Yang S, Zhang S, Li S, Yu K, Song S, Xu H, Yin Z, Yue J, Ni Q, Tang T, Zhang J, Guo M, Zhang S, Yao F, Liang X, Chen Z. Male-Biased Gut Microbiome and Metabolites Aggravate Colorectal Cancer Development. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2206238. [PMID: 37400423 PMCID: PMC10477899 DOI: 10.1002/advs.202206238] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/18/2023] [Indexed: 07/05/2023]
Abstract
Men demonstrate higher incidence and mortality rates of colorectal cancer (CRC) than women. This study aims to explain the potential causes of such sexual dimorphism in CRC from the perspective of sex-biased gut microbiota and metabolites. The results show that sexual dimorphism in colorectal tumorigenesis is observed in both ApcMin/ + mice and azoxymethane (AOM)/dextran sulfate sodium (DSS)-treated mice with male mice have significantly larger and more tumors, accompanied by more impaired gut barrier function. Moreover, pseudo-germ mice receiving fecal samples from male mice or patients show more severe intestinal barrier damage and higher level of inflammation. A significant change in gut microbiota composition is found with increased pathogenic bacteria Akkermansia muciniphila and deplets probiotic Parabacteroides goldsteinii in both male mice and pseudo-germ mice receiving fecal sample from male mice. Sex-biased gut metabolites in pseudo-germ mice receiving fecal sample from CRC patients or CRC mice contribute to sex dimorphism in CRC tumorigenesis through glycerophospholipids metabolism pathway. Sexual dimorphism in tumorigenesis of CRC mouse models. In conclusion, the sex-biased gut microbiome and metabolites contribute to sexual dimorphism in CRC. Modulating sex-biased gut microbiota and metabolites could be a potential sex-targeting therapeutic strategy of CRC.
Collapse
Affiliation(s)
- Ling Wang
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
- Shenzhen BranchGuangdong Laboratory for Lingnan Modern AgricultureGenome Analysis Laboratory of the Ministry of AgricultureAgricultural Genomics Institute at ShenzhenChinese Academy of Agricultural SciencesShenzhen518000China
| | - Yi‐Xuan Tu
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Lu Chen
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Yuan Zhang
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Xue‐Ling Pan
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Shu‐Qiao Yang
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Shuai‐Jie Zhang
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Sheng‐Hui Li
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Ke‐Chun Yu
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Shuo Song
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Hong‐Li Xu
- Department of Medical OncologyHubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430079China
| | - Zhu‐Cheng Yin
- Department of Medical OncologyHubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430079China
| | - Jun‐Qiu Yue
- Department of Medical OncologyHubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430079China
| | - Qian‐Lin Ni
- Wuhan Metwell Biotechnology Co., Ltd. WuhanWuhan430075China
| | - Tang Tang
- Wuhan Metwell Biotechnology Co., Ltd. WuhanWuhan430075China
| | - Jiu‐Liang Zhang
- College of Food Science and TechnologyHuazhong Agricultural UniversityWuhan430070China
| | - Min Guo
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
| | - Shuai Zhang
- Hubei Hongshan LaboratoryWuhan430070China
- Shenzhen BranchGuangdong Laboratory for Lingnan Modern AgricultureGenome Analysis Laboratory of the Ministry of AgricultureAgricultural Genomics Institute at ShenzhenChinese Academy of Agricultural SciencesShenzhen518000China
| | - Fan Yao
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
- Shenzhen BranchGuangdong Laboratory for Lingnan Modern AgricultureGenome Analysis Laboratory of the Ministry of AgricultureAgricultural Genomics Institute at ShenzhenChinese Academy of Agricultural SciencesShenzhen518000China
| | - Xin‐Jun Liang
- Department of Medical OncologyHubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430079China
| | - Zhen‐Xia Chen
- Hubei Hongshan LaboratoryWuhan430070China
- Hubei Key Laboratory of Agricultural BioinformaticsCollege of Life Science and TechnologyInterdisciplinary Sciences InstituteHuazhong Agricultural UniversityWuhan430070China
- Shenzhen BranchGuangdong Laboratory for Lingnan Modern AgricultureGenome Analysis Laboratory of the Ministry of AgricultureAgricultural Genomics Institute at ShenzhenChinese Academy of Agricultural SciencesShenzhen518000China
- Shenzhen Institute of Nutrition and HealthHuazhong Agricultural UniversityShenzhen518000China
- College of Biomedicine and HealthHuazhong Agricultural UniversityWuhan430070China
| |
Collapse
|
3
|
Pecere S, Ciuffini C, Chiappetta MF, Petruzziello L, Papparella LG, Spada C, Gasbarrini A, Barbaro F. Increasing the accuracy of colorectal cancer screening. Expert Rev Anticancer Ther 2023; 23:583-591. [PMID: 37099725 DOI: 10.1080/14737140.2023.2207828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major health issue, being responsible for nearly 10% of all cancer-related deaths. Since CRC is often an asymptomatic or paucisymptomatic disease until it reaches advanced stages, screening is crucial for the diagnosis of preneoplastic lesions or early CRC. AREAS COVERED The aim of this review is to summarize the literature evidence on currently available CRC screening tools, with their pros and cons, focusing on the level of accuracy reached by each test over time. We also provide an overview of novel technologies and scientific advances that are currently being investigated and that in the future may represent real game-changers in the field of CRC screening. EXPERT OPINION We suggest that best screening modalities are annual or biennial FIT and colonoscopy every 10 years. We believe that the introduction of artificial intelligence (AI)-tools in the CRC screening field could lead to a significant improvement of the screening efficacy in reducing CRC incidence and mortality in the future. More resources should be put into implementing CRC programmes and support research project to further increase accuracy of CRC screening tests and strategies.
Collapse
Affiliation(s)
- Silvia Pecere
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Cristina Ciuffini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Michele Francesco Chiappetta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Lucio Petruzziello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Luigi Giovanni Papparella
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Cristiano Spada
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| | - Federico Barbaro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
- Università Cattolica Del Sacro Cuore di Roma, Rome
| |
Collapse
|
4
|
Lv G, Wang X, Jiang X, Li M, Lu K. Impact of Alzheimer’s disease and related dementias on colorectal cancer screening utilization, knowledge, and associated health disparities. Front Pharmacol 2022; 13:872702. [PMID: 36160445 PMCID: PMC9490131 DOI: 10.3389/fphar.2022.872702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 12/09/2022] Open
Abstract
Background: Colorectal cancer screening can detect colorectal cancer at an early stage and reduce mortality. None of the existing clinical practice guidelines provide specific recommendations for colorectal cancer screening in patients with Alzheimer’s disease and related dementias (ADRD). Limited studies have assessed the impacts of ADRD on colorectal cancer screening use and knowledge, and no studies have focused on the associated health disparities.Objectives: To examine the utilization, knowledge, and associated health disparities of colorectal cancer screening in older adults with ADRD.Methods: This study used the Medicare Current Beneficiary Survey from 2015 to 2018. Two types of colorectal cancer screening, including fecal occult blood test (FOBT) and colonoscopy/sigmoidoscopy, were measured. The colorectal cancer screening knowledge was evaluated by asking if the participants have heard of two screening methods and whether they knew Medicare pays for colorectal cancer screenings. Logistic regression models were used to examine the impact of ADRD diagnosis on the utilization and knowledge of colorectal cancer screening.Results: The overall colorectal cancer screening rate in older adults increased from 86.4% to 88.96% from 2015 to 2018. Patients with AD were 39% (OR: 0.61; 95% CI: 0.50–0.76) less likely and those with RD were 25% (OR: 0.75; 95% CI: 0.62–0.91) less likely to use any colorectal cancer screening when compared to older adults without ADRD. The rate of knowledge of colonoscopy/sigmoidoscopy remained high between 84.23% and 84.57% while the knowledge of FOBT increased from 64.32% to 78.69% during the study period. Compared to older adults without ADRD, those with AD were 77% (OR: 1.77; 95% CI: 1.12–2.81) more likely to hear of colonoscopy/sigmoidoscopy. The rate of knowledge of Medicare pay for colorectal cancer screening increased from 42.19% to 45.27% during the study period. Compared to older adults without ADRD, those with AD were 19% (OR: 0.81; 95% CI: 0.70–0.94) less likely to know that Medicare pays for colorectal cancer screening.Conclusion: ADRD was significantly associated with colorectal cancer screening utilization and knowledge. In addition, this study identified health disparities in race/ethnicity, gender, and urban/rural residence in colorectal cancer screening use and knowledge.
Collapse
Affiliation(s)
- Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoxia Wang
- College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Xiangxiang Jiang
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Minghui Li, ; Kevin Lu,
| | - Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
- *Correspondence: Minghui Li, ; Kevin Lu,
| |
Collapse
|
5
|
Losurdo P, Mastronardi M, de Manzini N, Bortul M. Survival and long-term surgical outcomes after colorectal surgery: are there any gender-related differences? Updates Surg 2022; 74:1337-1343. [PMID: 35810269 PMCID: PMC9338158 DOI: 10.1007/s13304-022-01323-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) incidence and mortality seems to be lower in women than in men. The present study aims to evaluate the impact of gender on CRC diagnosis, treatment, and survival. This is a retrospective cohort study based on a single-center dataset of CRC patients from the University Hospital of Trieste (Italy). Data of 1796 consecutive CRC patients referred to our center from November 11th, 2004, to December 31st, 2017, were analyzed. Right-sided carcinomas are more frequent in women than in men; furthermore, women had a lower surgical complication rate. Men showed a higher 5- and 10-year mortality. This survival benefit for women was observed independently of the tumor localization. The 5-year hazard ratio (HR) for women vs men was 0.776 (p 0.003), and after 10-year 0.816 (p 0.017). Regarding the disease-free survival (DFS), 5 and 10-year HR was 0.759 (p 0.034) and 0.788 (p 0.07), respectively. On multivariable analysis, respecting tumor localization, the odds of female gender were higher than man with right colon disease. Male gender was more independently associated with age at the surgery time. Women survival advantage was higher than men, except for patients older than 80. Surgical outcome and survival after CRC surgical treatment seem to be gender related. For this reason, gender could play an important role in CRC diagnosis and therapy, allowing an earlier diagnosis in women.
Collapse
Affiliation(s)
- Pasquale Losurdo
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Manuela Mastronardi
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicolò de Manzini
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Marina Bortul
- Surgical Clinic Unit, Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| |
Collapse
|
6
|
Pontone S, Lauriola M, Palma R, Panetta C, Tomai M, Baker R. Do difficulties in emotional processing predict procedure pain and shape the patient's colonoscopy experience? BMJ Open 2022; 12:e050544. [PMID: 35190415 PMCID: PMC8860019 DOI: 10.1136/bmjopen-2021-050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Pain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain have been found to depend on patients' maladaptive cognitions and exaggerated emotional responses. The present study investigated whether emotional processing difficulties predicted colonoscopy pain and the associated catastrophising thoughts. DESIGN Prospective, observational, blinded. METHOD A sample of 123 patients was assessed for specific emotional processing difficulties (ie, suppression of emotions, unprocessed emotions, failure to control emotions, avoidance of emotional triggers and impoverished emotional experience) and anxiety-related variables (ie, worry, anxiety and depression) before colonoscopy. A trained medical doctor rated patients' behavioural manifestations of pain during colonoscopy. After complete recovery from sedation, the patients rated the endoscopy experience using perceived pain and situation-specific pain catastrophising scales. RESULTS About half of the patients were above the cut-off for anxiety before the procedure. Notwithstanding sedation, behavioural manifestations of pain during colonoscopy indicated probable or moderate pain for about one-third of the patients. Failure to control emotions, poor emotional experience and avoiding emotional triggers were positively correlated with behavioural manifestations of pain, self-reported pain and pain catastrophising. Regression analyses, controlling for gender, age, colonoscopy experience and sedation, revealed that avoidance of emotional triggers uniquely contributed to predicting pain outcomes. CONCLUSIONS Early identification of emotional processing difficulties associated with pain catastrophising can help define personalised psychological preparation paths to manage negative emotions in patients who fear colonoscopy pain.
Collapse
Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Roma, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Manuela Tomai
- Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, Italy
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
| |
Collapse
|
7
|
Papastergiou V, Viazis N, Mantzaris GJ. Letter: towards gender-stratified colorectal cancer screening and surveillance? Aliment Pharmacol Ther 2022; 55:504-505. [PMID: 35092048 DOI: 10.1111/apt.16737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Vasilios Papastergiou
- Gastroenterology Department, Evangelismos-Polykliniki General Hospitals of Athens, Athens, Greece
| | - Nikos Viazis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospitals of Athens, Athens, Greece
| | - Gerassimos J Mantzaris
- Gastroenterology Department, Evangelismos-Polykliniki General Hospitals of Athens, Athens, Greece
| |
Collapse
|
8
|
Xie W, Huang X, Wei C, Mo X, Ru H, Zhang L, Ge L, Tang W, Liu J. Preoperative Neutrophil-BMI Ratio As a Promising New Marker for Predicting Tumor Outcomes in Colorectal Cancer. Technol Cancer Res Treat 2022; 21:15330338211064077. [PMID: 35225701 PMCID: PMC8891895 DOI: 10.1177/15330338211064077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Inflammation and nutritional status are highly associated with colorectal cancer (CRC) prognosis. This study aimed to evaluate the prognostic value of the preoperative neutrophil-BMI ratio (NBR) in patients with CRC. Methods: A retrospective analysis was performed on 2471 patients with CRC who underwent surgical resection between 2004 and 2019. Patients were divided into two groups based on the cutoff value for NBR. Cox regression and Kaplan–Meier curves were used to evaluate overall survival (OS). Results: High NBR was associated with female sex, low BMI, colon, right-sided CRC, poor differentiation, T3 to 4 stage, M1 to 2 stage, high carcinoembryonic antigen (CEA) level, III-IV stage, microsatellite instability (MSI), and no adjuvant chemotherapy (all P < .05). The high NBR group had a shorter OS than the low NBR group. Female and right sided patients with CRC and with high NBR had a worse prognosis. Univariate Cox regression suggested that NBR was significantly associated with poor prognosis. Multivariate analysis confirmed that age (P = .019,HR:1.012), differentiation (P = .001,HR:1.306), TNM stage (P < .001,HR:2.432), CEA (P = .014,HR:1.001), and NBR (P < .001, HR: 3.309) were independent poor prognostic factors for OS. Subgroup univariate analysis indicated that female patients with high NBR had a worse prognosis. A nomogram composed of TNM stage, CEA, and NBR was developed, and internal validation was based on female patients with CRC. The nomogram provided good discrimination for both the training and validation sets, with area under the curve values of 0.79 and 0.769, respectively. Conclusions: High preoperative levels of NBR are indicators of poor prognosis in patients with CRC.
Collapse
Affiliation(s)
- Weishun Xie
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xiaoliang Huang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Chunyin Wei
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xianwei Mo
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Haiming Ru
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Lihua Zhang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Lianying Ge
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Weizhong Tang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Jungang Liu
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| |
Collapse
|
9
|
Cubiella J, González A, Almazán R, Rodríguez-Camacho E, Zubizarreta R, Peña-Rey Lorenzo I. Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study. BMC Cancer 2021; 21:869. [PMID: 34325674 PMCID: PMC8323280 DOI: 10.1186/s12885-021-08606-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/16/2021] [Indexed: 02/16/2023] Open
Abstract
Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08606-w.
Collapse
Affiliation(s)
- Joaquín Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense, Rúa Ramón Puga 52-56, 32003, Ourense, Spain. .,Instituto de Investigación Sanitaria Galicia Sur, Ourense, Spain. .,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Ourense, Spain.
| | - Antía González
- Department of Preventive Medicine, Hospital Universitario de Ourense, Ourense, Spain
| | - Raquel Almazán
- Dirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain
| | | | - Raquel Zubizarreta
- Dirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain
| | | |
Collapse
|
10
|
Georgescu DE, Patrascu T, Georgescu TF, Tulin A, Mosoia L, Bacalbasa N, Stiru O, Georgescu MT. Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer. In Vivo 2021; 35:2495-2501. [PMID: 34182536 DOI: 10.21873/invivo.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival. PATIENTS AND METHODS Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence. RESULTS Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients. CONCLUSION The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.
Collapse
Affiliation(s)
- Dragos Eugen Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Traian Patrascu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; .,Department of General Surgery, Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania
| | - Liviu Mosoia
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Central Military Emergency Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai-Teodor Georgescu
- Department of Radiotherapy II, "Prof. Dr. Alex. Trestioreanu" Institute of Oncology, Bucharest, Romania.,Discipline of Oncology, Department 8 (Radiology, Oncology, Haematology), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
11
|
Viscido A, Ciccone F, Vernia F, Gabrieli D, Capannolo A, Stefanelli G, Necozione S, Valerii G, Ashktorab H, Latella G. Association of Colonic Diverticula with Colorectal Adenomas and Cancer. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57020108. [PMID: 33504050 PMCID: PMC7910864 DOI: 10.3390/medicina57020108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Conflicting evidence is reported regarding any association between colonic diverticula with colorectal adenomas or cancer. The present study aimed to evaluate, in a cohort of Caucasian patients, the association between colonic diverticula and colorectal polyps and cancer. Materials and Methods: All consecutive patients undergoing colonoscopy at our institution were included in the study. The presence and location of diverticula, polyps, and cancers were recorded. Histologically, polyps were classified as adenoma (with low or high dysplasia), hyperplastic, or inflammatory. The relative risk of the association of polyps and cancer with diverticula was assessed. Multiple logistic regression analyses, including age, sex, family history for colorectal cancer (CRC), and family history for diverticula, were carried out. Results: During the study period, 1490 patients were enrolled; 37.2% (n = 555) showed colonic diverticula or polyps or CRC (308 males, mean age 66 years). Particularly, 12.3% (n = 183) patients presented only diverticula, 13.7% (n = 204) only polyps or cancer, 11.3% (n = 168) both diseases, and 62.7% (n = 935) neither diverticula nor polyps and cancer. A total of 38 patients presented colorectal cancer, 17 of which had also diverticula. A significant increase in relative risk (RR 2.81, 95% CI 2.27-3.47, p < 0.0001) of colorectal adenoma and cancer in patients with colonic diverticula was found. At multivariate analysis, only diverticula resulted to be significantly associated with colorectal adenomas and cancer (Odds Ratio, OR 3.86, 95% CI 2.90-5.14, p < 0.0001). Conclusions: A significant association of colonic diverticula with colorectal adenoma or cancer was found. This implies that patients with colonic diverticula require a vigilant follow-up procedure for the prevention of colorectal cancer from those applicable to the general population.
Collapse
Affiliation(s)
- Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Fabiana Ciccone
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Filippo Vernia
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Dolores Gabrieli
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Annalisa Capannolo
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Gianpiero Stefanelli
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Stefano Necozione
- Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Giorgio Valerii
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Hassan Ashktorab
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20059, USA;
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-0862-434735; Fax: +39-0862-433425
| |
Collapse
|
12
|
Mojica CM, Lind B, Gu Y, Coronado GD, Davis MM. Predictors of Colorectal Cancer Screening Modality Among Newly Age-Eligible Medicaid Enrollees. Am J Prev Med 2021; 60:72-79. [PMID: 33223363 PMCID: PMC8493888 DOI: 10.1016/j.amepre.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study examines individual- and practice-level predictors of screening modality among 1,484 Medicaid enrollees who initiated colorectal cancer screening (fecal immunochemical test/fecal occult blood tests or colonoscopy) within a year of turning age 50 years. Understanding screening modality patterns for patients and health systems can help optimize colorectal cancer screening initiatives that will lead to high screening completion rates. METHODS Multivariable logistic regression was conducted in 2019 to analyze Medicaid claims data (January 2013-June 2015) to explore predictors of colonoscopy screening (versus fecal testing). RESULTS Overall, 64% of enrollees received a colonoscopy and 36% received a fecal immunochemical test/fecal occult blood test. Male (OR=1.21, 95% CI=1.08, 1.37) compared with female enrollees and those with 4-6 (OR=1.57, 95% CI=1.15, 2.15), 7-10 (OR=2.23, 95% CI=1.64, 3.03), and ≥11 (OR=1.79, 95% CI=1.22, 2.65) primary care visits compared with 0-3 visits had higher odds of colonoscopy screening. Non-White, non-Hispanic enrollees (OR=0.71, 95% CI=0.58, 0.87) compared with White, non-Hispanics Whites had lower odds of colonoscopy screening. Practices with an endoscopy facility within their ZIP code (OR=1.50, 95% CI=1.08, 2.08) compared with practices without a nearby endoscopy facility had higher odds of colonoscopy screening. CONCLUSIONS Among newly age-eligible Medicaid enrollees who received colorectal cancer screening, non-White, non-Hispanic individuals were less likely and male enrollees and those with ≥4 primary care visits were more likely to undergo colonoscopy versus fecal immunochemical test/fecal occult blood test. Colonoscopy also was the more common modality among adults whose primary care clinic had an endoscopy facility in the same ZIP code. Future research is needed to fully understand patient, provider, and practice preferences regarding screening modality.
Collapse
Affiliation(s)
- Cynthia M Mojica
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
| | - Bonnie Lind
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Yifan Gu
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | | | - Melinda M Davis
- Department of Family Medicine, School of Public Health, Oregon Health & Science University, Portland, Oregon; 5Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
13
|
Amitay EL, Carr PR, Jansen L, Alwers E, Roth W, Herpel E, Kloor M, Bläker H, Chang-Claude J, Brenner H, Hoffmeister M. Postmenopausal hormone replacement therapy and colorectal cancer risk by molecular subtypes and pathways. Int J Cancer 2020; 147:1018-1026. [PMID: 31943160 DOI: 10.1002/ijc.32868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
Abstract
Postmenopausal hormone replacement therapy (HRT) was found to be associated with lower risk of colorectal cancer (CRC). However, little is known regarding associations with molecular subtypes of CRC. The current study includes female participants of a large German population-based case-control study (922 CRC cases and 1,183 controls). Tumor tissue samples were analyzed for microsatellite instability (MSI), CpG island methylator phenotype (CIMP), BRAF and KRAS mutation status. Multivariable logistic regression models were used to assess the association of HRT use with molecular subtypes and pathways. Postmenopausal HRT use was overall associated with reduced risk of CRC (adjusted odds ratio (aOR) 0.62, 95% confidence interval (CI) 0.50-0.76) and no major differences were observed for molecular subtypes or for tumor marker combinations representing molecular pathways. When stratified by median age (≤/>71 years) potentially stronger risk reductions were observed in the older group for subtypes showing MSI (OR = 0.36, 95% CI 0.17-0.76), BRAF mutation (OR = 0.40, 95% CI 0.30-0.83) and CIMP-high (OR = 0.40, 95% CI 0.21-0.73) and for CRC suggestive of the sessile serrated pathway (OR = 0.45, 95% CI 0.20-1.01). In conclusion, postmenopausal use of HRT was similarly associated with risk reduction of major molecular tumor subtypes and pathways of CRC. Potentially stronger risk reductions with CRC subtypes diagnosed at higher ages require confirmation and clarification from other studies. The current study extends the limited understanding of the mechanisms of HRT in CRC prevention.
Collapse
Affiliation(s)
- Efrat L Amitay
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elizabeth Alwers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Wilfried Roth
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany.,Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Esther Herpel
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,NCT Tissue Bank, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Germany
| | - Hendrik Bläker
- Institute of Pathology, Charité University Medicine, Berlin, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
14
|
Hoff G, Ursin G, Løberg M, de Lange T, Skovlund E, Holme Ø. Continuous development of colorectal cancer screening programs. Acta Oncol 2019; 58:822-823. [PMID: 30939973 DOI: 10.1080/0284186x.2019.1588475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Colorectal cancer (CRC) screening programs are far from perfect. Many crucial questions remain, yet expensive CRC screening services are implemented throughout the world without a plan on how to evaluate and improve the service. The time is ripe for improving the design of CRC screening programs.
Collapse
Affiliation(s)
- Geir Hoff
- Cancer Registry of Norway, Oslo, Norway
- Department of Research and Development, Telemark Hospital, Skien, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Magnus Løberg
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas de Lange
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Øyvind Holme
- Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
15
|
Lim H, Kim SY, Lee E, Lee S, Oh S, Jung J, Kim KS, Moon A. Sex-Dependent Adverse Drug Reactions to 5-Fluorouracil in Colorectal Cancer. Biol Pharm Bull 2019; 42:594-600. [DOI: 10.1248/bpb.b18-00707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hyesol Lim
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| | - Sun Young Kim
- Department of Chemistry, College of Natural Sciences, Duksung Women’s University
| | - Eunhye Lee
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| | - Seungeun Lee
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| | - Sungryong Oh
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| | - Joohee Jung
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| | - Kwi Suk Kim
- Department of Pharmacy, Seoul National University Hospital
| | - Aree Moon
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University
| |
Collapse
|
16
|
Shao Y, Hua Z, Zhao L, Shen Y, Guo X, Niu C, Wei W, Liu F. Time Trends of Gastrointestinal Cancers Incidence and Mortality in Yangzhong From 1991 to 2015: An Updated Age-Period-Cohort Analysis. Front Oncol 2018; 8:638. [PMID: 30619771 PMCID: PMC6306425 DOI: 10.3389/fonc.2018.00638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Gastrointestinal (GI) cancers are the common cause of morbidity and mortality in China which seriously threaten people's health and lives. The aim of this study was to describe the temporal trend in the epidemiology of GI cancers from 1991 to 2015, with an emphasis on the effects of age, period and cohort in Yangzhong City, Jiangsu province, a high-risk area of GI cancers in China. Methods: Our study extracted cases of gastric cancer, esophageal cancer and colorectal cancer diagnosed from 1991 to 2015 from Yangzhong Cancer Registry. Age-standardized rates (ASRs) were calculated and joinpoint regression was used to compute the estimated annual percent changes. Age-period-cohort (APC) model was performed to investigate the independent effects of age, calendar period, and birth cohort. Results: Between 1991 and 2015, 18,006 new cases and 10,262 deaths were registered with GI cancers in Yangzhong. The age-standardized incidence rates (ASIRs) of gastric cancer decreased in both sexes during the study period. And the incidence rates of esophageal cancer stabilized at first then continued to decline, the turning point was in 2005 for men and 2001 for women. Changes in the mortality rates of gastric cancer and esophageal cancer showed significant declined trends around 2000-2010 in both genders. The incidence rates of colorectal cancer increased steadily during the entire study period, and the increase was more pronounced in the mortality rates of men. The results of APC analysis suggest that general decreases in incidence and mortality of esophageal cancer and gastric cancer might be caused by the downward trend of the period and cohort effects, while the increases in colorectal cancer might be caused by the uptrend of the period effects. Conclusions: The incidence and mortality rates of esophageal and gastric cancers showed a downward trend and colorectal cancer was on the rise as a whole in Yangzhong City. The different burden of gastrointestinal cancer indicating heterogeneous risk factors exist and may have contributed to these temporal variations.
Collapse
Affiliation(s)
- Yi Shao
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Zhaolai Hua
- Department of Epidemiology, Yangzhong Cancer Research Institute, Yangzhong, China
| | - Lei Zhao
- Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Yi Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xudong Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Chen Niu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Wenqiang Wei
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fen Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| |
Collapse
|
17
|
White A, Ironmonger L, Steele RJC, Ormiston-Smith N, Crawford C, Seims A. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer 2018; 18:906. [PMID: 30236083 PMCID: PMC6149054 DOI: 10.1186/s12885-018-4786-7] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.
Collapse
Affiliation(s)
- Alan White
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK.
| | - Lucy Ironmonger
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Robert J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, DD1 9SY, UK
| | - Nick Ormiston-Smith
- Department of Health, 15 Butterfield Street, Herston, Brisbane, 4006, QLD, Australia
| | - Carina Crawford
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Amanda Seims
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK
| |
Collapse
|
18
|
Epidemiology and risk factors of colorectal polyps. Best Pract Res Clin Gastroenterol 2017; 31:419-424. [PMID: 28842051 DOI: 10.1016/j.bpg.2017.06.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/07/2017] [Accepted: 06/25/2017] [Indexed: 02/06/2023]
Abstract
The lifetime risk of colorectal cancer (CRC) in the Western world is around 5%. CRC commonly develops from precursor lesions termed polyps, classified as adenomatous or serrated polyps according to growth pattern. Despite the well-known connection between polyps and cancer, most polyps will never develop into CRC. For those that do, the time until CRC development is generally thought of as >10 years. This gives opportunity for interventional strategies to prevent transformation into cancer. This article aims to provide an overview of the epidemiology of and risk factors for colorectal polyps in the average risk population, and will encompass the effect of age, gender, ethnicity, smoking, obesity, alcohol, physical activity, NSAIDs and dietary factors on colorectal polyps.
Collapse
|
19
|
Wheeler SB, Kuo TM, Meyer AM, Martens CE, Hassmiller Lich KM, Tangka FK, Richardson LC, Hall IJ, Smith JL, Mayorga ME, Brown P, Crutchfield TM, Pignone MP. Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50. Prev Med Rep 2017; 6:9-16. [PMID: 28210537 PMCID: PMC5300695 DOI: 10.1016/j.pmedr.2016.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/14/2016] [Accepted: 11/24/2016] [Indexed: 12/24/2022] Open
Abstract
Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10-15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.
Collapse
Affiliation(s)
- Stephanie B. Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, United States
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, United States
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, United States
| | - Anne Marie Meyer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7435, McGavran Greenberg Hall, Chapel Hill, NC 27599-7435, United States
| | - Christa E. Martens
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, United States
| | - Kristen M. Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, United States
| | - Florence K.L. Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Ingrid J. Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Maria E. Mayorga
- Department of Industrial & Systems Engineering, North Carolina State University, Campus Box 7906, Raleigh, NC 27965-7906, United States
| | - Paul Brown
- University of California at Merced, SSM Building Room 308a, Merced, CA 95343, United States
| | - Trisha M. Crutchfield
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, United States
| | - Michael P. Pignone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, United States
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, United States
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| |
Collapse
|
20
|
Gaitonde SG, Nissan A, Protić M, Stojadinovic A, Wainberg ZA, Chen DC, Bilchik AJ. Sex-Specific Differences in Colon Cancer when Quality Measures Are Adhered to: Results from International, Prospective, Multicenter Clinical Trials. J Am Coll Surg 2017; 225:85-92. [PMID: 28392435 DOI: 10.1016/j.jamcollsurg.2017.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is no consensus on the relationship between patient sex and the location, stage, and oncologic outcome of colon cancer (CC). We hypothesized that there is a sex-specific difference in the biology and management of CC. STUDY DESIGN Our cohort was drawn from a database of patients enrolled in international trials of nodal ultrastaging for nonmetastatic CC. These trials required strict adherence to surgical and pathologic quality measures. Postoperative follow-up included colonoscopy at 1 and 4 years and annual CT scans. Sex-specific differences in tumor biology, location, stage, and recurrence were evaluated by chi-square, Fischer's exact, and independent t-tests. RESULTS The cohort included 435 males (median age 69 years) and 423 females (median age 70 years). Females had more right-sided (p = 0.03) and earlier T stage (p = 0.05) tumors, but there was no sex-based difference in pathologic grade, total lymph nodes retrieved, nodal positivity (p = 0.47) or lymphovascular invasion (p = 0.45). The overall 4-year disease-free survival (DFS) was comparable in females and males (77.9% and 77.5%, respectively). By multivariate analysis, only nodal positivity and cancer recurrence affected overall survival (OS) (p = 0.008). Neither sex nor primary tumor affected DFS or OS. CONCLUSIONS This is the first prospective study to demonstrate sex-specific differences in location and T stage of CC when surgical and pathologic management adhered to strict quality standards. The predominance of right-sided CC in females suggests that flexible sigmoidoscopy may be inadequate for screening and surveillance. Interestingly, earlier stage and right-sided location did not confer a DFS or OS advantage for women. Additional studies are needed to determine why females have a higher propensity for right-sided lesions and a potential difference in CC biology.
Collapse
Affiliation(s)
- Shrawan G Gaitonde
- Department of Surgical Oncology, John Wayne Cancer Institute, University of California Los Angeles, Santa Monica, CA.
| | - Aviram Nissan
- Department of Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mladjan Protić
- Department of Surgical Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Alexander Stojadinovic
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Zev A Wainberg
- Department of Medicine, University of California Los Angeles, Santa Monica, CA
| | - David C Chen
- Department of Surgery, University of California Los Angeles, Santa Monica, CA
| | - Anton J Bilchik
- Department of Surgical Oncology, John Wayne Cancer Institute, University of California Los Angeles, Santa Monica, CA
| |
Collapse
|
21
|
Coughlin SS, Blumenthal DS, Seay SJ, Smith SA. Toward the Elimination of Colorectal Cancer Disparities Among African Americans. J Racial Ethn Health Disparities 2016; 3:555-564. [PMID: 27294749 PMCID: PMC4911324 DOI: 10.1007/s40615-015-0174-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the USA, race and socioeconomic status are well-known factors associated with colorectal cancer incidence and mortality rates. These are higher among blacks than whites and other racial/ethnic groups. METHODS In this article, we review opportunities to address disparities in colorectal cancer incidence, mortality, and survivorship among African Americans. RESULTS First, we summarize the primary prevention of colorectal cancer and recent advances in the early detection of the disease and disparities in screening. Then, we consider black-white disparities in colorectal cancer treatment and survival including factors that may contribute to such disparities and the important roles played by cultural competency, patient trust in one's physician, and health literacy in addressing colorectal cancer disparities, including the need for studies involving the use of colorectal cancer patient navigators who are culturally competent. CONCLUSION To reduce these disparities, intervention efforts should focus on providing high-quality screening and treatment for colorectal cancer and on educating African Americans about the value of diet, weight control, screening, and treatment. Organized approaches for delivering colorectal cancer screening should be accompanied by programs and policies that provide access to diagnostic follow-up and treatment for underserved populations.
Collapse
Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, One University Avenue, Kitson Hall 311A, Lowell, MA, 01854, USA.
| | - Daniel S Blumenthal
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Selina A Smith
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| |
Collapse
|
22
|
Lorentzen JA, Grzyb K, De Angelis PM, Hoff G, Eide TJ, Andresen PA. Oncogene Mutations in Colorectal Polyps Identified in the Norwegian Colorectal Cancer Prevention (NORCCAP) Screening Study. Clin Med Insights Pathol 2016; 9:19-28. [PMID: 27656095 PMCID: PMC5015815 DOI: 10.4137/cpath.s40143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 01/17/2023] Open
Abstract
Data are limited on oncogene mutation frequencies in polyps from principally asymptomatic participants of population-based colorectal cancer screening studies. In this study, DNA from 204 polyps, 5 mm or larger, were collected from 176 participants of the NORCCAP screening study and analyzed for mutations in KRAS, BRAF, and PIK3CA including the rarely studied KRAS exons 3 and 4 mutations. KRAS mutations were identified in 23.0% of the lesions and were significantly associated with tubulovillous adenomas and large size. A significantly higher frequency of KRAS mutations in females was associated with mutations in codon 12. The KRAS exon 3 and 4 mutations constituted 23.4% of the KRAS positive lesions, which is a larger proportion compared to previous observations in colorectal cancer. BRAF mutations were identified in 11.3% and were associated with serrated polyps. None of the individuals were diagnosed with de novo or recurrent colorectal cancer during the follow-up time (median 11.2 years). Revealing differences in mutation-spectra according to gender and stages in tumorigenesis might be important for optimal use of oncogenes as therapeutic targets and biomarkers.
Collapse
Affiliation(s)
- Jon A Lorentzen
- Department of Pathology, Oslo University Hospital, Oslo, Norway.; University of Oslo, Oslo, Norway
| | - Krzysztof Grzyb
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | | | - Geir Hoff
- University of Oslo, Oslo, Norway.; Department of Medicine, Telemark Hospital, Skien, Norway.; Cancer Registry of Norway, Oslo, Norway
| | - Tor J Eide
- Department of Pathology, Oslo University Hospital, Oslo, Norway.; University of Oslo, Oslo, Norway
| | | |
Collapse
|
23
|
Grobbee EJ, Wieten E, Hansen BE, Stoop EM, de Wijkerslooth TR, Lansdorp-Vogelaar I, Bossuyt PM, Dekker E, Kuipers EJ, Spaander MC. Fecal immunochemical test-based colorectal cancer screening: The gender dilemma. United European Gastroenterol J 2016; 5:448-454. [PMID: 28507758 DOI: 10.1177/2050640616659998] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite differences between men and women in incidence of colorectal cancer (CRC) and its precursors, screening programs consistently use the same strategy for both genders. OBJECTIVE The objective of this article is to illustrate the effects of gender-tailored screening, including the effects on miss rates of advanced neoplasia (AN). METHODS Participants (age 50-75 years) in a colonoscopy screening program were asked to complete a fecal immunochemical test (FIT) before colonoscopy. Positivity rates, sensitivity and specificity for detection of AN at multiple cut-offs were determined. Absolute numbers of detected and missed AN per 1000 screenees were calculated. RESULTS In total 1,256 individuals underwent FIT and colonoscopy, 51% male (median age 61 years; IQR 56-66) and 49% female (median age 60 years; IQR 55-65). At all cut-offs men had higher positivity rates than women, ranging from 3.8% to 10.8% versus 3.2% to 4.8%. Sensitivity for AN was higher in men than women; 40%-25% and 35%-22%, respectively. More AN were found and missed in absolute numbers in men at all cut-offs. CONCLUSION More AN were both detected and missed in men compared to women at all cut-offs. Gender-tailored cut-offs could either level sensitivity in men and women (i.e., lower cut-off in women) or level the amount of missed lesions (i.e., lower cut-off in men).
Collapse
Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Els Wieten
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther M Stoop
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thomas R de Wijkerslooth
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Davis J, Rieders B, Borum ML. Clinical Practice Patterns Suggest Female Patients Prefer Female Endoscopists. Dig Dis Sci 2015; 60:3149-50. [PMID: 26314250 DOI: 10.1007/s10620-015-3794-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/30/2015] [Indexed: 12/09/2022]
Affiliation(s)
- Jessica Davis
- Division of Gastroenterology and Liver Diseases, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC, 20037, USA.
| | - Brandon Rieders
- Division of Gastroenterology and Liver Diseases, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC, 20037, USA.
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, George Washington University, 2150 Pennsylvania Avenue, NW Suite 3-405, Washington, DC, 20037, USA.
| |
Collapse
|