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de Pinho JHS, Riscado LVS, Sales MPM, de Souza GS, de Castro AR, Bechara CDS. Low-cost Colonoscopic Simulator and Colonoscope to Train Basic Skills in Colonoscopy during Undergraduate Studies. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1757774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Objective To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications.
Methods Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region.
Results We were able to build a simulator and a colonoscope with a total amount of R$ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy.
Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students.
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Cui Y, Cheng G, Tian G, He S, Yan Y. Secular trends in the mortality of gastrointestinal cancers across China, Japan, the US, and India: An age-period-cohort, Joinpoint analyses, and Holt forecasts. Front Public Health 2022; 10:925011. [PMID: 36249214 PMCID: PMC9559557 DOI: 10.3389/fpubh.2022.925011] [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: 04/21/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023] Open
Abstract
Background Colon cancer, esophageal cancer, and stomach cancer are the common causes of morbidity and mortality in China, Japan, the US., and India. The current study aims to assess and compare secular trends of the mortality of gastrointestinal cancers during the period, 1990-2017 in age-specific, time period, and birth cohort effects. Method We used the Joinpoint model to collect age-standardized mortality rates (ASMRs) for four countries. We designed an age-period-cohort (APC) analysis to estimate the independent effects on the mortality of three types of cancers. Result The Joinpoint model shows that in addition to the death rate of esophageal cancer in Japan, the ASMR of esophageal cancer and stomach cancer in other countries declined rapidly. The APC analysis presented a similar pattern of age effect between four countries for colon cancer and stomach cancer, which increased from 20 to 89 age groups. Differently, the period effect rapidly increased for esophageal cancer and stomach cancer in the US, and the period effect in China presented a declining volatility, showing its highest value in 2007. In future, highest mortality trends are likely to occur in China. Conclusion Therefore, the obvious increase in colon cancer recommended that earlier tactics must be performed to reduce mortality from specific causes from 2018 to 2027.
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de Benito Sanz M, Hernández L, Garcia Martinez MI, Diez-Redondo P, Joao Matias D, Gonzalez-Santiago JM, Ibáñez M, Núñez Rodríguez MH, Cimavilla M, Tafur C, Mata L, Guardiola-Arévalo A, Feito J, García-Alonso FJ. Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy 2022; 54:35-44. [PMID: 33264811 DOI: 10.1055/a-1327-8357] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9 mm polyps in terms of complete resection and adverse events. METHODS This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5-9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without < 5 mm or > 9 mm polyps. RESULTS 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval -1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01). CONCLUSIONS We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.
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Affiliation(s)
- Marina de Benito Sanz
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Burgos, Spain
| | | | - Pilar Diez-Redondo
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Diana Joao Matias
- Department of Gastroenterology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Mercedes Ibáñez
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | | | - Marta Cimavilla
- Department of Gastroenterology, Hospital Río Carrión, Palencia, Spain
| | - Carla Tafur
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | - Laura Mata
- Department of Gastroenterology, Hospital de Medina del Campo, Valladolid, Spain
| | - Antonio Guardiola-Arévalo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, IdiPAz (Instituto de investigación Hospital Universitario La Paz), Madrid, Spain
| | - Jorge Feito
- Department of Pathology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Stratmann K, Bock H, Filmann N, Fister P, Weber C, Tacke W, Simonis B, Höftmann M, Schröder O, Hausmann J, Zeuzem S, Blumenstein I. Individual invitation letters lead to significant increase in attendance for screening colonoscopies: Results of a pilot study in Northern Hesse, Germany. United European Gastroenterol J 2018; 6:1082-1088. [PMID: 30228897 DOI: 10.1177/2050640618769713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most common cancer in Germany. Screening colonoscopies are considered an effective tool for early detection and prevention of CRC and are recommended in Germany for citizens over the age of 55. To increase the participation rate for screening colonoscopies, an invitation procedure was initiated in parts of Germany for patients between the ages of 55 and 75 who had never undergone a screening colonoscopy before. Methods We examined the number of participating patients before, during, and after the invitation procedure and compared the number of the participating patients who received a cover letter with the participating patients from the control group. Additionally, we classified the findings of the colonoscopies including CRC, advanced adenomas, and polyps. Results During the invitation period, the participation rate of the invitation group increased from 220 patients to 531 patients compared to 1256 to 1693 in the control group. The increase was significantly greater in patients with cover letters (+141% vs.+35%, p < 0.0001). Also, significantly more polyps and adenomas were found in patients from the invitation letter group (254 (+102%) vs. 679 (-9%), p < 0.0001). Conclusions Our study clearly indicates that personal invitation letters are an effective measure to increase overall participation rates in screening colonoscopies.
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Affiliation(s)
- K Stratmann
- First Department of Internal Medicine, Division of Gastroenterology, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany
| | - H Bock
- Quality Management Group of Gastroenterologists in Hesse, Gastroenterologie Hessen eG, Frankfurt/Main, Germany
| | - N Filmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany
| | - P Fister
- Quality Management Group of Gastroenterologists in Hesse, Gastroenterologie Hessen eG, Frankfurt/Main, Germany
| | - C Weber
- Quality Management Group of Gastroenterologists in Hesse, Gastroenterologie Hessen eG, Frankfurt/Main, Germany
| | - W Tacke
- Quality Management Group of Gastroenterologists in Hesse, Gastroenterologie Hessen eG, Frankfurt/Main, Germany
| | - B Simonis
- Quality Management Group of Gastroenterologists in Hesse, Gastroenterologie Hessen eG, Frankfurt/Main, Germany
| | | | - O Schröder
- Bürgerhospital Frankfurt, Department of Internal Medicine, Frankfurt/Main, Germany
| | - J Hausmann
- First Department of Internal Medicine, Division of Gastroenterology, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany
| | - S Zeuzem
- First Department of Internal Medicine, Division of Gastroenterology, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany
| | - I Blumenstein
- First Department of Internal Medicine, Division of Gastroenterology, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany
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Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of Colorectal Cancer Incidence Trends in the United States (2000-2014). J Clin Med 2018; 7:jcm7020022. [PMID: 29385768 PMCID: PMC5852438 DOI: 10.3390/jcm7020022] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) incidence rates have declined in recent years for people of all races/ethnicities; however, the extent to which the decrease varies annually by demographic and disease-related characteristics is largely unknown. This study examines trends and annual percent change (APC) in the incidence among persons diagnosed with CRC in the United States of America from 2000-2014. The data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program were analyzed, and all persons (N = 577,708) with malignant CRC recorded in the SEER 18 database from 2000 to 2014 were characterized according to sex, race, age at diagnosis, disease site and stage. Incidence rates and APC were calculated for the entire study period. Overall, the incidence rate of CRC decreased from 54.5 in 2000 to 38.6 per 100,000 in 2014, with APC = -2.66 (p < 0.0001). Decline in rates was most profound between 2008 and 2011 from 46.0 to 40.7 per 100,000 (APC = -4.04; p < 0.0001). Rates were higher for males (vs. females; rate ratio (RR) = 1.33) and for blacks (vs. whites; RR = 1.23). Proximal colon cancers at the localized stage were the predominant cancers. An increase in rate was observed among people younger than 50 years (6.6 per 100,000, APC= 1.5). The annual rate of CRC has decreased over time. However, the development and implementation of interventions that further reduce the disparities among demographic and disease-related subgroups are warranted.
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Affiliation(s)
- Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.
| | - Steven S Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
| | - Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA.
| | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
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Eberth JM, Josey MJ, Mobley LR, Nicholas DO, Jeffe DB, Odahowski C, Probst JC, Schootman M. Who Performs Colonoscopy? Workforce Trends Over Space and Time. J Rural Health 2017; 34:138-147. [PMID: 29143383 DOI: 10.1111/jrh.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/01/2017] [Accepted: 10/16/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types. METHODS Using an all-payer outpatient discharge records database from South Carolina, we conducted a retrospective analysis of all colonoscopy procedures performed between 2001 and 2010. FINDINGS We identified a major shift in the type of facilities performing colonoscopy in South Carolina since 2001, with substantial gains in ambulatory surgery settings (2001: 15, 2010: 34, +127%) versus hospitals (2001: 58, 2010: 59, +2%), particularly in urban areas (2001: 12, 2010: 27, +125%). The number of internists (2001: 46, 2010: 76) and family physicians (2001: 34, 2010: 106) performing colonoscopies also increased (+65% and +212%, respectively), while their annual procedures volumes stayed fairly constant. Significant variation in annual colonoscopy volume was observed across medical specialties (P < .001), with nongastroenterologists having lower volumes versus gastroenterologists and colon and rectal surgeons. CONCLUSIONS There have been substantial changes over time in the number of facilities and physicians performing colonoscopy in South Carolina since 2001, particularly in urban counties. Findings suggest nongastroenterologists are meeting a need for colonoscopies in rural areas.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michele J Josey
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lee R Mobley
- Department of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Davidson O Nicholas
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri.,Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Donna B Jeffe
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Cassie Odahowski
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Janice C Probst
- Department of Health Services Policy and Management and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mario Schootman
- Department of Epidemiology, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri
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Changes in trends in colorectal cancer incidence rate by anatomic site between 1978 and 2004 in Japan. Eur J Cancer Prev 2017; 26:269-276. [DOI: 10.1097/cej.0000000000000255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tomašević R, Milosavljević T, Stojanović D, Gluvić Z, Dugalić P, Ilić I, Vidaković R. Predictive Value of Carcinoembryonic and Carbohydrate Antigen 19-9 Related to Some Clinical, Endoscopic and Histological Colorectal Cancer Characteristics. J Med Biochem 2016; 35:324-332. [PMID: 28356884 PMCID: PMC5346811 DOI: 10.1515/jomb-2016-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is an important oncological and public health problem worldwide, including Serbia. Unfortunately, half of the patients are recognized in an advanced stage of the disease, therefore, early detection through specific tumor biomarkers, such as carcinoembryonic (CEA) and carbohydrate antigen 19-9 (CA 19-9), is the only way to cope with CRC expansion. METHODS Our cross-sectional study evaluated the influence of some clinical, endoscopic and histological characteristics of CRC on CEA and CA 19-9 serum levels, to determine whether these biomarkers could be related to CRC detection. The study included 372 participants: 181 suffered from CRC and 191 participants were controls. Endoscopic and histological examinations were used for CRC diagnosis, while additional ultrasound and abdominal computerised tomography imaging were used for staging the disease. Measurement of CEA and CA 19-9 was performed after CRC confirmation. RESULTS Age, gender, tumor localization, macro-morphological and histological characteristics did not influence biomarkers serum levels. Both were significantly higher (p<0.01) in patients with Dukes D stage of CRC compared with controls. Sensitivity (76.8%) and specificity (76.6%) of CEA alone were higher than for CA 19-9, but with no statistical significance. Furthermore, sensitivity of CEA alone in the Dukes A/B group was similar to the entire CRC patient group. CONCLUSIONS Although not recommended as a screening method for the general population, elevated values of each biomarker indicate further diagnostic procedures and their simultaneous testing can improve the diagnostic sensitivity in early detection of CRC, as shown by the united analysis (AUC 0.842).
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Affiliation(s)
- Ratko Tomašević
- Clinical Hospital Center Zemun, Belgrade, Clinic of Internal Medicine, University of Belgrade, School of Medicine
| | - Tomica Milosavljević
- Clinical Center of Serbia, Gastroenterology and Hepatology Clinic, University of Belgrade, School of Medicine
| | - Dragoš Stojanović
- Clinical Hospital Center Zemun, Belgrade, Surgery Clinic, University of Belgrade, School of Medicine
| | - Zoran Gluvić
- Clinical Hospital Center Zemun, Belgrade, Clinic of Internal Medicine, University of Belgrade, School of Medicine
| | - Predrag Dugalić
- Clinical Hospital Center Zemun, Belgrade, Clinic of Internal Medicine, University of Belgrade, School of Medicine
| | - Ivan Ilić
- Clinical Hospital Center Zemun, Belgrade, Clinic of Internal Medicine, University of Belgrade, School of Medicine
| | - Radosav Vidaković
- Clinical Hospital Center Zemun, Belgrade, Clinic of Internal Medicine, University of Belgrade, School of Medicine
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Kim HG, Huh KC, Koo HS, Kim SE, Kim JO, Kim TI, Kim HS, Myung SJ, Park DI, Shin JE, Yang DH, Lee SH, Lee JS, Lee CK, Chang DK, Joo YE, Cha JM, Hong SP, Kim HJ. Sodium Picosulfate with Magnesium Citrate (SPMC) Plus Laxative Is a Good Alternative to Conventional Large Volume Polyethylene Glycol in Bowel Preparation: A Multicenter Randomized Single-Blinded Trial. Gut Liver 2016; 9:494-501. [PMID: 25287163 PMCID: PMC4477993 DOI: 10.5009/gnl14010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background/Aims We investigated whether sodium picosulfate with magnesium citrate (SPMC) plus bisacodyl compares favorably with conventional polyethylene glycol (PEG) with respect to bowel cleansing adequacy, compliance, and safety. Methods We performed a multicenter, prospective, single-blinded study in outpatients undergoing daytime colonoscopies. Patients were randomized into a split preparation SPMC/bisacodyl group and a conventional split PEG group. We compared preparation adequacy using the Boston bowel preparation scale (BBPS), ease of use using a modified Likert scale (LS), compliance/satisfaction level using a visual analogue scale (VAS), and safety by monitoring adverse events during the colonoscopy between the two groups. Results A total of 365 patients were evaluated by intention to treat (ITT) analysis, and 319 were evaluated by per protocol (PP) population analysis (153 for SPMC/bisacodyl, 166 for PEG). The mean total BBPS score was not different between the two groups in both the ITT and PP analyses (p>0.05). The mean VAS score for satisfaction and LS score for the ease of use were higher in the SPMC/bisacodyl group (p<0.001). The adverse event rate was lower in the SPMC/bisacodyl group than in the PEG group (p<0.05). Conclusions The SPMC/bisacodyl treatment was comparable to conventional PEG with respect to bowel preparation adequacy and superior with respect to compliance, satisfaction, and safety.
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Affiliation(s)
- Hyun Gun Kim
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyu Chan Huh
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Hoon Sup Koo
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Seong-Eun Kim
- Division of Gastroenterology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck-Ho Lee
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Biostatistical Consulting Unit, Soonchunhynag University College of Medicine, Seoul, Korea
| | - Chang Kyun Lee
- Biostatistical Consulting Unit, Soonchunhynag University College of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Eun Joo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Myung Cha
- Biostatistical Consulting Unit, Soonchunhynag University College of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Kring TS, Piper TB, Jørgensen LN, Olsen J, Rahr HB, Nielsen KT, Laurberg S, Davis G, Dowell B, Johansen JS, Christensen IJ, Brünner N, Nielsen HJ. Blood-based Biomarkers at Large Bowel Endoscopy and Prediction of Future Malignancies. BIOMARKERS IN CANCER 2015; 7:57-61. [PMID: 26526637 PMCID: PMC4620935 DOI: 10.4137/bic.s31330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 12/11/2022]
Abstract
Soluble cancer-related protein biomarker levels may be increased in subjects without findings at large bowel endoscopy performed due to symptoms associated with colorectal cancer. The present study focused on a possible association between increased biomarker levels in such subjects and subsequent development of malignant diseases. In a major study of 4,990 subjects undergoing large bowel endoscopy, 691 were without pathology and comorbidity. Plasma levels of TIMP-1, CEA, CA19-9, and YKL-40 were determined in samples collected just before endoscopy and compared with subsequent development of a malignant disease within a period of 7-8 years. The upper 90% limits of the reference levels of every single protein were used to differentiate between normal and increased levels. The levels were separated into three groups: 0, none of the biomarkers increased; 1, one biomarker increased; 2, two or more biomarkers increased. A total of 43 subjects developed a primary malignant disease in the observation period. Univariatly, increase of all four biomarkers was significantly associated with subsequent development of a malignant disease. A multivariate analysis showed that increased biomarker levels were associated with subsequent development of a malignant disease (P = 0.002). The cumulative risk of developing malignant disease within the first 5 years after endoscopy was group 0, 3.3%; group 1, 5.8%; group 2, 7.8%. It is concluded that increased levels of plasma TIMP-1, CEA, CA19-9, and serum YKL-40 at large bowel endoscopy without findings may be associated with an increased risk of developing a subsequent malignant disease.
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Affiliation(s)
- Thomas S Kring
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Thomas B Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark. ; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Olsen
- Department of Surgical Gastroenterology, Glostrup Hospital, Glostrup, Denmark
| | - Hans B Rahr
- Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Knud T Nielsen
- Department of Surgery, Randers Hospital, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital THG, Aarhus, Denmark
| | | | | | | | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Nils Brünner
- Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark. ; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Garcia GH, Riechelmann RP, Hoff PM. Adherence to colonoscopy recommendations for first-degree relatives of young patients diagnosed with colorectal cancer. Clinics (Sao Paulo) 2015; 70:696-9. [PMID: 26598083 PMCID: PMC4602375 DOI: 10.6061/clinics/2015(10)07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/03/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Colorectal cancer is the third leading cause of cancer death in the United States. The American College of Gastroenterology recommends screening for first-degree relatives of patients diagnosed with colorectal cancer before the age of 50. A colonoscopy is one of the most commonly recommended exams due to its specificity and the possibility to resect pre-malignant lesions. Nevertheless, the rate of physician adherence to this recommendation is unknown. METHODS This transversal study was performed at a major cancer center in Brazil with 62 patients, aged 18 to 50, who completed a questionnaire on information received from their physicians regarding screening their first-degree relatives. We used the answers from patients who provided explicit consent. RESULTS Two hundred and three patients were eligible to participate and 93 (45.8%) agreed to complete the questionnaire. Twenty-three questionnaires (24.73%) were returned and 39 were completed by telephone. Of the patients who answered the questionnaire, 39 (62.9%) had received a colonoscopy recommendation for their first-degree relatives and 23 (37.1%) were not informed of the recommendation. Among the patients who received the recommendations, 20.51% affirmed that all relatives completed the exam and 51.28% stated that no relatives completed the exam. DISCUSSION The adherence rate of our physicians to the ACG guideline recommendations was 62.9%. Considering that our study was performed at a leading center for cancer treatment in Latin America, we had expected better adherence. The results show that adherence to the colorectal cancer screening recommendations for high-risk patients must be improved.
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Affiliation(s)
- Guilherme H Garcia
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Corresponding author: E-mail: /
| | - Rachel P Riechelmann
- Instituto do Cancer do Estado de São Paulo; Disciplina de Radiologia e Oncologia, São Paulo, SP, Brazil
| | - Paulo M Hoff
- Instituto do Cancer do Estado de São Paulo; Disciplina de Radiologia e Oncologia, São Paulo, SP, Brazil
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Del Vecchio Blanco G, Paoluzi OA, Sileri P, Rossi P, Sica G, Pallone F. Familial colorectal cancer screening: When and what to do? World J Gastroenterol 2015; 21:7944-7953. [PMID: 26185367 PMCID: PMC4499338 DOI: 10.3748/wjg.v21.i26.7944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/04/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of death worldwide and represents a clinical challenge. Family members of patients affected by CRC have an increased risk of CRC development. In these individuals, screening is strongly recommended and should be started earlier than in the population with average risk, in order to detect neoplastic precursors, such as adenoma, advanced adenoma, and nonpolypoid adenomatous lesions of the colon. Fecal occult blood test (FOBT) is a non invasive, widespread screening method that can reduce CRC-related mortality. Sigmoidoscopy, alone or in addition to FOBT, represents another screening strategy that reduces CRC mortality. Colonoscopy is the best choice for screening high-risk populations, as it allows simultaneous detection and removal of preneoplastic lesions. The choice of test depends on local health policy and varies among countries.
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Fukuzawa M, Uematsu J, Kono S, Suzuki S, Sato T, Yagi N, Tsuji Y, Yagi K, Kusano C, Gotoda T, Kawai T, Moriyasu F. Clinical impact of endoscopy position detecting unit (UPD-3) for a non-sedated colonoscopy. World J Gastroenterol 2015; 21:4903-4910. [PMID: 25945003 PMCID: PMC4408462 DOI: 10.3748/wjg.v21.i16.4903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/12/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether an endoscopy position detecting unit (UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale (VAS) pain scores, regardless of the colonoscopist’s level of experience.
METHODS: A total of 260 patients (170 men and 90 women) who underwent a colonoscopy were divided into the UPD-3-guided group or the conventional group (no UPD-3 guidance). Colonoscopies were performed by experts (experience of more than 1000 colonoscopies) or trainees (experience of less than 100 colonoscopies). Cecal intubation rates, cecal intubation times, insertion methods (straight insertion: shortening the colonic fold through the bending technique; roping insertion: right turn shortening technique) and patient discomfort were assessed. Patient discomfort during the endoscope insertion was scored by the VAS that was divided into 6 degrees of pain.
RESULTS: The cecum intubation rates, cecal intubation times, number of cecal intubations that were performed in < 15 min and insertion methods were not significantly different between the conventional group and the UPD-3-guided group. The number of patients who experienced pain during the insertion was markedly less in the UPD-3-guided group than in the conventional group. Univariate and multivariate analysis showed that the following factors were associated with lower VAS pain scores during endoscope insertion: insertion method (straight insertion) and UPD-3 guidance in the trainee group. For the experts group, univariate analysis showed that only the insertion method (straight insertion) was associated with lower VAS pain scores.
CONCLUSION: Although UPD-3 guidance did not shorten intubation times, it resulted in less patient pain during endoscope insertion compared with conventional endoscopy for the procedures performed by trainees.
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Abstract
Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior.
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Affiliation(s)
- David G Hewett
- School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia.
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, 550 North University Boulevard, Indiana University Hospital #4100, Indianapolis, IN 46202, USA
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Jeon SR, Kim HG, Lee JS, Kim JO, Lee TH, Cho JH, Kim YH, Cho JY, Lee JS. Randomized controlled trial of low-volume bowel preparation agents for colonic bowel preparation: 2-L polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate. Int J Colorectal Dis 2015; 30:251-8. [PMID: 25410648 DOI: 10.1007/s00384-014-2066-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Both 2-L polyethylene glycol with ascorbic acid (2-L PEG/Asc) and sodium picosulfate with magnesium citrate (SP/MC) are low-volume combined agents for colonic preparation. The aim of the current study was to compare the preparation adequacy and patient tolerability of 2-L PEG/Asc and SP/MC. METHODS We performed a prospective randomized controlled study in outpatients undergoing daytime colonoscopy at a tertiary academic hospital. We compared preparation adequacy based on the Boston Bowel Preparation Scale (BBPS), polyp and adenoma detection rate (PDR and ADR), compliance, tolerability for ease and palatability, intention to reuse, and patient satisfaction using a questionnaire between 2-L PEG/Asc and three sachets of SP/MC, both given in a split-dose method. RESULTS A total of 388 patients were evaluated based on intention to treat (ITT) and 356 patients per protocol (PP). No significant differences in preparation adequacy were observed in ITT and PP analyses, based on the BBPS (p > 0.05). The PDR and ADR were greater than 60 and 40% in both groups, respectively (p > 0.05). Compliance levels were higher in the 2-L PEG/Asc group than in the SP/MC group (p < 0.001). Satisfaction (ITT, p = 0.014; PP, p = 0.032) and palatability (ITT and PP, p < 0.001) levels were higher in the SP/MC group than in the 2-L PEG/Asc group, but values for tolerability for ease and intention to reuse were similar in both groups (ITT and PP, p > 0.05). CONCLUSIONS Both 2-L PEG/Asc and SP/MC had adequate bowel cleansing efficacy to satisfy PDR and ADR as quality indicator and had showed similar tolerability.
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Affiliation(s)
- Seong Ran Jeon
- Institute of Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 140-743, South Korea
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Jang JY, Chun HJ. Bowel preparations as quality indicators for colonoscopy. World J Gastroenterol 2014; 20:2746-2750. [PMID: 24659866 PMCID: PMC3961991 DOI: 10.3748/wjg.v20.i11.2746] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/11/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy is the principal investigative procedure for colorectal neoplasms because it can detect and remove most precancerous lesions. The effectiveness of colonoscopy depends on the quality of the examination. Bowel preparation is an essential part of high-quality colonoscopies because only an optimal colonic cleansing allows the colonoscopist to clearly view the entire colonic mucosa and to identify any polyps or other lesions. Suboptimal bowel preparation not only prolongs the overall procedure time, decreases the cecal intubation rate, and increases the costs associated with colonoscopy but also increases the risk of missing polyps or adenomas during the colonoscopy. Therefore, a repeat examination or a shorter colonoscopy follow-up interval may be suitable strategies for a patient with suboptimal bowel preparation.
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Wang WJ, Gao JX, Qian JY, Qi YR, Sun MH, Han HY, Liu WT. Water injection versus air insufflation for colonoscopy in elderly patients. Shijie Huaren Xiaohua Zazhi 2014; 22:601-605. [DOI: 10.11569/wcjd.v22.i4.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the impact of water injection versus air insufflation for colonoscopy on cecal intubation rate, cecal intubation time and pain degree in elderly patients.
METHODS: Two hundred elderly patients (aged 65-82 years) who underwent non-narcotic colonoscopy were randomly divided into two groups: water injection and air insufflation. The cecal intubation rate, cecal intubation time and pain degree were compared between the two groups.
RESULTS: There were no significant differences in cecal intubation rate (98% vs 94%, P > 0.05) or cecal intubation time (7.83 min ± 1.58 min vs 8.01 min ± 1.26 min, P > 0.05) between the water injection and air insufflation groups. Abdominal pain score was significantly lower in the water injection than in the air insufflation group (3.23 ± 1.71 vs 4.87 ± 1.94, P < 0.05).
CONCLUSION: Compared with air insufflation colonoscopy, water injection colonoscopy has similar cecal intubation rate and cecal intubation time, but is associated with significantly lower pain in elderly patients.
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Prevalence of colorectal cancer and its precursor lesions in symptomatic and asymptomatic patients undergoing total colonoscopy: results of a large prospective, multicenter, controlled endoscopy study. Eur J Gastroenterol Hepatol 2013; 25:556-61. [PMID: 23283303 DOI: 10.1097/meg.0b013e32835d1ef4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cancer in Germany. Screening colonoscopies have been offered in Germany since 2002. However, validation of screening programs for CRC relies on estimates up to date. OBJECTIVE The aim of this study was to analyze the influence of the risk factor tumor-suspicious symptoms on the prevalence of CRC and its precursor lesions in patients at least 55 years of age undergoing colonoscopy in comparison with an age-matched and sex-matched control population undergoing screening colonoscopy. DESIGN Multicenter, prospective, controlled colonoscopy study. SETTING Integrated care program of 49 gastroenterological practices in collaboration with a health insurance company and the screening colonoscopy program in Hesse, Germany. PATIENTS In total, 1075 symptomatic and 5375 asymptomatic participants were matched for age and sex (1 : 5) from 1 October 2008 to 30 September 2010. MAIN OUTCOME MEASUREMENTS Detection of CRC and its precursor lesions. RESULTS Overall, the prevalence of CRC was significantly equivalent in both the symptomatic (n=13/1075, 1.21%) and the control group [n=55/5375, 1.02%, 95% confidence interval (CI) for the difference: [-0.46%, 0.83%], P=0.0002, equivalence test with δ=1.5%], respectively. Advanced adenomas were observed in significantly fewer symptomatic patients (61/1075, 5.67%) compared with 432/5375 matched asymptomatic screening participants (8.03%, 95% CI for the difference: [-3.98%, -0.74%], P=0.0094, difference test). Finally, polyps were found significantly less often in symptomatic patients (n=269/1075, 25.0%) than in matched screening participants (n=1807/5375, 33.6%, 95% CI for the difference: [-11.53%, -5.66%], P<0.0001, difference test). CONCLUSION The results underline the importance of screening the symptom-free population at least 55 years of age to prevent CRC.
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Singal AG, Tiro JA, Gupta S. Improving hepatocellular carcinoma screening: applying lessons from colorectal cancer screening. Clin Gastroenterol Hepatol 2013; 11. [PMID: 23200983 PMCID: PMC3610769 DOI: 10.1016/j.cgh.2012.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) screening is a complex process, with failure at any step in the process contributing to a gap between its efficacy and effectiveness. Important lessons can be learned from colorectal cancer (CRC) screening studies to improve the HCC screening process in clinical practice. Lack of provider recommendations is a barrier for both CRC and HCC screening; however, under-recognition of at-risk individuals appears to be unique to HCC. Future HCC screening interventions should help providers identify at-risk patients as well as promote ordering of HCC screening among those with cirrhosis. Patient adherence, a well-recognized barrier to CRC screening, does not appear to be a major issue in HCC screening. Poor patient adherence may become an important factor in the future when upstream provider-level factors are addressed. Other steps in the screening process, including radiology capacity and timely follow-up, have been demonstrated as barriers for CRC screening but have yet to be assessed for HCC screening. Overall, many lessons learned from challenges to CRC screening can be applied to rapidly optimize HCC screening delivery.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA.
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Abstract
OBJECTIVES Although research shows that African Americans and Hispanics frequently receive less colorectal cancer screening (CRCS) than whites, few studies have focused on CRCS among Asians. The aims of this study were to compare CRCS between Asians and whites and to evaluate for clinical predictors of CRCS. METHODS From the 2007 California Health Interview Survey, we identified all Asian and white respondents who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status, birthplace, or language skills, while controlling for other confounders. RESULTS Baseline characteristics were similar between Asians and whites. Only 58% of Asians and 66% of whites reported undergoing up-to-date CRCS (P < 0.01). In multivariate analyses, visiting a physician more than 5 times produced the highest odds of being up-to-date with screening. When compared with whites, Asians had decreased odds of being up-to-date with screening. Stratified analyses showed that this disparity existed mainly in the insured, but not in the uninsured, and it was not modified by place of birth or English language proficiency. CONCLUSIONS Despite its ability to reduce mortality, CRCS is suboptimal in our US population-based cohort of Asians when compared with whites. A contributing factor to this problem for the Chinese and Koreans may be a lack of awareness regarding CRCS, whereas the source of the problem in the Vietnamese seems to be related to healthcare access.
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Maffei F, Angelini S, Cantelli Forti G, Hrelia P. Blood Biomarkers Linked to Oxidative Stress and Chronic Inflammation for Risk Assessment of Colorectal Neoplasia. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-012-0156-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lambert R. Endoscopy in screening for digestive cancer. World J Gastrointest Endosc 2012; 4:518-25. [PMID: 23293721 PMCID: PMC3536848 DOI: 10.4253/wjge.v4.i12.518] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/12/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to describe the role of endoscopy in detection and treatment of neoplastic lesions of the digestive mucosa in asymptomatic persons. Esophageal squamous cell cancer occurs in relation to nutritional deficiency and alcohol or tobacco consumption. Esophageal adenocarcinoma develops in Barrett's esophagus, and stomach cancer in chronic gastric atrophy with Helicobacter pylori infection. Colorectal cancer is favoured by a high intake in calories, excess weight, low physical activity. In opportunistic or individual screening endoscopy is the primary detection procedure offered to an asymptomatic individual. In organized or mass screening proposed by National Health Authorities to a population, endoscopy is performed only in persons found positive to a filter selection test. The indications of primary upper gastrointestinal endoscopy and colonoscopy in opportunistic screening are increasingly developing over the world. Organized screening trials are proposed in some regions of China at high risk for esophageal cancer; the selection test is cytology of a balloon or sponge scrapping; they are proposed in Japan for stomach cancer with photofluorography as a selection test; and in Europe, America and Japan; for colorectal cancer with the fecal occult blood test as a selection test. Organized screening trials in a country require an evaluation: the benefit of the intervention assessed by its impact on incidence and on the 5 year survival for the concerned tumor site; in addition a number of bias interfering with the evaluation have to be controlled. Drawbacks of screening are in the morbidity of the diagnostic and treatment procedures and in overdetection of none clinically relevant lesions. The strategy of endoscopic screening applies to early cancer and to benign adenomatous precursors of adenocarcinoma. Diagnostic endoscopy is conducted in 2 steps: at first detection of an abnormal area through changes in relief, in color or in the course of superficial capillaries; then characterization of the morphology of the lesion according to the Paris classification and prediction of the risk of malignancy and depth of invasion, with the help of chromoscopy, magnification and image processing with neutrophil bactericidal index or FICE. Then treatment decision offers 3 options according to histologic prediction: abstention, endoscopic resection, surgery. The rigorous quality control of endoscopy will reduce the miss rate of lesions and the occurrence of interval cancer.
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Affiliation(s)
- René Lambert
- René Lambert, World Health Organization International Agency for Research on Cancer, Screening Group, Lyon 69372, France
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Imperiale TF, Glowinski EA, Lin-Cooper C, Ransohoff DF. Tailoring colorectal cancer screening by considering risk of advanced proximal neoplasia. Am J Med 2012; 125:1181-7. [PMID: 23062404 PMCID: PMC3529406 DOI: 10.1016/j.amjmed.2012.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Quantifying the risk of advanced proximal colorectal neoplasia might allow tailoring of colorectal cancer screening, with colonoscopy for those at high risk and less invasive screening for very low-risk persons. METHODS We analyzed findings from 10,124 consecutive adults aged≥50 years who underwent screening colonoscopy to the cecum. We quantified the risk of advanced neoplasia (tubular adenoma≥1 cm, a polyp with villous histology or high-grade dysplasia, or adenocarcinoma) both proximally (cecum to splenic flexure) and distally (descending colon to anus). The prevalence of advanced proximal neoplasia was quantified by age, gender, and distal findings. RESULTS The mean (standard deviation) age was 57.5 (6.0) years; 44% were women; 7835 (77%) had no neoplasia, and 1856 (18%) had 1 or more nonadvanced adenomas. Overall, 433 subjects (4.3%) had advanced neoplasia (267 distally, 196 proximally, 30 both), 33 (0.33%) of which were adenocarcinoma (18 distal, 15 proximal). The risk of advanced proximal neoplasia increased with age decade (1.13%, 2.00%, and 5.26%, respectively; P=.001) and was higher in men (relative risk [RR], 1.91; confidence interval [CI], 1.32-2.77). In women aged less than 70 years, the risk was 1.1% overall (vs 2.2% in men; RR, 1.98; CI, 1.42-2.76) and 0.86% in those with no distal neoplasia (vs 1.54% in men; RR, 1.81; CI, 1.20-2.74). CONCLUSIONS Risk of advanced proximal neoplasia is a function of age and gender. Women aged less than 60 to 70 years have a very low risk, particularly those with no distal adenoma. Sigmoidoscopy with or without occult blood testing may be sufficient and even preferable for screening these subgroups.
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Affiliation(s)
- Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
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Serum seleno-proteins status for colorectal cancer screening explored by data mining techniques - a multidisciplinary pilot study. Microchem J 2012. [DOI: 10.1016/j.microc.2012.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Zapka J, Klabunde CN, Taplin S, Yuan G, Ransohoff D, Kobrin S. Screening colonoscopy in the US: attitudes and practices of primary care physicians. J Gen Intern Med 2012; 27:1150-8. [PMID: 22539065 PMCID: PMC3514996 DOI: 10.1007/s11606-012-2051-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 02/14/2012] [Accepted: 03/09/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rising colorectal cancer (CRC) screening rates in the last decade are attributable almost entirely to increased colonoscopy use. Little is known about factors driving the increase, but primary care physicians (PCPs) play a central role in CRC screening delivery. OBJECTIVE Explore PCP attitudes toward screening colonoscopy and their associations with CRC screening practice patterns. DESIGN Cross-sectional analysis of data from a nationally representative survey conducted in 2006-2007. PARTICIPANTS 1,266 family physicians, general practitioners, general internists, and obstetrician-gynecologists. MAIN MEASURES Physician-reported changes in the volume of screening tests ordered, performed or supervised in the past 3 years, attitudes toward colonoscopy, the influence of evidence and perceived norms on their recommendations, challenges to screening, and practice characteristics. RESULTS The cooperation rate (excludes physicians without valid contact information) was 75%; 28% reported their volume of FOBT ordering had increased substantially or somewhat, and the majority (53%) reported their sigmoidoscopy volume decreased either substantially or somewhat. A majority (73%) reported that colonoscopy volume increased somewhat or substantially. The majority (86%) strongly agreed that colonoscopy was the best of the available CRC screening tests; 69% thought it was readily available for their patients; 59% strongly or somewhat agreed that they might be sued if they did not offer colonoscopy to their patients. All three attitudes were significantly related to substantial increases in colonoscopy ordering. CONCLUSIONS PCPs report greatly increased colonoscopy recommendation relative to other screening tests, and highly favorable attitudes about colonoscopy. Greater emphasis is needed on informed decision-making with patients about preferences for test options.
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Affiliation(s)
- Jane Zapka
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Park SM, Lee SH, Shin KY, Heo J, Sung SH, Park SH, Choi SY, Lee DW, Park HG, Lee HS, Jeon SW, Kim SK, Jung MK. The cap-assisted technique enhances colonoscopy training: prospective randomized study of six trainees. Surg Endosc 2012; 26:2939-43. [PMID: 22538693 DOI: 10.1007/s00464-012-2288-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/26/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colonoscopy and polypectomy procedures have effectively reduced the incidence of colorectal cancer. Currently, competence in colonoscopy is an essential part of the education program for gastrointestinal (GI) trainees. However, considerable training is required for the optimal performance of a colonoscopy. METHODS This study involved six colonoscopy trainees, three of whom used the cap whereas the others did not. Each trainee managed 100 cases of screening colonoscopy from beginning to end. The cecal intubation success rate, cecal intubation time, polyp detection rate, adenoma detection rate, advanced adenoma detection rate, and adenocarcinoma detection rate were checked. The rate of successful cecal intubation and the cecal intubation time were reviewed every 10 cases. RESULTS The cecal intubation rate was 80.7 % (242/300) in the cap group and 63.3 % (190/300) in the non-cap group. The average cecal intubation time was 13.7 min in the cap group and 18.7 min in the non-cap group. The statistical analysis of these results suggested that the cap group had a significantly higher success rate (p < 0.001) and a shorter cecal intubation time (p < 0.001) than the non-cap group. However, the two groups did not differ significantly in the detection rate for polyps (45.3 vs 43 %; p = 0.565), adenomas (26.3 vs 25 %; p = 0.709), advanced adenomas (2.6 vs 0.6 %; p = 0.056), or adenocarcinomas (5.3 vs 3 %; p = 0.153). CONCLUSION Cap-assisted colonoscopies might help to increase the rate of cecal intubation success and shorten the cecal intubation time for GI trainees.
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Affiliation(s)
- Sang Man Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, 50, Samduk-Dong 2 Ga, Junggu, Daegu, 700-721, South Korea
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Trends in colorectal cancer incidence by anatomic site and disease stage in the United States from 1976 to 2005. Am J Clin Oncol 2012; 34:573-80. [PMID: 21217399 DOI: 10.1097/coc.0b013e3181fe41ed] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objectives of the current study were to examine the trends in incidence rates of subsite-specific colorectal cancer at all stages in a large US population and to explore the impact of age and sex on colorectal cancer incidence. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) 9 registries. Colorectal cancer incidence was divided into 3 anatomic subsite groupings: proximal colon, distal colon, and rectum. Incidence rates and relative risk were calculated using the SEER*Stat software provided by the National Cancer Institute. RESULTS From 1976 to 2005, age-adjusted incidence of proximal colon, distal colon, and rectal cancers per 100,000 population have steadily decreased from 22.5, 18.8, and 19.2 to 21.1, 11.7, and 13.6, respectively, contributing to the overall decline in the incidence of colorectal cancer from 60.5 to 46.4. Distal colon cancer had the greatest incidence decline (-37.79%), whereas the most minimal change in the incidence rates occurred for proximal colon cancer (-6.37%) because of increased incidence rates of ascending colon (24.8%) and hepatic flexure (21.3%) over 30 years. The steadily increased proportion of proximal colorectal cancer subsites was observed in both men and women starting at age 50 although women experienced a greater increase than did men. CONCLUSIONS Overall incidence rate of colorectal cancer decreased over the past 3 decades. The percent of ascending colon and hepatic flexure cancers diagnosed at early stages (localized and regional) increased. The finding on sex difference over years suggests that great attention should be paid in the future studies to male and female disparities.
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Nielsen HJ, Jakobsen KV, Christensen IJ, Brünner N. Screening for colorectal cancer: possible improvements by risk assessment evaluation? Scand J Gastroenterol 2011; 46:1283-94. [PMID: 21854094 PMCID: PMC3205805 DOI: 10.3109/00365521.2011.610002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 06/24/2011] [Accepted: 07/07/2011] [Indexed: 02/06/2023]
Abstract
Emerging results indicate that screening improves survival of patients with colorectal cancer. Therefore, screening programs are already implemented or are being considered for implementation in Asia, Europe and North America. At present, a great variety of screening methods are available including colono- and sigmoidoscopy, CT- and MR-colonography, capsule endoscopy, DNA and occult blood in feces, and so on. The pros and cons of the various tests, including economic issues, are debated. Although a plethora of evaluated and validated tests even with high specificities and reasonable sensitivities are available, an international consensus on screening procedures is still not established. The rather limited compliance in present screening procedures is a significant drawback. Furthermore, some of the procedures are costly and, therefore, selection methods for these procedures are needed. Current research into improvements of screening for colorectal cancer includes blood-based biological markers, such as proteins, DNA and RNA in combination with various demographically and clinically parameters into a "risk assessment evaluation" (RAE) test. It is assumed that such a test may lead to higher acceptance among the screening populations, and thereby improve the compliances. Furthermore, the involvement of the media, including social media, may add even more individuals to the screening programs. Implementation of validated RAE and progressively improved screening methods may reform the cost/benefit of screening procedures for colorectal cancer. Therefore, results of present research, validating RAE tests, are awaited with interest.
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Affiliation(s)
- Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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Recommendations for post-polypectomy surveillance in community practice. Dig Dis Sci 2011; 56:2623-30. [PMID: 21698368 PMCID: PMC3199324 DOI: 10.1007/s10620-011-1791-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/06/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number. AIMS To learn physicians' recommendations for post-polypectomy surveillance from physicians' office charts. METHODS Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted. RESULTS Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4-6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1-3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than "excellent." Prep quality was not reported for 32% of examinations. CONCLUSIONS Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.
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Dear K, Scott L, Chambers S, Corbett MC, Taupin D. Perception of Colorectal Cancer Risk does not Enhance Participation in Screening. Therap Adv Gastroenterol 2011; 1:157-67. [PMID: 21180525 DOI: 10.1177/1756283x08097776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
High participation is a key requirement for effective cancer screening. Many strategies to improve participation hold that a person's knowledge and beliefs dictate screening behavior. We compared perception of colon cancer risk in participants and nonparticipants in a population-based study of screening colonoscopy, and also assessed past screening behavior. Surprisingly, while past screening behavior was a predictor of participation, we found that participants perceived their risk of colorectal cancer to be significantly and substantially lower than the real figure and that of nonparticipants. Our data suggest that health promotion strategies aimed at improving health knowledge may not be effective in improving population screening rates.
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Affiliation(s)
- Keith Dear
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
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Wu RSY, Chan SSW, Cheung NK, Graham CA, Rainer TH. Open-access colonoscopy: outcomes of referrals from the emergency department. Colorectal Dis 2011; 13:826-8. [PMID: 20456463 DOI: 10.1111/j.1463-1318.2010.02301.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM The study investigated the diagnostic outcome of colonoscopy referrals from the emergency department (ED) via an open-access system. METHOD A retrospective cohort study over two years was performed on all patients under 65 years referred for open-access colonoscopy by the ED in a hospital with an annual ED attendance of 140,000. Patient characteristics and presenting symptoms were retrieved. Waiting times from presentation to colonoscopy were recorded. RESULTS Over a 2-year period, 266 patients were referred, of whom 37 defaulted, leaving 229 patients who had a colonoscopy. The mean age was 48.3 ± 11.3 (SD) and the female/male ratio was 229/125. The most frequent presenting symptoms included: rectal bleeding (n = 142, 62%), change of bowel habit (n = 47, 20.5%) and abdominal pain (n = 40, 17.5%). The median waiting time from presentation to colonoscopy was 17 (range 1-69) days. A positive colonoscopic finding was recorded in 45.4%, including colorectal cancer in 12 (5.2%). CONCLUSION The rate of a positive diagnoses from the ED-based colonoscopy referral service was comparable to that of the general Hong Kong population. This approach may help to reduce the waiting time for colonoscopy in a specialist colorectal clinic.
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Affiliation(s)
- R S Y Wu
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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Nielsen HJ, Brünner N, Jorgensen LN, Olsen J, Rahr HB, Thygesen K, Hoyer U, Laurberg S, Stieber P, Blankenstein MA, Davis G, Dowell BL, Christensen IJ. Plasma TIMP-1 and CEA in detection of primary colorectal cancer: a prospective, population based study of 4509 high-risk individuals. Scand J Gastroenterol 2011; 46:60-9. [PMID: 20799911 DOI: 10.3109/00365521.2010.513060] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The combination of plasma tissue inhibitor of metalloproteinases-1 (TIMP-1) and carcinoembryonic antigen (CEA) may be valuable biomarkers for early detection of colorectal cancer (CRC). A prospective, population based study was performed to validate this hypothesis. MATERIAL AND METHODS Individuals (n = 4509) referred for large bowel endoscopy due to symptoms of CRC were prospectively included. Baseline data and concurrent diseases were recorded. The primary endpoint was detection of CRC and findings at examinations were recorded using International Classification of Diseases-10 codes. Plasma was obtained before endoscopy and TIMP-1 and CEA levels were determined after the inclusion of all individuals. RESULTS Findings were based on sigmoidoscopy in 1766 and colonoscopy in 2743 individuals. Colon cancer (CC) was detected in 184 and rectal cancer in 110 individuals. Ten individuals with other cancers, 856 with adenomas and 1176 with non-neoplastic findings were also detected. The biomarker levels were increased in a variety of diseases including CRC compared to individuals without any findings at endoscopy. A multivariable analysis demonstrated that both markers were significant and independent detectors of CRC. Combining both biomarkers, independent contributions from each (TIMP-1, odds ratio (OR) = 1.8 (95% confidence interval (CI): 1.4-2.2), p < 0.0001; CEA < 5 ng/ml, OR = 1.6, 1.3-1.9, or ≥ 5 ng/ml, OR = 2.3, 95% CI: 1.9-2.7 (p < 0.0001)) were obtained. Subgroup analysis of individuals examined by colonoscopy with CC as the endpoint showed that combining both biomarkers, independent contributions from each (TIMP-1, OR = 2.5, 95% CI: 1.8-3.4, p < 0.0001; CEA < 5 ng/ml, OR = 1.4, 95% CI: 1.1-1.8, and CEA ≥ 5 ng/ml, OR = 2.3, 95% CI: 1.8-3.0 (p < 0.0001)) were obtained. CONCLUSIONS This prospective validation study supports the use of the combination of plasma TIMP-1 and CEA protein measurements as a potential aid in early detection of CRC and specifically of CC.
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Affiliation(s)
- Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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Vannelli A, Battaglia L, Poiasina E, Leo E. Diagnosis of rectal cancer by Tissue Resonance Interaction Method. BMC Gastroenterol 2010; 10:45. [PMID: 20462445 PMCID: PMC2874761 DOI: 10.1186/1471-230x-10-45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 05/12/2010] [Indexed: 12/16/2022] Open
Abstract
Background Since population screening has the potential to reduce mortality from rectal cancer (RC), novel methods with improved cost-effectiveness warrant consideration. In a previous pilot study, we found that the rapid, inexpensive and non-invasive electromagnetic detection of RC is a highly specific and sensitive technique. The aim of the present prospective study was to evaluate the prediction accuracy of electromagnetic detection of RC. Methods 304 eligible subjects were consecutively enrolled in our Institute and subjected to electromagnetic detection followed by colonoscopy and histopathologic analysis of biopsies. A putative RC carrier status was attributed to subjects showing an electromagnetic signal < 50 units (U). Results RC patients showed a significantly lower electromagnetic signal (40.9 ± 0.9 U; mean ± S.E.) than did non-RC subjects (79.2 ± 1.4 U; P < 2.2e-16). At a threshold < 50 U, electromagnetic detection identified 103 putative patients, whereas colonoscopy detected 108 patients, with an overlap of 91 patients between the two methods. The 15.7% false-negative rate by electromagnetic detection was brought to zero by raising the threshold value to 70 U; on the other hand, such a threshold increased the false-positive rate to 30%. Conclusion Electromagnetic detection of RC at a signal threshold < 70 U appears to eliminate false-negative results. Although colonoscopy would still be required in examining the false-positives associated with the < 70 U electromagnetic threshold, the need for this method would be reduced. Thus, electromagnetic detection represents a new accurate, rapid, simple, and inexpensive tool for early detection of RC that merits testing in large population-based programs.
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Lambert R. [Colonoscopy: maximizing detection and characterization]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33:737-746. [PMID: 19683885 DOI: 10.1016/j.gcb.2009.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The endoscopic analysis of the colonic lumen with a flexible tube began around1960, at first with a gastrocamera, then with a fibrocolonoscope. After 1990, the electronic imaging brought a three points revolution with increased resolution of the image, transfer of the image on a television monitor giving access to multiple observers, electronic image processing. The recent colonoscopes have an increased resolution with more pixels in the Charged Coupled Device (CCD) sensor, a High Definition Television (HDTV) image and an electronic and/or optical zoom for magnification. Colonoscopy is now often performed in a similar environment to that of surgery. Therapeutic applications justify a strict strategy for endoscopic diagnosis. At first, detection of the lesion in standard vision, then characterization with the help of chromoscopy for the evaluation of morphology and with the help of magnification for the evaluation of the pit pattern. Then, comes the time for treatment decision between abstention, endoscopic resection or surgery. The legitimacy of the management is controlled in retrospective by the analysis of the tissue samples. Recent alternatives to colonoscopy (3D radiological imaging, colon capsule) should not invalidate the priority attributed to colonoscopy which associates treatment to the early detection of colorectal cancer and precursors.
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Affiliation(s)
- R Lambert
- Group of Screening, International Agency for Research on Cancer, 69372 Lyon cedex 08, France.
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Loktionov A, Ferrett CG, Gibson JJS, Bandaletova T, Dion C, Llewelyn AH, Lywood HGG, Lywood RCG, George BD, Mortensen NJ. A case-control study of colorectal cancer detection by quantification of DNA isolated from directly collected exfoliated colonocytes. Int J Cancer 2009; 126:1910-1919. [DOI: 10.1002/ijc.24729] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Croswell JM, Kramer BS, Kreimer AR, Prorok PC, Xu JL, Baker SG, Fagerstrom R, Riley TL, Clapp JD, Berg CD, Gohagan JK, Andriole GL, Chia D, Church TR, Crawford ED, Fouad MN, Gelmann EP, Lamerato L, Reding DJ, Schoen RE. Cumulative incidence of false-positive results in repeated, multimodal cancer screening. Ann Fam Med 2009; 7:212-22. [PMID: 19433838 PMCID: PMC2682972 DOI: 10.1370/afm.942] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Multiple cancer screening tests have been advocated for the general population; however, clinicians and patients are not always well-informed of screening burdens. We sought to determine the cumulative risk of a false-positive screening result and the resulting risk of a diagnostic procedure for an individual participating in a multimodal cancer screening program. METHODS Data were analyzed from the intervention arm of the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a randomized controlled trial to determine the effects of prostate, lung, colorectal, and ovarian cancer screening on disease-specific mortality. The 68,436 participants, aged 55 to 74 years, were randomized to screening or usual care. Women received serial serum tests to detect cancer antigen 125 (CA-125), transvaginal sonograms, posteroanterior-view chest radiographs, and flexible sigmoidoscopies. Men received serial chest radiographs, flexible sigmoidoscopies, digital rectal examinations, and serum prostate-specific antigen tests. Fourteen screening examinations for each sex were possible during the 3-year screening period. RESULTS After 14 tests, the cumulative risk of having at least 1 false-positive screening test is 60.4% (95% CI, 59.8%-61.0%) for men, and 48.8% (95% CI, 48.1%-49.4%) for women. The cumulative risk after 14 tests of undergoing an invasive diagnostic procedure prompted by a false-positive test is 28.5% (CI, 27.8%-29.3%) for men and 22.1% (95% CI, 21.4%-22.7%) for women. CONCLUSIONS For an individual in a multimodal cancer screening trial, the risk of a false-positive finding is about 50% or greater by the 14th test. Physicians should educate patients about the likelihood of false positives and resulting diagnostic interventions when counseling about cancer screening.
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Affiliation(s)
- Jennifer Miller Croswell
- Office of the Director, Office of Disease Prevention, National Institutes of Health, 6100 Executive Blvd, Suite 2B-03, Bethesda, MD 20892, USA.
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Abstract
The incidence of hepatocellular carcinoma (HCC) is rising, and the number of patients with HCC is expected to more than double over the next 1 to 2 decades. HCC meets the criteria for establishment of a surveillance program. Patients with cirrhosis, regardless of the cause, are at the highest risk for developing HCC and this is the population in which surveillance should be performed. (Alpha-fetoprotein and hepatic ultrasonography are the currently recommended surveillance tests. If a surveillance test is abnormal, there is a need for a recall test for diagnostic evaluation of HCC. Triple-phase imaging is recommended for evaluation at recall, with MRI being more sensitive and specific. Novel genetic markers can improve the histologic diagnosis of early HCC. The Barcelona staging classification is the best system for determining the prognosis of patients and it is linked to an evidence-based treatment algorithm. Resection, transplantation, and percutaneous ablation are considered curative interventions and are currently applied to about 30% of all patients with HCC.
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Affiliation(s)
- Jorge A Marrero
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, Ann Arbor, MI 48109-0362, USA.
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Bond J, Tuckey M. An evaluation of current methods of diagnosing colorectal cancer in the United Kingdom. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lynch HT, Boland CR, Gong G, Shaw TG, Lynch PM, Fodde R, Lynch JF, de la Chapelle A. Phenotypic and genotypic heterogeneity in the Lynch syndrome: diagnostic, surveillance and management implications. Eur J Hum Genet 2009; 14:390-402. [PMID: 16479259 DOI: 10.1038/sj.ejhg.5201584] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lynch syndrome is the most common form of hereditary colorectal cancer (CRC). This review covers the cardinal features of Lynch syndrome with particular emphasis upon its diagnostic criteria, molecular genetics, natural history, genetic counseling, surveillance and management. Considerable attention has been given to the etiologic role of mismatch repair (MMR) genes as well as low penetrance alleles and modifier genes. The American founder mutation, a deletion of exons 1-6 of MSH2, is discussed in some detail, owing to its high frequency in the US (19 000-30 000 carriers). Genetic counseling is essential prior to patients' undergoing DNA testing and again when receiving their test results. Families with a lower incidence of CRC and extracolonic cancers, in the face of being positive for Amsterdam I criteria but who do not have MMR deficiency by tumor testing, are probably not Lynch syndrome, and thereby should preferably be designated as familial CRC of undetermined type. Patients who are either noncompliant or poorly compliant with colonoscopy, and who are MMR mutation positive, may be candidates for prophylactic colectomy, while MMR mutation-positive women who are noncompliant with gynecologic surveillance may be candidates for prophylactic hysterectomy and bilateral salpingo-oophorectomy.
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Affiliation(s)
- Henry T Lynch
- Department of Preventive Medicine, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
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Faecal occult blood test-based screening programme with high compliance for colonoscopy has a strong clinical impact on colorectal cancer. Br J Surg 2009; 96:533-40. [DOI: 10.1002/bjs.6568] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abstract
Background
The results of a pilot colorectal cancer screening programme by biennial immunochemical faecal occult blood test (FOBT) are reported.
Methods
All residents aged between 50 and 69 years in the Italian province of Lecco were invited to have a FOBT. Those with a positive result were offered colonoscopy. FOBT uptake and compliance with colonoscopy were assessed. Detection rate and positive predictive value (PPV) for cancer and adenoma were calculated. Tumour stages were compared between screen-detected cancers and other colorectal cancers diagnosed within the target age group.
Results
Some 38 693 (49·6 per cent) of 78 083 individuals had a FOBT and 2392 (6·2 per cent) had a positive result. Colorectal cancer was diagnosed in 4·6 per cent and advanced adenoma in 32·7 per cent. PPVs were 4·0 per cent for cancer, 28·1 per cent for advanced adenoma and 36·6 per cent for any adenoma. There was a significant difference in incidence of stage III/IV disease between screened and non-screened cohorts. Compliance for colonoscopy was 92·0 per cent. Major determinants of compliance were age less than 59 years, female sex, high education level and non-manual work.
Conclusion
These results justify extension of colorectal cancer screening to other regions of Italy.
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Lu S, Chiu YSY, Smith AP, Moore D, Lee NM. Biomarkers correlate with colon cancer and risks: a preliminary study. Dis Colon Rectum 2009; 52:715-24. [PMID: 19404080 DOI: 10.1007/dcr.0b013e31819ed196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE We previously reported that gene expression analysis of biopsies of normal-appearing large intestinal mucosa can distinguish individuals with colonic cancer and many individuals at risk for colon cancer from controls. The purpose of this study was to determine whether noninvasively removed rectal swabs can identify individuals with colon cancer or risk of colon cancer as effectively as we previously demonstrated using biopsies. METHODS Rectal mucosa cells were removed by rectal swabs, and their gene expression profiles were compared with those of biopsies removed by colonoscopy. Expression of 16 genes in the rectal mucosa of 12 individuals with colon cancer, 25 with polyps, 37 with family or self-reported cancer history, and 23 controls was measured by real-time reverse transcription-polymerase chain reaction. RESULTS We found similar results using rectal swabs and biopsies. Groups of individuals with or at risk for cancer showed an altered gene expression profile compared with controls. Moreover, each of the 12 cancer patients showed altered expression relative to the mean of controls. CONCLUSIONS Gene expression analysis using rectal swabs may provide a convenient way to screen for colon cancer.
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Affiliation(s)
- Shan Lu
- California Pacific Medical Center Research Institute, San Francisco, California 94107, USA
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Courtier R, Casamitjana M, Macià F, Panadés A, Castells X, Gil MJ, Parés D, Sánchez-Ortega JM, Grande L. [Results of a study on populational colorectal cancer screening]. Cir Esp 2009; 85:152-7. [PMID: 19309603 DOI: 10.1016/j.ciresp.2008.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 10/06/2008] [Indexed: 01/22/2023]
Abstract
INTRODUCTION As colorectal cancer (CRC) screening based on occult blood detection has been shown to be effective in reducing mortality due to this disease, it is now important to decide on the best methods to obtain the maximum numbers of participants. The aim of the study was to analyse the results from a pilot CRC screening programme in a general population sample in Barcelona. A follow-up of false positive cases was made after five years. PATIENTS AND METHOD A cross section of the population aged 50-74 years in one primary health care centre was studied. The screening test consisted of an immunological method for the detection of faecal occult blood which was sent to the homes of the target population. RESULTS Participation was 46.6%, 11.7% of the tests were positive, and 79.3% agreed to have a colonoscopy. Eight adenocarcinomas and 32 patients with adenomas >0.4 cm were diagnosed. CONCLUSIONS The results obtained on the initial participation and the follow-up at five years suggest the viability of a CCR screening programme in our country.
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Affiliation(s)
- Ricardo Courtier
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Mar, Barcelona, Spain.
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Brenner H, Hoffmeister M, Brenner G, Altenhofen L, Haug U. Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopy programme: estimates based on 1,875,708 screening colonoscopies. Eur J Cancer 2009; 45:2027-33. [PMID: 19289271 DOI: 10.1016/j.ejca.2009.02.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/05/2009] [Accepted: 02/11/2009] [Indexed: 12/15/2022]
Abstract
In late 2002, colonoscopy was introduced as a primary screening tool for colorectal cancer (CRC) in Germany. We aimed to estimate the expected reduction in case numbers and incidence of CRC between 2003 and 2010 by detection and removal of advanced adenomas. Data from 1,875,708 women and men included in the national screening colonoscopy database were combined with estimates of transition rates of advanced adenomas and with national population projections. Despite relatively low screening participation, incident CRC cases are expected to be reduced by more than 15,000 between 2003 and 2010. The impact is expected to be largest in age groups 55-59, 60-64 and 65-69 in whom total case numbers in 2010 are expected to be reduced by 13%, 19% and 14% among women, and by 11%, 15% and 12%, respectively, among men. Our results forecast a major rapid reduction of the CRC burden in Germany by screening colonoscopy.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, D-69115 Heidelberg, Germany.
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Bowel preparation before colonoscopy in the era of mass screening for colo-rectal cancer: a practical approach. Dig Liver Dis 2009; 41:87-95. [PMID: 18676211 DOI: 10.1016/j.dld.2008.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/19/2008] [Accepted: 06/05/2008] [Indexed: 02/06/2023]
Abstract
Colonoscopy constitutes the principal investigation for colo-rectal neoplasms due to its ability to detect and remove most of precancerous lesions; due to the ongoing or planned colon cancer screening programs in many European countries we should expect an enormous increase in colonoscopic demand over the next few years. Diagnostic accuracy and therapeutic safety of colonoscopy strictly depends upon the quality of bowel cleansing which is often perceived as the most unpleasant part of the procedure in individuals undergoing this examination. The ideal preparation for colonoscopy should reliably empty the colon from all faecal material allowing the optimal visualization of the entire colonic mucosa without causing great patient's discomfort nor significant shifts in fluids or electrolytes. Standard PEG solutions and sodium phosphate (NaP) compounds are the most frequently used preparations; both are accepted and relatively well tolerated by the majority of patients undergoing colonoscopy; however, NaP compounds should be avoided in elderly subjects as well as in those with congestive heart failure, renal and hepatic insufficiency or taking diuretics, ACE inhibitors or angiotensin receptor blockers, since they can induce severe electrolyte and/or fluid disturbances. Standard PEG solutions are often taken incompletely due to the low palatability and the high volume of liquids required which induce nausea and vomiting with negative consequences in terms of colon cleansing. Reduced volume and better palatability of PEG solutions, such as those obtained with the newest PEG formulations, as well as improved patient education concerning the importance of bowel cleansing could undoubtedly increase compliance with oral bowel preparations and promote adherence to colo-rectal cancer screening programs.
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Colorectal Cancer Diagnosis Using DNA Levels in Blood and Stool. COLORECTAL CANCER 2009. [DOI: 10.1007/978-1-4020-9545-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shapiro JA, Seeff LC, Thompson TD, Nadel MR, Klabunde CN, Vernon SW. Colorectal cancer test use from the 2005 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2008; 17:1623-30. [PMID: 18628413 DOI: 10.1158/1055-9965.epi-07-2838] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Screening is effective in reducing colorectal cancer mortality. Recommended colorectal cancer screening options include a home fecal occult blood test (FOBT) or colorectal endoscopy (sigmoidoscopy or colonoscopy). Past surveys have indicated that colorectal cancer screening prevalence in the United States is low. The purpose of this analysis was to determine the prevalence of colorectal cancer test use in the United States by various factors and to examine reasons for not having a colorectal cancer test. METHODS Data on respondents ages > or =50 years from the 2005 National Health Interview Survey (n = 13,269) were analyzed. The proportion of the U.S. population that had home FOBT within the past year or endoscopy within the past 10 years was examined by sociodemographic, health-care access, and other health-related factors. Reported reasons for not having FOBT or endoscopy were also analyzed. RESULTS The age-standardized proportion of respondents who reported FOBT within the past year and/or endoscopy within the past 10 years was 50.0% [95% confidence interval (95% CI), 48.8-51.2]. Colorectal cancer testing rates were particularly low among people without health-care coverage (24.1%; 95% CI, 19.2-29.7) or without a usual source of health care (24.7%; 95% CI, 20.8-29.0). The most commonly reported reason for not having a colorectal cancer test was "never thought about it." CONCLUSIONS In 2005, about half of Americans ages > or =50 years did not have appropriate colorectal cancer testing. Increased efforts to expand health-care coverage or to provide colorectal cancer tests to people without health-care coverage are needed to increase colorectal cancer screening.
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Affiliation(s)
- Jean A Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA.
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Frenette CT, Strum WB. Relative rates of missed diagnosis for colonoscopy, barium enema, and flexible sigmoidoscopy in 379 patients with colorectal cancer. J Gastrointest Cancer 2008; 38:148-53. [PMID: 19089670 DOI: 10.1007/s12029-008-9027-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 08/22/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Failures of diagnosis of colorectal cancer by colonoscopy, barium enema, and flexible sigmoidoscopy have been demonstrated using various techniques. A relative assessment of these diagnostic tests for patients with colorectal cancer has not been reported. This study was designed to determine relative rates of failures for these tests when applied to diagnosis of colorectal cancer. METHODS We created a database of patients with colorectal cancer diagnosed between 2000 and 2005. Records were reviewed for the results of colonoscopy, barium enema, and flexible sigmoidoscopy in the 3 years prior to diagnosis. An examination that was negative for cancer with no immediate follow-up was defined as a failure of diagnosis, either from inaccurate observation, failure to examine the entire colon, or failure of timely follow-up. The failure rates were compared. RESULTS Three hundred seventy-nine patients, who had 421 examinations, were analyzed. The diagnosis of colorectal cancer failed in 60 of 379 patients (16%). These 60 patients had 71 examinations that failed to make the diagnosis: 25 of 282 colonoscopies (9%), 16 of 79 barium enemas (20%), and 30 of 60 flexible sigmoidoscopies (50%). These differences were statistically significant. CONCLUSIONS Failure rates for colonoscopy, barium enema, and flexible sigmoidoscopy were 9%, 20%, and 50%.
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Affiliation(s)
- Catherine T Frenette
- Division of Gastroenterology and Hepatology, Scripps Clinic and The Scripps Research Institute, La Jolla, CA, USA.
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Møller Sørensen N, Vejgaard Sørensen I, Ørnbjerg Würtz S, Schrohl AS, Dowell B, Davis G, Jarle Christensen I, Nielsen HJ, Brünner N. Biology and potential clinical implications of tissue inhibitor of metalloproteinases-1 in colorectal cancer treatment. Scand J Gastroenterol 2008; 43:774-86. [PMID: 18584515 DOI: 10.1080/00365520701878163] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related death in the industrialized world. About half of "curatively" resected patients develop recurrent disease within the next 3-5 years despite the lack of clinical, histological and biochemical evidence of remaining overt disease after resection of the primary tumour. Availability of validated biological markers for early detection, selection for adjuvant therapy, prediction of treatment efficacy and monitoring of treatment efficacy would most probably increase survival. Tissue inhibitor of metalloproteinases-1 (TIMP-1) may be such a marker. TIMP-1 inhibits the proteolytic activity of metalloproteinases, which are centrally involved in tumour invasion and metastases. However, in clinical investigations high tumour tissue or plasma levels of TIMP-1 have shown a strong and independent association with a shorter survival time in CRC patients, suggesting that TIMP-1 could have a tumour-promoting function. Furthermore, measurement of plasma TIMP-1 has been shown to be useful for disease detection, with a high sensitivity and high specificity for early-stage colon cancer. This review describes some basic information on the current knowledge of the biology of TIMP-1 as well as the potential use of TIMP-1 as a biological marker in the management of CRC patients.
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Affiliation(s)
- Nanna Møller Sørensen
- Section of Biomedicine, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
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Nielsen HJ, Brünner N, Frederiksen C, Lomholt AF, King D, Jørgensen LN, Olsen J, Rahr HB, Thygesen K, Hoyer U, Laurberg S, Christensen IJ. Plasma tissue inhibitor of metalloproteinases-1 (TIMP-1): a novel biological marker in the detection of primary colorectal cancer. Protocol outlines of the Danish-Australian endoscopy study group on colorectal cancer detection. Scand J Gastroenterol 2008; 43:242-8. [PMID: 18224568 DOI: 10.1080/00365520701523439] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
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