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Zhen L, Tang X, Xu Z, Huang Y, Qian X, Lin H, Li C, Cui R, Fang H, Yang H, Qiu J, Fang Z, Peng X, Jin Y, Nie J, Guo S, Wang Y, Zhong M, Gu H, Xu H. Early Diagnosis of Colorectal Cancer Based on Bisulfite-free Site-specific Methylation Identification PCR Strategy: High-Sensitivity, Accuracy, and Primary Medical Accessibility. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2401137. [PMID: 38868913 DOI: 10.1002/advs.202401137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/26/2024] [Indexed: 06/14/2024]
Abstract
Due to its decade-long progression, colorectal cancer (CRC) is most suitable for population screening to achieve a significant reduction in its incidence and mortality. DNA methylation has emerged as a potential marker for the early detection of CRC. However, the current mainstream methylation detection method represented by bisulfite conversion has issues such as tedious operation, DNA damage, and unsatisfactory sensitivity. Herein, a new high-performance CRC screening tool based on the promising specific terminal-mediated polymerase chain reaction (STEM-PCR) strategy is developed. CRC-related methylation-specific candidate CpG sites are first prescreened through The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases using self-developed bioinformatics. Next, 9 homebrew colorectal cancer DNA methylated STEM‒PCR assays (ColoC-mSTEM) with high sensitivity (0.1%) and high specificity are established to identify candidate sites. The clinical diagnostic performance of these selected methylation sites is confirmed and validated by a case-control study. The optimized diagnostic model has an overall sensitivity of 94.8% and a specificity of 95.0% for detecting early-stage CRC. Taken together, ColoC-mSTEM, based on a single methylation-specific site, is a promising diagnostic approach for the early detection of CRC which is perfectly suitable for the screening needs of CRC in primary healthcare institutions.
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Affiliation(s)
- Linqing Zhen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Xinlu Tang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
| | - Zhengguo Xu
- Medical community of Linhai First People's Hospital, Zhejiang, 317000, P. R. China
| | - Yizhou Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Xiaohua Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Haiping Lin
- Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Chao Li
- Medical community of Linhai First People's Hospital, Zhejiang, 317000, P. R. China
| | - Rong Cui
- Jiading Hospital of Traditional Chinese medicine, Shanghai, 201800, P. R. China
| | - Hongsheng Fang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
| | - Hao Yang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Jiani Qiu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Zhaoqi Fang
- Shanghai Healzone Biotechnology Co., LTD, Shanghai, 200000, P. R. China
| | - Xiaohuan Peng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Yifeng Jin
- Jiading Hospital of Traditional Chinese medicine, Shanghai, 201800, P. R. China
| | - Jianing Nie
- Shanghai Healzone Biotechnology Co., LTD, Shanghai, 200000, P. R. China
| | - Shiwei Guo
- Medical community of Linhai First People's Hospital, Zhejiang, 317000, P. R. China
| | - Yuguang Wang
- Medical community of Linhai First People's Hospital, Zhejiang, 317000, P. R. China
| | - Ming Zhong
- Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Hongchen Gu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
| | - Hong Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China
- Hefei Cancer Early Screening Innovation Technology Institute, Anhui Province, China
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Luo WF, Jiao YT, Lin XL, Zhao Y, Wang SB, Shen J, Deng J, Ye YF, Han ZP, Xie FM, He JH, Wan Y. Effectiveness of fecal DNA syndecan-2 methylation testing for detection of colorectal cancer in a high-risk Chinese population. World J Gastrointest Oncol 2024; 16:1361-1373. [PMID: 38660655 PMCID: PMC11037044 DOI: 10.4251/wjgo.v16.i4.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is among the most prevalent and life-threatening malignancies worldwide. Syndecan-2 methylation (mSDC2) testing has emerged as a widely used biomarker for early detection of CRC in stool and serum samples. Cancer (CRC) is among the most prevalent and life-threatening malignancies worldwide. mSDC2 testing has emerged as a widely used biomarker for early detection of CRC in stool and serum samples. AIM To validate the effectiveness of fecal DNA mSDC2 testing in the detection of CRC among a high-risk Chinese population to provide evidence-based data for the development of diagnostic and/or screening guidelines for CRC in China. METHODS A high-risk Chinese cohort consisting of 1130 individuals aged 40-79 years was selected for evaluation via fecal mSDC2 testing. Sensitivity and specificity for CRC, advanced adenoma (AA) and advanced colorectal neoplasia (ACN) were determined. High-risk factors for the incidence of colorectal lesions were determined and a logistic regression model was constructed to reflect the efficacy of the test. RESULTS A total of 1035 high-risk individuals were included in this study according to established criteria. Among them, 16 suffered from CRC (1.55%), 65 from AA (6.28%) and 189 from non-AAs (18.26%); 150 patients were diagnosed with polyps (14.49%). Diagnoses were established based upon colonoscopic and pathological examinations. Sensitivities of the mSDC2 test for CRC and AA were 87.50% and 40.00%, respectively; specificities were 95.61% for other groups. Positive predictive values of the mSDC2 test for CRC, AA and ACN were 16.09%, 29.89% and 45.98%, respectively; the negative predictive value for CRC was 99.79%. After adjusting for other high-risk covariates, mSDC2 test positivity was found to be a significant risk factor for the occurrence of ACN (P < 0.001). CONCLUSION Our findings confirmed that offering fecal mSDC2 testing and colonoscopy in combination for CRC screening is effective for earlier detection of malignant colorectal lesions in a high-risk Chinese population.
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Affiliation(s)
- Wen-Feng Luo
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Yu-Ting Jiao
- South China Normal University-Panyu Central Hospital Joint Laboratory of Translational Medical Research, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Xiao-Ling Lin
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Ying Zhao
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Sheng-Bo Wang
- Digestive Disease Center, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Jian Shen
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Jie Deng
- Shunde Vocational and Technical College, Foshan 528300, Guangdong Province, China
| | - Yu-Feng Ye
- Medical Imaging Institute of Panyu, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Ze-Ping Han
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Fang-Mei Xie
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Jin-Hua He
- Central Laboratory of Panyu Central Hospital, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
| | - Yu Wan
- Digestive Disease Center, Guangzhou Panyu Central Hospital, Guangzhou 511400, Guangdong Province, China
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Zhang M, Zhang Y, Guo L, Zhao L, Jing H, Yang X, Zhang W, Zhang Y, Nie Z, Zhu S, Zhang S, Zhang X. Trends in colorectal cancer screening compliance and incidence among 60- to 74-year-olds in China. Cancer Med 2024; 13:e7133. [PMID: 38634216 PMCID: PMC11024507 DOI: 10.1002/cam4.7133] [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: 11/15/2022] [Revised: 10/26/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74. METHODS A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy. RESULTS A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN. CONCLUSION This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.
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Affiliation(s)
- Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Lu Guo
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xiao Yang
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Endoscopy Center, Tianjin Union Medical Center, Tianjin, China
| | - Wen Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Yong Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Zhenguo Nie
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Siwei Zhu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Shiwu Zhang
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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Zhu M, Zhong X, Liao T, Peng X, Lei L, Peng J, Cao Y. Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study. BMC Public Health 2024; 24:655. [PMID: 38429684 PMCID: PMC10905924 DOI: 10.1186/s12889-024-18201-w] [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: 07/12/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a global health issue with noticeably high incidence and mortality. Microsimulation models offer a time-efficient method to dynamically analyze multiple screening strategies. The study aimed to identify the efficient organized CRC screening strategies for Shenzhen City. METHODS A microsimulation model named CMOST was employed to simulate CRC screening among 1 million people without migration in Shenzhen, with two CRC developing pathways and real-world participation rates. Initial screening included the National Colorectal Polyp Care score (NCPCS), fecal immunochemical test (FIT), and risk-stratification model (RS model), followed by diagnostic colonoscopy for positive results. Several start-ages (40, 45, 50 years), stop-ages (70, 75, 80 years), and screening intervals (annual, biennial, triennial) were assessed for each strategy. The efficiency of CRC screening was assessed by number of colonoscopies versus life-years gained (LYG). RESULTS The screening strategies reduced CRC lifetime incidence by 14-27 cases (30.9-59.0%) and mortality by 7-12 deaths (41.5-71.3%), yielded 83-155 LYG, while requiring 920 to 5901 colonoscopies per 1000 individuals. Out of 81 screening, 23 strategies were estimated efficient. Most of the efficient screening strategies started at age 40 (17 out of 23 strategies) and stopped at age 70 (13 out of 23 strategies). Predominant screening intervals identified were annual for NCPCS, biennial for FIT, and triennial for RS models. The incremental colonoscopies to LYG ratios of efficient screening increased with shorter intervals within the same test category. Compared with no screening, when screening at the same start-to-stop age and interval, the additional colonoscopies per LYG increased progressively for FIT, NCPCS and RS model. CONCLUSION This study identifies efficient CRC screening strategies for the average-risk population in Shenzhen. Most efficient screening strategies indeed start at age 40, but the optimal starting age depends on the chosen willingness-to-pay threshold. Within insufficient colonoscopy resources, efficient FIT and NCPCS screening strategies might be CRC initial screening strategies. We acknowledged the age-dependency bias of the results with NCPCS and RS.
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Affiliation(s)
- Minmin Zhu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen City, 518054, Guangdong, China.
| | - Xuan Zhong
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen City, 518054, Guangdong, China
| | - Tong Liao
- Harbin Institute of Technology Shenzhen, Shenzhen City, Guangdong, China
| | - Xiaolin Peng
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen City, 518054, Guangdong, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen City, Guangdong, China
| | - Ji Peng
- Shenzhen Center for Chronic Disease Control, Shenzhen City, Guangdong, China
| | - Yong Cao
- Harbin Institute of Technology Shenzhen, Shenzhen City, Guangdong, China
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Liu S, Wang Y, Wang Y, Duan C, Liu F, Zhang H, Tian X, Ding X, Zhang M, Cao D, Liu Y, Jiang R, Zhuo D, Peng J, Zhu S, Zhao L, Wang J, Wei L, Shi Z. Population-based screening for colorectal cancer in Wuhan, China. Front Oncol 2024; 14:1284975. [PMID: 38487726 PMCID: PMC10937563 DOI: 10.3389/fonc.2024.1284975] [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: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Fecal DNA test has emerged as a non-invasive alternative for colorectal cancer (CRC) screening in average-risk population. However, there is currently insufficient evidence in China to demonstrate the effectiveness of population-based CRC screening using fecal DNA based test. Here, a large-scale real-world study for CRC screening was implemented in Wuhan, Hubei province, China. A total of 98,683 subjects aged between 45 and 60 years were screened by a fecal DNA test (ColoTect®) which detected methylation status of SDC2, ADHFE1, and PPP2R5C. Participants who tested positive were advised to receive diagnostic colonoscopy. 4449 (4.5%) subjects tested positive for fecal DNA test, and 3200 (71.9%) underwent colonoscopy. Among these, 2347 (73.3%) had abnormal colonoscopy findings, of which 1330 (56.7%) subjects received pathological diagnosis. Detection rates for CRC and advanced precancerous lesions were 1.3% and 2.3%, respectively. Detection rates for nonadvanced adenomas and polyps were 14.0% and 21.6%, respectively. 28.0% of all colonoscopies showed colorectal neoplasm but lack pathological diagnosis. 6.1% showed other abnormalities such as enteritis. In conclusion, preliminary real-world evidence suggested that fecal DNA tests had promising diagnostic yield in population-based CRC screening. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=192838, identifier ChiCTR2300070520.
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Affiliation(s)
- Song Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Wang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Chaofan Duan
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Zhang
- Department of Gastroenterology, Wuhan Central Hospital, Wuhan, Hubei, China
| | - Xia Tian
- Department of Gastroenterology, The Third Hospital of Wuhan (Tongren Hospital of Wuhan University), Wuhan, Hubei, China
| | - Xiangwu Ding
- Department of Gastroenterology, The Fourth Hospital of Wuhan, Wuhan, Hubei, China
| | - Manling Zhang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Cao
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Duan Zhuo
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Shida Zhu
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Jian Wang
- BGI Genomics Co., Ltd., Shenzhen, China
| | - Li Wei
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhaohong Shi
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wu W, Tan S, Huang J, Chen Y, Wong MCS, Xu W. A qualitative interview study on colorectal cancer screening in China. Front Med (Lausanne) 2024; 11:1232134. [PMID: 38357645 PMCID: PMC10864664 DOI: 10.3389/fmed.2024.1232134] [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: 05/31/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Background The effectiveness of triage screening for colorectal cancer (CRC) is not fully achieved in Chinese populations, mainly due to low compliance to colonoscopy follow-up. This study aimed to collect viewpoints of experts in China on ongoing screening programs and emerging screening tests for CRC, which may help to improve effectiveness of CRC screening in the country. Methods We conducted 15 semi-structured interviews with experts involving CRC screening in China during October to November of 2020. Interview topics included personal characteristics, work context, opinions on ongoing screening programs, challenges and opportunities in optimization of screening strategies, and prospects for CRC screening in near future. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. Results This analysis revealed a total of 83 initial categories, 37 subcategories and 10 main categories, which included 4 core categories of current modality for CRC screening, factors influencing screening effectiveness, optimization of CRC screening modality, and prospects for development of CRC screening. The results provide insight into the factors underlying the challenges of the ongoing CRC screening programs in China: the most important concern is the low compliance to colonoscopy, followed by the low specificity of the currently-used initial tests. The experts proposed to use quantitative instead of qualitative fecal immunochemical test (FIT), and optimize risk assessment tools to improve specificity of initial tests. Regarding the emerging screening tests, 9 of 15 experts did not think that the novel techniques are good enough to replace the current tests, but can be used complementarily in opportunistic screening for CRC. Conclusion The viewpoints of Chinese experts suggested that use quantitative FIT or optimize risk assessment tools may help to identify high-risk individuals of CRC more accurately, improve adherence to colonoscopy, and thus fully achieve the effectiveness of screening.
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Affiliation(s)
- Weimiao Wu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Songsong Tan
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yingyao Chen
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wanghong Xu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
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Yuan Z, Wang S, Wang Y, Li H, Gao W, Liu X, Han Y, Liu Z, Zhang Q, Ma H, Wang J, Wei X, Zhang X, Cui W, Zhang C. Age- and sex-stratified detection rates and associated factors of colorectal neoplasia in the Tianjin colorectal cancer screening program from 2012 to 2020. BMC Gastroenterol 2023; 23:435. [PMID: 38087194 PMCID: PMC10714643 DOI: 10.1186/s12876-023-03060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Colorectal cancer (CRC) screening has been implemented in Tianjin, China since 2012. The objective was to estimate the neoplasia detection rate in a high-risk population by age and sex and to investigate the potential factors associated with colorectal neoplasia. PATIENTS AND METHODS This study is based on data of the Tianjin CRC screening program from 2012 to 2020. Residents with a positive high-risk factors questionnaire (HRFQ) or a positive faecal immunochemical test (FIT) were identified as high-risk participants and were subsequently recommended for a free colonoscopy. RESULTS A total of 4,117,897 eligible participants aged 40-74 years completed both a HRFQ and FIT, and 217,164 (5.3%) of them were identified as high-risk participants. Positive rates of preliminary screening increased with age and were higher in females than in males. For 57,971 participants undertaking colonoscopy, the detection rates of nonadvanced adenoma, advanced adenoma and CRC were 37.8%, 5.7% and 1.6%, respectively. Detection rates of advanced neoplasia increased from the age of 50 and were higher in males. For nonadvanced neoplasia, a strong increase was observed in males from the age of 40 and in females from the age of 50. Male sex had a greater impact on individuals aged 40-49 than on older individuals. Several factors including current smoking, drinking, and higher body mass index (BMI) were significantly associated with the presence of neoplasia, whereas, these associations were mainly restricted to individuals aged above 50 but not those aged 40-49 years. CONCLUSIONS These findings support that age-specific risk stratification and sex-specific initiating ages for CRC screening should be recommended to improve the accuracy and effectiveness of current screening strategy.
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Affiliation(s)
- Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Yuqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Hongzhou Li
- Department of Endoscopy, Tianjin Union Medical Center, Tianjin, China
| | - Weifeng Gao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xinyu Liu
- Tianjin Medical University, Tianjin, China
| | - Youkui Han
- Department of General Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zhaoce Liu
- School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Hong Ma
- Department of Nursing, Tianjin Union Medical Center, Tianjin, China
| | - Junying Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xiaomeng Wei
- Hospital Infection Management Division, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
| | - Wei Cui
- School of Mathematical Sciences and LPMC, Nankai University, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
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8
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Zhao X, Wang S, Yuan Z, Yan S, Pang W, Liu X, Wang W, Yi B, Han Q, Zhang Q, Zhang X, Zhang C. Colonoscopy compliance and diagnostic yield in a large population-based colorectal cancer screening programme. Int J Colorectal Dis 2023; 38:227. [PMID: 37700205 PMCID: PMC10497689 DOI: 10.1007/s00384-023-04517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES With the intention of providing a reference for secondary prevention, our study provides some insight on diagnostic yield of factors influencing compliance with colonoscopy and the presence of advanced adenomas (AA). METHODS We conducted large-scale CRC screening among local Tianjin residents aged 40-75 years between 2012 and 2019. A high-risk factor questionnaire (HRFQ) was distributed to each participant, followed by the performance of a fecal immunochemical test (FIT). Participants who tested positively for any of these items were advised to undergo a colonoscopy. Relevant basic information was collected from participants during CRC screening, and the screening data were sorted and analysed. RESULTS A total of 5,670,924 people participated in CRC screening by the end of 2019, including 275,708 people in the high-risk group, and 74,685 (27.1%) people who underwent colonoscopy. The results of the logistic regression model demonstrated that participants with a history of mucous bloody stool (OR = 8.20, 95% CI: 7.92, 8.50, p < 0.001), chronic diarrhea (OR = 5.73, 95% CI: 5.57, 5.89, p < 0.001), and higher level of education (OR = 1.87, 95% CI: 1.80, 1.93, p < 0.001) were more likely to comply with a colonoscopy. Several factors including age (70-75 years old:OR = 3.72, 95% CI: 2.71, 5.10, p < 0.001), and FIT( +) (OR = 1.65, 95% CI: 1.42,1.90, p < 0.001) were identified to be associated with the presence of AA. CONCLUSIONS Increased compliance with colonoscopy is urgently needed. Our findings can inform the design of future effective large-scale population-based CRC screening programmes.
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Grants
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- Key R&D Projects in the Tianjin Science and Technology Pillar Program
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Affiliation(s)
- Xinzhu Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenwen Pang
- Department of Clinical Laboratory, Tianjin Union Medical Center, Tianjin, China
| | - Xinyu Liu
- Tianjin Medical University, Tianjin, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ben Yi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiurong Han
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
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9
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Zhang X, Yang L, Liu S, Li H, Li Q, Li H, Wang N, Ji J. Performance of different colorectal cancer screening strategies: a long-term passive follow-up population-based screening program in Beijing, China. BMC Public Health 2023; 23:1640. [PMID: 37641033 PMCID: PMC10463986 DOI: 10.1186/s12889-023-16564-0] [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: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND We aimed to assess the performance of the risk assessment questionnaire and fecal immunochemical test (FIT) in a population-based colorectal cancer (CRC) screening program to provide timely evidence for tailored screening strategies in China. METHODS This analysis was conducted using data from Beijing Cancer Screening Prospective Cohort Study (BCSPCS). A risk assessment questionnaire and FIT were selected as the primary screening methods, and participants with any positive results were referred to undergo a diagnostic colonoscopy. RESULTS From 2015 to 2020, 148,636 Beijing residents aged 40-69 years were invited from designated communities, with 147,807 finishing the risk assessment questionnaire and 115,606 (78.2%) completing the FIT. Among the 42,969 (29.1%) high-risk CRC participants, 23,824 (55.4%) underwent colonoscopy. One year after enrollment, all subjects were linked to the Beijing Cancer Registry (BCR) database and 241 cases of CRC were confirmed. The CRC incidence rate was 58.2/100,000 for the low-risk arm and 418.9/100,000 for the high-risk arm. For participants who underwent colonoscopy, 91 CRC cases were detected, with a detection rate of 91.9% and 63.7% of them were early-stage cases. Furthermore, the sensitivities of utilizing the risk assessment questionnaire alone, FIT alone, combined risk assessment questionnaire and FIT were 75.7%, 50.1%, and 95.1%, and the specificities were 75.3%, 87.3%, and 70.7%, respectively. CONCLUSION The Beijing CRC screening program can effectively detect early-onset CRC; however, the compliance with colonoscopy still needs to be improved.
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Affiliation(s)
- Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Lei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Shuo Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Huichao Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Qingyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Haoxin Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Ning Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
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10
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Soylar P, Ozer A. The effect of spirituality and health perception on screening behavior of people with and without a family history of cancer. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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11
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Yuan Z, Wang S, Liu Z, Liu Y, Wang Y, Han Y, Gao W, Liu X, Li H, Zhang Q, Ma H, Wang J, Wei X, Zhang X, Cui W, Zhang C. A risk scoring system for advanced colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in Tianjin, China. BMC Gastroenterol 2022; 22:466. [PMCID: PMC9670427 DOI: 10.1186/s12876-022-02563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Given the limited effectiveness of the current Chinese colorectal cancer (CRC) screening procedure, adherence to colonoscopy remains low. We aim to develop and validate a scoring system based on individuals who were identified as having a high risk in initial CRC screening to achieve more efficient risk stratification and improve adherence to colonoscopy.
Methods
A total of 29,504 screening participants with positive High-Risk Factor Questionnaire (HRFQ) or faecal immunochemical test (FIT) who underwent colonoscopy in Tianjin from 2012–2020 were enrolled in this study. Binary regression analysis was used to evaluate the association between risk factors and advanced colorectal neoplasia. Internal validation was also used to assess the performance of the scoring system.
Results
Male sex, older age (age ≥ 50 years), high body mass index (BMI ≥ 28 kg/m2), current or past smoking and weekly alcohol intake were identified as risk factors for advanced colorectal neoplasm. The odds ratios (ORs) for significant variables were applied to construct the risk score ranging from 0–11: LR, low risk (score 0–3); MR, moderate risk (score 4–6); and HR, high risk (score 7–11). Compared with subjects with LR, those with MR and HR had ORs of 2.47 (95% confidence interval, 2.09–2.93) and 4.59 (95% confidence interval, 3.86–5.44), respectively. The scoring model showed an outstanding discriminatory capacity with a c-statistic of 0.64 (95% confidence interval, 0.63–0.65).
Conclusions
Our results showed that the established scoring system could identify very high-risk populations with colorectal neoplasia. Combining this risk score with current Chinese screening methods may improve the effectiveness of CRC screening and adherence to colonoscopy.
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12
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Wang S, Yuan Z, Wang Y, Zhao X, Gao W, Li H, Zhao Y, Zhang Z, Liang S, Liu Z, Zhang Q, Ma H, Zhang X, Cui W, Zhang C. Modifiable lifestyle factors have a larger contribution to colorectal neoplasms than family history. BMC Cancer 2022; 22:1051. [PMID: 36207694 PMCID: PMC9547467 DOI: 10.1186/s12885-022-10141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening recommendations for colorectal cancer (CRC) are mainly based on family history rather than lifestyle risk factors. We aimed to assess and compare risk factors for colorectal neoplasm (CRN) and evaluate trends in neoplasm detection rates during the three rounds of screening from 2012 to 2020 in Tianjin, China. METHODS This study was based on 89,535 first-recorded colonoscopies in Tianjin CRC screening program, 2012-2020. Of these, 45,380 individuals with complete family history and lifestyle factors were included for population attributable fraction (PAF) estimation. RESULTS The overall detection rate of nonadvanced adenomas, advanced adenomas and CRC was 39.3%, 5.9% and 1.5%, respectively. The PAFs of current smoking, alcohol consumption, physical activity, higher BMI and family history of CRC, respectively, were 8.9%, 2.6%, 1.9%, 5.8%, and 1.1% for males with nonadvanced CRN; 12.3%, 7.3%, 4.9%, 7.2%, and 0.8% for males with advanced CRN; 3.4%, 0.4%, 2.1%, 7.8%, and 0.7% for females with nonadvanced CRN; and 4.3%, 0.2%, 8.2%, 8.5%, and -0.6% for females with advanced CRN. The PAFs of selected lifestyle factors were 19.9% for males with nonadvanced CRN, 29.0% for males with advanced CRN, 9.7% for females with nonadvanced CRN and 13.8% for females with advanced CRN. CONCLUSIONS Modifiable lifestyle factors, including smoking, alcohol consumption, physical activity and BMI, have a larger contribution to CRN than family history of CRC. Our findings will provide references for developing guidelines of CRC prevention and control in China.
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Affiliation(s)
- Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Yuqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Xuanzhu Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weifeng Gao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Hongzhou Li
- Department of Endoscopy, Tianjin Union Medical Center, Tianjin, China
| | - Yuanshun Zhao
- Department of Endoscopy, Tianjin Union Medical Center, Tianjin, China
| | - Zili Zhang
- Tianjin Third Central Hospital, Tianjin, China
| | - Shuiqing Liang
- Dagang Hospital of Tianjin Binhai New Area, Tianjin, China
| | - Zhaoce Liu
- School of Medicine, Nankai University, Tianjin, China.,Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Hong Ma
- Department of Nursing, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China. .,Tianjin Institute of Coloproctology, Tianjin, China. .,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
| | - Wei Cui
- School of Mathematical Sciences and LPMC, Nankai University, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China. .,Tianjin Institute of Coloproctology, Tianjin, China. .,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
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13
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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14
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Zhang M, Zhao L, Zhang Y, Jing H, Wei L, Li Z, Zhang H, Zhang Y, Zhu S, Zhang S, Zhang X. Colorectal Cancer Screening With High Risk-Factor Questionnaire and Fecal Immunochemical Tests Among 5, 947, 986 Asymptomatic Population: A Population-Based Study. Front Oncol 2022; 12:893183. [PMID: 35712520 PMCID: PMC9195590 DOI: 10.3389/fonc.2022.893183] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background The recent uptrend in colorectal cancer (CRC) incidence in China is causing an increasingly overwhelming social burden. And its occurrence can be effectively reduced by sensitizing CRC screening for early diagnosis and treatment. However, a large number of people in China do not undergo screening due to multiple factors. To address this issue, since 2012, a CRC screening program has been initiated in Tianjin. Methods Residents aged 40-74 years were eligible for CRC screening. The first was to complete the high-risk factor questionnaire (HRFQ) and undergo fecal immunochemical test (FIT). Then those with a positive result in any of the two screening methods were recommended for a free colonoscopy. Results The detection rate of intestinal diseases increased with age, had a male predominance, and was higher in residents from central urban areas and those with primary school above education level. The sensitivity of predicting CRC after colonoscopy in the high-risk group was 76.02%; the specificity was 25.33%.A significant decrease in the detection rate of intestinal disease, CRC and advanced adenoma was observed from positive FIT, the high-risk group and positive HRFQ, 47.13%, 44.79%, 42.30%; 3.15%, 2.44%, 1.76%; 7.72%, 6.42%, 5.08%, in that order, while no inter-group difference was found for the detection of polyps. In addition, the different combinations of HRFQ and FIT can enroll more high-risk population than FIT or (and) HRFQ only, and thus detect more intestinal diseases (include CRC/AA/Polyp). Conclusion The superimposition of different screening method for HRFQ and FIT is an effective strategy for the detection of CRC, AA, and Polyp, compared to HRFQ or FIT alone. However, further improvements in screening and interventions are needed to promote colonoscopy compliance.
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Affiliation(s)
- Mingqing Zhang
- Nankai University School of Medicine, Nankai University, Tianjin, China.,Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Lianbo Wei
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Zhixuan Li
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Haixiang Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Yong Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Siwei Zhu
- Nankai University School of Medicine, Nankai University, Tianjin, China.,Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Shiwu Zhang
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.,Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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15
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Li JB, Ke KJ, Zhang WL, Wang LY, Wu YP, Weng F, Tian H, Qiu ZY, Li Y, Lin SY, Ye MX, Ou QJ, Gong CH, Lu ZH, Pan ZZ, Wan DS, Peng JH, Fang YJ. Factors associated with adherence to colonoscopy among individuals who were positive in the preliminary screening for colorectal neoplasms. Cancer Med 2022; 11:4321-4331. [PMID: 35441812 DOI: 10.1002/cam4.4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the potential factors associated with adherence to colonoscopy among participants who were preliminarily screened positive in a community-based colorectal cancer screening program in China. METHODS This study analyzed data from 1219 out of 6971 community residents who were identified as positive cases by the well-validated high-risk factor questionnaire (HRFQ) or fecal immunochemical test (FIT) in the preliminary screening stage for colorectal neoplasms. Patients showing adherence to colonoscopy were defined as those who received positive results in a preliminary screening for colorectal neoplasms and later received a colonoscopy examination as required. The associations of social-demographic factors, lifestyle behaviors, history of diabetes, body mass index (BMI), and risk factors in the HRFQ with adherence to colonoscopy were evaluated using logistic regression models. RESULTS Among 1219 participants who preliminarily screened positive, the top five risk factors reported by the participants were chronic constipation (25.9%), hematochezia (23.5%), family history of CRC in first-degree relatives (22.1%), chronic diarrhea (21.8%), and history of polyps (16.6%). Around 14.2% of participants who preliminarily screened positive reported three or more risk factors, and the proportion was 26.2% among participants who were positive according to both HRFQ and FIT. Among all participants who were preliminarily screened positive, the multivariable results showed that those who were married (OR = 1.58, 95% CI: 1.12, 2.25, p = 0.01), had chronic diarrhea (OR = 1.34, 95% CI: 1.00, 1.78, p = 0.047), and had a positive FIT (OR = 1.60, 95% CI: 1.21, 2.10, p < 0.001 for patients who were negative according to HRFQ but positive according to FIT; OR = 2.12, 95% CI: 1.33, 2.78, p = 0.002 for patients who were positive for both HRFQ and FIT) were more likely to adhere to colonoscopy, while participants with a history of cancer (OR: 0.50, 95% CI: 0.31, 0.79, p = 0.003) were less likely to adhere to colonoscopy. The results among participants who were tested positive according to only HRFQ were similar to those among all participants who were tested positive according to HRFQ or FIT. However, among participants who were tested positive according to only FIT, we only found that those who were married (OR = 2.52, 95% CI: 1.08, 5.90, p = 0.033) had a higher odds of adhering to colonoscopy, while those with a history of diabetes (OR = 0.35, 95% CI: 0.13, 0.96, p = 0.042) were less likely to adhere to colonoscopy. CONCLUSION Our findings provide evidence supporting the development of tailored interventional strategies that aim to improve adherence to colonoscopy for individuals with a high risk of colorectal neoplasms. Both barriers and facilitators associated with adherence to colonoscopy should be considered in supportive systems and health policies. However, further well-designed prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Ji-Bin Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Keng-Jian Ke
- Shenzhen Hospital, Southern Medical University, Shenzhen, P. R. China
| | - Wei-Li Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Ling-Yan Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yan-Ping Wu
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Fan Weng
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Huan Tian
- Dadong Street Community Health Service Center, Guangzhou, P. R. China
| | - Zhi-Yu Qiu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yin Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Shi-Yong Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Mei-Xian Ye
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Qing-Jian Ou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Cheng-Hua Gong
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, P. R. China
| | - Zhen-Hai Lu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Zhi-Zhong Pan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - De-Sen Wan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Jian-Hong Peng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
| | - Yu-Jing Fang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China
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Wu W, Huang J, Wong MCS, Xu W. Reducing workloads of public health workers in organised colorectal cancer screening in China. Eur J Cancer Care (Engl) 2022; 31:e13576. [PMID: 35316857 DOI: 10.1111/ecc.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/23/2021] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Weimiao Wu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wanghong Xu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
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17
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Li JB, Qiu ZY, Deng YX, Li Y, Lin ZC, Wu YP, Weng F, Tian H, Ou QJ, Gong CH, Pan ZZ, Wan DS, Peng JH, Fang YJ. Factors associated with positive predictive value of preliminary screening in a two-step screening strategy for colorectal neoplasms in China. Discov Oncol 2022; 13:4. [PMID: 35201502 PMCID: PMC8777551 DOI: 10.1007/s12672-022-00463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. We aim to explore independent factors associated with PPVs of HRFQ combined FIT for selecting high risk individuals for colonoscopy. METHODS A total of 6971 residents were enrolled in a community-based screening program. Participants who had positive results of HRFQ and/or FIT and subsequently received colonoscopy were involved. The associations of socio-demographic factors, lifestyle behaviors, and high risk factors of colorectal cancer with PPVs of HRFQ, FIT, and their combination were evaluated by multivariable logistic regression models. RESULTS Among 572 involved cases, 249 (43.5%) colorectal neoplasms were detected by colonoscopy, including 71 advanced adenoma (12.4%) and 9 colorectal cancer (CRC) (1.6%). The PPVs of preliminary screening were 43.5% for total colorectal neoplasms, 14.0% for advanced neoplasm, and 1.6% for CRC. Adding positive HRFQ to FIT could improve the PPV from 3.5 to 8.0% for detecting CRC. Preliminarily screened positive individuals who were males [adjusted odds ratio (AOR): 1.95, 95% CI 1.31, 2.90; p < 0.001], elders (> 60 years) (AOR: 1.70, 95% CI 1.17, 2.46; p = 0.005), or ex-/current smokers (AOR: 3.04, 95% CI 1.31, 7.09; p = 0.10) had higher odds of PPVs of detecting colorectal neoplasms. CONCLUSIONS Combining HRFQ and FIT could largely improve PPVs for screening advanced neoplasm and CRC. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm.
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Affiliation(s)
- Ji-Bin Li
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhi-Yu Qiu
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yu-Xiang Deng
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yin Li
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhuo-Chen Lin
- Department of Medical Records, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
| | - Yan-Ping Wu
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Fan Weng
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Huan Tian
- Dadong Street Community Health Service Center, Guangzhou, 510000, People's Republic of China
| | - Qing-Jian Ou
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Cheng-Hua Gong
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Zhi-Zhong Pan
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - De-Sen Wan
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Jian-Hong Peng
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - Yu-Jing Fang
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
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Liang L, Liang Y, Li K, Qin P, Lin G, Li Y, Xu H, Wang S, Jing Q, Liang B, Xu L. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac002. [PMID: 35154783 PMCID: PMC8827054 DOI: 10.1093/gastro/goac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background The uptake of colonoscopy is low in individuals at risk of colorectal cancer (CRC). We constructed a risk-prediction score (RPS) in a large community-based sample at high risk of CRC to enable more accurate risk stratification and to motivate and increase the uptake rate of colonoscopy. Methods A total of 12,628 participants classified as high-risk according to positivity of immunochemical fecal occult blood tests or High-Risk Factor Questionnaire underwent colonoscopy. Logistic regression was used to derive a RPS and analysed the associations of the RPS with colorectal lesions, giving odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the participants, men (OR = 1.73, 95% CI = 1.58–1.90), older age (≥65 years; 1.41, 1.31–1.53), higher body mass index (≥28 kg/m2; 1.22, 1.07–1.39), ever smoking (1.47, 1.31–1.65), and weekly alcohol use (1.28, 1.09–1.52) were associated with a higher risk of colorectal lesions. We assigned 1 point to each of the above five risk factors and derived a RPS ranging from 0 to 5, with a higher score indicating a higher risk. Compared with a RPS of 0, a RPS of 1, 2, 3, and 4–5 showed a higher risk of colorectal lesions, with the OR (95% CI) being 1.50 (1.37–1.63), 2.34 (2.12–2.59), 3.58 (3.13–4.10), and 3.91 (3.00–5.10), respectively. The area under the receiver-operating characteristic curve of RPS in predicting colorectal lesions was 0.62. Conclusions Participants with an increase in the RPS of ≥1 point had a significantly higher risk of colorectal lesions, suggesting the urgency for measuring colonoscopy in this very high-risk group. High-risk strategies incorporating RPS may be employed to achieve a higher colonoscopy-uptake rate.
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Affiliation(s)
- Lixin Liang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yingru Liang
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Ke Li
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Pengzhe Qin
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Guozhen Lin
- Department of Primary Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Yan Li
- Department of Food-borne Disease and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Huan Xu
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Suixiang Wang
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Qinlong Jing
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
| | - Boheng Liang
- Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, P. R. China
- Corresponding authors. Boheng Liang, Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Baiyun District, Guangzhou, Guangdong 510440, China. Tel: +86-20-36055855; Fax: +86-20-36055885. ; Lin Xu, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China. Tel: +86-20-87335523; Fax: +86-20-87330446;
| | - Lin Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- School of Public Health, University of Hong Kong, Hong Kong, China
- Corresponding authors. Boheng Liang, Department of Chronic Noncommunicable Disease Prevention and Control, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Baiyun District, Guangzhou, Guangdong 510440, China. Tel: +86-20-36055855; Fax: +86-20-36055885. ; Lin Xu, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong 510080, China. Tel: +86-20-87335523; Fax: +86-20-87330446;
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Rațiu I, Lupușoru R, Vora P, Popescu A, Sporea I, Goldiș A, Dănilă M, Miuțescu B, Barbulescu A, Hnatiuc M, Diaconescu R, Tăban S, Lazar F, Șirli R. Opportunistic Colonoscopy Cancer Screening Pays off in Romania-A Single-Centre Study. Diagnostics (Basel) 2021; 11:diagnostics11122393. [PMID: 34943629 PMCID: PMC8700238 DOI: 10.3390/diagnostics11122393] [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: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 12/09/2022] Open
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in men (after prostate and lung cancers) and in women (after breast and lung cancer). It is the second cause of cancer death in men (after lung cancer) and the third one in women (after breast and lung cancers). It is estimated that, in EU-27 countries in 2020, colorectal cancer accounted for 12.7% of all new cancer diagnoses and 12.4% of all deaths due to cancer. Our study aims to assess the opportunistic colorectal cancer screening by colonoscopy in a private hospital. A secondary objective of this study is to analyse the adenoma detection rate (ADR), polyp detection rate (PDR), and colorectal cancer (CRC) detection rate. We designed a retrospective single-centre study in the Gastroenterology Department of Saint Mary Hospital. The study population includes all individuals who performed colonoscopies in 2 years, January 2019–December 2020, addressed to our department by their family physician or came by themselves for a colonoscopy. One thousand seven hundred seventy-eight asymptomatic subjects underwent a colonoscopy for the first time. The mean age was 59.0 ± 10.9, 59.5% female. Eight hundred seventy-three polyps were found in 525 patients. Five hundred and twenty-five had at least one polyp, 185 patients had two polyps, 87 had three polyps, and 40 patients had more than three polyps. The PDR was 49.1%, ADR 39.0%, advanced adenomas in 7.9%, and carcinomas were found in 5.4% of patients. In a country without any colorectal cancer screening policy, polyps were found in almost half of the 1778 asymptomatic patients evaluated in a single private center, 39% of cases adenomas, and 5.4% colorectal cancer. Our study suggests starting screening colonoscopy at the age of 45. A poor bowel preparation significantly impacted the adenoma detection rate.
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Affiliation(s)
- Iulia Rațiu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Raluca Lupușoru
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-733912028
| | - Prateek Vora
- Department of Gastroenterology, Saint Mary Hospital, 300203 Timisoara, Romania;
| | - Alina Popescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Ioan Sporea
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Adrian Goldiș
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Mirela Dănilă
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Bogdan Miuțescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Andreea Barbulescu
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Madalina Hnatiuc
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
| | - Razvan Diaconescu
- Department of Surgery, Faculty of Medicine, “Vasile Goldiş” Western University of Arad, 310025 Arad, Romania;
| | - Sorina Tăban
- ANAPATMOL Research Center, Discipline of Morphopathology, Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Fulger Lazar
- Department X, 2nd Surgical Clinic, Researching Future Chirurgie 2, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timisoara, Romania;
| | - Roxana Șirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.R.); (A.P.); (I.S.); (A.G.); (M.D.); (B.M.); (A.B.); (M.H.); (R.Ș.)
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Evaluating the Clinical Performance of a Dual-Target Stool DNA Test for Colorectal Cancer Detection. J Mol Diagn 2021; 24:131-143. [PMID: 34890778 DOI: 10.1016/j.jmoldx.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
Previous work indicated that the dual-target stool DNA test, iColocomf, showed potential utility for colorectal cancer (CRC) detection, but its clinical accuracy was not validated on larger groups. This study aimed to evaluate the performance of iColocomf in a multicenter clinical trial. In this double-blinded case-control study, we enrolled 1164 participants from three independent hospitals, including 320 CRC patients, 148 adenomas, 396 interfering diseases, and 300 healthy controls. The primary indicators of sensitivity, specificity, and accuracy were estimated. Stool samples of participants were collected and tested by the assay. The test results were then verified by Sanger sequencing and retesting of resected participants. The sensitivity and specificity for CRC detection were 95.31% and 96.67%, respectively, with an accuracy of 90.29%. When combining the interfering diseases, the specificity was 88.39%. No statistically significant variations of positive detection rates were observed for the test in different patients' clinical features. For advanced adenomas (n = 38) and nonadvanced adenomas (n = 110), the sensitivities were 63.16% and 33.64%, respectively. The average accuracy was 99.62% for the methylation status of 375 samples verified by Sanger sequencing, and 94.12% for 34 participants who received the test second after surgical resection. The iColocomf test showed robust performance for the early detection of colorectal cancer and potential monitoring ability in clinical practice.
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Schliemann D, Ramanathan K, Matovu N, O'Neill C, Kee F, Su TT, Donnelly M. The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review. BMC Cancer 2021; 21:1125. [PMID: 34666704 PMCID: PMC8524916 DOI: 10.1186/s12885-021-08809-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs. METHODS We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries. RESULTS CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was 'uptake/reach'. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes. CONCLUSION Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
| | - Kogila Ramanathan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Nicholas Matovu
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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22
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Coll PP, Korc-Grodzicki B, Ristau BT, Shahrokni A, Koshy A, Filippova OT, Ali I. Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer. J Am Geriatr Soc 2020; 68:2399-2406. [PMID: 32880888 DOI: 10.1111/jgs.16791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/12/2022]
Abstract
The incidence of most cancers increases with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. The prevention and identification of cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This first of a two-part review addresses special considerations regarding cancer prevention for adults aged 65 and older. Screening decisions and the impact of limited life expectancy and an older adult's ability to tolerate cancer treatment are also addressed. Guidance is provided regarding the prevention and early identification of lung, colorectal, bladder, and kidney cancer in older adults. The prevention of breast, prostate, and female urogenital cancers are addressed in Part 2. J Am Geriatr Soc 68:2399-2406, 2020.
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Affiliation(s)
- Patrick P Coll
- Department of Family Medicine, UConn Health, Farmington, Connecticut, USA.,Center on Aging, UConn Health, Farmington, Connecticut, USA
| | - Beatriz Korc-Grodzicki
- Department of Medicine, Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Benjamin T Ristau
- Division of Urology, Department of Surgery, UConn Health, Farmington, Connecticut, USA
| | - Armin Shahrokni
- Department of Medicine, Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander Koshy
- Department of Medicine, Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olga T Filippova
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Imran Ali
- Center on Aging, UConn Health, Farmington, Connecticut, USA
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23
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Colonoscopy Screening Behaviour and Associated Factors Amongst First-Degree Relatives of People with Colorectal Cancer in China: Testing the Health Belief Model Using a Cross-Sectional Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144927. [PMID: 32650616 PMCID: PMC7400103 DOI: 10.3390/ijerph17144927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/31/2022]
Abstract
Colonoscopy is the best screening choice for at-risk persons, because it offers prevention through the removal of preneoplastic lesions in addition to early detection. This study aims to report the participation rate of colonoscopy screening and examine its associated factors amongst Chinese first-degree relatives of people with colorectal cancer based on the health belief model (HBM). A cross-sectional study was conducted in Shenzhen, China from March to May 2019. Demographic characteristics, family history, variables derived from the HBM and colonoscopy screening behaviours were measured through online surveys as the independent variables of interest. A total of 186 online surveys were returned, with a final response rate of 57.0%. The participation rate of colonoscopy was 15.6%. Univariate analysis (independent t-test/chi-square test/Fisher test) was applied first to identify the candidate independent variables. Then, multivariate logistic regression was used to examine the association between independent variables and uptake of colonoscopy. Perceived barriers and cues to action were identified as factors associated with undergoing colonoscopy. The participation rate of colonoscopy in the study population was low. Health communication to promote colonoscopy screening for the Chinese at-risk population should include components in reducing barriers to colonoscopy tests, family history information and health professional recommendations on screening. Future studies with large sample size are suggested to examine perceived susceptibility, fatalism and other characteristics considering family history (treatment and outcome of patients) and their potential impacts on cancer screening behaviours for Chinese at-risk populations due to family history.
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24
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Cheng P, Lu Z, Zhang M, Chen H, Guo Z, Zheng Z, Wang X. Is Additional Surgery Necessary After Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer? J INVEST SURG 2019; 34:889-894. [PMID: 31809614 DOI: 10.1080/08941939.2019.1697770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) is considered to be a curative treatment for early colorectal cancer, additional surgery with lymph node dissection is routinely recommended for patients treated in non-curative ESD, owing to the risk of residual cancer and lymph node metastasis (LNM). However, in clinical practice, few patients are found to have either residual cancer or LNM after additional surgery. Therefore, we conducted this study to determine the risk factors associated with residual cancer and LNM. METHODS Patients with early colorectal cancer after non-curative ESD and additional surgery from January 2015 to May 2019 were retrospectively identified. Clinicopathological characteristics were collected to determine the predictors of residual cancer and LNM. RESULTS A total of 62 patients were enrolled for analysis in this study. After additional surgery, residual cancer and LNM was detected in 12 patients (19.35%). Clinicopathological comparison of patients with the presence or absence of residual cancer and LNM demonstrated that piecemeal resection (80% vs. 14.04%, P < 0.001), submucosal invasion greater than 2000 μm (26.09% vs. 0%, P = 0.026), lymphovascular infiltration (37.5% vs. 13.04%, P = 0.033), and perineuronal invasion (75% vs. 15.52%, P = 0.004) were more frequent in residual cancer and LNM cases. Multivariate analysis identified lymphovascular infiltration (P = 0.031) as the only significantly independent risk factor associated with residual cancer and LNM. CONCLUSIONS Additional surgery with lymphadenectomy should be performed after non-curative ESD owing to the high risk of residual cancer and LNM, especially in cases with lymphovascular infiltration.
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Affiliation(s)
- Pu Cheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhao Lu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mingguang Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haipeng Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhixing Guo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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