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Mallabar-Rimmer B, Merriel SWD, Webster AP, Jackson L, Wood AR, Barclay M, Tyrrell J, Ruth KS, Thirlwell C, Oram R, Weedon MN, Bailey SER, Green HD. Colorectal cancer risk stratification using a polygenic risk score in symptomatic primary care patients-a UK Biobank retrospective cohort study. Eur J Hum Genet 2024:10.1038/s41431-024-01654-3. [PMID: 39090236 DOI: 10.1038/s41431-024-01654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/15/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. Accurate cancer risk assessment approaches could increase rates of early CRC diagnosis, improve health outcomes for patients and reduce pressure on diagnostic services. The faecal immunochemical test (FIT) for blood in stool is widely used in primary care to identify symptomatic patients with likely CRC. However, there is a 6-16% noncompliance rate with FIT in clinic and ~90% of patients over the symptomatic 10 µg/g test threshold do not have CRC. A polygenic risk score (PRS) quantifies an individual's genetic risk of a condition based on many common variants. Existing PRS for CRC have so far been used to stratify asymptomatic populations. We conducted a retrospective cohort study of 50,387 UK Biobank participants with a CRC symptom in their primary care record at age 40+. A PRS based on 201 variants, 5 genetic principal components and 22 other risk factors and markers for CRC were assessed for association with CRC diagnosis within 2 years of first symptom presentation using logistic regression. Associated variables were included in an integrated risk model and trained in 80% of the cohort to predict CRC diagnosis within 2 years. An integrated risk model combining PRS, age, sex, and patient-reported symptoms was predictive of CRC development in a testing cohort (receiver operating characteristic area under the curve, ROCAUC: 0.76, 95% confidence interval: 0.71-0.81). This model has the potential to improve early diagnosis of CRC, particularly in cases of patient noncompliance with FIT.
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Affiliation(s)
| | - Samuel W D Merriel
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Amy P Webster
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Leigh Jackson
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Andrew R Wood
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Matthew Barclay
- Department of Behavioural Science & Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jessica Tyrrell
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Katherine S Ruth
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | | | - Richard Oram
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Michael N Weedon
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Sarah E R Bailey
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Harry D Green
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK.
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2
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Kruse-Diehr AJ, Cegelka D, Holtsclaw E, Edward JS, Vos SC, Karrer M, Bathje K, Rogers M, Russell E, Knight JR. Feasibility and efficacy of a novel audiovisual tool to increase colorectal cancer screening among rural Appalachian Kentucky adults. Front Public Health 2024; 12:1415607. [PMID: 39056077 PMCID: PMC11269215 DOI: 10.3389/fpubh.2024.1415607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction Residents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool ("talking card") to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy. Materials and methods We collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion. Results Across the three study phases, 692 individuals participated. Survey respondents positively identified with the card's sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion. Discussion To reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings.
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Affiliation(s)
- Aaron J. Kruse-Diehr
- University of Kentucky College of Medicine, Lexington, KY, United States
- Center for Implementation, Dissemination and Evidence-Based Research, University of Kentucky Center for Clinical and Translational Science, Lexington, KY, United States
- Markey Cancer Center, Lexington, KY, United States
| | - Derek Cegelka
- Hawaii Pacific University School of Nursing, Honolulu, HI, United States
| | | | - Jean S. Edward
- Markey Cancer Center, Lexington, KY, United States
- University of Kentucky College of Nursing, Lexington, KY, United States
| | - Sarah C. Vos
- University of Kentucky College of Public Health, Lexington, KY, United States
| | | | - Katie Bathje
- American Cancer Society, Atlanta, GA, United States
| | - Melinda Rogers
- Markey Cancer Center, Lexington, KY, United States
- Kentucky Cancer Program, Somerset, KY, United States
| | - Elaine Russell
- Kentucky Cancer Consortium, Lexington, KY, United States
| | - Jennifer Redmond Knight
- Markey Cancer Center, Lexington, KY, United States
- University of Kentucky College of Public Health, Lexington, KY, United States
- Kentucky Cancer Consortium, Lexington, KY, United States
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3
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Mksyartinian P, Mohammad N, Wildgoose P, Stein BD. Understanding Colorectal Cancer Patient Experiences with Family Practitioners in Canada. Curr Oncol 2024; 31:3122-3148. [PMID: 38920721 PMCID: PMC11202889 DOI: 10.3390/curroncol31060237] [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: 04/02/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Despite ongoing screening efforts, colorectal cancer (CRC) remains a leading cause of death in Canada. The aim of this study was to better understand the experiences of Canadian CRC patients with their family practitioners (FPs) during and after their CRC diagnosis. Patient-reported data were collected through an online questionnaire to understand their CRC diagnosis experiences and identify potential gaps in care. Various factors contributing to challenges throughout a patient's CRC diagnosis (e.g., delayed CRC diagnosis) were determined using descriptive, qualitative, and inferential analyses. These factors could be targeted to optimize CRC care. This study found that 40.6% of the 175 respondents were unaware of at least one of the following aspects of CRC prior to their diagnosis: early-age onset (EAO), symptoms, and screening procedures. While 84.6% had access to a family physician (FP) before their diagnosis, only 17.7% were diagnosed by FPs. Higher proportions of younger individuals experienced misdiagnoses and felt dismissed compared to older individuals. Only half felt fully informed about their diagnosis when it was explained to them by their FP, while 53.1% had their diagnosis explained in plain language. Transitioning towards patient-centred care would promote pre-diagnosis CRC awareness, address differences in management of CRC care (e.g., dismissal and support), and accommodate for age and health-literacy-related disparities, thereby improving CRC care pathways for patients. Future research should investigate FPs experiences in detecting CRC cases to develop educational resources and recommendations, enhancing early detection and improving patient outcomes (1).
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Affiliation(s)
| | - Neha Mohammad
- Colorectal Cancer Canada, Westmount, QC H3Z 2P9, Canada; (P.M.); (N.M.)
| | - Petra Wildgoose
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Barry D. Stein
- Colorectal Cancer Canada, Westmount, QC H3Z 2P9, Canada; (P.M.); (N.M.)
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Dimaano K, Croman M, Montero S, Sandigo-Saballos I, Orellana M, Chervu N, Petrie BA, Lee H. Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems. Surg Open Sci 2024; 17:6-10. [PMID: 38235211 PMCID: PMC10792257 DOI: 10.1016/j.sopen.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Background Primary care physicians (PCP) play a key role in offering colorectal cancer (CRC) screenings, particularly amongst underserved populations. Given potential delays in or omission of CRC screening in the absence of a PCP, we aimed to determine stage of CRC at diagnosis in an underserved population. Methods A retrospective chart review was conducted at two Los Angeles County safety-net hospitals. Inclusion criteria were a CRC diagnosis between 2018 and 2021 and age between 50 and 75 years at diagnosis time. The primary outcome was the cancer stage at diagnosis. Results A total of 373 patients were included, of those, 52.5 % had a PCP. Compared to others, PCP was similar in age, racial composition, and primary spoken language (Table 1). Of patients with a PCP, 52.0% were diagnosed by screening. After screening, the most common indication for colonoscopy were blood per rectum (24.9 %) and imaging findings (18.0 %). Patients with a PCP had a significantly lower rate of late stage CRC than those without a PCP (42.4 % vs. 68.0 %, p < 0.001). After adjustment, having a PCP was associated with significantly reduced odds of late stage CRC (Adjusted Odds Ratio 0.83, 95 % Confidence Interval [0.68-1.04]). Having a PCP was not associated with any adjusted increase in number of adenomas or tumor size. Conclusions Patients with a PCP, irrespective of undergoing screening, were diagnosed at earlier CRC stages. This underlines the crucial role of PCPs in CRC and diagnosis, reinforcing the need for their active involvement in these processes.
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Affiliation(s)
- Katrina Dimaano
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Millicent Croman
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Stefania Montero
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Isabela Sandigo-Saballos
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Manuel Orellana
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nikhil Chervu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Beverley A. Petrie
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hanjoo Lee
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Castilho MJCD, Massago M, Arruda CE, Beltrame MHA, Strand E, Fontes CER, Nihei OK, Franco RDL, Staton CA, Pedroso RB, de Andrade L. Spatial distribution of mortality from colorectal cancer in the southern region of Brazil. PLoS One 2023; 18:e0288241. [PMID: 37418502 DOI: 10.1371/journal.pone.0288241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023] Open
Abstract
Colorectal cancer (CRC) is the leading cause of death due to cancer worldwide. In Brazil, it is the second most frequent cancer in men and women, with a mortality reaching 9.4% of those diagnosed. The aim of this study was to analyze the spatial heterogeneity of CRC deaths among municipalities in south Brazil, from 2015 to 2019, in different age groups (50-59 years, 60-69 years, 70-79 years, and 80 years old or more) and identify the associated variables. Global Spatial Autocorrelation (Moran's I) and Local Spatial Autocorrelation (LISA) analyses were used to evaluate the spatial correlation between municipalities and CRC mortality. Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) were applied to evaluate global and local correlations between CRC deaths, sociodemographic, and coverage of health care services. For all age groups, our results found areas with high CRC rates surrounded by areas with similarly high rates mainly in the Rio Grande do Sul state. Even as factors associated with CRC mortality varied according to age group, our results suggested that improved access to specialized health centers, the presence of family health strategy teams, and higher rates of colonoscopies are protective factors against colorectal cancer mortality in southern Brazil.
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Affiliation(s)
| | - Miyoko Massago
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Carlos Eduardo Arruda
- Postgraduate Program in Management, Technology and Innovation in Urgency and Emergency, State University of Maringa, Maringa, Parana, Brazil
| | | | - Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | - Oscar Kenji Nihei
- Center of Education, Literature and Health, Western Paraná State University, Foz do Iguaçu, Parana, Brazil
| | - Rogério do Lago Franco
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Catherine Ann Staton
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Raissa Bocchi Pedroso
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Luciano de Andrade
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
- Department of Medicine at the State University of Maringa, Maringa, Parana, Brazil
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Picazo-Perea M, Lopez-Martos A, Rodelgo-Jimenez L, Lorenzo-Lozano M. Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo. Semergen 2022; 48:101815. [DOI: 10.1016/j.semerg.2022.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 10/14/2022]
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Faecal immunochemical test: challenges and opportunities for cancer diagnosis in primary care. Br J Gen Pract 2022; 72:366-367. [PMID: 35902254 PMCID: PMC9343030 DOI: 10.3399/bjgp22x720209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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8
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Martins T, Abel G, Ukoumunne OC, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W. Assessing Ethnic Inequalities in Diagnostic Interval of Common Cancers: A Population-Based UK Cohort Study. Cancers (Basel) 2022; 14:3085. [PMID: 35804858 PMCID: PMC9264889 DOI: 10.3390/cancers14133085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study investigated ethnic differences in diagnostic interval (DI)-the period between initial primary care presentation and diagnosis. METHODS We analysed the primary care-linked data of patients who reported features of seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, and ovarian) one year before diagnosis. Accelerated failure time (AFT) models investigated the association between DI and ethnicity, adjusting for age, sex, deprivation, and morbidity. RESULTS Of 126,627 eligible participants, 92.1% were White, 1.99% Black, 1.71% Asian, 1.83% Mixed, and 2.36% were of Other ethnic backgrounds. Considering all cancer sites combined, the median (interquartile range) DI was 55 (20-175) days, longest in lung [127, (42-265) days], and shortest in breast cancer [13 (13, 8-18) days]. DI for the Black and Asian groups was 10% (AFT ratio, 95%CI 1.10, 1.05-1.14) and 16% (1.16, 1.10-1.22), respectively, longer than for the White group. Site-specific analyses revealed evidence of longer DI in Asian and Black patients with prostate, colorectal, and oesophagogastric cancer, plus Black patients with breast cancer and myeloma, and the Mixed group with lung cancer compared with White patients. DI was shorter for the Other group with lung, prostate, myeloma, and oesophagogastric cancer than the White group. CONCLUSION We found limited and inconsistent evidence of ethnic differences in DI among patients who reported cancer features in primary care before diagnosis. Our findings suggest that inequalities in diagnostic intervals, where present, are unlikely to be the sole explanation for ethnic variations in cancer outcomes.
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Affiliation(s)
- Tanimola Martins
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Gary Abel
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Sarah Price
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1–19 Torrington Place, London WC1E 7HB, UK;
| | - Frank Chinegwundoh
- Barts Health NHS Trust & Department of Health Sciences, University of London, London WC1E 7HB, UK;
| | - William Hamilton
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
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Pączek S, Łukaszewicz-Zając M, Mroczko B. Granzymes-Their Role in Colorectal Cancer. Int J Mol Sci 2022; 23:ijms23095277. [PMID: 35563668 PMCID: PMC9104098 DOI: 10.3390/ijms23095277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is among the most common malignancies worldwide. CRC is considered a heterogeneous disease due to various clinical symptoms, biological behaviours, and a variety of mutations. A number of studies demonstrate that as many as 50% of CRC patients have distant metastases at the time of diagnosis. However, despite the fact that social and medical awareness of CRC has increased in recent years and screening programmes have expanded, there is still an urgent need to find new diagnostic tools for early detection of CRC. The effectiveness of the currently used classical tumour markers in CRC diagnostics is very limited. Therefore, new proteins that play an important role in the formation and progression of CRC are being sought. A number of recent studies show the potential significance of granzymes (GZMs) in carcinogenesis. These proteins are released by cytotoxic lymphocytes, which protect the body against viral infection as well specific signalling pathways that ultimately lead to cell death. Some studies suggest a link between GZMs, particularly the expression of Granzyme A, and inflammation. This paper summarises the role of GZMs in CRC pathogenesis through their involvement in the inflammatory process. Therefore, it seems that GZMs could become the focus of research into new CRC biomarkers.
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Affiliation(s)
- Sara Pączek
- Department of Biochemical Diagnostics, Medical University in Bialystok, 15-269 Bialystok, Poland; (M.Ł.-Z.); (B.M.)
- Correspondence: ; Tel.: +48-85-831-8587
| | - Marta Łukaszewicz-Zając
- Department of Biochemical Diagnostics, Medical University in Bialystok, 15-269 Bialystok, Poland; (M.Ł.-Z.); (B.M.)
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University in Bialystok, 15-269 Bialystok, Poland; (M.Ł.-Z.); (B.M.)
- Department of Neurodegeneration Diagnostics, Medical University in Bialystok, 15-269 Bialystok, Poland
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