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Karmakar B, Zauber AG, Hahn AI, Lau YK, Doubeni CA, Joffe MM. Bias due to coarsening of time intervals in the inference for the effectiveness of colorectal cancer screening. Int J Epidemiol 2024; 53:dyae096. [PMID: 39002174 PMCID: PMC11246168 DOI: 10.1093/ije/dyae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/11/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Observational studies are frequently used to estimate the comparative effectiveness of different colorectal cancer (CRC) screening methods due to the practical limitations and time needed to conduct large clinical trials. However, time-varying confounders, e.g. polyp detection in the last screening, can bias statistical results. Recently, generalized methods, or G-methods, have been used for the analysis of observational studies of CRC screening, given their ability to account for such time-varying confounders. Discretization, or the process of converting continuous functions into discrete counterparts, is required for G-methods when the treatment and outcomes are assessed at a continuous scale. DEVELOPMENT This paper evaluates the interplay between time-varying confounding and discretization, which can induce bias in assessing screening effectiveness. We investigate this bias in evaluating the effect of different CRC screening methods that differ from each other in typical screening frequency. APPLICATION First, using theory, we establish the direction of the bias. Then, we use simulations of hypothetical settings to study the bias magnitude for varying levels of discretization, frequency of screening and length of the study period. We develop a method to assess possible bias due to coarsening in simulated situations. CONCLUSIONS The proposed method can inform future studies of screening effectiveness, especially for CRC, by determining the choice of interval lengths where data are discretized to minimize bias due to coarsening while balancing computational costs.
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Affiliation(s)
- Bikram Karmakar
- Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne I Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yan Kwan Lau
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Chyke A Doubeni
- Family and Community Medicine, Arthur G. James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Marshall M Joffe
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Jiang L, Xu F, Feng W, Fu C, Zhou C. The value of hypersensitivity quantitative fecal immunochemical test in early colorectal cancer detection. Postgrad Med J 2024; 100:135-141. [PMID: 38055911 DOI: 10.1093/postmj/qgad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
At present, both the incidence and mortality rates of colorectal cancer are on the rise, making early screening a crucial tool in reducing the fatality rate. Although colonoscopy is the recommended method according to the guidelines, compliance tends to be poor. The fecal immunochemical test (FIT), a new technology that uses latex immunoturbidimetry to detect fecal blood, offers high specificity and sensitivity. Additionally, it is low-cost, easy to operate, and less likely to be affected by food and drugs, thus improving the compliance rate for population screening. Compared to other screening techniques, FIT represents a safer and more accurate option. This article reviews the application of FIT in early colorectal cancer screening.
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Affiliation(s)
- Lianghong Jiang
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Fen Xu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Weiwei Feng
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Chen Fu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Changjiang Zhou
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
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Tran TN, Hoeck S, De Schutter H, Janssens S, Peeters M, Van Hal G. The Impact of a Six-Year Existing Screening Programme Using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer Incidence, Mortality and Survival: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1654. [PMID: 36674409 PMCID: PMC9864341 DOI: 10.3390/ijerph20021654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The faecal immunochemical test (FIT) has been increasingly used for organised colorectal cancer (CRC) screening. We assessed the impact of a six-year existing FIT screening programme in Flanders (Belgium) on CRC incidence, mortality and survival. The Flemish CRC screening programme started in 2013, targeting individuals aged 50-74 years. Joinpoint regression was used to investigate trends of age-standardised CRC incidence and mortality among individuals aged 50-79 years (2004-2019). Their 5-year relative survival was calculated using the Ederer II method. We found that FIT screening significantly reduced CRC incidence, especially that of advanced-stage CRCs (69.8/100,000 in 2012 vs. 51.1/100,000 in 2019), with a greater impact in men. Mortality started to decline in men two years after organised screening implementation (annual reduction of 9.3% after 2015 vs. 2.2% before 2015). The 5-year relative survival was significantly higher in screen-detected (93.8%) and lower in FIT non-participant CRCs (61.9%) vs. FIT interval cancers and CRCs in never-invited cases (67.6% and 66.7%, respectively). Organised FIT screening in Flanders clearly reduced CRC incidence (especially advanced-stage) and mortality (in men, but not yet in women). Survival is significantly better in screen-detected cases vs. CRCs in unscreened people. Our findings support the implementation of FIT organised screening and the continued effort to increase uptake.
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Affiliation(s)
- Thuy Ngan Tran
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Sarah Hoeck
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | | | - Sharon Janssens
- Research Department, Belgian Cancer Registry, 1210 Brussels, Belgium
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, 2650 Edegem, Belgium
- Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium
| | - Guido Van Hal
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial. Lancet Gastroenterol Hepatol 2022; 7:513-521. [DOI: 10.1016/s2468-1253(21)00473-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
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Luijken K, Dekkers OM, Rosendaal FR, Groenwold RHH. Exploratory analyses in aetiologic research and considerations for assessment of credibility: mini-review of literature. BMJ 2022; 377:e070113. [PMID: 35504648 PMCID: PMC9062703 DOI: 10.1136/bmj-2021-070113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To provide considerations for reporting and interpretation that can improve assessment of the credibility of exploratory analyses in aetiologic research. DESIGN Mini-review of the literature and account of exploratory research principles. SETTING This study focuses on a particular type of causal research, namely aetiologic studies, which investigate the causal effect of one or multiple risk factors on a particular health outcome or disease. The mini review included aetiologic research articles published in four epidemiology journals in the first issue of 2021: American Journal of Epidemiology, Epidemiology, European Journal of Epidemiology, and International Journal of Epidemiology, specifically focusing on observational studies of causal risk factors of diseases. MAIN OUTCOME MEASURES Number of exposure-outcome associations reported, grouped by type of analysis (main, sensitivity, and additional). RESULTS The journal articles reported many exposure-outcome associations: a mean number of 33 (range 1-120) exposure-outcome associations for the primary analysis, 30 (0-336) for sensitivity analyses, and 163 (0-1467) for additional analyses. Six considerations were discussed that are important in assessing the credibility of exploratory analyses: research problem, protocol, statistical criteria, interpretation of findings, completeness of reporting, and effect of exploratory findings on future causal research. CONCLUSIONS Based on this mini-review, exploratory analyses in aetiologic research were not always reported properly. Six considerations for reporting of exploratory analyses in aetiologic research were provided to stimulate a discussion about their preferred handling and reporting. Researchers should take responsibility for the results of exploratory analyses by clearly reporting their exploratory nature and specifying which findings should be investigated in future research and how.
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Affiliation(s)
- Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
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Ibáñez-Sanz G, Milà N, Vidal C, Rocamora J, Moreno V, Sanz-Pamplona R, Garcia M. Positive impact of a faecal-based screening programme on colorectal cancer mortality risk. PLoS One 2021; 16:e0253369. [PMID: 34191813 PMCID: PMC8244848 DOI: 10.1371/journal.pone.0253369] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/27/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The effectiveness of colorectal cancer (CRC) screening programs is directly related to participation and the number of interval CRCs. The objective was to analyse specific-mortality in a cohort of individuals invited to a CRC screening program according to type of CRC diagnosis (screen-detected cancers, interval cancers, and cancers among the non-uptake group). MATERIAL AND METHODS Retrospective cohort that included invitees aged 50-69 years of a CRC screening program (target population of 85,000 people) in Catalonia (Spain) from 2000-2015 with mortality follow-up until 2020. A screen-detected CRC was a cancer diagnosed after a positive faecal occult blood test (guaiac or immunochemical); an interval cancer was a cancer diagnosed after a negative test result and before the next invitation to the program (≤24 months); a non-uptake cancer was a cancer in subjects who declined screening. RESULTS A total of 624 people were diagnosed with CRC (n = 265 screen-detected, n = 103 interval cancers, n = 256 non-uptake). In the multivariate analysis, we observed a 74% increase in mortality rate in the group with interval CRC compared to screen-detected CRC adjusted for age, sex, location and stage (HR: 1.74%, 95% CI:1.08-2.82, P = 0.02). These differences were found even when we restricted for advanced-cancers participants. In the stratified analysis for type of faecal occult blood test, a lower mortality rate was only observed among FIT screen-detected CRCs. CONCLUSION CRC screening with the FIT was associated with a significant reduction in CRC mortality.
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Affiliation(s)
- Gemma Ibáñez-Sanz
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Gastroenterology Department, Bellvitge University Hospital -IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer research group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Núria Milà
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Vidal
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Rocamora
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Víctor Moreno
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer research group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Rebeca Sanz-Pamplona
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer research group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Montse Garcia
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L’Hospitalet de Llobregat, Barcelona, Spain
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Marita TG, Novella M, Heredia ME, Florido M, Sanchez-Contador C, Iyoa E, Ortega S, Miró E, Artigues G, Gelabert J, Garcia-Cortes P, Lucero J, Rodriguez C, Ruiz A, Roca P, Sastre J, Reyes J. RESULT OF THE FIRST TWO ROUNDS OF THE COLORECTAL CANCER SCREENING PROGRAM IN THE BALEARIC ISLANDS (SPAIN). GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45 Suppl 1:55-57. [PMID: 33545238 DOI: 10.1016/j.gastrohep.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Trelles G Marita
- Servicio de Digestivo. Hospital Comarcal de Inca. Mallorca, China; Grupo Multidiciplinar de Oncología Translacional (GMOT) Del Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Spain
| | - M Novella
- Servicio de Digestivo. Hospital Ca'Nmisses, Ibiza, China
| | - M E Heredia
- Servicio de Digestivo.HospitalMateuOrfila, Menorca, China
| | - M Florido
- Servicio de Digestivo. Hospital Comarcal de Inca. Mallorca, China
| | - C Sanchez-Contador
- Direccion General de Salut PúblIca I Participació. Conselleria de Salut. Govern de Les IlLes Balears, China
| | - E Iyoa
- Servicio de Digestivo. Hospital Comarcal de Inca. Mallorca, China
| | - S Ortega
- Servicio de Digestivo. Hospital Comarcal de Inca. Mallorca, China
| | - E Miró
- Direccion General de Salut PúblIca I Participació. Conselleria de Salut. Govern de Les IlLes Balears, China
| | - G Artigues
- Direccion General de Salut PúblIca I Participació. Conselleria de Salut. Govern de Les IlLes Balears, China
| | - J Gelabert
- Servicio de Digestivo.HospitalMateuOrfila, Menorca, China
| | | | - J Lucero
- Servicio de Digestivo. Hospital Ca'Nmisses, Ibiza, China
| | - C Rodriguez
- Servicio de Digestivo. Hospital Ca'Nmisses, Ibiza, China
| | - A Ruiz
- Servicio de Digestivo. Hospital Ca'Nmisses, Ibiza, China
| | - Pilar Roca
- Departamento de Biología Fundamental y Ciencias de la Salud de la Universidad de las Islas Baleares, Spain; Grupo Multidiciplinar de Oncología Translacional (GMOT) Del Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Spain
| | - Jordi Sastre
- Departamento de Biología Fundamental y Ciencias de la Salud de la Universidad de las Islas Baleares, Spain; Grupo Multidiciplinar de Oncología Translacional (GMOT) Del Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Spain
| | - J Reyes
- Servicio de Digestivo. Hospital Comarcal de Inca. Mallorca, China; Grupo Multidiciplinar de Oncología Translacional (GMOT) Del Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Spain
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