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Yu L, Wang H, Wang F, Guo J, Xiao B, Hou Z, Lu Z, Pan Z, Zhou Y, Ye S, Wan D, Lin B, Ou Q, Fang Y. Serum biomarkers REG1A and REG3A combined with the traditional CEA represent a novel nomogram for the screening and risk stratification of colorectal cancer. Clin Transl Oncol 2024:10.1007/s12094-024-03566-6. [PMID: 38965192 DOI: 10.1007/s12094-024-03566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/09/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND To develop and validate a serum protein nomogram for colorectal cancer (CRC) screening. METHODS The serum protein characteristics were extracted from an independent sample containing 30 colorectal cancer and 12 polyp tissues along with their paired samples, and different serum protein expression profiles were validated using RNA microarrays. The prediction model was developed in a training cohort that included 1345 patients clinicopathologically confirmed CRC and 518 normal participants, and data were gathered from November 2011 to January 2017. The lasso logistic regression model was employed for features selection and serum nomogram building. An internal validation cohort containing 576 CRC patients and 222 normal participants was assessed. RESULTS Serum signatures containing 27 secreted proteins were significantly differentially expressed in polyps and CRC compared to paired normal tissue, and REG family proteins were selected as potential predictors. The C-index of the nomogram1 (based on Lasso logistic regression model) which contains REG1A, REG3A, CEA and age was 0.913 (95% CI, 0.899 to 0.928) and was well calibrated. Addition of CA199 to the nomogram failed to show incremental prognostic value, as shown in nomogram2 (based on logistic regression model). Application of the nomogram1 in the independent validation cohort had similar discrimination (C-index, 0.912 [95% CI, 0.890 to 0.934]) and good calibration. The decision curve (DCA) and clinical impact curve (ICI) analysis demonstrated that nomogram1 was clinically useful. CONCLUSIONS This study presents a serum nomogram that included REG1A, REG3A, CEA and age, which can be convenient for screening of colorectal cancer.
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Affiliation(s)
- Long Yu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Hao Wang
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Fulong Wang
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Jian Guo
- Senboll Biotechnology Co., Ltd., Pingshan Bio-Pharmacy Business Accelerator, Pingshan District, Shenzhen, 518000, Guangdong, China
| | - Binyi Xiao
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhenlin Hou
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhenhai Lu
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhizhong Pan
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yaxian Zhou
- Senboll Biotechnology Co., Ltd., Pingshan Bio-Pharmacy Business Accelerator, Pingshan District, Shenzhen, 518000, Guangdong, China
| | - Sibin Ye
- Senboll Biotechnology Co., Ltd., Pingshan Bio-Pharmacy Business Accelerator, Pingshan District, Shenzhen, 518000, Guangdong, China
| | - Desen Wan
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Bo Lin
- Department of Thyroid Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510060, China.
| | - Qingjian Ou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
| | - Yujing Fang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
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Wang Y, Wu ZL, Wang YG, Wang H, Jia XY. Early colorectal cancer screening–no time to lose. World J Gastroenterol 2024; 30:2959-2963. [PMID: 38946873 PMCID: PMC11212702 DOI: 10.3748/wjg.v30.i23.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
In this editorial, we comment on the article entitled “Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?” by Agatsuma et al. Colorectal cancer (CRC) is emerging as an important health issue as its incidence continues to rise globally, adversely affecting the quality of life. Although the public has become more aware of CRC prevention, most patients lack screening awareness. Some poor lifestyle practices can lead to CRC and symptoms can appear in the early stages of CRC. However, due to the lack of awareness of the disease, most of the CRC patients are diagnosed already at an advanced stage and have a poor prognosis.
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Affiliation(s)
- Ying Wang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang Province, China
- Department of Oncology, Zhejiang Xiaoshan Hospital, Hangzhou 310018, Zhejiang Province, China
| | - Zheng-Long Wu
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang Province, China
| | - Yi-Gang Wang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang Province, China
| | - Hui Wang
- Department of Oncology, Zhejiang Xiaoshan Hospital, Hangzhou 310018, Zhejiang Province, China
| | - Xiao-Yuan Jia
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang Province, China
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3
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Winawer SJ, Hahn AI, Zauber AG. Reply. Gastroenterology 2023; 165:1580-1581. [PMID: 37678502 DOI: 10.1053/j.gastro.2023.09.001] [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: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Sidney J Winawer
- Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne I Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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4
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Aziz Z, Wagner S, Agyekum A, Pumpalova YS, Prest M, Lim F, Rustgi S, Kastrinos F, Grady WM, Hur C. Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened. JAMA Netw Open 2023; 6:e2343392. [PMID: 37971743 PMCID: PMC10654798 DOI: 10.1001/jamanetworkopen.2023.43392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Despite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening. Objective To estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US. Design, Setting, and Participants In this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy-liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy. Exposures No screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy-liquid biopsy hybrid screening. Main Outcomes and Measures Model outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained. Results This study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy-liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy-liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly. Conclusions and Relevance In this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.
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Affiliation(s)
- Zainab Aziz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sophie Wagner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alice Agyekum
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yoanna S. Pumpalova
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew Prest
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sheila Rustgi
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Fay Kastrinos
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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5
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Singh I, Das R, Kumar A. Network pharmacology-based anti-colorectal cancer activity of piperlonguminine in the ethanolic root extract of Piper longum L. Med Oncol 2023; 40:320. [PMID: 37796360 DOI: 10.1007/s12032-023-02185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
Colorectal cancer (CRC) has the second highest incidence and fatality rates of any malignancy, at 10.2 and 9.2%, respectively. Plants and plants-based products for thousands of years have been utilized to treat cancer along with other associated health issues. Alkaloids are a valuable class of chemical compounds with great potential as new medicine possibilities. Piper longum Linn contains various types of alkaloids. In this research, the ethanolic root extract of P. longum (EREPL) is the subject of study based on network pharmacology. Two alkaloids were chosen from the gas chromatography mass spectrometry (GC-MS) analysis. However, only piperlonguminine received preference because it adhered to Lipinski's rule and depicted no toxicity. Web tools which are available online, like, Swiss ADME, pkCSMand ProTox-II were used to evaluate the pharmacokinetics and physiochemical properties of piperlonguminine. The database that SwissTargetPrediction and TCMSP maintain contains the targets for piperlonguminine. Using DisGeNET, GeneCards and Open Targets Platform databases, we were able to identify targets of CRC. The top four hub genes identified by Cytoscape are SRC, MTOR, EZH2, and MAPK3. The participation of hub genes in colorectal cancer-related pathways was examined using the Kyoto Encyclopaedia of Genes and Genomes (KEGG) database. The colorectal cancer pathway, the ErbB signaling pathway and the mTOR signaling pathway emerged to be important. Our findings show that the hub genes are involved in the aforementioned pathways for tumor growth, which calls for their downregulation. Additionally, piperlonguminine has the potential to become a successful medicine in the future for the treatment of CRC.
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Affiliation(s)
- Indrajeet Singh
- Department of Biotechnology, Faculty of Engineering and Technology, Rama University, G.T. Road, Mandhana, Kanpur, Uttar Pradesh, 209217, India
| | - Richa Das
- Department of Biotechnology, Parul Institute of Applied Science, Parul University, Vadodara, Gujarat, 391760, India
| | - Ajay Kumar
- Department of Biotechnology, Faculty of Engineering and Technology, Rama University, G.T. Road, Mandhana, Kanpur, Uttar Pradesh, 209217, India.
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6
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Kaunitz JD, Bejjani A. Very Unstable Genetics: How the Confluence of Microsatellite Instability and Immunotherapy Revolutionized the Treatment of Colon Cancer. Dig Dis Sci 2023; 68:3494-3503. [PMID: 37402981 DOI: 10.1007/s10620-023-08007-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Jonathan D Kaunitz
- Medical Service, Section of Gastroenterology, Greater Los Angeles VAMC, Los Angeles, CA, USA.
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Anthony Bejjani
- Medical Service, Section of Hematology Oncology, Greater Los Angeles VAMC, Los Angeles, CA, USA
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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7
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Bretthauer M, Løberg M, Kaminski MF. Colonoscopy Screening and Colorectal Cancer Incidence and Mortality. Reply. N Engl J Med 2023; 388:378-379. [PMID: 36720141 DOI: 10.1056/nejmc2215192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Michal F Kaminski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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8
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Khannous-Lleiffe O, Willis JR, Saus E, Moreno V, Castellví-Bel S, Gabaldón T. Microbiome Profiling from Fecal Immunochemical Test Reveals Microbial Signatures with Potential for Colorectal Cancer Screening. Cancers (Basel) 2022; 15:cancers15010120. [PMID: 36612118 PMCID: PMC9817783 DOI: 10.3390/cancers15010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer deaths worldwide. Early diagnosis of CRC, which saves lives and enables better outcomes, is generally implemented through a two-step population screening approach based on the use of Fecal Immunochemical Test (FIT) followed by colonoscopy if the test is positive. However, the FIT step has a high false positive rate, and there is a need for new predictive biomarkers to better prioritize cases for colonoscopy. Here we used 16S rRNA metabarcoding from FIT positive samples to uncover microbial taxa, taxon co-occurrence and metabolic features significantly associated with different colonoscopy outcomes, underscoring a predictive potential and revealing changes along the path from healthy tissue to carcinoma. Finally, we used machine learning to develop a two-phase classifier which reduces the current false positive rate while maximizing the inclusion of CRC and clinically relevant samples.
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Affiliation(s)
- Olfat Khannous-Lleiffe
- Barcelona Supercomputing Center (BSC-CNS), Carrer de Jordi Girona, 29, 31, 08034 Barcelona, Spain
- Institute for Research in Biomedicine (IRB), Carrer de Baldiri Reixac, 10, 08028 Barcelona, Spain
| | - Jesse R. Willis
- Barcelona Supercomputing Center (BSC-CNS), Carrer de Jordi Girona, 29, 31, 08034 Barcelona, Spain
- Institute for Research in Biomedicine (IRB), Carrer de Baldiri Reixac, 10, 08028 Barcelona, Spain
| | - Ester Saus
- Barcelona Supercomputing Center (BSC-CNS), Carrer de Jordi Girona, 29, 31, 08034 Barcelona, Spain
- Institute for Research in Biomedicine (IRB), Carrer de Baldiri Reixac, 10, 08028 Barcelona, Spain
| | - Victor Moreno
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. de Monforte de Lemos, 3–5, 28029 Madrid, Spain
- Gastroenterology Department, University of Barcelona, 08036 Barcelona, Spain
| | - Sergi Castellví-Bel
- Gastroenterology Department, University of Barcelona, 08036 Barcelona, Spain
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, 08036 Barcelona, Spain
| | - Toni Gabaldón
- Barcelona Supercomputing Center (BSC-CNS), Carrer de Jordi Girona, 29, 31, 08034 Barcelona, Spain
- Institute for Research in Biomedicine (IRB), Carrer de Baldiri Reixac, 10, 08028 Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Centro Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC), 08028 Barcelona, Spain
- Correspondence:
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Alzahrani KM, Fallatah SM, Almehmadi RA, Alghamdi JS, Alsulaimani AI, Alkhaldi LM, Alsuwayhi AG. Colorectal Cancer and Its Screening Among Public in the Western Region of Saudi Arabia. Cureus 2022; 14:e27404. [PMID: 36046279 PMCID: PMC9419754 DOI: 10.7759/cureus.27404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Colorectal cancer (CRC) is defined as a cancer that starts in the colon or the rectum. CRC is the most commonly diagnosed cancer among Saudi males and ranks third in female individuals. Awareness among the population about CRC symptoms, risk factors, and screening tests is essential for preventing further morbidity and mortality. This study aimed to assess CRC knowledge in the western region of Saudi Arabia, as well as awareness of CRC risk factors, symptoms, and screening based on various demographic data. Methods: We conducted a cross-sectional study with a representative random sample of 358 Saudi residents in the western region. A self-administered questionnaire was distributed through social media sites starting from October 2021 till December 2021. Participants' awareness of CRC risk factors, symptoms, and screening was assessed using the questionnaire. For data analysis, we used SPSS Statistics, version 24 (IBM Corp., Armonk, NY). Results: Of the 385 participants, 76.4% were females, and most participants had a university degree level of education. Study respondents reported fear of colonoscopy as the top reason why they avoided CRC screening. Most participants (63.4%) showed insufficient knowledge. Certain factors showed a significant association with the participants' knowledge about CRC, such as age (p<.001), higher education (p=.002), and having a career in health care (p=.002). Conclusion: As the study resulted in overall insufficient knowledge about CRC among respondents, certain factors showed a significant association with the knowledge level. Raising awareness and health promotion programs should target older age groups and those with below university degree level of education to ultimately prevent morbidity and mortality related to colorectal cancer.
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Esmeeta A, Adhikary S, Dharshnaa V, Swarnamughi P, Ummul Maqsummiya Z, Banerjee A, Pathak S, Duttaroy AK. Plant-derived bioactive compounds in colon cancer treatment: An updated review. Biomed Pharmacother 2022; 153:113384. [PMID: 35820317 DOI: 10.1016/j.biopha.2022.113384] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/19/2022] Open
Abstract
Colon cancer is the third most predominant cancer caused by genetic, environmental and nutritional factors. Plant-based compounds are very well known to regress colon cancer in many ways, like delaying tumor growth, managing chemotherapy and radiation therapy side-effects, and working at the molecular levels. Medicinal plants contain many bioactive phytochemicals such as flavonoids, polyphenol compounds, caffeic acid, catechins, saponins, polysaccharides, triterpenoids, alkaloids, glycosides, phenols, quercetin, luteolin, kaempferol and luteolin glycosides, carnosic acid, oleanolic acid, rosmarinic acid, emodin, and eugenol and anthricin. These bioactive compounds can reduce tumor cell proliferation via several mechanisms, such as blocking cell cycle checkpoints and promoting apoptosis through activating initiator and executioner caspase. Traditional medicines have been used globally to treat cancers because of their anti-cancer effects, antioxidant properties, anti-inflammatory properties, anti-mutagenic effects, and anti-angiogenic effects. In addition, these medicines effectively suppress early and intermediate stages of carcinogenesis when administered in their active and pure form. However, traditional medicine is not very popular due to some critical challenges. These include poor solubility and absorption of these compounds, intellectual property-related issues, involvement of drug synergism, absence of drug-likeness, and unsure protocols for their extraction from the plant source. Using bioactive compounds in colon cancer has equal advantages and limitations. This review highlights the benefits and challenges of using bioactive compounds derived from plants for colon cancer. We have also discussed using these compounds to target cancer stem cell self-renewal, its effects on cancer cell metabolism, safety parameters, easy modulation, and their bioavailability.
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Affiliation(s)
- Akanksha Esmeeta
- Amity Institute of Biotechnology, Amity University, Sector 125, Noida, Uttar Pradesh 201301, India
| | - Subhamay Adhikary
- Amity Institute of Biotechnology, Amity University, Sector 125, Noida, Uttar Pradesh 201301, India
| | - V Dharshnaa
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chennai, India
| | - P Swarnamughi
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chennai, India
| | - Z Ummul Maqsummiya
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chennai, India
| | - Antara Banerjee
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chennai, India
| | - Surajit Pathak
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chennai, India.
| | - Asim K Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
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11
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Tran CTD, Nguyen MVT, Tran MT, Tuong TTV, Tran QH, Le LC, Pham HTT, Bui NC, Vu HH, Nguyen TTC, Ta PQ, Ha HTT, Trinh DT, Bui HTM, Trinh DQ, Van Nguyen K, Le SH, Van Vu K, Van Tran T, Tran HTT, Shrubsole MJ, Ye F, Cai Q, Zheng W, Boffetta P, Shu XO, Luu HN. Findings from the first colorectal cancer screening among 103 542 individuals in Vietnam with systematic review of colorectal cancer screening programs in Asia-Pacific region. Jpn J Clin Oncol 2022; 52:707-715. [PMID: 35383373 PMCID: PMC9264238 DOI: 10.1093/jjco/hyac043] [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: 07/27/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Colorectal cancer is a leading cancer incidence and cause of death worldwide and in Vietnam. Although screening is considered an effective measure to prevent and control colorectal cancer, there is no such effort in Vietnam. METHODS Between 01 January 2018 and 31 October 2019, a population-based colorectal cancer screening program was conducted in Hanoi, Vietnam. A health advocacy campaign and follow-up phone calls were used to enroll residents aged ≥40 years old to complete an immunochemical-fecal occult blood testing. Positive immunochemical-fecal occult blood testing was followed by a colonoscopy. We also conducted a systematic review of the colorectal cancer screening programs in the Asia-Pacific region that used similar approach by searching Ovid Medline and PubMed databases. RESULTS During study period, 103 542 individuals among 672 742 eligible residents attended the screening of whom 81.5% participants finished immunochemical-fecal occult blood testing test and the positive rate was 6.1%. The coverage rate for immunochemical-fecal occult blood testing test was 11.9%. Among 2278 individuals who underwent colonoscopy, 3.5% were histologically diagnosed with cancer, 17.8% with advanced adenomas, and 23.1% with non-advanced adenomas. Males had significantly higher detection rate of advanced adenomas, cancer or ≥ two polyps/tumor than females (P < 0.0001). The systematic review showed that in two-step modality (i.e. immunochemical-fecal occult blood testing/fecal immunochemical test and colonoscopy), the test positive was from 4.1 to 10.6%. Once colonoscopy was performed subsequently, the rate of cancer among positive participants was from 1.7 to 16.4% and that of advanced adenomas was from 7.1 to 23.1%. CONCLUSION We showed that the two-step modality is a promising strategy for colorectal cancer screening in Vietnam that might apply to similar settings with limited resources.
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Affiliation(s)
- Chi Thi-Du Tran
- Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System, Hanoi, Vietnam
- College of Health Sciences, VinUniversity (VinUni), Hanoi, Vietnam
- Center of Applied Sciences, Regenerative Medicine and Advanced Technology (CARA), Vinmec Healthcare System, Hanoi, Vietnam
| | - Mai Vu-Tuyet Nguyen
- Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System, Hanoi, Vietnam
| | - Mo Thi Tran
- Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System, Hanoi, Vietnam
| | - Thuy Thi-Van Tuong
- Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System, Hanoi, Vietnam
| | - Quang Hong Tran
- Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System, Hanoi, Vietnam
| | - Linh Cu Le
- College of Health Sciences, VinUniversity (VinUni), Hanoi, Vietnam
| | - Huong Thi-Thu Pham
- Department of Gastroenterology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Nam Chi Bui
- Department of Gastroenterology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Hien Huy Vu
- Department of Gastroenterology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Tu Thi-Cam Nguyen
- Department of Gastroenterology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Phuong Que Ta
- Department of Gastroenterology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Hien Thi-Thu Ha
- Department of Histopathology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Dung Tuan Trinh
- Department of Histopathology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
- Department of Histopathology, Tam Anh General Hospital, Hanoi, Vietnam
| | - Hanh Thi-My Bui
- Department of Histopathology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Dien Quang Trinh
- Department of Histopathology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Khanh Van Nguyen
- Department of Histopathology, Vinmec International Hospital at Times City, Vinmec Healthcare System, Hanoi, Vietnam
| | - Song Huu Le
- Center of Molecular and Genetic Research, 108 Hospital, Hanoi, Vietnam
| | - Khien Van Vu
- Department of Gastroenterology, 108 Hospital, Hanoi, Vietnam
| | - Thuan Van Tran
- Vietnam Ministry of Health, Hanoi, Vietnam
- Vietnam National Cancer Institute, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Huong Thi-Thanh Tran
- Vietnam National Cancer Institute, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Fei Ye
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brooke University, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hung N Luu
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Fulfilling the promise of colorectal cancer screening. Lancet Gastroenterol Hepatol 2022; 7:690-691. [DOI: 10.1016/s2468-1253(22)00121-2] [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: 03/24/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
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Moussallem M, Jreij M, Yeretzian JS, Asmar MK, Bou-Orm IR. Colorectal cancer screening knowledge and uptake in lebanon: a national survey. Rev Epidemiol Sante Publique 2022; 70:67-73. [PMID: 35339314 DOI: 10.1016/j.respe.2022.01.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The main aim of this national survey was to identify the levels of colorectal cancer screening knowledge and uptake in Lebanon. METHODS A total of 1200 participants were enrolled in this cross-sectional household survey targeting the Lebanese population aged 50 years and above. The sample was recruited using a two-stage stratified cluster sampling approach. RESULTS Of the total sample, 38.3% knew about any screening test for colorectal cancer but only 7.5% had ever used any. Thirty-nine percent of the participants rated their risk of getting colorectal cancer as very low or low, and only 53.5% were confident in their ability to undertake a screening test. Almost all participants agreed that medical advice and test reimbursement would encourage them to do a screening test. At the multivariate analysis level, hearing of an awareness campaign in the last two years showed the strongest association with the knowledge of a colorectal cancer screening test with an estimated ORadj = 5.12 (95%CI: 3.67 - 7.15). Other factors that were significantly associated with this knowledge variable included: a family history of colorectal cancer, a personal history of colorectal illness, having a health coverage, and knowledge of colorectal cancer signs and symptoms. DISCUSSION This national study highlights an alarming lack of uptake and low levels of knowledge of colorectal cancer screening tests even though it is among the most prevalent cancers in Lebanon and its prevalence has been continuously increasing in the past years. The evidence suggests that people who had an experience with colorectal cancer diagnostic tests, either personally or through a family member, and those who have heard of an awareness campaign about colorectal cancer in the last two years are more likely to know its screening tests. CONCLUSION Colorectal cancer screening knowledge and uptake in Lebanon are limited and justify the need for public health interventions. This study gives evidence that awareness campaigns, coupled with the involvement of medical providers and the reimbursement of screening test fees, would alleviate the burden of colorectal cancer in Lebanon.
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Affiliation(s)
- Marianne Moussallem
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut - Lebanon.
| | - Marc Jreij
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut - Lebanon
| | | | - Michèle Kosremelli Asmar
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut - Lebanon
| | - Ibrahim R Bou-Orm
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut - Lebanon
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14
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Fatima H, Wajid M, Krier C, Champion V, Carter-Harris L, Shedd-Steele R, Imperiale TF, Schwartz P, Strom S, Magnarella M, Rawl SM. Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems. Cureus 2022; 14:e23372. [PMID: 35475065 PMCID: PMC9020808 DOI: 10.7759/cureus.23372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/09/2022] Open
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Luu XQ, Lee K, Jun JK, Suh M, Jung KW, Choi KS. Effect of colorectal cancer screening on long-term survival of colorectal cancer patients: Results of the Korea National Cancer Screening Program. Int J Cancer 2022; 150:1958-1967. [PMID: 35099813 DOI: 10.1002/ijc.33953] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
The Korea National Cancer Screening Program (KNCSP) provides fecal immunochemical test-based colorectal cancer (CRC) screening for people aged ≥50 years. This study aimed to investigate the long-term survival effects of CRC screening based on screening history and interval time since screening. The study cohort was obtained by linking three national databases, namely the Korea Central Cancer Registry, KNCSP database, and Death Certificate. We included 32 509 CRC patients diagnosed in 2008-2009, who underwent CRC screening via the KNCSP between 2004 and 2009. The patients were followed-up until 2019, and their survival was assessed according to their CRC screening history. Cox proportional hazards regression was used to compare time to deaths among CRC patients according to CRC screening history, after adjusting for covariates. Of the 32 509 patients, 20 022 (61.5%) patients were alive by the end of 2019. Long-term survival was significantly higher among screened patients (68.2%) than non-screened (57.2%) individuals. Compared with never-screened patients, the hazard ratio (HR) for CRC-specific death in screened patients was 0.77 (95% CI%, 0.73-0.80). Lowest HR was observed in screened, localized CRC patients (HR, 0.48; 95% CI, 0.42-0.56); HR for CRC-specific death was the lowest in patients screened within 12 months of diagnosis (HR, 0.70; 95% CI, 0.66-0.74), following which, the HRs increased with increasing time interval. CRC screening was positively associated with favorable prognosis in CRC patients aged 50-79 years. The effects on long-term survival according to interval time was the best among individuals screened within one year before diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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Luu XQ, Lee K, Kim J, Sohn DK, Shin A, Choi KS. The classification capability of the Asia Pacific Colorectal Screening score in Korea: an analysis of the Cancer Screenee Cohort. Epidemiol Health 2021; 43:e2021069. [PMID: 34607403 PMCID: PMC8654505 DOI: 10.4178/epih.e2021069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screenings and potential factors relevant for implementing this tool in the Korean population. METHODS Our study analyzed data from the Cancer Screenee Cohort Study conducted by the National Cancer Center in Korea. The risk level was assessed using the Asia Pacific Colorectal Screening (APCS) score developed by the Asia-Pacific Working Group on Colorectal Cancer. Logistic regression models were used to examine the associations between colorectal-related outcomes and the risk level by APCS score. The discriminatory performance of the APCS score for various colorectal-related outcomes was assessed using C-statistics. RESULTS In 12,520 individuals, 317 ACN cases and 4,528 adenoma cases were found. The APCS tool successfully classified the study population into different risk groups, and significant differences in the ACN rate and other outcomes were observed. The APCS score demonstrated acceptable discrimination capability with area under the curve values ranging from 0.62 to 0.65 for various outcomes. The results of the multivariate logistic regression model revealed that the high-risk group had a 3.1-fold higher risk of ACN (95% confidence interval, 2.08 to 4.67) than the average-risk group. Body mass index (BMI) was identified as a significant predictor of ACN in both multivariate and subgroup analyses. CONCLUSIONS Our study highlighted significant differences in colorectal-related screening outcomes by colorectal risk level measured using the APCS score, and BMI could be used to improve the discriminatory capability of the APCS score.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Chadha S, Kumar A, Srivastava SA, Behl T, Ranjan R. Inulin as a Delivery Vehicle for Targeting Colon-Specific Cancer. Curr Drug Deliv 2021; 17:651-674. [PMID: 32459607 DOI: 10.2174/1567201817666200527133719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
Natural polysaccharides, as well as biopolymers, are now days widely developed for targeting colon cancer using various drug delivery systems. Currently, healing conformations are being explored that can efficiently play a multipurpose role. Owing to the capability of extravagance colonic diseases with the least adverse effects, biopolymers for site specific colon delivery have developed an increased curiosity over the past decades. Inulin (INU) was explored for its probable application as an entrapment material concerning its degradation by enzymes in the colonic microflora and its drug release behavior in a sustained and controlled manner. INU is a polysaccharide and it consists of 2 to 1 linkage having an extensive array of beneficial uses such as a carrier for delivery of therapeutic agents as an indicative/investigative utensil or as a dietary fiber with added well-being aids. In the main, limited research, as well as information, is available on the delivery of therapeutic agents using inulin specifically for colon cancer because of its capability to subsist in the stomach's acidic medium. This exceptional steadiness and robustness properties are exploited in numerous patterns to target drugs securely for the management of colonic cancer, where they effectively act and kills colonic tumor cells easily. In this review article, recent efforts and inulin-based nano-technological approaches for colon cancer targeting are presented and discussed.
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Affiliation(s)
- Swati Chadha
- Department of Pharmaceutics, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Arun Kumar
- Department of Pharmaceutics, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | | | - Tapan Behl
- Department of Pharmaceutics, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Rishu Ranjan
- Department of Pharmaceutics, Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Soonklang K, Siribumrungwong B, Siripongpreeda B, Auewarakul C. Comparison of multiple statistical models for the development of clinical prediction scores to detect advanced colorectal neoplasms in asymptomatic Thai patients. Medicine (Baltimore) 2021; 100:e26065. [PMID: 34011125 PMCID: PMC8137057 DOI: 10.1097/md.0000000000026065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/27/2021] [Indexed: 01/05/2023] Open
Abstract
A good clinical prediction score can help in the risk stratification of patients with colorectal cancer (CRC) undergoing colonoscopy screening. The aim of our study was to compare model performance of binary logistic regression (BLR), polytomous logistic regression (PLR), and classification and regression tree (CART) between the clinical prediction scores of advanced colorectal neoplasia (ACN) in asymptomatic Thai patients.We conducted a cross-sectional study of 1311 asymptomatic Thai patients to develop a clinical prediction model. The possible predictive variables included sex, age, body mass index, family history of CRC in first-degree relatives, smoking, diabetes mellitus, and the fecal immunochemical test in the univariate analysis. Variables with a P value of .1 were included in the multivariable analysis, using the BLR, CART, and PLR models. Model performance, including the area under the receiver operator characteristic curve (AUROC), was compared between the model types.ACN was diagnosed in 53 patients (4.04%). The AUROCs were not significantly different between the BLR and CART models for ACN prediction with an AUROC of 0.774 (95% confidence interval [95% CI]: 0.706-0.842) and 0.765 (95% CI: 0.698-0.832), respectively (P = .712). A significant difference was observed between the PLR and CART models in predicting average to moderate ACN risk with an AUROC of 0.767 (95% CI: 0.695-0.839 vs AUROC 0.675 [95% CI: 0.599-0.751], respectively; P = .009).The BLR and CART models yielded similar accuracies for the prediction of ACN in Thai patients. The PLR model provided higher accuracy for ACN prediction than the CART model.
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Affiliation(s)
- Kamonwan Soonklang
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok
- Department of Clinical Epidemiology, Faculty of Medicine
| | - Boonying Siribumrungwong
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani
| | - Bunchorn Siripongpreeda
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chirayu Auewarakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Agazzi S, Lenti MV, Klersy C, Strada E, Pozzi L, Rovedatti L, Bardone M, Mauro A, Costetti M, Costa S, De Grazia F, Di Sabatino A. Incidence and risk factors for preneoplastic and neoplastic lesions of the colon and rectum in patients under 50 referred for colonoscopy. Eur J Intern Med 2021; 87:36-43. [PMID: 33610414 DOI: 10.1016/j.ejim.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/30/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
Colorectal cancer (CRC) diagnosed before the age of 50, known as early-onset CRC (eoCRC), is considered uncommon. We aimed at analysing the incidence of preneoplastic and neoplastic lesions of the colon and rectum in patients under 50 years old and to identify possible predictors Methods: We retrospectively collected data from 1778 patients under 50 years old (mean age 39.9±7.8) referred for colonoscopy between 2015-2018. Cumulative incidence of adenomas and eoCRC was assessed. Multivariable regression models were fitted Results: The cumulative incidence for adenomas was 11.0% (95% CI 9-12), while it was 1.5% (95% CI 1-2) for eoCRC (metastatic disease in 13/27 patients). Age as a continuous variable was associated with the presence of adenomas (incidence rate ratio 1.06; 95% CI 1.03-1.09; p<0.001). EoCRC arose in most cases in the rectum (13/27, 48.1%). Age ≥40 was the main risk factor (OR 2.25; 95% CI 1.35-3.73; p=0.002) for both adenomas (160/196 patients, 81.6%) and eoCRC (20/27 patients, 74.1%), while smoking seemed to have no role (p=0.772). The presence of alarm symptoms was statistically significant at bivariable analysis for eoCRC only (OR 3.70; 95% CI 1.49-9.22; p=0.005), as well as having multiple gastrointestinal symptoms (OR 19.85; 95% CI 2.64-149.42; p=0.004). Only 3/27 (11.1%) patients with eoCRC had a family history for CRC Conclusions: A high cumulative incidence rate of both adenomas and eoCRC was found, this latter occurring more common in patients aged 40-49, without apparent risk factors. The presence of alarm symptoms or multiple gastrointestinal symptoms led to a late diagnosis.
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Affiliation(s)
- Simona Agazzi
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| | - Catherine Klersy
- Clinical Epidemiology & Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Elena Strada
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Lodovica Pozzi
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Laura Rovedatti
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Bardone
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Aurelio Mauro
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Martina Costetti
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefania Costa
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federico De Grazia
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, Endoscopy Unit, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Smith RA, Fedewa S, Siegel R. Early colorectal cancer detection-Current and evolving challenges in evidence, guidelines, policy, and practices. Adv Cancer Res 2021; 151:69-107. [PMID: 34148621 DOI: 10.1016/bs.acr.2021.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The understanding at the beginning of the last century that colorectal cancer began as a localized disease that progressed and became systemic, and that most colorectal cancer arose from adenomatous polyps gave rise to aggressive attempts at curative treatment and eventually attempts to detect advanced lesions before they progressed to invasive disease. In the last four decades, steadily greater uptake of screening has led to reductions in colorectal cancer incidence and mortality. However, the fullest potential of screening is not being met due to the lack of organized screening, where a systems approach could lead to higher rates of screening of average and high risk groups, higher quality screening, and prompt followup of adults with positive screening tests. ABSTRACT: Since the beginning of the 20th century, there has been a general understanding that colorectal cancer is a clonal disease that progresses from a localized stage with a favorable prognosis through progressively more advanced stages which have progressively worse prognosis. That understanding led first to determined efforts to detect and treat early stage symptomatic disease, and then to detect pre-symptomatic colorectal cancer and precursor lesions, where there was hope that the natural history of the disease could be arrested and the incidence and premature mortality of colorectal cancer averted. Toward the end of the last century, guidelines for colorectal cancer screening, growth in the number of technical options for screening, and a steady increase in the proportion of the adult population who attended screening contributed to the beginning of a significant decline in colorectal cancer incidence and mortality. Despite this progress, colorectal cancer remains the third leading cause of death among men and women in the United States. Screening for early detection of precursor lesions and localized cancer offers the single most productive opportunity to further reduce the burden of disease, and yet nearly four in five deaths from colorectal cancer are associated with having never been screened, not recently screened, or not followed up for an abnormal screening test. This simple observation is a call to action in all communities to apply existing knowledge to fulfill the potential to prevent avertable incidence and mortality.
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Affiliation(s)
- Robert A Smith
- Cancer Prevention and Early Detection Department, American Cancer Society, Atlanta, GA, United States.
| | - Stacey Fedewa
- Screening and Risk Factors Research, Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, United States
| | - Rebecca Siegel
- Surveillance Research, Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, United States
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Winawer SJ, Zauber AG, O’Brien MJ, Geenen J, Waye JD. The National Polyp Study at 40: challenges then and now. Gastrointest Endosc 2021; 93:720-726. [PMID: 33010298 PMCID: PMC7887080 DOI: 10.1016/j.gie.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Sidney J. Winawer
- Gastroenterology, Hepatology and Nutrition Service,
Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial
Sloan Kettering Cancer
| | - Michael J. O’Brien
- Department of Laboratory Pathology, Boston University
School of Medicine
| | - Joseph Geenen
- Department of Medicine, Medical College of Wisconsin
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22
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Jansen-Winkeln B, Barberio M, Chalopin C, Schierle K, Diana M, Köhler H, Gockel I, Maktabi M. Feedforward Artificial Neural Network-Based Colorectal Cancer Detection Using Hyperspectral Imaging: A Step towards Automatic Optical Biopsy. Cancers (Basel) 2021; 13:cancers13050967. [PMID: 33669082 PMCID: PMC7956537 DOI: 10.3390/cancers13050967] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Detection of colorectal carcinoma is performed visually by investigators and is confirmed pathologically. With hyperspectral imaging, an expanded spectral range of optical information is now available for analysis. The acquired recordings were analyzed with a neural network, and it was possible to differentiate tumor from healthy mucosa in colorectal carcinoma by automatic classification with high reliability. Classification and visualization were performed based on a four-layer perceptron neural network. Based on a neural network, the classification of CA or AD resulted in a sensitivity of 86% and a specificity of 95%, by means of leave-one-patient-out cross-validation. Additionally, significant differences in terms of perfusion parameters (e.g., oxygen saturation) related to tumor staging and neoadjuvant therapy were observed. This is a step towards optical biopsy. Abstract Currently, colorectal cancer (CRC) is mainly identified via a visual assessment during colonoscopy, increasingly used artificial intelligence algorithms, or surgery. Subsequently, CRC is confirmed through a histopathological examination by a pathologist. Hyperspectral imaging (HSI), a non-invasive optical imaging technology, has shown promising results in the medical field. In the current study, we combined HSI with several artificial intelligence algorithms to discriminate CRC. Between July 2019 and May 2020, 54 consecutive patients undergoing colorectal resections for CRC were included. The tumor was imaged from the mucosal side with a hyperspectral camera. The image annotations were classified into three groups (cancer, CA; adenomatous margin around the central tumor, AD; and healthy mucosa, HM). Classification and visualization were performed based on a four-layer perceptron neural network. Based on a neural network, the classification of CA or AD resulted in a sensitivity of 86% and a specificity of 95%, by means of leave-one-patient-out cross-validation. Additionally, significant differences in terms of perfusion parameters (e.g., oxygen saturation) related to tumor staging and neoadjuvant therapy were observed. Hyperspectral imaging combined with automatic classification can be used to differentiate between CRC and healthy mucosa. Additionally, the biological changes induced by chemotherapy to the tissue are detectable with HSI.
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Affiliation(s)
- Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
- Correspondence: ; Tel.: +49-341-9717211; Fax: +49-341-9728167
| | - Manuel Barberio
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France;
- Department of General Surgery, Hospital Card. G. Panico, 73039 Tricase, Italy
| | - Claire Chalopin
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
| | - Katrin Schierle
- Institute of Pathology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France;
| | - Hannes Köhler
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
| | - Marianne Maktabi
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
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Abualkhair WH, Zhou M, Ochoa CO, Lacayo L, Murphy C, Wu XC, Karlitz JJ. Geographic and intra-racial disparities in early-onset colorectal cancer in the SEER 18 registries of the United States. Cancer Med 2020; 9:9150-9159. [PMID: 33094553 PMCID: PMC7724480 DOI: 10.1002/cam4.3488] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background Although early‐onset colorectal cancer (EOCRC) incidence rates (IRs) are increasing, geographic and intra‐racial IR disparities are not well defined. Methods 2000‐2015 Surveillance, Epidemiology, and End Results (SEER) program CRC IR Analysis (170,434 cases) was performed from ages 30 to 60 in four US regions, 18 individual registries, metropolitan and nonmetropolitan locations and stratified by race. Analyses were conducted in 1‐year and 5‐year age increments. Results Wide US regional EOCRC IR variations exist: For example, age 45 IRs in the south are 26.8/100,000, 36.0% higher than the West, 19.7/100,000 (p < 0.0001). Disparities magnify between individual registries: EOCRC IRs in highest risk registries were 177‐348% (Alaska Natives), 75‐200% (Hawaii), 76‐128% (Louisiana), and 61‐125% (Kentucky) higher than lowest risk registries depending on age. EOCRC IRs are 18.2%‐25.6% higher in nonmetropolitan versus metropolitan settings. Wide geographic intra‐racial disparities exist. Within the White population, the greatest IR difference (78.8%) was between Kentucky (5.9/100,000) and Los Angeles (3.3/100,000) in 30‐ to 34‐year‐olds (p < .0001). Within the Black population, the greatest difference (136.2%) was between rural Georgia (30.7/100,000) and California excluding San Francisco‐Oakland/San Jose‐Monterey/Los Angeles (13/100,000) in 40‐ to 44‐year‐olds (p = 0003). Conclusion Marked geographic EOCRC disparities exist with disproportionately high IRs in Alaska Natives, Hawaii, and southern registries. Geographic intra‐racial disparities are present within White and Black populations. In Blacks, there are disproportionately high EOCRC IRs in rural Georgia. Although vigilance is required in all populations, attention must be paid to these higher risk populations. Potential interventions include assuring early investigation of symptoms, targeting modifiable risk factors and utilizing earlier age 45 screening options supported by some guidelines.
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Affiliation(s)
- Wesal H Abualkhair
- Master of Science in Clinical Research, School of Medicine, Department of Medicine, Tulane University, New Orleans, LA, USA
| | - Meijiao Zhou
- Louisiana Tumor Registry and Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Leonel Lacayo
- Gastroenterologist, Southeast Louisiana Veterans Health Care Systems, New Orleans, LA, USA
| | - Caitlin Murphy
- Department of Population and Data Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Xiao-Cheng Wu
- Public Health and Director of Louisiana Tumor Registry, Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jordan J Karlitz
- Southeast Louisiana Veterans Health Care System, New Orleans and Division of Gastroenterology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Kaluzny AD, O'Brien DM. How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research. HEALTH POLICY OPEN 2020; 1:100015. [PMID: 33073235 PMCID: PMC7550860 DOI: 10.1016/j.hpopen.2020.100015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
In 1971, Congress passed the National Cancer Act, landmark legislation that reorganized the National Institutes of Health's National Cancer Institute (NCI). The Act included a new focus on cancer control, including the requirement that the NCI award research grants and contracts, in collaboration with other public agencies and private industry, to conduct cancer control activities related to the diagnosis, prevention, and treatment of cancer. The requirement placed the NCI at the nexus of a rapidly changing science and a complex and dynamic healthcare delivery system and involved an evolutionary transformation to advance cancer control and cancer care delivery research along the cancer care continuum. Analysis is based on a qualitative ethnographic approach using historical records, oral histories, and targeted interviews. The multimethod approach provided the opportunity to describe the vision, leadership, and struggle to build an infrastructure, expand expertise, and forge collaboration with the NCI and a complex and changing healthcare system. As the 50th anniversary of the National Cancer Act approaches in 2021, the process and these achievements are at risk of being taken for granted or lost in the flow of history. Documenting the process, milestones, and key players provides insight and guidance for continuing to improve cancer care, advance research, and reduce cancer incidence and mortality. Cancer care is a microcosm of the larger healthcare system providing insight and lessons on the importance of developing and maintaining a research infrastructure and the role of multi-level collaboration and partnerships involving both the private and public sectors. Fifty years ago the U.S. National Cancer Act mandated Cancer Control activities. Vision and leadership at the NCI were critical to advance cancer control on a global scale. Cancer care is a microcosm of challenges facing health policy globally. Evidence based strategies and infrastructure are important building blocks. Public-private collaboration is essential for meeting future challenges.
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Affiliation(s)
- Arnold D Kaluzny
- Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Donna M O'Brien
- Strategic Visions in Healthcare LLC, New York, NY, United States of America.,International Cancer Expert Corps, Washington, DC, United States of America
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26
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Mei H, Wen Y. MicroRNAs for Diagnosis and Treatment of Colorectal Cancer. Endocr Metab Immune Disord Drug Targets 2020; 21:47-55. [PMID: 32819240 DOI: 10.2174/1871530320999200818134339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/28/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide, with high morbidity and mortality rates. The diagnosis and treatment of CRC have the most significant value for disease- free survival. Early diagnosis and early surgical resection are generally considered to be the most effective ways to reduce CRC mortality. In the past few years, many researchers have focused on the role of microRNAs in different tumors, making the functions of microRNAs gradually clear. The present study reviews the role of microRNAs in the diagnosis and treatment of colorectal cancer. Compared with the usual diagnosis methods and biomarker, circulating microRNAs can be promising new effective biomarkers for CRC diagnosis and treatment.
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Affiliation(s)
- Haitao Mei
- Shanghai General Hospital, Department of general surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yugang Wen
- Shanghai General Hospital, Department of general surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang HY, Lin TW, Chiu SYH, Lin WY, Huang SB, Hsieh JCH, Chen HC, Lu JJ, Wu MH. Novel Toilet Paper-Based Point-Of-Care Test for the Rapid Detection of Fecal Occult Blood: Instrument Validation Study. J Med Internet Res 2020; 22:e20261. [PMID: 32763879 PMCID: PMC7472847 DOI: 10.2196/20261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Colorectal cancer screening by fecal occult blood testing has been an important public health test and shown to reduce colorectal cancer-related mortality. However, the low participation rate in colorectal cancer screening by the general public remains a problematic public health issue. This fact could be attributed to the complex and unpleasant operation of the screening tool. OBJECTIVE This study aimed to validate a novel toilet paper-based point-of-care test (ie, JustWipe) as a public health instrument to detect fecal occult blood and provide detailed results from the evaluation of the analytic characteristics in the clinical validation. METHODS The mechanism of fecal specimen collection by the toilet-paper device was verified with repeatability and reproducibility tests. We also evaluated the analytical characteristics of the test reagents. For clinical validation, we conducted comparisons between JustWipe and other fecal occult blood tests. The first comparison was between JustWipe and typical fecal occult blood testing in a central laboratory setting with 70 fecal specimens from the hospital. For the second comparison, a total of 58 volunteers were recruited, and JustWipe was compared with the commercially available Hemoccult SENSA in a point-of-care setting. RESULTS Adequate amounts of fecal specimens were collected using the toilet-paper device with small day-to-day and person-to-person variations. The limit of detection of the test reagent was evaluated to be 3.75 µg of hemoglobin per milliliter of reagent. Moreover, the test reagent also showed high repeatability (100%) on different days and high reproducibility (>96%) among different users. The overall agreement between JustWipe and a typical fecal occult blood test in a central laboratory setting was 82.9%. In the setting of point-of-care tests, the overall agreement between JustWipe and Hemoccult SENSA was 89.7%. Moreover, the usability questionnaire showed that the novel test tool had high scores in operation friendliness (87.3/100), ease of reading results (97.4/100), and information usefulness (96.1/100). CONCLUSIONS We developed and validated a toilet paper-based fecal occult blood test for use as a point-of-care test for the rapid (in 60 seconds) and easy testing of fecal occult blood. These favorable characteristics render it a promising tool for colorectal cancer screening as a public health instrument.
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Affiliation(s)
- Hsin-Yao Wang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Wei Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan City, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | | | | | - Jason Chia-Hsun Hsieh
- Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Division of Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | | | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan City, Taiwan
| | - Min-Hsien Wu
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan.,Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan.,Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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Catalano F, Cerofolini A, Mengardo V, Tomezzoli A, Borghini R, Trecca A. Small type O-IIa de novo colon cancer treated with curative endoscopic full-thickness resection (EFTR). Tech Coloproctol 2020; 24:781-783. [PMID: 32444951 DOI: 10.1007/s10151-020-02241-6] [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: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- F Catalano
- Department of Emergency Surgical Endoscopy, Borgo Trento Hospital, Verona, Italy
| | - A Cerofolini
- Department of Emergency Surgical Endoscopy, Borgo Trento Hospital, Verona, Italy
| | - V Mengardo
- Department of Emergency Surgical Endoscopy, Borgo Trento Hospital, Verona, Italy
| | - A Tomezzoli
- Pathology Division, Borgo Trento Hospital, Verona, Italy
| | - R Borghini
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - A Trecca
- Operative Endoscopy, Progetto I-Salus, Rome, Italy.
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Loi CXA, Tyson DM, Chavarria EA, Gutierrez L, Klasko L, Davis S, Lopez D, Johns T, Meade CD, Gwede CK. 'Simple and easy:' providers' and latinos' perceptions of the fecal immunochemical test (FIT) for colorectal cancer screening. ETHNICITY & HEALTH 2020; 25:206-221. [PMID: 29319331 PMCID: PMC6513709 DOI: 10.1080/13557858.2017.1418298] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Objective: Colorectal cancer (CRC) screening efforts have effectively reduced CRC morbidity and mortality, yet screening remains relatively low among Latinos. The study's purpose was to document the awareness/knowledge of Fecal Immunochemical Test (FIT) among Latinos, gain better understanding of patient and health care provider perceptions about FIT, and explore the feasibility of adoption/uptake.Design/Methods: The study was guided by qualitative, ethnography design and methods. Eight focus groups (FG) with patients who self-identified as Hispanic/Latino between 50-75 years of age and key informant interviews with providers (N = 10) were conducted followed by a brief demographic questionnaire.Results: Awareness levels varied based on prior screening experiences among patients and providers. Both patients and providers believed the FIT is simple and easy to use; although, a minority of patients expressed doubts about the efficacy of the FIT when compared to colonoscopy.Conclusions: Despite the increasing acceptance of the FIT among the health care community, a significant lag time still exists among our study's populations. Study findings speak to novelty of the FIT test among underserved populations and the health disparity gap between health innovations/discoveries. Increased awareness and education efforts about the efficacy coupled with information about its accessibility, ease, and user instructions may increase the adoption of FIT.
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Affiliation(s)
- Claudia X. Aguado Loi
- Department of Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, 401 W. Kennedy Blvd, Box 30F, Tampa, FL 33606, USA
- Corresponding Author: Claudia X. Aguado Loi, Department of Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, 401 W. Kennedy Blvd, Box 30F, Tampa, FL 33606,
| | - Dinorah Martinez Tyson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA
| | - Enmanuel A. Chavarria
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, One West University Blvd., SPH Building N1.102H, Brownsville, TX 78520, USA
| | - Liliana Gutierrez
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Lynne Klasko
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Stacy Davis
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., 2814 14th Ave SE, Ruskin, FL, 33570, USA
| | - Tracy Johns
- Turley Family Health Center, BayCare Health System, 807 N Myrtle Ave, Clearwater, FL 33755, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
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Abualkhair WH, Zhou M, Ahnen D, Yu Q, Wu XC, Karlitz JJ. Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age. JAMA Netw Open 2020; 3:e1920407. [PMID: 32003823 PMCID: PMC7042874 DOI: 10.1001/jamanetworkopen.2019.20407] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Early-onset colorectal cancer incidence rates among patients aged 45 to 49 years have been considered much lower compared with the rates among patients aged 50 to 54 years, prompting debate about earlier screening benefits at 45 years. However, the observed incidence rates in the Surveillance, Epidemiology, and End Results (SEER) registries may underestimate colorectal cancer case burdens in those younger than 50 years compared with those older than 50 years because average-risk screening is generally not performed to detect preclinical cases of colorectal cancer. Finding steep incidence increases of invasive stage (beyond in situ) cases of colorectal cancer from age 49 to 50 years would be consistent with high rates of preexisting, undetected cancers in younger patients ultimately receiving a diagnosis of colorectal cancer after undergoing screening at 50 years. OBJECTIVE To assess the preclinical burden of colorectal cancer by analyzing its incidence in 1-year age increments, focusing on the transition between ages 49 and 50 years. DESIGN, SETTING, AND PARTICIPANTS Data from the SEER 18 registries, representing 28% of the US population, were used to conduct a cross-sectional study of colorectal cancer incidence rates from January 1, 2000, to December 31, 2015, in 1-year age increments (ages 30-60 years) stratified by US region (South, West, Northeast, and Midwest), sex, race, disease stage, and tumor location. Statistical analysis was conducted from November 1, 2018, to December 15, 2019. MAIN OUTCOMES AND MEASURES Incidence rates of colorectal cancer. RESULTS A total of 170 434 cases of colorectal cancer were analyzed among 165 160 patients (92 247 men [55.9%]; mean [SD] age, 51.6 [6.7] years). Steep increases in the incidence of colorectal cancer in the SEER 18 registries were found from 49 to 50 years of age (46.1% increase: 34.9 [95% CI, 34.1-35.8] to 51.0 [95% CI, 50.0-52.1] per 100 000 population). Steep rate increases from 49 to 50 years of age were also seen in all US regions, men and women, white and black populations, and in colon and rectal cancers. The rate ratio incidence increase in the SEER 18 registries from 49 to 50 years of age (1.46 [95% CI, 1.43-1.51]) was significantly higher than earlier 1-year age transitions. Steep rate increases in the SEER 18 registries were found from 49 to 50 years of age in localized-stage (75.9% increase: 11.2 [95% CI, 10.7-11.7] to 19.7 [95% CI, 19.0-20.3] per 100 000) and regional-stage (30.3% increase: 13.2 [95% CI, 12.7-13.8] to 17.2 [95% CI, 16.7-17.8] per 100 000) colorectal cancers. A total of 8799 of the 9474 cases (92.9%) of colorectal cancer in the SEER 18 registries from 2000 to 2015 that were diagnosed among individuals aged 50 years were invasive. CONCLUSIONS AND RELEVANCE Steep incidence increases between 49 and 50 years of age are consistent with previously undetected colorectal cancers diagnosed via screening uptake at 50 years. These cancers are not reflected in observed rates of colorectal cancer in the SEER registries among individuals younger than 50 years. Hence, using observed incidence rates from 45 to 49 years of age alone to assess potential outcomes of earlier screening may underestimate cancer prevention benefits.
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Affiliation(s)
- Wesal H. Abualkhair
- Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Meijiao Zhou
- Louisiana Tumor Registry, Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans
| | - Dennis Ahnen
- University of Colorado School of Medicine and Gastroenterology of the Rockies, Denver
| | - Qingzhao Yu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans
| | - Jordan J. Karlitz
- Southeast Louisiana Veterans Health Care System, New Orleans
- Division of Gastroenterology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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31
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Nam S, Choi YJ, Kim DW, Park EC, Kang JG. Risk Factors for Colorectal Cancer in Korea: A Population-Based Retrospective Cohort Study. Ann Coloproctol 2019; 35:347-356. [PMID: 31937075 PMCID: PMC6968718 DOI: 10.3393/ac.2019.10.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose The incidence of colorectal cancer in Korea has recently increased, making it the second most common cancer in men and the third most common cancer in women. Risk factors for colorectal cancer have been studied worldwide, but risk factors specific for the Korean population have not been established. In this study, we investigated incidence trends and risk factors of colorectal cancer in Korea. Methods A total of 8,846,749 subjects were included. Colorectal cancer incidence was investigated using Korea National Health Insurance Service claim data from 2004 to 2014. Colorectal cancer diagnoses were obtained by evaluating colorectal cancer diagnostic codes and the cancer registry for cost sharing. Risk factor identification for colorectal cancer was obtained from National Health Examination data from 2004 to 2005. Cox proportional hazard model statistical analysis was used to determine risk factors of colorectal cancer. Results The incidence of colorectal cancer gradually increased from 2006 to 2014 (from 45.4/100,000 to 54.5/100,000). There was a predominance among men (1.47:1), but incidence trends were similar in both sexes. Old age, high body mass index, and no history of colonoscopy were identified as risk factors in both sexes. High fasting blood glucose, familial history of cancer, frequent alcohol intake, and current smoker were identified as risk factors, especially in men. Conclusion The incidence of colorectal cancer has been increasing in Korea. Colonoscopy screening was a protective factor for colorectal cancer, and active use of colonoscopy may reduce incidence. Early diagnosis and care are important, particularly for the high-risk group.
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Affiliation(s)
- Soomin Nam
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoon Jung Choi
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong Wook Kim
- Big data department, National Health Insurance Service, Wonju, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Gu Kang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Hissong E, Pittman ME. Colorectal carcinoma screening: Established methods and emerging technology. Crit Rev Clin Lab Sci 2019; 57:22-36. [PMID: 31603697 DOI: 10.1080/10408363.2019.1670614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Colorectal carcinoma screening programs have shown success in lowering both the incidence and mortality rate of colorectal carcinoma at a population level, in part because this carcinoma is relatively slow growing and has an identifiable premalignant lesion. Still, many patients do not undergo the recommended screening for colorectal carcinoma, and of those who do, a subset may be over- or under-diagnosed by the currently available testing methods. The primary purpose of this article is to review the data regarding currently available colorectal cancer screening modalities, which include fecal occult blood testing, direct colonic visualization, and noninvasive imaging techniques. In addition, readers will be introduced to a variety of biomarkers that may serve as stand-alone or adjunct tests in the future. Finally, there is a brief discussion of the current epidemiologic considerations that public health officials must address as they create population screening guidelines. The data we provide as laboratory physicians and scientists are critical to the construction of appropriate recommendations that ultimately decrease the burden of disease from colorectal carcinoma.
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Affiliation(s)
- Erika Hissong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Meredith E Pittman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
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Colorectal cancer detection by biomarker quantification in noninvasively collected colorectal mucus: preliminary comparison of 24 protein biomarkers. Eur J Gastroenterol Hepatol 2019; 31:1220-1227. [PMID: 31498281 DOI: 10.1097/meg.0000000000001535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Noninvasive colorectal cancer detection and screening remain global diagnostic challenges because the existing stool tests either lack sensitivity or are complex and expensive. Moreover, colorectal cancer screening uptake is low due to stool sampling inconvenience. We have developed a simple and patient-friendly noninvasive technique for collecting highly informative colorectal mucus. In this study, we aimed to comparatively assess a range of candidate biomarkers in colorectal mucus samples for colorectal cancer detection. METHODS The study included 17 patients with colorectal cancer and 35 healthy controls, who provided noninvasively collected colorectal mucus samples. Protein biomarker quantification in these samples by enzyme-linked immunosorbent assays allowed comparing diagnostic performances of 24 candidate biomarkers that comprised haemoglobin, D-dimer, M2-pyruvate kinase, carcinoembryonic antigen, C-reactive protein, calprotectin, eosinophil-derived neurotoxin, protein S100A12, tumour necrosis factor α, clusterin, soluble cytokeratin 18, caspase-cleaved cytokeratin 18, citrullinated histone H3, peptidyl arginine deiminase 4, epidermal growth factor, epidermal growth factor receptor, matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, periostin, vascular endothelial growth factor A, vascular endothelial growth factor receptor 1, vascular cell adhesion molecule 1, intercellular adhesion molecule 1 and mucin 2. Tested biomarkers were ranked for colorectal cancer detection efficiency using receiver operating characteristic curve analysis. RESULTS High area under the curve values between 0.943 and 0.768 were observed for haemoglobin, tissue inhibitor of metalloproteinase 1, M2-pyruvate kinase, peptidyl arginine deiminase 4, C-reactive protein, matrix metalloproteinase 9, epidermal growth factor receptor, eosinophil-derived neurotoxin and calprotectin. CONCLUSION Quantification of protein biomarkers in noninvasively collected samples of colorectal mucus certainly allows detecting colorectal cancer. Further clinical evaluation of the optimal biomarkers identified by this study is needed.
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Puricelli Perin DM, Vogel AL, Taplin SH. Assessing Knowledge Sharing in Cancer Screening Among High-, Middle-, and Low-Income Countries: Insights From the International Cancer Screening Network. J Glob Oncol 2019; 5:1-8. [PMID: 31584835 PMCID: PMC6825252 DOI: 10.1200/jgo.19.00202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE As the global burden of cancer rises, global knowledge sharing of effective cancer control practices will be critical. The International Cancer Screening Network (ICSN) of the US National Cancer Institute facilitates knowledge sharing to advance cancer screening research and practice. Our analysis assessed perceptions of ICSN's value and knowledge sharing in cancer screening among participants working in high-income countries (HICs) and low- and middle-income countries (LMICs). METHODS In 2018, the National Cancer Institute fielded a self-administered, online survey to 665 ICSN participants from both HICs and LMICs. RESULTS Two hundred forty-three individuals (36.5%) completed the full survey. LMIC participants engaged in more diverse screening activities and had fewer years of experience (13.5% with more than 20 years of experience v 31%; P = .048) in screening and were more interested in cervical cancer (76.9% v 52.6%; P = .002) than HIC participants. However, both groups spent most of their time on research (30.8% LMIC v 36.6% HIC; P = .518) and agreed that the ICSN biennial meeting enabled them to learn from the experiences of both higher-resource (88.2% v 75.7%; P = .122) and lower-resource (61.8% v 68.0%; P = .507) settings. ICSN helped them form new collaborations for research and implementation (55.1% v 58.2%; P = .063); informed advances in research/evaluation (71.4% v 68.0%; P = .695), implementation (59.2% v 47.9%; P = .259), and policies in their settings (55.1% v 48.0%; P = .425); and provided the opportunity to contribute their knowledge and expertise to assist others (67.3% v 71.1%; P = .695). CONCLUSION Findings suggest that HIC and LMIC participants benefit from knowledge sharing at ICSN meetings although their interests, backgrounds, and needs differ. This points to the importance of international research networks that are inclusive of HIC and LMIC participants in cancer control to advance knowledge and effective practices globally.
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Affiliation(s)
| | - Amanda L. Vogel
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Stephen H. Taplin
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD
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Leung KM, Shabat G, Lu P, Fields AC, Lukashenko A, Davids JS, Melnitchouk N. Trends in Solid Tumor Incidence in Ukraine 30 Years After Chernobyl. J Glob Oncol 2019; 5:1-10. [PMID: 31454285 PMCID: PMC6733202 DOI: 10.1200/jgo.19.00099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE There is limited knowledge of the long-term health effects of the Chernobyl nuclear power plant accident that occurred more than 30 years ago in Ukraine. This study describes trends in the incidence of solid organ malignancy in Ukraine and the five regions most affected by the radioactive fallout. METHODS The National Cancer Registry of Ukraine was queried for age-standardized incidence rates (ASIRs) of solid organ malignancy in Ukraine and the regions of Kyiv, Chernihiv, Zhytomyr, Rivne, and Volyn covering the period of 1999 to 2016. Joinpoint analysis was used to calculate the average annual percentage of change. RESULTS The highest burdens of cancer incidence in Ukraine were seen in the lung, stomach, breast, and prostate. We observed significant increases in the ASIRs of colon (average annual percentage of change, 1.5 [95% CI, 1.3 to 1.7]), rectal (0.9 [95% CI, 0.6 to 1.2]), kidney (2.3 [95% CI, 1.8 to 2.9]), thyroid (4.2 [95% CI, 3.1 to 5.3]), breast (1 [95% CI, 0.6 to 1.4]), cervical (0.7 [95% CI, 0.3 to 1.2]), and prostate (3.9 [95% CI, 3.6 to 4.2]) cancers, with decreases in stomach (−2.4 [95% CI, −2.5 to −2.3]) and lung (−1.8 [95% CI, −2.1 to −1.5]) cancers. ASIRs in the affected regions were similar to nationwide rates, with the exception of those for Kyiv. CONCLUSION The incidence rates of many solid organ malignancies in Ukraine are rising. However, the rates of solid organ malignancy in the five regions most affected by fallout did not substantially differ from national patterns, with the exception of those for Kyiv. Ongoing monitoring of cancer incidence in Ukraine is necessary to understand how best to decrease disease burden nationwide and to elucidate the causes of regional variations in ASIRs, such as access to diagnostics and environmental exposures.
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Affiliation(s)
- Krystle M Leung
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Galyna Shabat
- National Cancer Institute, Kyiv, Ukraine.,University of Turin, Turin, Italy
| | - Pamela Lu
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | - Nelya Melnitchouk
- Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Mannucci A, Zuppardo RA, Rosati R, Leo MD, Perea J, Cavestro GM. Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis. World J Gastroenterol 2019; 25:2565-2580. [PMID: 31210710 PMCID: PMC6558439 DOI: 10.3748/wjg.v25.i21.2565] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.
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Affiliation(s)
- Alessandro Mannucci
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Riccardo Rosati
- Department of Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Department of Biomedical Science, Humanitas University, Milan 20090, Italy
| | - José Perea
- Surgery Department, “Fundación Jiménez Díaz” University Hospital, Madrid 28040, Spain
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Madrid 28040, Spain
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
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Bhatt DB, Emuakhagbon VS. Current Trends in Colorectal Cancer Screening. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00432-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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39
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Rising Proportion of Young Individuals With Rectal and Colon Cancer. Clin Colorectal Cancer 2019; 18:e87-e95. [DOI: 10.1016/j.clcc.2018.10.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/24/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022]
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40
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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41
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Maratt JK, Naylor K, Saini SD. Adding Value to the Conversation About Colorectal Cancer Screening: Practical Pearls For Gastroenterologists. Clin Gastroenterol Hepatol 2018; 16:1545-1548. [PMID: 29990592 DOI: 10.1016/j.cgh.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jennifer K Maratt
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
| | - Keith Naylor
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sameer D Saini
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
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Siegel RL, Jemal A, Wender RC, Gansler T, Ma J, Brawley OW. An assessment of progress in cancer control. CA Cancer J Clin 2018; 68:329-339. [PMID: 30191964 DOI: 10.3322/caac.21460] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/18/2022] Open
Abstract
This article summarizes cancer mortality trends and disparities based on data from the National Center for Health Statistics. It is the first in a series of articles that will describe the American Cancer Society's vision for how cancer prevention, early detection, and treatment can be transformed to lower the cancer burden in the United States, and sets the stage for a national cancer control plan, or blueprint, for the American Cancer Society goals for reducing cancer mortality by the year 2035. Although steady progress in reducing cancer mortality has been made over the past few decades, it is clear that much more could, and should, be done to save lives through the comprehensive application of currently available evidence-based public health and clinical interventions to all segments of the population. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Rebecca L Siegel
- Scientific Director, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Strategic Director, Pathology Research, American Cancer Society, Atlanta, GA
| | - Jiemin Ma
- Senior Principal Scientist, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society, Atlanta, GA
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Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YCT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68:250-281. [PMID: 29846947 DOI: 10.3322/caac.21457] [Citation(s) in RCA: 1136] [Impact Index Per Article: 189.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022] Open
Abstract
In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.
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Affiliation(s)
- Andrew M D Wolf
- Associate Professor and Attending Physician, University of Virginia School of Medicine, Charlottesville, VA
| | - Elizabeth T H Fontham
- Emeritus Professor, Louisiana State University School of Public Health, New Orleans, LA
| | - Timothy R Church
- Professor, University of Minnesota and Masonic Cancer Center, Minneapolis, MN
| | - Christopher R Flowers
- Professor and Attending Physician, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Carmen E Guerra
- Associate Professor of Medicine of the Perelman School of Medicine and Attending Physician, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Samuel J LaMonte
- Independent retired physician and patient advocate, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ruth Etzioni
- Biostatistician, University of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew T McKenna
- Professor and Director, Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin C Oeffinger
- Professor and Director of the Duke Center for Onco-Primary Care, Durham, NC
| | - Ya-Chen Tina Shih
- Professor, Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louise C Walter
- Professor and Attending Physician, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | - Kimberly S Andrews
- Director, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Scientific Officer and Executive Vice President-Research, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director for Risk Factor Screening and Surveillance, American Cancer Society, Atlanta, GA
| | | | - Rebecca L Siegel
- Strategic Director, Surveillance Information Services, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice President, Cancer Screening, Cancer Control Department, American Cancer Society, Atlanta, GA
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Villéger R, Lopès A, Veziant J, Gagnière J, Barnich N, Billard E, Boucher D, Bonnet M. Microbial markers in colorectal cancer detection and/or prognosis. World J Gastroenterol 2018; 24:2327-2347. [PMID: 29904241 PMCID: PMC6000297 DOI: 10.3748/wjg.v24.i22.2327] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/03/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer worldwide. CRC is still associated with a poor prognosis among patients with advanced disease. On the contrary, due to its slow progression from detectable precancerous lesions, the prognosis for patients with early stages of CRC is encouraging. While most robust methods are invasive and costly, actual patient-friendly screening methods for CRC suffer of lack of sensitivity and specificity. Therefore, the development of sensitive, non-invasive and cost-effective methods for CRC detection and prognosis are necessary for increasing the chances of a cure. Beyond its beneficial functions for the host, increasing evidence suggests that the intestinal microbiota is a key factor associated with carcinogenesis. Many clinical studies have reported a disruption in the gut microbiota balance and an alteration in the faecal metabolome of CRC patients, suggesting the potential use of a microbial-based test as a non-invasive diagnostic and/or prognostic tool for CRC screening. This review aims to discuss the microbial signatures associated with CRC known to date, including dysbiosis and faecal metabolome alterations, and the potential use of microbial variation markers for non-invasive early diagnosis and/or prognostic assessment of CRC and advanced adenomas. We will finally discuss the possible use of these markers as predicators for treatment response and their limitations.
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Affiliation(s)
- Romain Villéger
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
| | - Amélie Lopès
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Research Biologics, Sanofi R&D, Vitry-Sur-Seine 94400, France
| | - Julie Veziant
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Chirurgie digestive, Centre Hospitalier Universitaire, Clermont-Ferrand 63000, France
| | - Johan Gagnière
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Chirurgie digestive, Centre Hospitalier Universitaire, Clermont-Ferrand 63000, France
| | - Nicolas Barnich
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Elisabeth Billard
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Delphine Boucher
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Mathilde Bonnet
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
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Pramual P, Sarakarn P, Kamsa-ard S, Jirapornkul C, Maneenin N, Thavondunstid P, Juntarach P, Promthet S. Lack of Association between Red Meat Consumption and a Positive Fecal Immunochemical Colorectal Cancer Screening Test in Khon Kaen, Thailand: a Population- Based Randomized Controlled Trial. Asian Pac J Cancer Prev 2018; 19:271-278. [PMID: 29374412 PMCID: PMC5844630 DOI: 10.22034/apjcp.2018.19.1.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: There is convincing evidence from epidemiological studies that meat consumption increases colorectal cancer (CRC) risk. However, assessment of any association with a positive fecal immunochemical test (FIT) in CRC screening has been limited. If a link could be shown this might be helpful for establishing a risk group for colonoscopy. Objective: This study aimed to assess any association between meat consumption and other lifestyle factors and a positive FIT result in a Thai population. Methods: A cross-sectional analytical study was conducted with 1,167 participants in a population-based randomized controlled trial. CRC was screened from May 2016 - February 2017. Subjects aged 45-74 years who met the eligibility criteria were randomly allocated to the study arm. A positive FIT was determined with cut-off 100 ng/mL. Multiple logistic regression was used to analyze any relationship between lifestyle factors and a positive FIT. Result: The total number of subjects was 1,060 (90.8% return rate of FIT). With FIT100, FIT150, and FIT200, positive tests were found in 92 (8.68%), 74 (6.98%), and 60 (5.66%), respectively. No significant associations were noted with any of the variables, except for being aged 60-74 years (ORadj = 1.62, 95%CI: 1.03-2.54) Borderline significance was observed for high consumption of vegetables (ORadj = 0.62, 95%CI: 0.36-1.07) and being male (ORadj = 1.39, 95%CI:0.87-2.22). Conclusion: Despite the evidence from the literature, no association was here found between a positive FIT result and meat consumption or other well-established lifestyle parameters. Being aged 60-74 years was a risk factor which should be taken into account in CRC screening strategy in countries like Thailand with limited access to endoscopy.
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Affiliation(s)
- Putthikrai Pramual
- Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Thailand.,ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Thailand.
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Winawer SJ, Zauber AG. Can post-polypectomy surveillance be less intensive? Lancet Oncol 2017; 18:707-709. [PMID: 28457710 DOI: 10.1016/s1470-2045(17)30305-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Sidney J Winawer
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York 10065-6007, NY, USA.
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York 10065-6007, NY, USA
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Rakislova N, Montironi C, Aldecoa I, Fernandez E, Bombi JA, Jimeno M, Balaguer F, Pellise M, Castells A, Cuatrecasas M. Lymph node pooling: a feasible and efficient method of lymph node molecular staging in colorectal carcinoma. J Transl Med 2017; 15:14. [PMID: 28088238 PMCID: PMC5237515 DOI: 10.1186/s12967-016-1114-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/22/2016] [Indexed: 01/11/2023] Open
Abstract
Background Pathologic lymph node staging is becoming a deficient method in the demanding molecular era. Nevertheless, the use of more sensitive molecular analysis for nodal staging is hampered by its high costs and extensive time requirements. Our aim is to take a step forward in colon cancer (CC) lymph node (LN) pathology diagnosis by proposing a feasible and efficient molecular method in routine practice using reverse transcription loop-mediated isothermal amplification (RT-LAMP). Results Molecular detection of tumor cytokeratin 19 (CK19) mRNA with RT-LAMP was performed in 3206 LNs from 188 CC patients using two methods: individual analysis of 1449 LNs from 102 patients (individual cohort), and pooled LN analysis of 1757 LNs from 86 patients (pooling cohort). A median of 13 LNs (IQR 10–18) per patient were harvested in the individual cohort, and 18 LNs (IQR 13–25) per patient in the pooling cohort (p ≤ 0.001). The median of molecular assays performed in the pooling cohort was 2 per patient (IQR 1–3), saving a median of 16 assays/patient. The number of molecular assays performed in the individual cohort was 13 (IQR 10–18), corresponding to the number of LNs to be analyzed. The sensitivity and specificity of the pooling method for LN involvement (assessed by hematoxylin and eosin) were 88.9% (95% CI 56.5–98.0) and 79.2% (95% CI 68.9–86.8), respectively; concordance, 80.2%; PPV, 33.3%; NPV, 98.4%. The individual method had 100% sensitivity (95% CI 72.2–100), 44.6% specificity (95% CI 34.8–54.7), 50% concordance, 16.4% PPV, and 100% NPV. The amount of tumor burden detected in all LNs of a case, or total tumor load (TTL) was similar in both cohorts (p = 0.228). Conclusions LN pooling makes it possible to analyze a high number of LNs from surgical colectomies with few molecular tests per patient. This approach enables a feasible means to integrate LN molecular analysis from CC specimens into pathology diagnosis and provides a more accurate LN pathological staging with potential prognostic implications.
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Affiliation(s)
- Natalia Rakislova
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Carla Montironi
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Eva Fernandez
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Josep Antoni Bombi
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Mireya Jimeno
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Pellise
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department-Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, University of Barcelona, Escala 3, Planta 5, 08036, Barcelona, Spain. .,Tumor Bank, Biobanc Clinic-IDIBAPS and Xarxa de Bancs de Tumors de Catalunya (XBTC), Barcelona, Spain.
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Abstract
Cancer is fundamentally a genetic disease caused by mutational or epigenetic alterations in DNA. There has been a remarkable expansion of the molecular understanding of colonic carcinogenesis in the last 30 years and that understanding is changing many aspects of colorectal cancer care. It is becoming increasingly clear that there are genetic subsets of colorectal cancer that have different risk factors, prognosis, and response to treatment. This article provides a general update on colorectal cancer and highlights the ways that genetics is changing clinical care.
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Affiliation(s)
- Joshua C Obuch
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado, School of Medicine, 12631 E. 17th Avenue, MS B-158, Aurora, CO 80045, USA
| | - Dennis J Ahnen
- University of Colorado, School of Medicine, 12631 E. 17th Avenue, MS B-158, Aurora, CO 80045, USA.
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Endoscopic management of colonic perforations: clips versus suturing closure (with videos). Gastrointest Endosc 2016; 84:487-93. [PMID: 26364965 DOI: 10.1016/j.gie.2015.08.074] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/09/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and effectiveness of endoscopic closure of full-thickness colonic perforations. METHODS We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up. RESULTS Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients. CONCLUSION Endoscopic suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery, and appears more effective than closure with hemostatic endoscopic clips.
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Blume JE, Wilhelmsen M, Benz RW, Brünner N, Christensen IJ, Croner LJ, Dillon R, Hillig T, Jones JJ, Jørgensen LN, Kao A, Klaerke M, Laurberg S, Madsen MR, Nielsen KT, Vilandt J, Wilcox BE, You J, Nielsen HJ. Discovery and Validation of Plasma-Protein Biomarker Panels for the Detection of Colorectal Cancer and Advanced Adenoma in a Danish Collection of Samples from Patients Referred for Diagnostic Colonoscopy. ACTA ACUST UNITED AC 2016; 1:181-193. [DOI: 10.1373/jalm.2016.020271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/21/2016] [Indexed: 11/06/2022]
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