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Engel-Nitz NM, Miller-Wilson LA, Le L, Limburg P, Fisher DA. Patient and provider factors associated with colorectal cancer screening among average risk health plan enrollees in the US, 2015-2018. BMC Health Serv Res 2023; 23:550. [PMID: 37237408 DOI: 10.1186/s12913-023-09474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND To assess patient and primary care provider (PCP) factors associated with adherence to American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines for average risk colorectal cancer (CRC) screening. METHODS Retrospective case-control study of medical and pharmacy claims from the Optum Research Database from 01/01/2014 - 12/31/2018. Enrollee sample was adults aged 50 - 75 years with ≥ 24 months continuous health plan enrollment. Provider sample was PCPs listed on the claims of average-risk patients in the enrollee sample. Enrollee-level screening opportunities were based on their exposure to the healthcare system during the baseline year. Screening adherence, calculated at the PCP level, was the percent of average-risk patients up to date with screening recommendations each year. Logistic regression modelling was used to examine the association between receipt of screening and enrollee and PCP characteristics. An ordinary least squares model was used to determine the association between screening adherence among the PCP's panel of patients and patient characteristics. RESULTS Among patients with a PCP, adherence to ACS and USPSTF screening guidelines ranged from 69 to 80% depending on PCP specialty and type. The greatest enrollee-level predictors for CRC screening were having a primary/preventive care visit (OR = 4.47, p < 0.001) and a main PCP (OR = 2.69, p < 0.001). CONCLUSIONS Increased access to preventive/primary care visits could improve CRC screening rates; however, interventions not dependent on healthcare system contact, such as home-based screening, may circumvent the dependence on primary care visits to complete CRC screening.
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Affiliation(s)
- Nicole M Engel-Nitz
- Optum, Eden Prairie, MN, USA.
- , 11000 Optum Circle Eden Prairie, 952-205-7770, Eden Prairie, MN, 55344, USA.
| | | | - Lisa Le
- Optum, Eden Prairie, MN, USA
| | - Paul Limburg
- Exact Sciences, Madison, WI, USA
- Mayo Clinic, Rochester, MN, USA
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2
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Eom KY, Jarlenski M, Schoen RE, Robertson L, Sabik LM. Sex differences in the impact of Affordable Care Act Medicaid expansion on colorectal cancer screening. Prev Med 2020; 138:106171. [PMID: 32592796 DOI: 10.1016/j.ypmed.2020.106171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 05/14/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022]
Abstract
Access to care varies by sex such that interactions with insurance status result in mixed patterns of preventive services utilization. We examined sex-specific effects of ACA Medicaid expansions on receipt of CRC screening. We used Behavioral Risk Factor Surveillance System data (2008-2016) for adults aged 50-64 years with household income ≤138% of federal poverty level to examine self-reported lifetime use of guideline-recommended CRC screening services overall and by screening modality. We employed difference-in-difference models comparing changes in CRC screening in 20 Medicaid expansion states before and after the ACA to changes in 18 states that did not expand Medicaid during our study period. We divided the expansion period into implementation (2014) and post-expansion (2016) periods to account for possible lagged effects. We observed time-varying effects of Medicaid expansion that revealed relative increases in CRC screening occurring during the post-expansion period. Heterogeneous effects by sex and by screening modality were also observed: there was a significant relative increase of 16.2 percentage points (95% CI [2.2, 30.2]; p-value = 0.023) in lifetime colonoscopy use among women in expansion states relative to non-expansion states in the post-expansion period. There were no significant effects of Medicaid expansion among men. Health insurance expansion had a lagged but significant effect on CRC screening among low-income non-elderly women in Medicaid expansion states, but no effect for men. The observed increase in CRC screening among women suggests that barriers to CRC screening may differ by sex, and tailored interventions to increase CRC screening improve outcomes.
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Affiliation(s)
- Kirsten Y Eom
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America.
| | - Marian Jarlenski
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America
| | - Robert E Schoen
- University of Pittsburgh, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, PA, United States of America
| | - Linda Robertson
- UPMC Hillman Cancer Center, Pittsburgh, PA, United States of America
| | - Lindsay M Sabik
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America
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3
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Al-Husseini MJ, Saad AM, Jazieh KA, Elmatboly AM, Rachid A, Gad MM, Ruhban IA, Hilal T. Outcome disparities in colorectal cancer: a SEER-based comparative analysis of racial subgroups. Int J Colorectal Dis 2019; 34:285-292. [PMID: 30443675 DOI: 10.1007/s00384-018-3195-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies of ethnic disparities in colorectal cancer (CRC) have focused mainly on patients of Caucasian and African-American descent. We aimed to evaluate outcomes for a range of races, representing a broader demographic of the US population. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with CRC diagnosed between 1994 and 2014. We performed unadjusted Kaplan-Meier test and multivariable covariate-adjusted Cox models to calculate the overall and CRC-specific survival of patients according to their race. RESULTS We identified 401,723 patients diagnosed with CRC between 1994 and 2014. Overall survival (OS) and CRC-specific survival were compared across different races stratified by age, sex, marital status, disease stage and grade, and undergoing surgery as a treatment. Overall, Asian/Pacific Islanders and Hispanics had improved CRC-specific survival compared to Whites (HR = 0.873, 95%CI 0.853-0.893, P < .001, and HR = 0.958, 95%CI 0.937-0.979, P < .001, respectively). Blacks had the worst CRC-specific survival outcomes when compared to Whites (HR = 1.215, 95%CI 1.192-1.238, P < .001). Racial disparity persisted when looking at two different time periods (1994-2003 and 2004-2014). CONCLUSIONS Asians/Pacific Islanders have improved outcomes from CRC compared to other races. Multifactorial, including genetic, environmental, and socioeconomic factors appear to influence outcomes and need to be addressed separately in order to reduce racial disparities among patients with CRC.
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Affiliation(s)
- Muneer J Al-Husseini
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt
| | - Anas M Saad
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt.
| | - Khalid A Jazieh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ahmad Rachid
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt
| | - Mohamed M Gad
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Inas A Ruhban
- Pathology Department, Faculty of Medicine, Damascus University, Cairo, Egypt
| | - Talal Hilal
- Division of Hematology/Oncology, Mayo Clinic Cancer Center, 5881 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
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4
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Neugut AI, MacLean SA, Dai WF, Jacobson JS. Physician Characteristics and Decisions Regarding Cancer Screening: A Systematic Review. Popul Health Manag 2019; 22:48-62. [DOI: 10.1089/pop.2017.0206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Alfred I. Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - Wei F. Dai
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Judith S. Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York
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5
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Malhotra J, Rotter D, Tsui J, Llanos AAM, Balasubramanian BA, Demissie K. Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey. Cancer Epidemiol Biomarkers Prev 2017; 26:1804-1811. [PMID: 29021217 DOI: 10.1158/1055-9965.epi-17-0660] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive.Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest.Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs.Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study.Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26(12); 1804-11. ©2017 AACR.
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Affiliation(s)
- Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - David Rotter
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Adana A M Llanos
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | | | - Kitaw Demissie
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
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6
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Tucker CM, Wippold GM, Guastello AD, Arthur TM, Desmond FF, Rivers BM, Davis JL, Rivers D, Green BL. Predictors of Cancer Screening Among Culturally Diverse Men. Am J Mens Health 2016; 12:837-843. [PMID: 27118456 DOI: 10.1177/1557988316644398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men's likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% "other") recruited at the Men's Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men's motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.
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7
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Manning M, Burnett J, Chapman R. Predicting Incongruence between Self-reported and Documented Colorectal Cancer Screening in a Sample of African American Medicare Recipients. Behav Med 2016; 42:238-47. [PMID: 25961362 PMCID: PMC4641836 DOI: 10.1080/08964289.2015.1011600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Assessments of colorectal cancer (CRC) screening rates typically rely on self-reported screening data, which are often incongruent with medical records. We used multilevel models to examine health-related, socio-demographic and psychological predictors of incongruent self-reports for CRC screening among Medicare-insured African Americans (N = 3,740). Results indicated that living alone decreased, and income increased, the odds of congruently self-reporting endoscopic CRC screening. Being male and having greater number of comorbidities decreased, and having less than a high school education increased, the odds of congruently self-reported fecal occult blood tests. Living alone, age and income had the most robust effects across classifications into one of four mutually exclusive categories defined by screening status (screened/unscreened) and congruence of self-reports. The results underscore the clinical importance of gathering socio-demographic data via patient interviews, and the relevance of these data for judging the veracity of self-reported CRC screenings behaviors.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R - MM03CB, Detroit, MI 48201
| | - Janice Burnett
- Josephine Ford Cancer Institute, Division of Hematology and Medical Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
| | - Robert Chapman
- Josephine Ford Cancer Institute, Division of Hematology and Medical Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
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8
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Brittain K, Christy SM, Rawl SM. African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? J Health Care Poor Underserved 2016; 27:51-67. [PMID: 27182187 DOI: 10.1353/hpu.2016.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing
| | - Shannon M Christy
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis
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9
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Henrikson NB, Webber EM, Goddard KA, Scrol A, Piper M, Williams MS, Zallen DT, Calonge N, Ganiats TG, Janssens ACJW, Zauber A, Lansdorp-Vogelaar I, van Ballegooijen M, Whitlock EP. Family history and the natural history of colorectal cancer: systematic review. Genet Med 2015; 17:702-12. [PMID: 25590981 PMCID: PMC4955831 DOI: 10.1038/gim.2014.188] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/17/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Family history of colorectal cancer (CRC) is a known risk factor for CRC and encompasses both genetic and shared environmental risks. METHODS We conducted a systematic review to estimate the impact of family history on the natural history of CRC and adherence to screening. RESULTS We found high heterogeneity in family-history definitions, the most common definition being one or more first-degree relatives. The prevalence of family history may be lower than the commonly cited 10%, and confirms evidence for increasing levels of risk associated with increasing family-history burden. There is evidence for higher prevalence of adenomas and of multiple adenomas in people with family history of CRC but no evidence for differential adenoma location or adenoma progression by family history. Limited data regarding the natural history of CRC by family history suggest a differential age or stage at cancer diagnosis and mixed evidence with respect to tumor location. Adherence to recommended colonoscopy screening was higher in people with a family history of CRC. CONCLUSION Stratification based on polygenic and/or multifactorial risk assessment may mature to the point of displacing family history-based approaches, but for the foreseeable future, family history may remain a valuable clinical tool for identifying individuals at increased risk for CRC.
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Affiliation(s)
| | | | | | - Aaron Scrol
- Group Health Research Institute, Seattle, Washington, USA
| | - Margaret Piper
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Marc S Williams
- Geisinger Health System, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | | | | | | | | | - Ann Zauber
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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10
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Abstract
Early screening for colon cancer (CC) allows for early stage diagnosis of the malignancy and potentially reduces disease mortality as the cancer is most likely curable at its earliest stages. Early detection would be desirable if accurate, practical and cost-effective diagnostic measures for this cancer were available. Mortality and morbidity from CC represent a major health problem involving a malignant disease that is theoretically preventable through screening. Current screening methods (e.g., the convenient and inexpensive immunological fecal occult blood test, FOBTi, obtained from patients' medical records) either lack sensitivity and require dietary restriction, which impedes compliance and use; are costly (e.g., colonoscopy), which decreases compliance; or could result in mortality. In comparison with the FOBT test, a non-invasive sensitive screen for which there is no requirement for dietary restriction would be a more convenient test. Colorectal cancer is the only cancer for which colonoscopy is recommended as a screening method. Although colonoscopy is a reliable screening tool, the invasive nature, abdominal pain, potential complications and high cost have hampered the application of this procedure worldwide. A screening approach using the stable miRNA molecules, which are relatively non-degradable when extracted from non-invasive stool and semi-invasive blood samples by commercially available kits and manipulated thereafter, would be preferable to a transcriptomic mRNA-, a mutation DNA-, an epigenetic- or a proteomic-based test. The approach uses reverse transcriptase, modified real-time quantitative PCR. Although exosomal RNA would be missed, using a restricted extraction of total RNA from stool or blood, a parallel test could also be carried out on RNA obtained from stool or plasma samples, and appropriate corrections for exsosomal loss can be made for accurate and quantitative test result. Eventually, a chip can be developed to facilitate diagnosis, as has been done for the quantification of genetically modified organisms in foods. The gold standard to which the molecular miRNA test is compared is colonoscopy, which can be obtained from patients' medical records. If performance criteria are met, as detailed herein, a miRNA test in human stool or blood samples based on high-throughput automated technologies and quantitative expression measurements commonly used in the diagnostic clinical laboratory should be advanced to the clinical setting, which will make a significant impact on CC prevention.
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Affiliation(s)
- Farid E Ahmed
- Institute for Research in Biotechnology, GEM Tox Labs, 2607 Calvin Way, Greenville, NC 27834, USA
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11
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Amri R, Stronks K, Bordeianou LG, Sylla P, Berger DL. Gender and ethnic disparities in colon cancer presentation and outcomes in a US universal health care setting. J Surg Oncol 2014; 109:645-51. [PMID: 24474677 DOI: 10.1002/jso.23567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/31/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Access to care is a pillar of U.S. healthcare reform and could potentially challenge existing ethnic and gender disparities in care. We present a snapshot of these disparities in surgical colon cancer patients in the largest public hospital in Massachusetts, a state leading in providing universal healthcare, to indicate potential changes that might result from universal care access. METHODS All surgical colon cancer patients at Massachusetts General Hospital (2004-2011) were included. Baseline characteristics, perioperative, and long-term outcomes were compared. RESULTS Among 1,071 patients, the 110 (10.3%) minority patients presented with more comorbid (mean Charlson score 0.84 vs. 0.71; P = 0.039), metastatic (21.8% vs. 14%; P = 0.026), and node-positive disease (50% vs. 38.8%; P = 0.014). Women (n = 521; 48.6%) had less screening diagnoses (overall: 17.8% vs. 22.6%; P = 0.049, screening age: 26.4% vs. 32.7%; P = 0.036) with subsequently higher rates of metastatic disease on pathology (11.3% vs. 7.1%, P = 0.02). Multivariate adjustment for baseline staging makes outcome disparities no longer statistically significant. CONCLUSIONS Significant gender and ethnic disparities subsist at baseline despite long-standing low-threshold healthcare access, although seemingly mitigated by enrollment into high-level care, empowering equal chances for underprivileged groups. The outcomes are also a reminder that universal healthcare will not be a panacea for the deeply rooted and dynamic causes of presentation inequalities.
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Affiliation(s)
- Ramzi Amri
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Abstract
Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29% of respondents had never been screened for CRC. In the adjusted model, 36.6% of US adults age 50-59 years and 29.1% of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2%) reported never being screened than members of other racial and ethnic groups. Nearly 37% of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29% reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.
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13
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Choi KC, So WKW, Chan DNS, Shiu ATY, Ho SSM, Chan HYL, Lam WWT, Cheng KKF, Goggins WB, Chan CWH. Gender differences in the use of colorectal cancer tests among older Chinese adults. Eur J Oncol Nurs 2013; 17:603-9. [PMID: 23462304 DOI: 10.1016/j.ejon.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/20/2012] [Accepted: 01/05/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.
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Affiliation(s)
- Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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14
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Surveillance of colorectal cancer screening in new Mexico hispanics and non-Hispanic whites. J Community Health 2013; 37:1279-88. [PMID: 22544418 DOI: 10.1007/s10900-012-9568-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The incidence of colorectal cancer (CRC) among Hispanics in the state of New Mexico has increased in the past decade while that among whites has declined significantly. Using the 2006 New Mexico Behavioral Risk Factor Surveillance System (BRFSS) survey, we compared CRC screening among Hispanics and whites by gender to examine the influence of demographic, socioeconomic, preventive health, and clinical measures on the utilization of CRC screening. Although we found no ethnic differences in the prevalence of current breast, cervical and cancer screening, Hispanics were less likely to be current with CRC screening than whites. These differences were observed across a range of socioeconomic and other explanatory measures and in both genders. Hispanics also had a higher prevalence of CRC-related risk factors than whites, including inactivity, obesity, and diabetes, and ranked lower for most socioeconomic measures. Adjusting for healthcare coverage, education, and income in logistic regression models eliminated the Hispanic-white differences in CRC screening among men, and substantially reduced but did not eliminate screening differences among women. Innovative methods are needed to reach Hispanics to raise awareness of and participation in CRC screening. Because many CRC risk factors are potentially modifiable, appropriate cultural and linguistic interventions tailored to specific Hispanic subgroups and aimed at promoting CRC screening and reducing CRC risk factors may decrease ethnic disparities in CRC incidence.
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15
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Consedine NS, Reddig MK, Ladwig I, Broadbent EA. Gender and ethnic differences in colorectal cancer screening embarrassment and physician gender preferences. Oncol Nurs Forum 2012; 38:E409-17. [PMID: 22037340 DOI: 10.1188/11.onf.e409-e417] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine colorectal cancer (CRC) screening embarrassment among men and women from three ethnic groups and the associated physician gender preference by patient gender and ethnicity. DESIGN Cross-sectional, purposive sampling. SETTING Urban community in Brooklyn, NY. SAMPLE A purpose-derived, convenience sample of 245 European American, African American, and immigrant Jamaican men and women (aged 45-70 years) living in Brooklyn, NY. METHODS Participants provided demographics and completed a comprehensive measure of CRC screening embarrassment. MAIN RESEARCH VARIABLES Participant gender and ethnicity, physician gender, and CRC screening embarrassment regarding feces or the rectum and unwanted physical intimacy. FINDINGS As predicted, men and women both reported reduced fecal and rectal embarrassment and intimacy concern regarding same-gender physicians. As expected, Jamaicans reported greater embarrassment regarding feces or the rectum compared to European Americans and African Americans; however, in contrast to expectations, women reported less embarrassment than men. Interactions indicated that rectal and fecal embarrassment was particularly high among Jamaican men. CONCLUSIONS Men and women have a preference for same-gender physicians, and embarrassment regarding feces and the rectum shows the most consistent ethnic and gender variation. IMPLICATIONS FOR NURSING Discussing embarrassment and its causes, as well as providing an opportunity to choose a same-gender physician, may be promising strategies to reduce or manage embarrassment and increase CRC screening attendance.
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Affiliation(s)
- Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, New Zealand.
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16
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White PM, Sahu M, Poles MA, Francois F. Colorectal cancer screening of high-risk populations: A national survey of physicians. BMC Res Notes 2012; 5:64. [PMID: 22272666 PMCID: PMC3284403 DOI: 10.1186/1756-0500-5-64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 01/24/2012] [Indexed: 12/28/2022] Open
Abstract
Background The incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009. Results The average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement." Conclusions There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.
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Affiliation(s)
- Pascale M White
- Division of Gastroenterology and Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
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17
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Improving access to colorectal cancer screening through medical philanthropy: feasibility of a flexible sigmoidoscopy health fair for uninsured patients. Am J Gastroenterol 2011; 106:1741-6. [PMID: 21979199 DOI: 10.1038/ajg.2011.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Only half of eligible patients in the United States undergo colorectal cancer (CRC) screening as recommended. Hypothesizing that the medical philanthropy platform may be effective in improving access to CRC screening, we aimed to demonstrate the feasibility of a flexible sigmoidoscopy (FS)-based CRC screening "health fair" for uninsured patients. METHODS Uninsured patients older than 50 years who had not undergone CRC screening in the preceding 10 years were recruited through local free clinics and health fairs. A standard medical clinic was transformed into a fully functional endoscopy unit. Medicolegal protection for volunteers was obtained through the Florida Department of Health's Volunteer Health Care Provider Program. Unsedated FS with polypectomy was performed. Those with high-risk endoscopic features were given instructions on obtaining a full colonoscopy. RESULTS Fifty-two patients without access to any form of CRC screening underwent FS. Ninety-four percent had an adequate bowel preparation, although 40% required on-site enema. Eighteen patients had a total of 22 polyps, 4 of which were adenomatous. There were no complications. The total cost of the fair, excluding donated resources such as endoscopes and processors, was $6,531.47, amounting to $126 per patient screened. CONCLUSIONS Health fair-style CRC screening for uninsured patients is feasible. With improved efficiency, widespread application of CRC screening using the medical philanthropy platform may represent a viable approach to reducing the underuse of CRC screening among the uninsured.
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Kadiyala S, Strumpf EC. Are United States and Canadian cancer screening rates consistent with guideline information regarding the age of screening initiation? Int J Qual Health Care 2011; 23:611-20. [PMID: 21890706 DOI: 10.1093/intqhc/mzr050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To understand whether US and Canadian breast, colorectal and prostate cancer screening test utilization is consistent with US and Canadian cancer screening guideline information with respect to the age of screening initiation. DESIGN Cross-sectional, regression discontinuity. SETTING Canada and the US. PARTICIPANTS Canadian and American women of ages 30-60 and men of ages 40-60. INTERVENTIONS None. Main Outcomes Measures Mammography, prostate-specific antigen (PSA) and colorectal cancer test use within the past 2 years. METHODS We identify US and Canadian compliance with age screening information in a novel manner, by comparing test utilization rates of individuals who are immediately on either side of the guideline recommended initiation ages. RESULTS US mammography utilization within the last 2 years increased from 33% at age 39 to 48% at age 40 and 60% at age 41. US colorectal cancer test utilization, within the last 2 years, increased from 15% at age 49 to 18% at age 50 and 28% at age 51. US PSA utilization within the last 2 years increased from 37% at age 49 to 44% at age 50 and 54% at age 51. In Canada, mammography utilization within the last 2 years increased from 47% at age 49 to 57% at age 50 and 66% at age 51. CONCLUSION American and Canadian cancer screening utilization is generally consistent with each country's guideline recommendations regarding age. US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.
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Prevalence and implications of multiple cancer screening needs among Hispanic community health center patients. Cancer Causes Control 2011; 22:1343-9. [PMID: 21728056 DOI: 10.1007/s10552-011-9807-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine adherence rates for multiple cancer screening tests, which will inform prevention efforts in community health centers (CHCs). METHODS We report on the prevalence of screening for multiple cancers (cervical, breast and colorectal) among 43,000 patients who are predominantly Hispanic, in four CHC sites that share an integrated electronic medical record. RESULTS Among the 20,057 patients eligible for at least one test, 43% of the population was current on all screening targets; 15,887 additional screening tests were needed among 11,526 individuals. CONCLUSIONS Expanding use of health information technology in community health centers provides an opportunity to create an electronic infrastructure for addressing multiple screening needs from a patient-centered perspective.
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20
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Patient-provider language concordance and colorectal cancer screening. J Gen Intern Med 2011; 26:142-7. [PMID: 20857340 PMCID: PMC3019323 DOI: 10.1007/s11606-010-1512-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 08/17/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. KEY RESULTS Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). CONCLUSIONS Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.
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Frederiksen BL, Jørgensen T, Brasso K, Holten I, Osler M. Socioeconomic position and participation in colorectal cancer screening. Br J Cancer 2010; 103:1496-501. [PMID: 20959827 PMCID: PMC2990593 DOI: 10.1038/sj.bjc.6605962] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening with faecal occult blood test (FOBT) has the potential to reduce the incidence and mortality of CRC. Screening uptake is known to be inferior in people with low socioeconomic position (SEP) when compared with those with high position; however, the results of most previous studies have limited value because they are based on recall or area-based measures of socioeconomic position, and might thus be subject to selective participation and misclassification. In this study we investigated differences in CRC screening participation using register-based individual information on education, employment, and income to encompass different but related aspects of socioeconomic stratification. Also, the impact of ethnicity and cohabiting status was analysed. METHODS A feasibility study on CRC screening was conducted in two Danish counties in 2005 and 2006. Screening consisted of a self-administered FOBT kit mailed to 177 114 inhabitants aged 50-74 years. Information on individual socioeconomic status was obtained from Statistics Denmark. RESULTS A total of 85 374 (48%) of the invited returned the FOBT kits. Participation was significantly higher in women than in men (OR=1.58 (1.55-1.61)), when all socioeconomic and demographic variables were included in the statistical model. Participation also increased with increasing level of education, with OR=1.38 (1.33-1.43) in those with a higher education compared with short education. Also, participation increased with increasing income levels, with OR=1.94 (1.87-2.01) in the highest vs lowest quintile. Individuals with a disability pension, the unemployed and self-employed people were significantly less likely to participate (OR=0.77 (0.74-0.80), OR=0.83 (0.80-0.87), and OR=0.85 (0.81-0.89), respectively). Non-western immigrants were less likely to participate (OR=0.62 (0.59-0.66)) in a model controlling for age, sex, and county; however, this difference might be attributed to low SEP in these ethnic groups ((OR=0.93 (0.87-0.99), when adjusting for SEP indicators). CONCLUSION This study based on individual information on several socioeconomic dimensions in a large, unselected population allowed for identification of several specific subgroups within the population with low CRC screening participation. Improved understanding is needed on the effect of targeted information and other strategies in order to reduce socioeconomic inequalities in screening.
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Affiliation(s)
- B L Frederiksen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Building 84/85, DK-2600 Glostrup, Denmark.
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Red SN, Kassan EC, Williams RM, Penek S, Lynch J, Ahaghotu C, Taylor KL. Underuse of colorectal cancer screening among men screened for prostate cancer: a teachable moment? Cancer 2010; 116:4703-10. [PMID: 20578178 PMCID: PMC3639486 DOI: 10.1002/cncr.25229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that colorectal cancer (CRC) screening reduces disease-specific mortality, whereas the utility of prostate cancer screening remains uncertain. However, adherence rates for prostate cancer screening and CRC screening are very similar, with population-based studies showing that approximately 50% of eligible US men are adherent to both tests. Among men scheduled to participate in a free prostate cancer screening program, the authors assessed the rates and correlates of CRC screening to determine the utility of this setting for addressing CRC screening nonadherence. METHODS Participants (N = 331) were 50 to 70 years old with no history of prostate cancer or CRC. Men registered for free prostate cancer screening and completed a telephone interview 1 to 2 weeks before undergoing prostate cancer screening. RESULTS One half of the participants who underwent free prostate cancer screening were eligible for but nonadherent to CRC screening. Importantly, 76% of the men who were nonadherent to CRC screening had a regular physician and/or health insurance, suggesting that CRC screening adherence was feasible in this group. Furthermore, multivariate analyses indicated that the only significant correlates of CRC screening adherence were having a regular physician, health insurance, and a history of prostate cancer screening. CONCLUSIONS Free prostate cancer screening programs may provide a teachable moment to increase CRC screening among men who may not have the usual systemic barriers to CRC screening, at a time when they may be very receptive to cancer screening messages. In the United States, a large number of men participate in annual free prostate cancer screening programs and represent an easily accessible and untapped group that can benefit from interventions to increase CRC screening rates.
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Affiliation(s)
- Sara N. Red
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Elisabeth C. Kassan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Randi M. Williams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Sofiya Penek
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington, District of Columbia
| | - Chiledum Ahaghotu
- Division of Urology, Howard University Hospital, Washington, District of Columbia
| | - Kathryn L. Taylor
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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Colon Capsule Endoscopy compared to Conventional Colonoscopy under routine screening conditions. BMC Gastroenterol 2010; 10:66. [PMID: 20565828 PMCID: PMC2905323 DOI: 10.1186/1471-230x-10-66] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 06/18/2010] [Indexed: 12/11/2022] Open
Abstract
Background Colonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions. Methods We performed a prospective, single-center pilot study at a University Hospital. Data were obtained from November 2007 until May 2008. Patients underwent CCE on Day 1 and CSPY on Day 2. Outcomes were evaluated regarding sensitivity and specificity of polyp detection rate, with a significance level set at >5 mm. Results 59 individuals were included in this study, the results were evaluable in 56 patients (males 34, females 22; median age 59). CCE was complete in 36 subjects. Polyp detection rate for significant polyps was 11% on CSPY and 27% on CCE. 6/56 (11%) patients had polyps on CSPY not detected on CCE (miss rate). Overall sensitivity was 79% (95% confidence interval [CI], 61 to 90), specificity was 54% (95% CI, 35 to 70), positive predictive value (PPV) was 63% and negative predictive value (NPV) was 71%. Adjusted to significance of findings, sensitivity was 50% (95% CI, 19 to 81), specificity was 76% (95% CI, 63 to 86), PPV was 20% and NPV was 93%. Conclusion In comparison to the gold standard, the sensitivity of CCE for detection of relevant polyps is low, however, the high NPV supports its role as a possible screening tool. Trial Registration NCT00991003.
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Pilz JB, Portmann S, Peter S, Beglinger C, Degen L. Colon Capsule Endoscopy compared to Conventional Colonoscopy under routine screening conditions. BMC Gastroenterol 2010; 10:6. [PMID: 20082713 PMCID: PMC2836274 DOI: 10.1186/1471-230x-10-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/18/2010] [Indexed: 12/20/2022] Open
Abstract
Background Nodular regenerative hyperplasia (NRH) has been recently recognized as an emergent cause of liver disease in HIV-infected patients. NRH may cause non-cirrhotic portal hypertension with potentially severe consequences such as refractory ascites, variceal bleeding and hypersplenism. Obliteration of the small intrahepatic portal veins in association with prothrombotic disorders linked to HIV infection itself or anti-retroviral therapy seem to be the causes of NRH and thus the term HIV-associated obliterative portopathy has been proposed. Case Presentation Here we describe a case of a HIV-infected patient with biopsy-proven NRH and listed for liver transplantation (LT) because of refractory ascites and repeated upper gastrointestinal bleedings. A transjugular intrahepatic portosystemic shunt was placed as a bridge to LT and did not improve liver function. However, anticoagulant therapy with low-molecular-weight heparin (LMWH) was associated with rapid improvement in the liver condition and allowed to avoid LT in this patient. Conclusions Thus, this case underscores the relation between thrombophilia and HIV-associated NRH and emphasizes anticoagulant therapy as possible treatment.
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Affiliation(s)
- Julia B Pilz
- Department of Gastroenterology and Hepatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Brennenstuhl S, Fuller-Thomson E, Popova S. Prevalence and Factors Associated with Colorectal Cancer Screening in Canadian Women. J Womens Health (Larchmt) 2010; 19:775-84. [DOI: 10.1089/jwh.2009.1477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Sarah Brennenstuhl
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | | | - Svetlana Popova
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Canada
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Dahrouge S, Hogg W, Tuna M, Russell G, Devlin RA, Tugwell P, Kristjansson E. An evaluation of gender equity in different models of primary care practices in Ontario. BMC Public Health 2010; 10:151. [PMID: 20331861 PMCID: PMC2856534 DOI: 10.1186/1471-2458-10-151] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 03/23/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. METHODS This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). RESULTS Health service delivery measures were comparable in women and men, with differences CONCLUSIONS The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.
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Affiliation(s)
- Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, Canada
| | - William Hogg
- C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, Canada
- University of Ottawa, Department of Family Medicine, 43 Bruyère St, Ottawa, Ontario, Canada
- University of Ottawa, Department of Epidemiology and Community Medicine, 451 Smyth Road, Ottawa, Ontario, Canada
| | - Meltem Tuna
- C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, Canada
| | - Grant Russell
- C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, Canada
- University of Ottawa, Department of Family Medicine, 43 Bruyère St, Ottawa, Ontario, Canada
- University of Ottawa, Department of Epidemiology and Community Medicine, 451 Smyth Road, Ottawa, Ontario, Canada
| | - Rose Anne Devlin
- University of Ottawa, Department of Epidemiology and Community Medicine, 451 Smyth Road, Ottawa, Ontario, Canada
| | - Peter Tugwell
- University of Ottawa, Department of Epidemiology and Community Medicine, 451 Smyth Road, Ottawa, Ontario, Canada
- University of Ottawa, Institute of Population Health, 1 Stewart St, Room 300, Ottawa, Ontario, Canada
| | - Elisabeth Kristjansson
- University of Ottawa, Institute of Population Health, 1 Stewart St, Room 300, Ottawa, Ontario, Canada
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Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc 2010; 71:366-381.e2. [PMID: 19846082 DOI: 10.1016/j.gie.2009.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lower GI endoscopy, such as colonoscopy or sigmoidoscopy, is thought to have a substantial impact on colorectal cancer incidence and mortality through detection and removal of precancerous lesions and early cancers. We aimed to review prevalence estimates of history of colonoscopy or sigmoidoscopy in the general population and to analyze recent trends. METHODS A systematic review of the medical literature, including MEDLINE (1966 to August 2008) and EMBASE (1980 to August 2008), was undertaken, supplemented by searches of the European Health Interview & Health Examination Surveys database and bibliographies. Detailed age-specific and sex-specific prevalence estimates from the United States were obtained from the Behavioral Risk Factor Surveillance System surveys 2002, 2004, and 2006. RESULTS The search yielded 55 studies that met our inclusion criteria. The majority of the reports (43) originated from the United States. Other countries of origin included Australia (2), Austria (2), Canada (5), France (1), Germany (1), and Greece (1). Estimates from the United States were generally increasing over time up to 56% (2006) for lifetime use of colonoscopy or sigmoidoscopy in people aged 50 years and older. Analysis of national survey data showed higher prevalences among men aged 55 years and older than for women of the same age. Prevalences were highest for people aged 70 to 79 years. CONCLUSION Data from outside the United States were extremely limited. Prevalence estimates from the United States indicate that a considerable and increasing proportion of the population at risk has had at least 1 colonoscopy or sigmoidoscopy in their lives, although differences between age and sex groups persist. Prevalences of previous colonoscopy or sigmoidoscopy need to be taken into account in the interpretation of time trends in, and variation across, populations of colorectal cancer incidence and mortality.
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Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Power E, Miles A, von Wagner C, Robb K, Wardle J. Uptake of colorectal cancer screening: system, provider and individual factors and strategies to improve participation. Future Oncol 2010; 5:1371-88. [PMID: 19903066 DOI: 10.2217/fon.09.134] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Colorectal cancer (CRC) accounts for 9% of all new cancer cases worldwide and affects over 1 million people each year. Screening can reduce the mortality associated with the disease, yet participation rates are suboptimal. Compliers with CRC screening are less deprived; they have higher education than noncompliers and tend to be male, white and married. Likely reasons for nonparticipation encompass several 'modifiable' factors that could be targeted in interventions aimed at increasing participation rates. Successful intervention strategies include organizational changes, such as increasing access to fecal occult blood test (FOBT) kits, providing reminders to healthcare providers or users about screening opportunities, and educational strategies to improve awareness and attitudes towards CRC screening. Multifactor interventions that target more than one level of the screening process are likely to have larger effects. The biggest challenge for future research will be to reduce inequalities related to socio-economic position and ethnicity in the uptake of screening.
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Affiliation(s)
- Emily Power
- University College London, Department of Epidemiology & Public Health, Health Behaviour Research Centre, London, UK
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Kadiyala S. Are U.S. cancer screening test patterns consistent with guideline recommendations with respect to the age of screening initiation? BMC Health Serv Res 2009; 9:185. [PMID: 19821991 PMCID: PMC2770463 DOI: 10.1186/1472-6963-9-185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 10/12/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND U.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation. METHODS The 2006 Behavioral Risk Factor Social Survey and the 2003 National Health Interview Surveys were used to compute breast, colorectal and prostate cancer screening test rates by single year of age. Graphical and logistic regression analyses were used to compare screening rates for individuals close to and on either side of the guideline recommended screening initiation ages. RESULTS We identified large discrete shifts in the use of screening tests precisely at the ages where guidelines recommend that screening begin. Mammography screening in the last year increased from 22% [95% CI = 20, 25] at age 39 to 36% [95% CI = 33, 39] at age 40 and 47% [95% CI = 44, 51] at age 41. Adherence to the colorectal cancer screening guidelines within the last year increased from 18% [95% CI = 15, 22] at age 49 to 19% [95% CI = 15, 23] at age 50 and 34% [95% CI = 28, 39] at age 51. Prostate specific antigen screening in the last year increased from 28% [95% CI = 25, 31] at age 49 to 33% [95% CI = 29, 36] and 42% [95% CI = 38, 46] at ages 50 and 51. These results are robust to multivariate analyses that adjust for age, sex, income, education, marital status and health insurance status. CONCLUSION The results from this study suggest that cancer screening test utilization is consistent with guideline age information regarding the age of screening initiation. Screening test and adherence rates increased by approximately 100% at the breast and colorectal cancer guideline recommended ages compared to only a 50% increase in the screening test rate for prostate cancer screening. Since information regarding the age of cancer screening initiation varies across countries, results from this study also potentially have implications for cross-country comparisons of cancer incidence and survival statistics.
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Affiliation(s)
- Srikanth Kadiyala
- Department of Pharmacy, Pharmaceutical Outcomes Research Policy Program, University of Washington, Seattle, Washington, USA.
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Manne SL, Coups EJ, Winkel G, Markowitz A, Meropol NJ, Lesko SM, Jacobsen PB, Haller D, Jandorf L, Peterson SK. Identifying cluster subtypes for intentions to have colorectal cancer screening among non-compliant intermediate-risk siblings of individuals with colorectal cancer. HEALTH EDUCATION RESEARCH 2009; 24:897-908. [PMID: 19654222 PMCID: PMC2738960 DOI: 10.1093/her/cyp043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 06/21/2009] [Indexed: 05/28/2023]
Abstract
Although first-degree relatives of colorectal cancer (CRC) patients diagnosed at an early age are at increased risk for CRC, their compliance with colorectal cancer screening (CRCS) is not high. Relatively little is known about why these intermediate-risk family members do not comply with CRCS. Study aims were to identify subgroups of siblings of individuals diagnosed with CRC prior to age 61 who were not compliant with CRCS using cluster analysis and to identify demographical, medical and attitudinal correlates of cluster membership. A total of 421 siblings completed measures of pros, cons, processes of change, CRCS knowledge, physician and family CRCS support, CRC risk, severity, preventability, curability, closeness with the affected sibling, distress about the sibling's cancer and screening intentions. Three clusters characterized as 'Positive about Screening', 'Uncertain about Screening' and 'Negative about Screening' were identified. External validation revealed that those in the Positive about Screening cluster reported significantly stronger CRCS intentions than those who are Uncertain about Screening and Negative about Screening clusters. Results provide an empirical typology for understanding motivations for CRCS among at-risk family members and may lead to the development of more effective interventions to improve screening uptake.
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Dimou A, Syrigos KN, Saif MW. Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis. World J Gastroenterol 2009; 15:3734-43. [PMID: 19673013 PMCID: PMC2726450 DOI: 10.3748/wjg.15.3734] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [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
There are differences between African-American and white patients with colorectal cancer, concerning their characteristics before and after diagnosis. Whites are more likely to adhere to screening guidelines. This is also the case among people with positive family history. Colorectal cancer is more frequent in Blacks. Studies have shown that that since 1985, colon cancer rates have dipped 20% to 25% for Whites, while rates have gone up for African-American men and stayed the same for African-American women. Overall, African-Americans are 38% to 43% more likely to die from colon cancer than are Whites. Furthermore, it seems that there is an African-American predominance in right-sited tumors. African Americans tend to be diagnosed at a later stage, to suffer from better differentiated tumors, and to have worse prognosis when compared with Whites. Moreover, less black patients receive adjuvant chemotherapy for resectable colorectal cancer or radiation therapy for rectal cancer. Caucasians seem to respond better to standard chemotherapy regimens than African-Americans. Concerning toxicity, it appears that patients of African-American descent are more likely to develop 5-FU toxicity than Whites, possibly because of their different dihydropyridine dehydrogenase status. Last but not least, screening surveillance seems to be higher among white than among black long-term colorectal cancer survivors. Socioeconomic and educational status account for most of these differences whereas little evidence exists for a genetic contribution in racial disparity. Understanding the nature of racial differences in colorectal cancer allows tailoring of screening and treatment interventions.
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Emmons KM, Lobb R, Puleo E, Bennett G, Stoffel E, Syngal S. Colorectal cancer screening: prevalence among low-income groups with health insurance. Health Aff (Millwood) 2009; 28:169-77. [PMID: 19124867 DOI: 10.1377/hlthaff.28.1.169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined the prevalence of colorectal cancer (CRC) screening in a low-income, racial/ethnic minority sample, among whom 97 percent had health insurance that covered CRC screening. This is a model for examining the impact of health insurance on racial/ethnic disparities in screening. Screening rates (67 percent self-reported; 52 percent adjusted based on a validation substudy) were higher than among similar population-based samples who have lower levels of insurance coverage. There were no differences by race/ethnicity. This study suggests that insurance coverage for CRC screening should be considered as part of a comprehensive approach to address CRC disparities.
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Affiliation(s)
- Karen M Emmons
- Dana-Farber Cancer Institute/Harvard School of Public Health in Boston, Massachusetts, USA.
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Campbell J, Young B. Use of Screening Colonoscopy in Ambulatory HIV-Infected Patients. ACTA ACUST UNITED AC 2008; 7:286-8. [DOI: 10.1177/1545109708326666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Colorectal cancer screenings are underused in HIV-infected patients, but reasons for underuse have not been examined. Methods. Using a standardized questionnaire, HIV-infected patients aged !50 years were asked if they had a colorectal cancer screening and what factors influenced their decisions. Results. Among 55 patients (53 [96%] male; mean age 57 years [range: 51-71]); 35 (64%) ever received colorectal cancer screenings, 2 (4%) were scheduled for screening, 16 (29%) had never been screened, and 2 (4%) provided unusable results. Patients screened were more likely to remember discussing colorectal cancer (P < .01) and colorectal cancer screenings (P < .01) with a medical practitioner. Conclusions. In this population of HIV-infected patients >50 year olds, a significant minority of patients did not undergo the colorectal cancer screening. Discussions about the colorectal cancer screenings and colorectal cancer risk appear to have a significant impact on a patient's decision to be screened.
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Affiliation(s)
| | - Benjamin Young
- Rose Medical Center, University of Colorado, General Internal Medicine, Boulder, Colorado,
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Abstract
Adenomatous polyps are common and factors that increase risk include race, gender, smoking, and obesity. This author summarizes the evidence supporting increased risk with these factors and describes how epidemiological data may be used to tailor screening programs.
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Affiliation(s)
- Sarah W. Grahn
- Department of Surgery, University of California–San Francisco, San Francisco, California
| | - Madhulika G. Varma
- Department of Surgery, University of California–San Francisco, San Francisco, California
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Boudreau DM, Koehler E, Rulyak SJ, Haneuse S, Harrison R, Mandelson MT. Cardiovascular medication use and risk for colorectal cancer. Cancer Epidemiol Biomarkers Prev 2008; 17:3076-80. [PMID: 18957524 PMCID: PMC2675612 DOI: 10.1158/1055-9965.epi-08-0095] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the association between lipid-lowering agents, antihypertensive medications, and colorectal cancer risk. We hypothesized a reduction in colorectal cancer risk with 3-hydroxy-3-methylglutaryl coA reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors. METHODS We conducted a case-control study at Group Health Cooperative, an integrated delivery system in Washington State. Incident colorectal cancer cases diagnosed between January 1, 2000, and December 31, 2003, were identified from the western Washington Surveillance, Epidemiology, and End Results cancer registry. Controls were matched by age, sex, and duration of enrollment. Data on medication use and potential confounders were obtained from health plan records. We estimated odds ratios and 95% confidence intervals (95% CI) using multivariate conditional logistic regression. RESULTS Risk for colorectal cancer was not associated with use of statins (odds ratio, 1.02; 95% CI, 0.65-1.59), other lipid-lowering agents (odds ratio, 1.31; 95% CI, 0.70-2.47), angiotensin-converting enzyme inhibitors (odds ratio, 0.98; 95% CI, 0.67-1.43), calcium channel blockers (odds ratio, 1.06; 95% CI, 0.72-1.55), or diuretics (odds ratio, 1.00; 95% CI, 0.70-1.44). Risk did not differ by duration of medication use, including long-term use. CONCLUSIONS Risk for colorectal cancer was not reduced by use of statins or angiotensin-converting enzyme inhibitors. Other lipid-lowering and antihypertensive medications were also not associated with colorectal cancer risk.
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Affiliation(s)
- Denise M Boudreau
- Group Health Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
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Ballian N, Liu SH, Brunicardi FC. Transcription factor PDX-1 in human colorectal adenocarcinoma: A potential tumor marker? World J Gastroenterol 2008; 14:5823-6. [PMID: 18855980 PMCID: PMC2751891 DOI: 10.3748/wjg.14.5823] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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 examine the expression of pancreatic duodenal homeobox-1 (PDX-1) transcription factor in human colorectal cancer.
METHODS: RT-PCR, Western blotting, and immuno-histochemistry were performed to determine the expression pattern of transcription factor PDX-1 in primary colorectal tumor, hepatic metastasis, and benign colon tissue from a single patient.
RESULTS: The highest PDX-1 transcription levels were detected in the metastasis material. Lower levels of PDX-1 were found to be present in the primary tumor, while normal colon tissue failed to express detectable levels of PDX-1. Western blot data revealed a PDX-1 expression pattern identical to that of mRNA expression. Immunohistochemistry confirmed high metastasis PDX-1 expression, lower levels in the primary tumor, and the presence of only traces of PDX-1 in normal colon tissue.
CONCLUSION: These data argue for further evaluation of PDX-1 as a biomarker for colorectal cancer.
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Murff HJ, Peterson NB, Fowke JH, Hargreaves M, Signorello LB, Dittus RS, Zheng W, Blot WJ. Colonoscopy screening in African Americans and Whites with affected first-degree relatives. ACTA ACUST UNITED AC 2008; 168:625-31. [PMID: 18362255 DOI: 10.1001/archinte.168.6.625] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Family history is a risk factor for colon cancer, and guidelines recommend initiating screening at age 40 years in individuals with affected relatives. Racial differences in colon cancer mortality could be related to variations in screening of increased-risk individuals. METHODS Baseline data from 41 830 participants in the Southern Community Cohort Study were analyzed to determine the proportion of colonoscopy procedures in individuals with strong family histories of colon cancer, and whether differences existed based on race. RESULTS In participants with multiple affected first-degree relatives (FDRs) or relatives diagnosed before age 50 years, 27.3% (95% confidence interval [CI], 23.5%-31.1%) of African Americans reported having a colonoscopy within the past 5 years compared with 43.1% (95% CI, 37.0%-49.2%) of white participants (P<.001). African Americans in this group had an odds ratio of 0.51 (95% CI, 0.38-0.68) of having undergone recommended screening procedures compared with white participants after adjusting for age, sex, educational status, annual income, insurance status, total number of affected and unaffected FDRs, and time since last medical visit. African Americans with multiple affected FDRs or relatives diagnosed before age 50 years and who had ever undergone endoscopy were less likely to report a personal history of colon polyps (odds ratio, 0.29; 95% CI, 0.20-0.42) when compared with whites with similar family histories. CONCLUSIONS African Americans who have FDRs with colon cancer are less likely to undergo colonoscopy screening compared with whites who have affected relatives. Increased efforts need to be directed at identifying and managing underserved populations at increased risk for colon cancer based on their family histories.
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Affiliation(s)
- Harvey J Murff
- Vanderbilt Epidemiology Center, Nashville, TN 37203-1738, USA.
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Emmons K, Puleo E, McNeill LH, Bennett G, Chan S, Syngal S. Colorectal cancer screening awareness and intentions among low income, sociodemographically diverse adults under age 50. Cancer Causes Control 2008; 19:1031-41. [PMID: 18478340 DOI: 10.1007/s10552-008-9167-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 04/17/2008] [Indexed: 10/22/2022]
Abstract
Colorectal cancer (CRC) screening rates in the US are suboptimal, particularly among lower income and racial/ethnically diverse groups. If specific populations have limited awareness of screening when they reach age 50, there may be delays in screening adoption. This study investigated sociodemographic and social contextual factors associated with awareness of CRC and intentions to be screened at age 50 among 692 low income, racial, and ethnic minority adults living in low income housing. The majority of respondents (62%) were between ages 30 and 49, and 94% had some form of health insurance (e.g., Medicaid). About 70% reported having heard about CRC screening; 66% reported intentions to be screened at age 50. In multivariable analyses, screening awareness was associated with age and education. Immigrants who had English as a second language had lower awareness. Females tended to have higher awareness if they had private insurance; there were no differences among males. Multivariable analyses found that screening intentions were higher among men, those with more role responsibilities, more role conflicts, and higher levels of social cohesion. It is important to identify opportunities for maximizing screening uptake among those who become age-eligible for screening if we are to make a significant impact on CRC disparities.
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Affiliation(s)
- Karen Emmons
- Dana-Farber Cancer Institute, Harvard School of Public Health, Center for Community-Based Research, Boston, MA 02115, USA.
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Abstract
Although there are several methods available for colon cancer screening, none is optimal. This article reviews methods for screening, including fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, CT colonography, capsule endoscopy, and double contrast barium enema. A simple, inexpensive, noninvasive, and relatively sensitive screening test is needed to identify people at risk for developing advanced adenomas or colorectal cancer who would benefit from colonoscopy. It is hoped that new markers will be identified that perform better. Until then we fortunately have a variety of screening strategies that do work.
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Affiliation(s)
- Jack S Mandel
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 430, Atlanta, GA 30322, USA.
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Hartge P, Berg CD. Improving Uptake of Cancer Screening in Women. J Womens Health (Larchmt) 2007; 16:66-7. [PMID: 17324098 DOI: 10.1089/jwh.2006.e071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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