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Issaka RB, Bell-Brown A, Jewell T, Jackson SL, Weiner BJ. Interventions to Increase Follow-Up of Abnormal Stool-Based Colorectal Cancer Screening Tests in Safety Net Settings: A Systematic Review. Clin Gastroenterol Hepatol 2024; 22:1967-1974.e3. [PMID: 39322372 DOI: 10.1016/j.cgh.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/02/2024] [Indexed: 09/27/2024]
Affiliation(s)
- Rachel B Issaka
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, Washington
| | - Sara L Jackson
- Department of Medicine, University of Washington, Seattle, Washington
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington
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2
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Giuliani O, Baldacchini F, Bucchi L, Mancini S, Ravaioli A, Vattiato R, Zamagni F, Sassatelli R, Triossi O, Trande P, Palmonari C, Mussetto A, Fabbri C, Giovanardi M, de Padova A, Falcini F. Factors affecting treatment decisions for endoscopically resected low- and high-risk malignant colorectal polyps in a screening setting. Dig Liver Dis 2024:S1590-8658(24)01002-8. [PMID: 39327146 DOI: 10.1016/j.dld.2024.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/22/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION The European Guidelines for colorectal cancer screening of 2006 state that only high-risk endoscopically resected malignant colorectal polyps (MCPs), defined as poor/no differentiation or positive resection margins or lymphovascular invasion, require colonic resection. METHODS A multicentre series of 954 patients with screen-detected MCP (northern Italy, 2005-2016, age 50-69) was studied to identify (1) the factors affecting the choice of colonic resection, and (2) the factors associated with deviation from the European Guidelines for low- and high-risk patients. Data analysis was based on multilevel logistic regression models. RESULTS Five hundred sixty-four (59.1 %) patients underwent colonic resection. The factors significantly associated with surgical referral included: distal and rectal versus proximal tumour site (inverse association); sessile and flat versus pedunculated morphology (direct association); tumour size (direct); moderate/poor versus good differentiation (direct); adenocarcinoma of not otherwise specified type versus adenocarcinoma with a residual adenoma component (direct); positive versus negative resection margins (direct); lymphovascular invasion (direct); and high-grade versus low-grade/absent tumour budding (direct). In low-risk MCPs, tumour budding encouraged strongly the decision for surgery. In high-risk MCPs, a distal/rectal tumour site encouraged the follow-up option. CONCLUSION The identification of factors associated with treatment choices other than those currently recommended may help prioritise the clinical questions in the development of future guidelines.
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Affiliation(s)
- Orietta Giuliani
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Omero Triossi
- Gastroenterology Unit, Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Paolo Trande
- Struttura Semplice Dipartimentale Screening del Colon-Retto, AUSL di Modena, Modena, Italy
| | - Caterina Palmonari
- Western Health District and UOSD Management, Epidemiology, Oncologic screening, Health promotion programmes, AUSL Ferrara, Ferrara, Italy
| | - Alessandro Mussetto
- Gastroenterology Unit, Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Local Health Authority, Forlì-Cesena, Italy
| | - Mauro Giovanardi
- Gastroenterology and Digestive Endoscopy Unit, Local Health Authority, Rimini, Italy
| | - Angelo de Padova
- Gastroenterology and Digestive Endoscopy Unit, Local Health Authority, Rimini, Italy
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy; Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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3
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Hsiao BY, Chiang CJ, Yang YW, Lin LJ, Hsieh PC, Hsu TH, Lee WC. Insights Into Colorectal Cancer Screening: A Multidatabase Cohort Study of Over 1.5 Million Taiwanese. Am J Prev Med 2024; 67:339-349. [PMID: 38697323 DOI: 10.1016/j.amepre.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) remains a significant public health concern. This study aims to provide a comprehensive understanding of the effectiveness of fecal immunochemical test (FIT) screening on CRC incidence and mortality, leveraging the scale of over 1.5 million randomly selected Taiwanese and more than 11.7 million person-years of follow-up. METHODS This prospective cohort study merges data from 3 robust Taiwanese health databases: the CRC screening program, cancer registration, and death registration databases. Incidence and mortality rates of CRC were calculated based on age, sex, urbanization, and past screening status. Cox proportional hazard models were used to assess the association between screening statuses and CRC incidence or mortality, adjusting for age, sex, and urbanization levels. Statistical analysis of the data was conducted in 2021-2022. RESULTS FIT screening was associated with a 33% reduction in CRC incidence and a 47% reduction in mortality. The study identified a dose-response relationship between the fecal hemoglobin concentration (f-HbC) levels and CRC risk. Participants with consistent FIT-negative results had significantly reduced CRC incidence and mortality risks, while those with one or more positive FIT results faced increased risks. Notably, compliance with follow-up examinations after a positive FIT significantly lowered mortality risk. CONCLUSIONS This large-scale study validates the efficacy of FIT screening in reducing CRC incidence and mortality. It offers a nuanced understanding of how various screening statuses impact CRC risks, thus providing valuable insights for public health strategies aimed at CRC prevention.
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Affiliation(s)
- Bo-Yu Hsiao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Ya-Wen Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Pei-Chun Hsieh
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan; Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan.
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4
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Sinonquel P, Jans A, Bisschops R. Painless colonoscopy: fact or fiction? Clin Endosc 2024; 57:581-587. [PMID: 38932703 DOI: 10.5946/ce.2024.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/19/2024] [Indexed: 06/28/2024] Open
Abstract
Although colonoscopy is a routinely performed procedure, it is not devoid of challenges, such as the potential for perforation and considerable patient discomfort, leading to patients postponing the procedure with several healthcare risks. This review delves into preprocedural and procedural solutions, and emerging technologies aimed at addressing the drawbacks of colonoscopies. Insufflation and sedation techniques, together with various other methods, have been explored to increase patient satisfaction, and thereby, the quality of endoscopy. Recent advances in this field include the prevention of loop formation, encompassing the use of variable-stiffness endoscopes, computer-guided scopes, magnetic endoscopic imaging, robotics, and capsule endoscopy. An autonomous endoscope that relies on self-propulsion to completely avoid looping is a potentially groundbreaking technology for the next generation of endoscopes. Nevertheless, critical techniques need to be refined to ensure the development of effective and efficient endoscopes.
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Affiliation(s)
- Pieter Sinonquel
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Alexander Jans
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
- Department of Internal Medicine, UZ Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
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5
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Parodi MC, Antonelli G, Galloro G, Radaelli F, Manes G, Manno M, Camellini L, Sereni G, Caserta L, Arrigoni A, Fasoli R, Sassatelli R, Pigò F, Iovino P, Scimeca D, De Luca L, Rizkala T, Tringali A, Campari C, Capogreco A, Testoni SGG, Bertani H, Fantin A, Mitri RD, Familiari P, Labardi M, De Angelis C, Anghinoni E, Rubeca T, Cassoni P, Zorzi M, Mussetto A, Hassan C, Senore C. SIED-GISCOR recommendations for colonoscopy in screening programs: Part I - Diagnostic. Dig Liver Dis 2024; 56:1350-1357. [PMID: 38105148 DOI: 10.1016/j.dld.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The implementation of FIT programs reduces incidence and mortality from CRC in the screened subjects. The ultimate efficacy for CRC morbidity and mortality prevention in a FIT program depends on the colonoscopy in FIT+ subjects that has the task of detecting and removing these advanced lesions. Recently, there has been growing evidence on factors that influence the quality of colonoscopy specifically withing organized FIT programs, prompting to dedicated interventions in order to maximize the benefit/harm ratio of post-FIT colonoscopy. This document focuses on the diagnostic phase of colonoscopy, providing indications on how to standardise colonoscopy in FIT+ subjects, regarding timing of examination, management of antithrombotic therapy, bowel preparation, competence and sedation.
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Affiliation(s)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Giuseppe Galloro
- Surgical Endoscopy Unit, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
| | | | - Giampiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | | | - Giuliana Sereni
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Caserta
- Department of Medicine - Unit of Gastroenterology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Arrigo Arrigoni
- Diagnostic and Interventional Digestive Endoscopy, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Renato Fasoli
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, SA, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Tommy Rizkala
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | | | - Cinzia Campari
- Screening Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Capogreco
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | - Alberto Fantin
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Maurizio Labardi
- Gastroenterology and Endoscopy Department, Firenze Hospital, Firenze, Italy
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emanuela Anghinoni
- Servizio Medicina Preventiva nelle Comunità - AUSL Mantova, via Dei Toscani 1, 46100 Mantova, Italy
| | - Tiziana Rubeca
- S.C. Laboratorio regionale prevenzione oncologica, ISPO, Firenze, Italy
| | - Paola Cassoni
- Department of Medical Science, Pathology unit, University of Turin, Turin, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Alessandro Mussetto
- Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Viale Vincenzo Randi, 5, Ravenna 48121, Italy
| | - Cesare Hassan
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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6
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O'Leary TJ. Colorectal Cancer Screening: Increasing the Options. J Mol Diagn 2024; 26:669-672. [PMID: 38851387 DOI: 10.1016/j.jmoldx.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024] Open
Affiliation(s)
- Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
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7
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Lieberman DA. Commentary: Liquid Biopsy for Average-Risk Colorectal Cancer Screening. Clin Gastroenterol Hepatol 2024; 22:1160-1164.e1. [PMID: 38552672 PMCID: PMC11265647 DOI: 10.1016/j.cgh.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 04/05/2024]
Affiliation(s)
- David A Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
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8
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Robertson DJ, Rex DK, Ciani O, Drummond MF. Colonoscopy vs the Fecal Immunochemical Test: Which is Best? Gastroenterology 2024; 166:758-771. [PMID: 38342196 DOI: 10.1053/j.gastro.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
Although there is no debate around the effectiveness of colorectal cancer screening in reducing disease burden, there remains a question regarding the most effective and cost-effective screening modality. Current United States guidelines present a panel of options that include the 2 most commonly used modalities, colonoscopy and stool testing with the fecal immunochemical test (FIT). Large-scale comparative effectiveness trials comparing colonoscopy and FIT for colorectal cancer outcomes are underway, but results are not yet available. This review will separately state the "best case" for FIT and colonoscopy as the screening tool of first choice. In addition, the review will examine these modalities from a health economics perspective to provide the reader further context about the relative advantages of these commonly used tests.
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Affiliation(s)
- Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
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9
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Zhang M, Zhang Y, Guo L, Zhao L, Jing H, Yang X, Zhang W, Zhang Y, Nie Z, Zhu S, Zhang S, Zhang X. Trends in colorectal cancer screening compliance and incidence among 60- to 74-year-olds in China. Cancer Med 2024; 13:e7133. [PMID: 38634216 PMCID: PMC11024507 DOI: 10.1002/cam4.7133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 10/26/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74. METHODS A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy. RESULTS A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN. CONCLUSION This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.
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Affiliation(s)
- Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Lu Guo
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xiao Yang
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Endoscopy Center, Tianjin Union Medical Center, Tianjin, China
| | - Wen Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Yong Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Zhenguo Nie
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Siwei Zhu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Shiwu Zhang
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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10
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Maratt JK, Leiman DA, Imperiale TF. Closing a Gap in Colorectal Cancer Screening. JAMA Netw Open 2024; 7:e242652. [PMID: 38526496 DOI: 10.1001/jamanetworkopen.2024.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Affiliation(s)
- Jennifer K Maratt
- Indiana University School of Medicine, Indianapolis
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Thomas F Imperiale
- Indiana University School of Medicine, Indianapolis
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
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11
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Liu S, Wang Y, Wang Y, Duan C, Liu F, Zhang H, Tian X, Ding X, Zhang M, Cao D, Liu Y, Jiang R, Zhuo D, Peng J, Zhu S, Zhao L, Wang J, Wei L, Shi Z. Population-based screening for colorectal cancer in Wuhan, China. Front Oncol 2024; 14:1284975. [PMID: 38487726 PMCID: PMC10937563 DOI: 10.3389/fonc.2024.1284975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Fecal DNA test has emerged as a non-invasive alternative for colorectal cancer (CRC) screening in average-risk population. However, there is currently insufficient evidence in China to demonstrate the effectiveness of population-based CRC screening using fecal DNA based test. Here, a large-scale real-world study for CRC screening was implemented in Wuhan, Hubei province, China. A total of 98,683 subjects aged between 45 and 60 years were screened by a fecal DNA test (ColoTect®) which detected methylation status of SDC2, ADHFE1, and PPP2R5C. Participants who tested positive were advised to receive diagnostic colonoscopy. 4449 (4.5%) subjects tested positive for fecal DNA test, and 3200 (71.9%) underwent colonoscopy. Among these, 2347 (73.3%) had abnormal colonoscopy findings, of which 1330 (56.7%) subjects received pathological diagnosis. Detection rates for CRC and advanced precancerous lesions were 1.3% and 2.3%, respectively. Detection rates for nonadvanced adenomas and polyps were 14.0% and 21.6%, respectively. 28.0% of all colonoscopies showed colorectal neoplasm but lack pathological diagnosis. 6.1% showed other abnormalities such as enteritis. In conclusion, preliminary real-world evidence suggested that fecal DNA tests had promising diagnostic yield in population-based CRC screening. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=192838, identifier ChiCTR2300070520.
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Affiliation(s)
- Song Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Wang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Chaofan Duan
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Zhang
- Department of Gastroenterology, Wuhan Central Hospital, Wuhan, Hubei, China
| | - Xia Tian
- Department of Gastroenterology, The Third Hospital of Wuhan (Tongren Hospital of Wuhan University), Wuhan, Hubei, China
| | - Xiangwu Ding
- Department of Gastroenterology, The Fourth Hospital of Wuhan, Wuhan, Hubei, China
| | - Manling Zhang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Cao
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Duan Zhuo
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Shida Zhu
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Jian Wang
- BGI Genomics Co., Ltd., Shenzhen, China
| | - Li Wei
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhaohong Shi
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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12
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West-Szymanski DC, Zhang Z, Cui XL, Kowitwanich K, Gao L, Deng Z, Dougherty U, Williams C, Merkle S, Moore M, He C, Bissonnette M, Zhang W. Machine learning identifies cell-free DNA 5-hydroxymethylation biomarkers that detect occult colorectal cancer in PLCO Screening Trial subjects. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.25.581955. [PMID: 38464122 PMCID: PMC10925134 DOI: 10.1101/2024.02.25.581955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Colorectal cancer (CRC) is a leading cause of cancer-related mortality, and CRC detection through screening improves survival rates. A promising avenue to improve patient screening compliance is the development of minimally-invasive liquid biopsy assays that target CRC biomarkers on circulating cell-free DNA (cfDNA) in peripheral plasma. In this report, we identify cfDNA biomarker candidate genes bearing the epigenetic mark 5-hydroxymethylcytosine (5hmC) that diagnose occult CRC up to 36 months prior to clinical diagnosis using the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial samples. Methods Archived PLCO Trial plasma samples containing cfDNA were obtained from the National Cancer Institute (NCI) biorepositories. Study subjects included those who were diagnosed with CRC within 36 months of blood collection (i.e., case, n = 201) and those who were not diagnosed with any cancer during an average of 16.3 years of follow-up (i.e., controls, n = 402). Following the extraction of 3 - 8 ng cfDNA from less than 300 microliters plasma, we employed the sensitive 5hmC-Seal chemical labeling approach, followed by next-generation sequencing (NGS). We then conducted association studies and machine-learning modeling to analyze the genome-wide 5hmC profiles within training and validation groups that were randomly selected at a 2:1 ratio. Results Despite the technical challenges associated with the PLCO samples (e.g., limited plasma volumes, low cfDNA amounts, and long archival times), robust genome-wide 5hmC profiles were successfully obtained from these samples. Association analyses using the Cox proportional hazards models suggested several epigenetic pathways relevant to CRC development distinguishing cases from controls. A weighted Cox model, comprised of 32-associated gene bodies, showed predictive detection value for CRC as early as 24-36 months prior to overt tumor presentation, and a trend for increased predictive power was observed for blood samples collected closer to CRC diagnosis. Notably, the 5hmC-based predictive model showed comparable performance regardless of sex and self-reported race/ethnicity, and significantly outperformed risk factors such as age and obesity according to BMI (body mass index). Additionally, further improvement of predictive performance was achieved by combining the 5hmC-based model and risk factors for CRC. Conclusions An assay of 5hmC epigenetic signals on cfDNA revealed candidate biomarkers with the potential to predict CRC occurrence despite the absence of clinical symptoms or the availability of effective predictors. Developing a minimally-invasive clinical assay that detects 5hmC-modified biomarkers holds promise for improving early CRC detection and ultimately patient survival through higher compliance screening and earlier intervention. Future investigation to expand this strategy to prospectively collected samples is warranted.
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13
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Tang JC, Ma JW, Jian JJ, Shen J, Cao LL. Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients. World J Gastrointest Oncol 2024; 16:364-371. [PMID: 38425386 PMCID: PMC10900156 DOI: 10.4251/wjgo.v16.i2.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/11/2023] [Accepted: 12/25/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND According to clinical data, a significant percentage of patients experience pain after surgery, highlighting the importance of alleviating postoperative pain. The current approach involves intravenous self-control analgesia, often utilizing opioid analgesics such as morphine, sufentanil, and fentanyl. Surgery for colorectal cancer typically involves general anesthesia. Therefore, optimizing anesthetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative recovery. The study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients' postoperative pain. AIM To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal cancer. METHODS Following the inclusion criteria and exclusion criteria, a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included, of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group, and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research group. After data collection, the effects of postoperative analgesia, sedation, and recovery were compared. RESULTS Compared to the control group, the research group had shorter recovery times for orientation, extubation, eye-opening, and spontaneous respiration (P < 0.05). The research group also showed lower Visual analog scale scores at 24 h and 48 h, higher Ramany scores at 6 h and 12 h, and improved cognitive function at 24 h, 48 h, and 72 h (P < 0.05). Additionally, interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group (P < 0.05). Levels of CD3+, CD4+, and CD4+/CD8+ were also lower in the research group at multiple time points (P < 0.05). CONCLUSION For patients with colorectal cancer, general anesthesia coupled with epidural anesthesia and multi-mode analgesia can achieve better postoperative analgesia and sedation effects, promote postoperative rehabilitation of patients, improve inflammatory stress and immune status, and have higher safety.
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Affiliation(s)
- Ji-Chun Tang
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu Province, China
- Department of Anesthesiology, People's Hospital of Aheqi County, Kizilsu Kirgiz Autonomous Prefecture 843599, Xinjiang Uygur Autonomous Region, China
| | - Jia-Wei Ma
- Department of Critical Care Medicine, Jiangnan University Medical Center, Wuxi 214122, Jiangsu Province, China
- Department of Critical Care Medicine, People's Hospital of Aheqi County, Kizilsu Kirgiz Autonomous Prefecture, 843599, Xinjiang Uygur Autonomous Region, China
| | - Jin-Jin Jian
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Jie Shen
- Department of Anesthesiology, Jiangyuan Hospital Affiliated to Jiangsu Institute of Atomic Medicine, Wuxi 214063, Jiangsu Province, China
| | - Liang-Liang Cao
- Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu Province, China
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14
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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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15
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Liu Y, Wang XX, Li YL, He WT, Li H, Chen H. Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching. World J Gastrointest Surg 2024; 16:124-133. [PMID: 38328309 PMCID: PMC10845282 DOI: 10.4240/wjgs.v16.i1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing annually. Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice. AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching (PSM). METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City) were analyzed retrospectively. The control group included patients who underwent open surgery (n = 43), and those who underwent laparoscopic surgery formed the observation group (n = 57). The baseline information of both groups was equipoised using 1 × 1 PSM. Differences in the perioperative parameters, inflammatory response, immune function, degree of pain, and physical status between the groups were analyzed. RESULTS Thirty patients from both groups were successfully matched. After PSM, baseline data showed no statistically significant differences between the groups: (1) Perioperative parameters: The observation group had a longer surgery time, less intraoperative blood loss, earlier first ambulation and first anal exhaust times, and shorter gastric tube indwelling time than the control group; (2) Inflammatory response: 24 h after surgery, the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) between groups were higher than preoperatively. IL-6, CRP, and TNF-α levels in the observation group were lower than in the control group; (3) Immune function: At 24 h after surgery, counts of CD4-positive T-lymphocytes (CD4+) and CD4+/CD8-positive T-lymphocytes (CD8+) in both groups were lower than those before surgery, whereas CD8+ was higher than that before surgery. At 24 h after surgery, both CD4+ counts and CD4+/CD8+ in the observation group were higher than those in the control group, whereas CD8+ counts were lower; (4) Degree of pain: The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery; and (5) Physical status: One month after surgery, the Karnofsky performance score in the observation group was higher than that in the control group. CONCLUSION Laparoscopic radical resection of CRC has significant benefits, such as reducing postoperative pain and postoperative inflammatory response, avoiding excessive immune inhibition, and contributing to postoperative recovery.
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Affiliation(s)
- Yang Liu
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Xian-Xue Wang
- Department of Anesthesiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Yu-Lin Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Wen-Tao He
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hong Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hua Chen
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
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16
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Dimaano K, Croman M, Montero S, Sandigo-Saballos I, Orellana M, Chervu N, Petrie BA, Lee H. Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems. Surg Open Sci 2024; 17:6-10. [PMID: 38235211 PMCID: PMC10792257 DOI: 10.1016/j.sopen.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Background Primary care physicians (PCP) play a key role in offering colorectal cancer (CRC) screenings, particularly amongst underserved populations. Given potential delays in or omission of CRC screening in the absence of a PCP, we aimed to determine stage of CRC at diagnosis in an underserved population. Methods A retrospective chart review was conducted at two Los Angeles County safety-net hospitals. Inclusion criteria were a CRC diagnosis between 2018 and 2021 and age between 50 and 75 years at diagnosis time. The primary outcome was the cancer stage at diagnosis. Results A total of 373 patients were included, of those, 52.5 % had a PCP. Compared to others, PCP was similar in age, racial composition, and primary spoken language (Table 1). Of patients with a PCP, 52.0% were diagnosed by screening. After screening, the most common indication for colonoscopy were blood per rectum (24.9 %) and imaging findings (18.0 %). Patients with a PCP had a significantly lower rate of late stage CRC than those without a PCP (42.4 % vs. 68.0 %, p < 0.001). After adjustment, having a PCP was associated with significantly reduced odds of late stage CRC (Adjusted Odds Ratio 0.83, 95 % Confidence Interval [0.68-1.04]). Having a PCP was not associated with any adjusted increase in number of adenomas or tumor size. Conclusions Patients with a PCP, irrespective of undergoing screening, were diagnosed at earlier CRC stages. This underlines the crucial role of PCPs in CRC and diagnosis, reinforcing the need for their active involvement in these processes.
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Affiliation(s)
- Katrina Dimaano
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Millicent Croman
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Stefania Montero
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Isabela Sandigo-Saballos
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Manuel Orellana
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nikhil Chervu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Beverley A. Petrie
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hanjoo Lee
- Department of Surgery, Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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17
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Park JH, Cho KH, Choi J, Chun S, Lee JK, Cho H, Kim B. Risk factors for colorectal cancer in a fecal immunochemical test-positive group: The National Health Insurance Service-National Health Screening Cohort. J Gastroenterol Hepatol 2024; 39:74-80. [PMID: 37855299 DOI: 10.1111/jgh.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long-term studies on subjects with FIT-positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT-positive patients using the National Health Insurance Service Bigdata database. METHODS Among 1 737 633 individuals with a FIT screening result for CRC in 2009, 101 143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10 years (up to 2018) of these participants was investigated using the National Cancer Registry. RESULTS Out of the 101 143 FIT-positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT-positive patients who underwent a second round of screening showed a 5-year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT-positive patients, the CRC incidence in the non-compliance group for the second round of screening was 2.8 times higher than that in the compliance group. CONCLUSIONS In FIT-positive participants, non-compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT-positive patients to increase the rate of compliance with the second round of CRC screening.
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Affiliation(s)
- Joo Hyun Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyung Hee Cho
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Junho Choi
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sungyoun Chun
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Kwang Lee
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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18
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Zhu Y, Li X, Hu Y, Chen K, Zheng S, Ding K. Nonadherence to Referral Colonoscopy After Positive Fecal Immunochemical Test Results Increases the Risk of Distal Colorectal Cancer Mortality. Gastroenterology 2023; 165:1558-1560.e4. [PMID: 37598799 DOI: 10.1053/j.gastro.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Yingshuang Zhu
- Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Hangzhou, China; Zhejiang Provincial Clinical Research Center for CANCER, Hangzhou, Zhejiang, China; Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xue Li
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yeting Hu
- Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Hangzhou, China; Zhejiang Provincial Clinical Research Center for CANCER, Hangzhou, Zhejiang, China; Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Kun Chen
- Department of Epidemiology and Biostatistics, Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shu Zheng
- Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Hangzhou, China; Zhejiang Provincial Clinical Research Center for CANCER, Hangzhou, Zhejiang, China; Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China.
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19
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Pilonis N. Positive fecal immunochemical test but negative colonoscopy: what's next? Endoscopy 2023; 55:1070-1071. [PMID: 37922956 DOI: 10.1055/a-2182-6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Nastazja Pilonis
- Department of Oncological Gastroenterology, National Research Institute of Oncology, Warsaw, Poland
- Division of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
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20
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Vaziri H, Anderson JC. Colorectal Screening During the COVID-19 Pandemic: Delayed but Not Forgotten. Dig Dis Sci 2023; 68:4282-4284. [PMID: 37794296 DOI: 10.1007/s10620-023-08124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Haleh Vaziri
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA.
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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21
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Rex DK, Ladabaum U, Anderson JC, Shaukat A, Butterly LF, Dominitz JA, Kaltenbach T, Levin TR, Hassan C. Does Screening Colonoscopy Have a Future in the United States? Clin Gastroenterol Hepatol 2023; 21:3005-3010. [PMID: 37536529 DOI: 10.1016/j.cgh.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; Division of Gastroenterology and Hepatology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Aasma Shaukat
- New York University Grossman School of Medicine, New York Harbor Veterans Affairs Medical Center, New York, New York
| | - Lynn F Butterly
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jason A Dominitz
- National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, District of Columbia; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Tonya Kaltenbach
- Veterans Affairs San Francisco Healthcare System, San Francisco, California; Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Milan, Italy
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22
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Zorzi M, Battagello J, Barbiellini Amidei C. Reply: Immortal time bias in a retrospective study examining colorectal cancer mortality according to adherence to colonoscopy. Gut 2023; 72:2190-2192. [PMID: 36332970 DOI: 10.1136/gutjnl-2022-328905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
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23
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Fendrick AM, Lieberman D, Chen JV, Vahdat V, Ozbay AB, Limburg PJ. Impact of Eliminating Cost-Sharing by Medicare Beneficiaries for Follow-Up Colonoscopy After a Positive Stool-based Colorectal Cancer Screening Test. CANCER RESEARCH COMMUNICATIONS 2023; 3:2113-2117. [PMID: 37787758 PMCID: PMC10581033 DOI: 10.1158/2767-9764.crc-23-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
Medicare coverage of a follow-up colonoscopy after a positive stool-based colorectal cancer screening test with no patient cost-sharing started January 2, 2023, which may favorably affect screening behavior. This analysis estimated the clinical and economic effects of increased colorectal cancer screening participation potentially resulting from this policy change in Medicare beneficiaries. The validated Colorectal Cancer and Adenoma Incidence & Mortality (CRC-AIM) model simulated three guideline-endorsed colorectal cancer screening strategies for average-risk individuals (colonoscopy every 10 years, annual fecal immunochemical test, triennial multitarget stool DNA) from ages 65-75 years. The base-case scenario assumed 0% coinsurance for initial screening and follow-up colonoscopy, real-world screening test use (colonoscopy = 45.3%, stool-based test = 24.4%, unscreened = 30.3%), and real-world follow-up colonoscopy rates. Comparative scenarios assumed an increase in the overall screening rate from 0% to 15% (5% increments) and an increase in the follow-up colonoscopy rate from 0% to 15% (5% increments). The base-case scenario resulted in 128 life-years gained (LYG)/1,000 individuals versus no screening and total screening and treatment costs of $7,938/person. The changes resulted in an increase of up to 26 LYG/1,000 individuals and a decrease in total screening and treatment costs by as much as $128/person. Follow-up colonoscopy at $0 coinsurance became cost-saving with any increase in either overall screening or follow-up colonoscopy. Policies that remove cost barriers to completing colorectal cancer screening may increase rates of screening participation, potentially improving economic and clinical outcomes. SIGNIFICANCE A follow-up colonoscopy after a positive stool-based colorectal cancer screening test is necessary to complete the full screening process. Policies that remove cost barriers to completing colorectal cancer screening may lead to increases in overall participation rates and use of follow-up colonoscopy, improving clinical and economic outcomes.
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Affiliation(s)
- A. Mark Fendrick
- Department of Internal Medicine and Department of Health Management and Policy, Division of General Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Lieberman
- Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
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Kwok K, Levin TR, Dominitz JA, Panganamamula K, Feld AD, Bardall B, Newbury K, Day LW. Transportation barriers and endoscopic procedures: barriers, legal challenges, and strategies for GI endoscopy units. Gastrointest Endosc 2023; 98:475-481. [PMID: 37632487 DOI: 10.1016/j.gie.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Karl Kwok
- Department of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Theodore R Levin
- Division of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California, USA
| | - Jason A Dominitz
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Andrew D Feld
- Division of Gastroenterology, Kaiser Permanente and Division of Medicine, University of Washington, Seattle, Washington, USA
| | - Bruce Bardall
- The Joint Commission, Oakbrook Terrace, Illinois, USA
| | - Kara Newbury
- Ambulatory Surgery Center Association, Alexandria, Virginia, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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25
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Gimeno-García AZ, Quintero E. Role of colonoscopy in colorectal cancer screening: Available evidence. Best Pract Res Clin Gastroenterol 2023; 66:101838. [PMID: 37852706 DOI: 10.1016/j.bpg.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 10/20/2023]
Abstract
Colonoscopy is the cornerstone examination for colorectal cancer (CRC) screening and it is recommended as the first examination in the context of individuals with high risk of CRC development. Thereby, this examination is of choice in the setting of patients with hereditary CRC syndromes or in patients with long-standing inflammatory bowel disease with colon involvement. However, its role is less clear in the average risk-risk population and in patients with family history of CRC not linked to hereditary CRC syndromes. Despite this, current guidelines, include colonoscopy as alternative for CRC screening either in average risk population with the same evidence level that other screening strategies or in the familial risk population. The present manuscript reviews the clinical evidence on the role of colonoscopy in preventing CRC in different screening settings.
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Affiliation(s)
- Antonio Z Gimeno-García
- Department of Gastroenterology of Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, Spain
| | - Enrique Quintero
- Department of Gastroenterology of Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, Spain.
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26
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Star J, Bandi P, Siegel RL, Han X, Minihan A, Smith RA, Jemal A. Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic. J Clin Oncol 2023; 41:4352-4359. [PMID: 36821800 PMCID: PMC10911528 DOI: 10.1200/jco.22.02170] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions. [Media: see text].
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Affiliation(s)
- Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Rebecca L. Siegel
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Adair Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Early Cancer Detection Science Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
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27
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Winters C, Ford AC. Immortal time bias in a retrospective study examining colorectal cancer mortality according to adherence to colonoscopy. Gut 2023; 72:1799-1800. [PMID: 37549982 DOI: 10.1136/gutjnl-2022-328419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 08/09/2023]
Affiliation(s)
- Conchubhair Winters
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander Charles Ford
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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28
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Tumino E, Visaggi P, Bolognesi V, Ceccarelli L, Lambiase C, Coda S, Premchand P, Bellini M, de Bortoli N, Marciano E. Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy. Diagnostics (Basel) 2023; 13:2452. [PMID: 37510196 PMCID: PMC10378494 DOI: 10.3390/diagnostics13142452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients' reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients' compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.
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Affiliation(s)
- Emanuele Tumino
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Pierfrancesco Visaggi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Valeria Bolognesi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Linda Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Christian Lambiase
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Sergio Coda
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Purushothaman Premchand
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Emanuele Marciano
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
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29
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Scott RE, Chang P, Kluz N, Baykal-Caglar E, Agrawal D, Pignone M. Equitable Implementation of Mailed Stool Test-Based Colorectal Cancer Screening and Patient Navigation in a Safety Net Health System. J Gen Intern Med 2023; 38:1631-1637. [PMID: 36456842 PMCID: PMC10212848 DOI: 10.1007/s11606-022-07952-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Mailed stool testing programs increase colorectal cancer (CRC) screening in diverse settings, but whether uptake differs by key demographic characteristics is not well-studied and has health equity implications. OBJECTIVE To examine the uptake and equity of the first cycle of a mailed stool test program implemented over a 3-year period in a Central Texas Federally Qualified Health Center (FQHC) system. DESIGN Retrospective cohort study within a single-arm intervention. PARTICIPANTS Patients in an FQHC aged 50-75 at average CRC risk identified through electronic health records (EHR) as not being up to date with screening. INTERVENTIONS Mailed outreach in English/Spanish included an introductory letter, free-of-charge fecal immunochemical test (FIT), and lab requisition with postage-paid mailer, simple instructions, and a medical records update postcard. Patients were asked to complete the FIT or postcard reporting recent screening. One text and one letter reminded non-responders. A bilingual patient navigator guided those with positive FIT toward colonoscopy. MAIN MEASURES Proportions of patients completing mailed FIT in response to initial cycle of outreach and proportion of those with positive FIT completing colonoscopy; comparison of whether proportions varied by demographics and insurance status obtained from the EHR. KEY RESULTS Over 3 years, 33,606 patients received an initial cycle of outreach. Overall, 19.9% (n = 6672) completed at least one mailed FIT, 5.6% (n = 374) tested positive during that initial cycle, and 72.5% (n = 271 of 374) of those with positive FIT completed a colonoscopy. Hispanic/Latinx, Spanish-speaking, and uninsured patients were more likely to complete mailed FIT compared with white, English-speaking, and commercially insured patients. Spanish-speaking patients were more likely to complete colonoscopy after positive FIT compared with English-speaking patients. CONCLUSIONS Mailed FIT outreach with patient navigation implemented in an FQHC system was effective in equitably reaching patients not up to date for CRC screening.
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Affiliation(s)
- Rebekah E Scott
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Patrick Chang
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, USA
| | - Nicole Kluz
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Eda Baykal-Caglar
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, USA
- CommUnityCare Health Centers, Austin, TX, USA
| | - Deepak Agrawal
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Michael Pignone
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, USA.
- Livestrong Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, USA.
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30
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Zhang M, Zhang Y, Zhang W, Zhao L, Jing H, Wu X, Guo L, Zhang H, Zhang Y, Zhu S, Zhang S, Zhang X. Postponing colonoscopy for 6 months in high-risk population increases colorectal cancer detection in China. Cancer Med 2023; 12:11816-11827. [PMID: 36951442 PMCID: PMC10242305 DOI: 10.1002/cam4.5850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/11/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND AND AIMS Colonoscopy is an important colorectal cancer (CRC) screening modality; however, not all high-risk groups identified by fecal immunochemical test (FIT) and/or high-risk factor questionnaire (HRFQ) undergo colonoscopy in time. The impact of delays in colonoscopy on CRC detection among high-risk populations remains poorly understood, warranting further clarification. METHODS A retrospective study was conducted among CRC high-risk population identified by Tianjin CRC screening program. According to the colonoscopy results after HRFQ and FIT, patients were classified into CRC, advanced adenoma, non-advanced adenoma, and normal groups. The time interval between CRC screening and colonoscopy was investigated and its relationship with colonoscopy results. Logistic regression was performed to explore the risk factors of CRC detection. RESULTS Among the high-risk population without a history of CRC or polyps, 49,810 underwent HRFQ, FIT, and colonoscopy, and a time interval of fewer than 6 months was found for 79.56% of patients (n = 39,630). People with positive FIT were more likely to undergo colonoscopy within 6 months, and detection rates of CRC and/or advanced adenoma were positively related to time intervals. Similar results were found in people with a negative FIT but positive HRFQ. A time interval longer than 6 months was a significant predictor of CRC detection in high-risk populations. CONCLUSION For high-risk people identified by CRC screening, especially those with a positive FIT, a time interval of 6 months was associated with an increased probability of CRC detection. Our findings emphasize that populations at high risk should undergo colonoscopy at least within 6 months.
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Affiliation(s)
- Mingqing Zhang
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Yongdan Zhang
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Wen Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Lizhong Zhao
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Haoren Jing
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Xiaojing Wu
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Lu Guo
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Haixiang Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Yong Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Siwei Zhu
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Shiwu Zhang
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
- Department of PathologyTianjin Union Medical CenterTianjinChina
| | - Xipeng Zhang
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
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31
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Chan FKL, Wong MCS, Chan AT, East JE, Chiu HM, Makharia GK, Weller D, Ooi CJ, Limsrivilai J, Saito Y, Hang DV, Emery JD, Makmun D, Wu K, Ali RAR, Ng SC. Joint Asian Pacific Association of Gastroenterology (APAGE)-Asian Pacific Society of Digestive Endoscopy (APSDE) clinical practice guidelines on the use of non-invasive biomarkers for diagnosis of colorectal neoplasia. Gut 2023:gutjnl-2023-329429. [PMID: 37019620 DOI: 10.1136/gutjnl-2023-329429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 04/07/2023]
Abstract
Screening for colorectal cancer (CRC) is effective in reducing CRC related mortality. Current screening methods include endoscopy based and biomarker based approaches. This guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society of Digestive Endoscopy (APSDE), developed in response to the increasing use of, and accumulating supportive evidence for the role of, non-invasive biomarkers for the diagnosis of CRC and its precursor lesions. A systematic review of 678 publications and a two stage Delphi consensus process involving 16 clinicians in various disciplines was undertaken to develop 32 evidence based and expert opinion based recommendations for the use of faecal immunochemical tests, faecal based tumour biomarkers or microbial biomarkers, and blood based tumour biomarkers for the detection of CRC and adenoma. Comprehensive up-to-date guidance is provided on indications, patient selection and strengths and limitations of each screening tool. Future research to inform clinical applications are discussed alongside objective measurement of research priorities. This joint APAGE-APSDE practice guideline is intended to provide an up-to-date guide to assist clinicians worldwide in utilising non-invasive biomarkers for CRC screening; it has particular salience for clinicians in the Asia-Pacific region.
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Affiliation(s)
- Francis K L Chan
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
- Centre for Health Education and Health Promotion, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Julajak Limsrivilai
- Internal Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Dao V Hang
- Hanoi Medical University, Hanoi, Vietnam
| | - Jon D Emery
- Department of General Practice, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | | | - Kaichun Wu
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Xian, China
| | | | - Siew C Ng
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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32
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Zorzi M, Antonelli G, Barbiellini Amidei C, Battagello J, Germanà B, Valiante F, Benvenuti S, Tringali A, Bortoluzzi F, Cervellin E, Giacomin D, Meggiato T, Rosa-Rizzotto E, Fregonese D, Dinca M, Baldassarre G, Scalon P, Pantalena M, Milan L, Bulighin G, Di Piramo D, Azzurro M, Gabbrielli A, Repici A, Rex DK, Rugge M, Hassan C, Giacomin A, Buda A, Costa D, Checchin D, Marin R, Patarnello E, Ceriani A, Guido E, Bertomoro P, Merlini N, Murer F, Ntakirutimana E, Benazzato L, Bellocchi MCC. Adenoma Detection Rate and Colorectal Cancer Risk in Fecal Immunochemical Test Screening Programs : An Observational Cohort Study. Ann Intern Med 2023; 176:303-310. [PMID: 36802754 DOI: 10.7326/m22-1008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening programs based on fecal immunochemical tests (FITs) represent the standard of care for population-based interventions. Their benefit depends on the identification of neoplasia at colonoscopy after FIT positivity. Colonoscopy quality measured by adenoma detection rate (ADR) may affect screening program effectiveness. OBJECTIVE To examine the association between ADR and postcolonoscopy CRC (PCCRC) risk in a FIT-based screening program. DESIGN Retrospective population-based cohort study. SETTING Fecal immunochemical test-based CRC screening program between 2003 and 2021 in northeastern Italy. PATIENTS All patients with a positive FIT result who had a colonoscopy were included. MEASUREMENTS The regional cancer registry supplied information on any PCCRC diagnosed between 6 months and 10 years after colonoscopy. Endoscopists' ADR was categorized into 5 groups (20% to 39.9%, 40% to 44.9%, 45% to 49.9%, 50% to 54.9%, and 55% to 70%). To examine the association of ADR with PCCRC incidence risk, Cox regression models were fitted to estimate hazard ratios (HRs) and 95% CIs. RESULTS Of the 110 109 initial colonoscopies, 49 626 colonoscopies done by 113 endoscopists between 2012 and 2017 were included. After 328 778 person-years follow-up, 277 cases of PCCRC were diagnosed. Mean ADR was 48.3% (range, 23% and 70%). Incidence rates of PCCRC from lowest to highest ADR group were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10 000 person-years. There was a significant inverse association between ADR and PCCRC incidence risk, with a 2.35-fold risk increase (95% CI, 1.63 to 3.38) in the lowest group compared with the highest. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (CI, 0.95 to 0.98). LIMITATION Adenoma detection rate is partly determined by FIT positivity cutoff; exact values may vary in different settings. CONCLUSION In a FIT-based screening program, ADR is inversely associated with PCCRC incidence risk, mandating appropriate colonoscopy quality monitoring in this setting. Increasing endoscopists' ADR may significantly reduce PCCRC risk. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy (M.Z., C.B.A., J.B.)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, and Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy (G.A.)
| | | | | | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy (B.G.)
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre (BL), Italy (F.V.)
| | - Stefano Benvenuti
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy (S.B.)
| | - Alberto Tringali
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Conegliano (TV), Italy (A.T.)
| | - Francesco Bortoluzzi
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Venezia, Italy (F.B.)
| | - Erica Cervellin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Dolo (VE), Italy (E.C.)
| | - Davide Giacomin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave (VE), Italy (D.G.)
| | - Tamara Meggiato
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5 Rovigo, Italy (T.M.)
| | - Erik Rosa-Rizzotto
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Padova, Italy (E.R.-R.)
| | - Diego Fregonese
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Camposampiero, Italy (D.F.)
| | - Manuela Dinca
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Monselice, Italy (M.D.)
| | - Gianluca Baldassarre
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Santorso, Italy (G.B.)
| | - Paola Scalon
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy (P.S.)
| | - Maurizio Pantalena
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Arzignano, Italy (M.P.)
| | - Luisa Milan
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Vicenza, Italy (L.M.)
| | - Gianmarco Bulighin
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, San Bonifacio, Italy (G.B.)
| | - Daniele Di Piramo
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Villafranca, Italy (D. Di P.)
| | - Maurizio Azzurro
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Legnago, Italy (M.A.)
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy (A.G.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, and IRCCS Humanitas Research Hospital, Endoscopy Unit, Rozzano, Milan, Italy (A.R., C.H.)
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana (D.K.R.)
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, and Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy (M.R.)
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, and IRCCS Humanitas Research Hospital, Endoscopy Unit, Rozzano, Milan, Italy (A.R., C.H.)
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Colonoscopies save lives. Why did a trial suggest they might not? Nature 2023; 613:235-237. [PMID: 36627420 DOI: 10.1038/d41586-023-00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Oberhofer E. [Not Available]. MMW Fortschr Med 2022; 164:12-13. [PMID: 36510050 DOI: 10.1007/s15006-022-2184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Elke Oberhofer
- Springer Medizin Verlag GmbH, Aschauer Str. 30, 81549, München, Germany
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Fendrick AM, Lieberman D, Vahdat V, Chen JV, Ozbay AB, Limburg PJ. Cost-Effectiveness of Waiving Coinsurance for Follow-Up Colonoscopy after a Positive Stool-Based Colorectal Screening Test in a Medicare Population. Cancer Prev Res (Phila) 2022; 15:653-660. [PMID: 35768200 PMCID: PMC9530644 DOI: 10.1158/1940-6207.capr-22-0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
Commercial insurance covers a follow-up colonoscopy after a positive colorectal cancer-screening test with no patient cost-sharing. Instituting a similar policy for Medicare beneficiaries may increase screening adherence and improve outcomes. The cost-effectiveness of stool-based colorectal cancer screening was compared across adherence scenarios that assumed Medicare coinsurance status quo (20% for follow-up colonoscopy) or waived coinsurance. The CRC-AIM model simulated previously unscreened eligible Medicare beneficiaries undergoing stool-based colorectal cancer screening at age 65 for 10 years. Medicare costs, colorectal cancer cases, colorectal cancer-related deaths, life-years gained (LYG), and quality-adjusted life-years (QALY) were estimated versus no screening. Scenario 1 (S1) assumed 20% coinsurance for follow-up colonoscopy. Scenario 2 (S2) assumed waived coinsurance without adherence changes. Scenarios 3-7 (S3-S7) assumed that waiving coinsurance increased real-world stool-based screening and/or follow-up colonoscopy adherence by 5% or 10%. Sensitivity analyses assumed 1%-4% increased adherence. Cost-effectiveness threshold was ≤$100,000/QALY. Waiving coinsurance without adherence changes (S2) did not affect outcomes versus S1. S3-S7 versus S1 over 10 years estimated up to 3.6 fewer colorectal cancer cases/1,000 individuals, up to 2.1 fewer colorectal cancer deaths, up to 20.7 more LYG, and had comparable total costs per-patient (≤$6,478 vs. $6,449, respectively) as reduced colorectal cancer medical costs offset increased screening and colonoscopy costs. In sensitivity analyses, any increase in adherence after waiving coinsurance was cost-effective and increased LYG. In simulated Medicare beneficiaries, waiving coinsurance for follow-up colonoscopy after a positive stool-based test improved outcomes and was cost-effective when assumed to modestly increase colorectal cancer screening and/or follow-up colonoscopy adherence. PREVENTION RELEVANCE Follow-up colonoscopy after a positive stool-based test is necessary to complete the colorectal cancer-screening process. This analysis demonstrated that in a simulated Medicare population, waiving coinsurance for a follow-up colonoscopy improved estimated outcomes and was cost-effective when it was assumed that waiving the coinsurance modestly increased screening adherence. See related Spotlight, p. 641.
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Affiliation(s)
- A. Mark Fendrick
- Division of General Medicine, Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, Michigan
- Corresponding Author: A. Mark Fendrick, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Building 16/4th floor, Ann Arbor, MI 48109. Phone: 734-647-9688; Fax: 734-936-8944;
| | - David Lieberman
- Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | | | | | | | - Paul J. Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Winters C, Subramanian V, Valdastri P. Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review. World J Gastroenterol 2022; 28:5093-5110. [PMID: 36188716 PMCID: PMC9516669 DOI: 10.3748/wjg.v28.i35.5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 02/06/2023] Open
Abstract
Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed.
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Affiliation(s)
- Conchubhair Winters
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Venkataraman Subramanian
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
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Lieberman D, Ladabaum U, Brill JV, May FP, Kim LS, Murphy C, Wender R, Teixeira K. Reducing the Burden of Colorectal Cancer: AGA Position Statements. Gastroenterology 2022; 163:520-526. [PMID: 35715380 DOI: 10.1053/j.gastro.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022]
Affiliation(s)
- David Lieberman
- Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon.
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California
| | - Joel V Brill
- Predictive Health, Phoenix, Arizona; University of Arizona College of Medicine, Phoenix, Arizona
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California; University of California-Los Angeles Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California; Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Caitlin Murphy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Richard Wender
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Self-Reported and Objective Impact of the COVID-19 Pandemic on Planning, Compliance and Timeliness of a Diagnostic Colonoscopy after a Positive FIT Screening Result in the Flemish Colorectal Cancer Screening Program. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4030013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: During the COVID-19 pandemic, the Flemish colorectal cancer (CRC) screening program (by fecal immunochemical test, FIT) was suspended and non-urgent medical procedures were discommended. This study estimates how this impacted diagnostic colonoscopy (DC) scheduling after a positive FIT and the interval between both in 2020. Methods: An online survey was sent to participants in the Flemish CRC screening program with a positive FIT but without a DC to explore the possible impact of COVID-19 on the scheduling of a DC. Self-reported survey results were complemented with objective data on DC compliance and the interval between FIT and DC. Results: In 2020, DC compliance was 4–5% lower than expected (for 3780 positive FITs no DC was performed). In February–March 2020, the median time between a positive FIT and DC significantly increased. Survey participants reported fear of COVID-19 contamination, perception to create hospital overload, delay in non-urgent medical procedures (on government advice) and not being sure a DC could be performed as contributing reasons. Conclusions: On top of a 3% lower participation, the COVID-19 pandemic further increased existing DC non-compliance and the positive FIT–DC interval. The survey confirmed the crucial role of COVID-19 in the decision not to plan a DC.
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Effect of Chronic Comorbidities on Follow-up Colonoscopy After Positive Colorectal Cancer Screening Results: A Population-Based Cohort Study. Am J Gastroenterol 2022; 117:1137-1145. [PMID: 35333781 DOI: 10.14309/ajg.0000000000001742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/18/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fecal occult blood tests (FOBTs) are colorectal cancer screening tests used to identify individuals requiring further investigation with colonoscopy. Delayed colonoscopy after positive FOBT (FOBT+) is associated with poorer cancer outcomes. We assessed the effect of comorbidity on colonoscopy receipt within 12 months after FOBT+. METHODS Population-based healthcare databases from Ontario, Canada, were linked to assemble a cohort of 50-74-year-old individuals with FOBT+ results between 2008 and 2017. The associations between comorbidities and colonoscopy receipt within 12 months after FOBT+ were examined using multivariable cause-specific hazard regression models. RESULTS Of 168,701 individuals with FOBT+, 80.5% received colonoscopy within 12 months. In multivariable models, renal failure (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.62-0.82), heart failure (HR 0.77, CI 0.75-0.80), and serious mental illness (HR 0.88, CI 0.85-0.92) were associated with the lowest colonoscopy rates, compared with not having each condition. The number of medical conditions was inversely associated with colonoscopy uptake (≥4 vs 0: HR 0.64, CI 0.58-0.69; 3 vs 0: HR 0.75, CI 0.72-0.78; and 2 vs 0: HR 0.87, CI 0.85-0.89). Having both medical and mental health conditions was associated with a lower colonoscopy uptake relative to no comorbidity (HR 0.88, CI 0.87-0.90). DISCUSSION Persons with medical and mental health conditions had lower colonoscopy rates after FOBT+ than those without these conditions. Better strategies are needed to optimize colorectal cancer screening and follow-up in individuals with comorbidities.
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Concepcion J, Yeager M, Alfaro S, Newsome K, Ibrahim J, Bilski T, Elkbuli A. Trends of Cancer Screenings, Diagnoses, and Mortalities During the COVID-19 Pandemic: Implications and Future Recommendations. Am Surg 2022:31348221091948. [PMID: 35420510 PMCID: PMC9014329 DOI: 10.1177/00031348221091948] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction The impact of the COVID-19 pandemic on cancer screenings and care has yet to
be determined. This study aims to investigate the screening, diagnosis, and
mortality rates of the top five leading causes of cancer mortality in the
United States from 2019 to 2021 to determine the potential impact of the
COVID-19 pandemic on cancer care. Methods A retrospective cohort study investigating the impact of the COVID-19
pandemic on screening, diagnoses, and mortality rates of the top five
leading causes of cancer death (lung/bronchus, colon/rectum, pancreas,
breast, and prostate), as determined by the National Institute of Health
(NIH) utilizing The United States Healthcare Cost Institute and American
Cancer Society databases from 2019 to 2021. Results Screenings decreased by 24.98% for colorectal cancer and 16.01% for breast
cancer from 2019 to 2020. Compared to 2019, there was a .29% increase in
lung/bronchus, 19.72% increase in colorectal, 1.46% increase in pancreatic,
2.89% increase in breast, and 144.50% increase in prostate cancer diagnoses
in 2020 (all P < .01). There was an increase in the total number of
deaths from colorectal, pancreatic, breast, and prostate cancers from 2019
to 2021. Conclusion There was a decrease in the screening rates for breast and colorectal cancer,
along with an increase in the estimated incidence and mortality rate among
the five leading causes of cancer deaths from 2019 to 2021. The findings
suggest that the COVID-19 pandemic is associated with impaired cancer
screening, diagnosis, and care, and further emphasizes the need for
proactive screening and follow-up to prevent subsequent cancer morbidity and
mortality.
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Affiliation(s)
| | - Matthew Yeager
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Sophie Alfaro
- 390414A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Kevin Newsome
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Joseph Ibrahim
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
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Zorzi M, Rugge M. United we win: Pushing for follow up after a positive faecal immunochemical test. Dig Liver Dis 2021; 53:1058. [PMID: 34083154 DOI: 10.1016/j.dld.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy.
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padova, Italy; Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy
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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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