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Guerrero-Nancuante C, Eguiguren P, Bass C, Garmendia ML. Socio-economic factors related to premature death from colorectal cancer in Santiago de Chile, 2014-2018: a cross-sectional study. Public Health 2024; 231:1-6. [PMID: 38582055 DOI: 10.1016/j.puhe.2024.03.003] [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: 10/30/2023] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES In Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile. STUDY DESIGN This was a cross-sectional study. METHODS We analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models. RESULTS During the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.53) and single marital status (OR 1.45; 95% CI 1.24-1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47-0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15-4.57). CONCLUSIONS This study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.
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Affiliation(s)
- C Guerrero-Nancuante
- Programa de Doctorado en Salud Pública, Escuela de Salud Pública Dr. Salvador Allende, Facultad de Medicina, Universidad de Chile, Chile; Escuela de Enfermería, Universidad de Valparaíso, Chile
| | - P Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende, Facultad de Medicina, Universidad de Chile, Chile
| | - C Bass
- Escuela de Salud Pública Dr. Salvador Allende, Facultad de Medicina, Universidad de Chile, Chile
| | - M L Garmendia
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile.
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Luu XQ, Lee K, Jun JK, Suh M, Choi KS. Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021. Epidemiol Health 2023; 45:e2023086. [PMID: 37752795 PMCID: PMC10728610 DOI: 10.4178/epih.e2023086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels. METHODS We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model. RESULTS The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening. CONCLUSIONS Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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López Salas M, De Haro Gázquez D, Fernández Sánchez B, Amador Muñoz ML. Knowledge, Compliance, and Inequities in Colon Cancer Screening in Spain: An Exploratory Study. Healthcare (Basel) 2023; 11:2475. [PMID: 37761672 PMCID: PMC10530971 DOI: 10.3390/healthcare11182475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
In Spain, inequities exist in implementing colorectal cancer (CRC) tests with the target population-adults aged 50 to 69-as part of population-based CRC screening programs. This research aims to further our understanding of the target population's awareness, attitudes, and perceptions of these test-based screening programs. A survey was carried out using an online panel representative of the target population, with a sample collected from 5313 individuals. Data collection took place in June 2022. Descriptive and bivariate analyses were carried out using contingency tables, the Chi-square test, and Cramer's V statistics. The sample was also segmented based on key variables. Finally, the results were analyzed using logistic regression. In the sample population, 62.5% had taken the fecal occult blood test (FOBT), 72.5% reported receiving the invitation letter to participate in the screening program, and 86.8% had prior knowledge of the FOBT. Noncompliance was mainly due to lack of symptoms (40%), non-receipt of invitation letters (39.7%), and forgetfulness or neglect (28.5%). On the contrary, receipt of the letter of invitation (OR 7.35, p < 0.01) and prior knowledge of FOBT (OR 6.32, p < 0.01) were the main variables that increased the probability of test uptake. Other significant variables included frequency of primary care visits (OR 1.71, p < 0.01) and being older (65-69 years old) (OR 1.52, p < 0.01) There is still a pressing need for greater awareness of both CRC risk factors and the benefits of early detection, as well as for overcoming the common misconception that detection should only be sought when symptoms are present.
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Affiliation(s)
- Mario López Salas
- Asociación Española Contra el Cáncer, Teniente Coronel Noreña, 30, 28045 Madrid, Spain; (D.D.H.G.); (B.F.S.); (M.L.A.M.)
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de Haro Gázquez D, Fernández Sánchez B, María Luz AM. [Actitudes e imágenes sociales sobre el cribado de cáncer colorrectal. Una aproximación exploratoria mediante grupos de discusión.]. Rev Esp Salud Publica 2023; 97:e202308063. [PMID: 37970927 PMCID: PMC10541245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The screening for colorectal cancer (CRC) through the fecal occult blood test (FOBT) has achieved high implementation in Spain, although participation rates are still not optimal. At the same time, available data show significant differences in participation both among autonomous communities and among different sociodemographic groups, which raises various equity issues. This study aimed to conduct an exploratory analysis from a qualitative perspective on the attitudes, perceptions, and social images that the target population for colorectal cancer screenings holded regarding them, as well as the barriers and areas for improvement identified through these. METHODS This study was designed using a qualitative research approach, through the conduct of four focus groups in May 2022, with a total of twenty-six participants (equal number of men and women) aged fifty to sixty-nine years. The participants were residents of the Community of Madrid, Catalonia, Andalusia, and the Basque Country (in both large and small cities), with varying educational levels and different previous experiences of participation in the CRC screening program. RESULTS Different conceptualizations of prevention were identified, but none that encompassed cancer (especially colorectal cancer) as an element to be incorporated into daily practices since its occurrence is primarily associated with chance. In addition to the lack of knowledge about CRC compared to other types of cancer (such as breast or prostate cancer), various attitudinal barriers to participation in the CRC screening program were perceived. These included the rejection of being part of the older age group (targeted by the test), fear of waiting for the results, lack of reliability, or the sense of being able to postpone the moment. CONCLUSIONS This study highlights the need for interventions aimed at promoting the attitude with which the invitation to participate is received and interpreted. It also emphasizes the importance of incorporating colon cancer into the dominant framework of concerns, raising awareness about the significance of early detection, and addressing potential sources of inequity. These interventions should address the broader conceptualization of the role of prevention observed among individuals with higher cultural capital and the greater normalization of screening programs found among women due to their previous experience with breast cancer screening.
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Affiliation(s)
- Diego de Haro Gázquez
- Asociación Española Contra el CáncerAsociación Española Contra el CáncerMadridSpain
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van de Schootbrugge-Vandermeer HJ, Lansdorp-Vogelaar I, de Jonge L, van Vuuren AJ, Dekker E, Spaander MCW, Ramakers CRB, Nagtegaal ID, van Kemenade FJ, van Leerdam ME, Toes-Zoutendijk E. Socio-demographic and cultural factors related to non-participation in the Dutch colorectal cancer screening programme. Eur J Cancer 2023; 190:112942. [PMID: 37406529 DOI: 10.1016/j.ejca.2023.112942] [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: 03/24/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND High participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed. We investigated demographic differences between participants and non-participants in the Dutch faecal immunochemical test-based colorectal cancer (CRC) screening programme. METHODS In this population-based cohort study, we included all invitees for CRC screening in 2018 and 2019. Participation status, birth year, and sex were extracted from the Dutch national screening information system and linked to demographic characteristics from Statistics Netherlands, including migration background, level of education, socioeconomic category, household composition, and household income. A multivariable logistic regression was used to assess the association between demographic factors and participation. RESULTS A total of 4,383,861 individuals were invited for CRC screening in 2018 and 2019, of which 3,170,349 (72.3%) participated. Individuals were less likely to participate when they were single and/or living with others (single with other residents versus couple: odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.31-0.38), had a migration background (e.g. Moroccan migrant versus Dutch background: OR 0.43, 95% CI: 0.42-0.44), or had a low income (lowest versus highest quintile: OR 0.45, 95% CI: 0.44-0.45). Although to a lesser extent, non-participation was also significantly associated with being male, being younger, receiving social welfare benefits and having a low level of education. CONCLUSION We found that individuals who were single and/or living with others, immigrants from Morocco or individuals with low income were the least likely to participate in the Dutch CRC screening programme. Targeted interventions are needed to minimise inequities in CRC screening.
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Affiliation(s)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Christian R B Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Bright D, Hillier S, Song J, Huws DW, Greene G, Hodgson K, Akbari A, Griffiths R, Davies AR, Gjini A. Inequalities in colorectal cancer screening uptake in Wales: an examination of the impact of the temporary suspension of the screening programme during the COVID-19 pandemic. BMC Public Health 2023; 23:546. [PMID: 36949447 PMCID: PMC10031708 DOI: 10.1186/s12889-023-15345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/28/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Response to the early stages of the COVID-19 pandemic resulted in the temporary disruption of cancer screening in the UK, and strong public messaging to stay safe and to protect NHS capacity. Following reintroduction in services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who may benefit from tailored interventions. METHODS Records within the BSW were linked to electronic health records (EHR) and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank. Ethnic group was obtained from a linked data method available within SAIL. We examined uptake for the first 3 months of invitations (August to October) following the reintroduction of BSW programme in 2020, compared to the same period in the preceding 3 years. Uptake was measured across a 6 month follow-up period. Logistic models were conducted to analyse variations in uptake by sex, age group, income deprivation quintile, urban/rural location, ethnic group, and clinically extremely vulnerable (CEV) status in each period; and to compare uptake within sociodemographic groups between different periods. RESULTS Uptake during August to October 2020 (period 2020/21; 60.4%) declined compared to the same period in 2019/20 (62.7%) but remained above the 60% Welsh standard. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Compared to the pre-pandemic period in 2019/20, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most income deprived group. Uptake continues to be lower in males, younger individuals, people living in the most income deprived areas and those of Asian and unknown ethnic backgrounds. CONCLUSION Our findings are encouraging with overall uptake achieving the 60% Welsh standard during the first three months after the programme restarted in 2020 despite the disruption. Inequalities did not worsen after the programme resumed activities but variations in CRC screening in Wales associated with sex, age, deprivation and ethnic group remain. This needs to be considered in targeting strategies to improve uptake and informed choice in CRC screening to avoid exacerbating disparities in CRC outcomes as screening services recover from the pandemic.
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Affiliation(s)
- Diana Bright
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK.
| | - Sharon Hillier
- Health Protection and Screening Services Directorate. Public Health Wales, Cardiff, Wales
| | - Jiao Song
- Communicable Disease Surveillance Centre. Public Health Wales, Cardiff, Wales
| | - Dyfed W Huws
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Giles Greene
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Karen Hodgson
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Rowena Griffiths
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Alisha R Davies
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Ardiana Gjini
- Health Protection and Screening Services Directorate. Public Health Wales, Cardiff, Wales
- Cardiff University, Cardiff, UK
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Vanaclocha-Espí M, Pinto-Carbó M, Martín-Pozuelo J, Romeo-Cervera P, Peiró-Pérez R, Barona C, Ortiz F, Nolasco A, Castán S, Salas D, Molina-Barceló A. Construction of an individual socioeconomic status index for analysing inequalities in colorectal cancer screening. PLoS One 2022; 17:e0278275. [PMID: 36454740 PMCID: PMC9714724 DOI: 10.1371/journal.pone.0278275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP). METHODS Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models. RESULTS The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175). CONCLUSIONS An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.
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Affiliation(s)
- Mercedes Vanaclocha-Espí
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- * E-mail:
| | - Marina Pinto-Carbó
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Javier Martín-Pozuelo
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Paula Romeo-Cervera
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
| | - Rosana Peiró-Pérez
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Carmen Barona
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Ortiz
- Health Insurance Service and the SIP of the Conselleria de Sanitat, Valencian Community, Spain
| | | | - Susana Castán
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Dolores Salas
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
- General Directorate of Public Health, Valencian Community, Spain
| | - Ana Molina-Barceló
- Foundation for the Promotion of Health and Biomedical Research-Public Health Research FISABIO–Public Health Research, Valencia, Spain
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Caló RDS, Souza RAGD, Alves MR, Carvalho AED, Galvão ND. Socioeconomic development and colorectal cancer mortality in a state of the Brazilian Legal Amazon from 2005 to 2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220006. [PMID: 35766763 DOI: 10.1590/1980-549720220006.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the correlation between colorectal cancer (CRC) mortality rates and socioeconomic factors in the five mesoregions (North, Northeast, Southeast, Southwest and Center-South) of the state of Mato Grosso, from 2005 to 2016. METHODS Ecological study that considered deaths from CRC (C18 to C21) of residents of the state. Mortality rates were standardized by the direct method, using the world standard population. For the analysis of socioeconomic factors, the Firjan Municipal Development Index (IFDM) and its components (education, income and employment and health) were used. Means of mortality rates and socioeconomic factors between the mesoregions were tested using ANOVA, and Pearson's correlation coefficient was used to analyze the correlation between mortality rates due to CRC and these factors. RESULTS In the period from 2005 to 2016, 1,492 deaths from CRC were registered in the state of Mato Grosso. The Southwest mesoregion had the highest average for both the crude rate and standardized CRC mortality rates (3.47 and 3.86 deaths/100,000 inhabitants, respectively). There was a significant correlation between mortality rates from the disease with the following indicators: Overall IFDM for the North, Southeast and Center-South mesoregions; education for the North and Southeast mesoregions; income and employment for the North and Center-South mesoregions; and health for the North, Southeast and Center-South mesoregions. CONCLUSION There was a correlation between CRC mortality rates and better socioeconomic development in the state.
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Affiliation(s)
- Romero Dos Santos Caló
- Universidade Federal de Mato Grosso, Institute of Collective Health, Post-graduation Program in Collective Health - Cuiabá (MT), Brazil
| | - Rita Adriana Gomes de Souza
- Universidade Federal de Mato Grosso, Institute of Collective Health, Post-graduation Program in Collective Health - Cuiabá (MT), Brazil
| | - Mario Ribeiro Alves
- Universidade Federal de Mato Grosso, Institute of Collective Health, Post-graduation Program in Collective Health - Cuiabá (MT), Brazil
| | | | - Noemi Dreyer Galvão
- Universidade Federal de Mato Grosso, Institute of Collective Health - Cuiabá (MT), Brazil
- Mato Grosso State Health Department - Cuiabá (MT), Brazil
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Nouni-García R, Lara-López Á, Carratalá-Munuera C, Gil-Guillén VF, López-Pineda A, Orozco-Beltrán D, Quesada JA. Factors Associated with Colorectal Cancer Screening in Spain: Results of the 2017 National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5460. [PMID: 35564855 PMCID: PMC9100170 DOI: 10.3390/ijerph19095460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to determine the CRC screening coverage of people aged between 50 and 69 years who were living in Spain in 2017 and describe the factors associated with not having had a faecal occult blood test (FOBT). A cross-sectional study was performed using data from the Spanish National Health Survey 2017. We analysed 7568 individuals between the ages of 50 and 69 years. The proportion of respondents between 50 and 69 years old who had had an FOBT was 29.0% (n = 2191). The three autonomous communities with the lowest proportion of respondents who had had an FOBT were Extremadura (8.7%, n = 16), Ceuta-Melilla (10.4%, n = 3), and Andalucia (14.1%, n = 186). The variables associated with not having had an FOBT were being 50-54 years old (PR = 1.09; 95% CI 1.04-1.14), having been born outside of Spain (PR = 1.11; 95% CI 1.06-1.16), not having been vaccinated against the flu (PR = 1.09; 95% CI 1.04-1.15), never having had a colonoscopy (PR = 1.49; 95% CI 1.40-1.59), not having had an ultrasound scan in the last year (PR = 1.09; 95% CI 1.04-1.14), and not having seen a primary care physician in the last month (PR = 1.08; 95% CI 1.04-1.12). The factors associated with not getting an FOBT were young age, having been born outside of Spain, not having been vaccinated against the flu in the last campaign, and not making frequent use of healthcare services.
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Affiliation(s)
- Rauf Nouni-García
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Ángela Lara-López
- San Juan de Alicante Campus, Faculty of Medicine, Miguel Hernández University, 03202 San Juan de Alicante, Spain;
| | - Concepción Carratalá-Munuera
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Vicente F. Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Adriana López-Pineda
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
| | - Jose A. Quesada
- Department of Clinical Medicine, Miguel Hernández University, Ctra. Nnal. 332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain; (R.N.-G.); (C.C.-M.); (V.F.G.-G.); (D.O.-B.); (J.A.Q.)
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Takemura T, Kataoka Y, Ashi N, Shirakawa C, Okazaki K, Sakurai A, Imakita T, Ikegaki S, Matsumoto H, Saito E, Takata H, Kaku S, Wada N, Shinomiya M, Otoshi T, Shimada M, Nikaido J, Iki R, Hirano K, Hirai T, Endo K, Hirabayashi M, Naganuma T. Influence of social isolation and loneliness on the prognosis of advanced lung cancer patients: a prospective cohort study. Support Care Cancer 2022; 30:6045-6053. [PMID: 35416501 DOI: 10.1007/s00520-022-07026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of social isolation and loneliness on the overall survival and death at home in patients with lung cancer. METHODS This prospective cohort study was conducted in a Japanese tertiary hospital. The enrollment period was from April 2018 to March 2020. Patients with pathologically diagnosed advanced lung cancer were included in this study. The primary outcome was overall survival, whereas the secondary outcome was death at home. The exposures were social isolation and loneliness. RESULTS A total of 211 patients were enrolled and divided into two groups and further into quartiles according to their social isolation and loneliness level, respectively. The hazard ratios of social isolation were 1.65 (95% confidence interval; 1.12 to 2.44) and 1.87 (95% confidence interval; 1.15 to 3.03) in the univariate analysis, while 1.40 (95% confidence interval; 0.92 to 2.13) in the multivariate analysis with complete case and multiple imputation. The odds ratio of death at home with social isolation was 3.47 (95% confidence interval; 1.08 to 11.1) in the multivariate analysis with multiple imputation. Loneliness was not associated with overall survival or death at home. CONCLUSIONS Our study suggests that social isolation may be related to overall survival and death at home among patients with advanced lung cancer. More attention should be given to such patients at the time of diagnosis.
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Affiliation(s)
- Tomoyasu Takemura
- Department of Internal Medicine, Kyoto Min-Iren Chuo Hospital, Uzumasa Tsuchimotocho, 2-1, Ukyo, Kyoto, 616-8147, Japan.
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, 89 Tanaka-asukaicho Sakyo, Kyoto, Japan
| | - Nanami Ashi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Chigusa Shirakawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koya Okazaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Azusa Sakurai
- Department of Gynecology, Kyoto University Hospital, Kyoto, Japan
| | - Takuma Imakita
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunkichi Ikegaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Emiko Saito
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Hirohito Takata
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Sawako Kaku
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo, Tokyo, Japan
| | - Nobuko Wada
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Mariko Shinomiya
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Takehiro Otoshi
- Division of Respiratory Medicine/Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Junichi Nikaido
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Reika Iki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Katsuya Hirano
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Tomoyuki Hirai
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Kazuo Endo
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Masataka Hirabayashi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Toru Naganuma
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, Japan.,Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
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11
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AI and Clinical Decision Making: The Limitations and Risks of Computational Reductionism in Bowel Cancer Screening. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Advances in artificial intelligence in healthcare are frequently promoted as ‘solutions’ to improve the accuracy, safety, and quality of clinical decisions, treatments, and care. Despite some diagnostic success, however, AI systems rely on forms of reductive reasoning and computational determinism that embed problematic assumptions about clinical decision-making and clinical practice. Clinician autonomy, experience, and judgement are reduced to inputs and outputs framed as binary or multi-class classification problems benchmarked against a clinician’s capacity to identify or predict disease states. This paper examines this reductive reasoning in AI systems for colorectal cancer (CRC) to highlight their limitations and risks: (1) in AI systems themselves due to inherent biases in (a) retrospective training datasets and (b) embedded assumptions in underlying AI architectures and algorithms; (2) in the problematic and limited evaluations being conducted on AI systems prior to system integration in clinical practice; and (3) in marginalising socio-technical factors in the context-dependent interactions between clinicians, their patients, and the broader health system. The paper argues that to optimise benefits from AI systems and to avoid negative unintended consequences for clinical decision-making and patient care, there is a need for more nuanced and balanced approaches to AI system deployment and evaluation in CRC.
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12
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van der Meulen MP, Toes-Zoutendijk E, Spaander MCW, Dekker E, Bonfrer JMG, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, van Velthuysen MF, Thomeer MGJ, van Veldhuizen H, de Koning HJ, Lansdorp-Vogelaar I, van Leerdam ME. Socioeconomic differences in participation and diagnostic yield within the Dutch national colorectal cancer screening programme with faecal immunochemical testing. PLoS One 2022; 17:e0264067. [PMID: 35176116 PMCID: PMC8853540 DOI: 10.1371/journal.pone.0264067] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/02/2022] [Indexed: 12/22/2022] Open
Abstract
Background CRC mortality rates are higher for individuals with a lower socioeconomic status (SES). Screening could influence health inequalities. We therefore aimed to investigate SES differences in participation and diagnostic yield of FIT screening. Methods All invitees in 2014 and 2015 in the Dutch national CRC screening programme were included in the analyses. We used area SES as a measure for SES and divided invitees into quintiles, with Quintile 1 being the highest SES. Logistic regression analysis was used to compare the participation rate, positivity rate, colonoscopy uptake, positive predictive value (PPV) and detection rate across the SES groups. Results Participation to FIT screening was significantly lower for Quintile 5 (67.0%) compared to the other Quintiles (73.0% to 75.1%; adjusted OR quintile 5 versus quintile 1: 0.73, 95%CI: 0.72–0.74), as well as colonoscopy uptake after a positive FIT (adjusted OR 0.73, 95%CI: 0.69–0.77). The detection rate per FIT participant for advanced neoplasia gradually increased from 3.3% in Quintile 1 to 4.0% in Quintile 5 (adjusted OR 1.20%, 95%CI 1.16–1.24). As a result of lower participation, the yield per invitee was similar for Quintile 5 (2.04%) and Quintile 1 (2.00%), both being lower than Quintiles 2 to 4 (2.20%-2.28%). Conclusions Screening has the potential to reduce health inequalities in CRC mortality, because of a higher detection in participants with a lower SES. However, in the Dutch screening programme, this is currently offset by the lower participation in this group.
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Affiliation(s)
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Academic University Medical Centers, Amsterdam, The Netherlands
| | - Johannes M. G. Bonfrer
- Department of Clinical Chemistry, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anneke J. van Vuuren
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - M. F. van Velthuysen
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten G. J. Thomeer
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harriët van Veldhuizen
- Department of Quality Improvement, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harry J. de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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13
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Bozhar H, McKee M, Spadea T, Veerus P, Heinävaara S, Anttila A, Senore C, Zielonke N, de Kok I, van Ravesteyn N, Lansdorp-Vogelaar I, de Koning H, Heijnsdijk E. Socio-economic Inequality of Utilization of Cancer Testing in Europe: A Cross-Sectional Study. Prev Med Rep 2022; 26:101733. [PMID: 35198362 PMCID: PMC8850331 DOI: 10.1016/j.pmedr.2022.101733] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/06/2021] [Accepted: 02/06/2022] [Indexed: 12/27/2022] Open
Abstract
There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50–0.61), cervical smear tests (OR = 0.60, 95%CI:0.56–0.65) and colorectal testing (OR = 0.82, 95%CI:0.78–0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.
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14
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Caló RDS, Souza RAGD, Alves MR, Carvalho AED, Galvão ND. Desenvolvimento socioeconômico e mortalidade por câncer colorretal em uma unidade federativa da Amazônia Legal, de 2005 a 2016. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220006.supl.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Analisar a correlação entre as taxas de mortalidade por câncer colorretal (CCR) e os fatores socioeconômicos nas cinco mesorregiões (norte, nordeste, sudeste, sudoeste e centro-sul) do estado de Mato Grosso, de 2005 a 2016. Métodos: Estudo ecológico que considerou os óbitos por CCR (C18 a C21) de residentes do estado. As taxas de mortalidade foram padronizadas pelo método direto, utilizando-se a população padrão mundial. Para a análise dos fatores socioeconômicos, foram usados o Índice Firjan de Desenvolvimento Municipal Geral (IFDM) e seus componentes (educação; renda e emprego; saúde). Foram testadas as médias das taxas de mortalidade e dos fatores socioeconômicos entre as mesorregiões por meio da análise de variância (ANOVA), e empregou-se o coeficiente de correlação de Pearson para análise da correlação entre as taxas de mortalidade por CCR e esses fatores. Resultados: No período de 2005 a 2016, foram registrados 1.492 óbitos por CCR no estado de Mato Grosso. A mesorregião com a maior média tanto da taxa bruta quanto da taxa padronizada de mortalidade por CCR foi a sudoeste (3,47 e 3,86 óbitos/100 mil habitantes). Houve correlação significante entre as taxas de mortalidade por CCR com os seguintes indicadores: IFDM geral para as mesorregiões norte, sudeste e centro-sul; educação para as mesorregiões norte e sudeste; renda e emprego para as mesorregiões norte e centro-sul; e saúde para as mesorregiões norte, sudeste e centro-sul. Conclusão: Houve correlação da taxa de mortalidade de CCR com melhor desenvolvimento socioeconômico no estado.
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Affiliation(s)
| | | | | | | | - Noemi Dreyer Galvão
- Universidade Federal de Mato Grosso, Brazil; Mato Grosso State Health Department, Brazil
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15
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Analysis of Post-Colonoscopy Colorectal Cancer and Its Subtypes in a Screening Programme. Cancers (Basel) 2021; 13:cancers13205105. [PMID: 34680254 PMCID: PMC8533900 DOI: 10.3390/cancers13205105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Using the algorithm of the World Endoscopy Organisation (WEO), we have studied retrospectively all colorectal cancers, both detected and non-detected by the Basque Country screening programme from 2009 to 2017. In the screening programme 61,335 colonoscopies were performed following a positive Faecal Immunochemical test (FIT) (≥20 µg Hb/g faeces) and the 128 cases of post-colonoscopy colorectal cancer (PCCRC) detected were analysed. Among them, 50 interval type PCCRCs were diagnosed (before the recommended surveillance), 0.8 cases per 1000 colonoscopies performed, and 78 non-interval type PCCRCs (in the surveillance carried out at the recommended time or delayed), 1.3 per 1000 colonoscopies. Among the non-interval type PCCRCs, 61 cases were detected in the surveillance carried out at the recommended time (type A) and 17 when the surveillance was delayed (type B), 1 case per 1000 colonoscopies performed and 0.28 cases per 1000 colonoscopies performed, respectively. Interval type PCCRC is less frequent than non-interval type PCCRC. In interval type PCCRCs, CRCs detected in advanced stages (stages III-IV) were significantly more frequent than those detected in early stages, compared to those of non-interval type PCCRCs (OR = 3.057; 95% CI, 1.410-6.625; p < 0.005). Non-interval type B PCCRCs are less frequent than non-interval type A PCCRCs, but the frequency of advanced stages is higher in interval type B PCCRCs.
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16
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Unanue-Arza S, Portillo I, Idígoras I, Arostegui I, Arana-Arri E. Facilitators and barriers to participation in population-based colorectal cancer screening programme from the perspective of healthcare professionals: Qualitative research study. Eur J Cancer Care (Engl) 2021; 30:e13507. [PMID: 34462982 DOI: 10.1111/ecc.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High participation determines the success of colorectal cancer screening programmes in reducing incidence and mortality. The factors that determine participation must be studied from the perspective of professionals that implement the programme. The aim was to identify factors that facilitate or hinder the participation of the invited people in the bowel cancer screening programme of the Basque Country (Spain) from professional's perspective. METHODS Qualitative design based on individual interviews and focus groups. Thirty-eight primary care professionals who implement the programme participated (administrative staff, nurses and general practitioners). Thematic analysis was performed. RESULTS Professionals show high satisfaction with the programme, and they believe firmly in its benefits. Facilitators for participation include professionals' commitment to the programme, their previous positive experiences, their optimistic attitude towards the prognosis of cancer and their trust in the health system and accessibility. Barriers include invitees' lack of independence to make decisions, fear of a positive test result and patient vulnerability and labour mobility of the health professionals. CONCLUSIONS Professionals show a high degree of involvement and identify primary care is an appropriate place to carry out disease prevention. They identify the closeness to patients, the personal attitude and the characteristics of the health system as key factors that influence participation.
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Affiliation(s)
- Saloa Unanue-Arza
- Department of Nursing, Faculty of Medicine and Nursing, University of the Basque Country (UPV-EHU), Leioa, Spain
| | - Isabel Portillo
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain.,Biocruces Health Research Institute, Barakaldo, Spain
| | - Isabel Idígoras
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain.,Biocruces Health Research Institute, Barakaldo, Spain
| | - Inmaculada Arostegui
- Department of Applied Mathematics, Statistics and Operations Research. Faculty of Science and Technology, University of the Basque Country (UPV-EHU), Leioa, Spain.,Basque Center for Applied Mathematics-BCAM, Bilbao, Spain.,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas-REDISSEC, Madrid, Spain
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17
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Rollet Q, Tron L, De Mil R, Launoy G, Guillaume É. Contextual factors associated with cancer screening uptake: A systematic review of observational studies. Prev Med 2021; 150:106692. [PMID: 34166675 DOI: 10.1016/j.ypmed.2021.106692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.
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Affiliation(s)
- Quentin Rollet
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France.
| | - Laure Tron
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Rémy De Mil
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Élodie Guillaume
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
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18
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Unanue-Arza S, Solís-Ibinagagoitia M, Díaz-Seoane M, Mosquera-Metcalfe I, Idigoras I, Bilbao I, Portillo I. Inequalities and risk factors related to non-participation in colorectal cancer screening programmes: a systematic review. Eur J Public Health 2021; 31:346-355. [PMID: 33313657 PMCID: PMC8071594 DOI: 10.1093/eurpub/ckaa203] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Colorectal cancer (CRC) screening programmes require high levels of participation in order to reduce mortality. To improve participation rates, it is necessary to identify the health risk factors and social inequalities associated with non-participation. Methods A systematic review was conducted between June and September of 2019 in six databases: CINHAL, Medline, Scopus, Social Sciences Citation Index, Embase and PsycINFO. Studies assessing the relationship between health risk factors, participation in preventive activities and participation in CRC screening were included. Methodological assessment was carried out according to the Quality Assessment Tools of the National Heart, Lung and Blood Institute. Results A total of nine studies that analyze participation in both organized and opportunistic screening programmes using any type of screening method were finally selected. Data were mainly self-reported although in two studies medical records were also studied. We identified several variables: gender, body mass index, consultation with a doctor or a specialist, educational level, employment, health insurance, residence, ethnicity, age, marital status, income, other preventive activities, obesity, physical activity, smoking, family history of CRC and general health status. Conclusion The scarcity of studies linking risk factors, social inequalities and participation in preventive activities for participation in screening in the same study makes it difficult to reach definitive patterns related to non-participation in CRC screening programmes. Nevertheless, being under 60, obese, smoker and sedentary have shown an association with non-participation as well as not visiting a doctor.
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Affiliation(s)
- Saloa Unanue-Arza
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
- Correspondence: Saloa Unanue-Arza., Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n 48940 Leioa, Bizkaia, Spain, Tel: +34 946 01 5610, e-mail:
| | | | - Marta Díaz-Seoane
- Department of Preventive Medicine and Public Health, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | - Isabel Idigoras
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Isabel Bilbao
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Isabel Portillo
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
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19
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Solís-Ibinagagoitia M, Unanue-Arza S, Díaz-Seoane M, Martínez-Indart L, Lebeña-Maluf A, Idigoras I, Bilbao I, Portillo I. Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme. Front Public Health 2020; 8:604385. [PMID: 33363095 PMCID: PMC7760939 DOI: 10.3389/fpubh.2020.604385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Despite the high participation rates in the Basque Country, colorectal cancer screening programme (Spain), there is still a part of the population that has never participated. Since it is essential to ensure equal access to health services, it is necessary to identify the determinants of health and socio-economic factors related to non-participation in the screening programme. Methods: Cross sectional descriptive study including all invited population in a complete round between 2015 and the first trimester of 2017. Health risk factors available in medical records and their control have been analyzed using univariate and multivariate analyses. Results: 515,388 people were invited at the programme with a 71.9% of fecal immunochemical test participation rate. Factors that increase the risk of non-participation are: being men (OR = 1.10, 95% CI 1.09-1.12); younger than 60 (OR = 1.18, 95% CI 1.17-1.20); smoker (OR = 1.20, 95% CI 1.18-1.22); hypertensive (OR = 1.14, 95% CI 1.12-1.15) and diabetic (OR = 1.40, 95% CI 1.36-1.43); having severe comorbidity (OR = 2.09, 95% CI 2.00-2.19) and very high deprivation (OR = 1.15, 95% CI 1.12-1.17), as well as making <6 appointments to Primary Care in 3 years (OR = 2.39, 95% CI 2.33-2.45). Still, the area under the curve (AUC) indicates that there are more factors related to non-participation. Conclusions: The participation in the Basque Country colorectal cancer-screening Programme is related to some risk factors controlled by Primary Care among others. Therefore, the involvement of these professionals could improve, not only the adherence to the CRC screening, but also other health styles and preventive interventions.
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Affiliation(s)
| | - S Unanue-Arza
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain
| | - M Díaz-Seoane
- Department of Preventive Medicine and Public Health, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | - A Lebeña-Maluf
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - I Idigoras
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain.,Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - I Bilbao
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - I Portillo
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain.,Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
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Hoeck S, van de Veerdonk W, De Brabander I, Kellen E. Does the Flemish colorectal cancer screening programme reach equity in FIT uptake? Eur J Public Health 2020; 29:1108-1114. [PMID: 30887054 DOI: 10.1093/eurpub/ckz043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. METHODS Men and women, aged 56-74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. RESULTS A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56-60 and 70-74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy's for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. CONCLUSIONS There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.
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Affiliation(s)
- S Hoeck
- Centre for Cancer Detection, Bruges, Belgium.,Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W van de Veerdonk
- Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | | | - E Kellen
- Centre for Cancer Detection, Bruges, Belgium.,University Hospital Leuven, Leuven, Belgium
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21
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Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test. Cancers (Basel) 2020; 12:cancers12092412. [PMID: 32854370 PMCID: PMC7565457 DOI: 10.3390/cancers12092412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
Population screening has improved early diagnosis of colorectal cancer (CRC). Nonetheless, most cases are diagnosed in symptomatic patients. Faecal immunochemical testing has been recommended for assessing patients with lower gastrointestinal symptoms, but whether it improves patient survival is unknown. Our objective was to compare CRC survival in 50- to 69-year-olds between asymptomatic screen-detected patients and symptomatic patients by route to diagnosis. Methods: We identified all cases of CRC diagnosed in 50-to 69-year-olds between 2009 and 2016, in Donostialdea (Gipuzkoa, Spain). Three groups were created: 1-screen-detected CRC; 2-CRC detected in symptomatic patients after a positive faecal immunochemical test(FIT); and 3-CRC detected in symptomatic patients without a FIT or after a negative result. We analysed survival using the Kaplan-Meier method and log-rank tests. Results: Of 930 patients diagnosed with CRC, 433 cases were detected through screening and 497 in symptomatic patients, 7.9% after a positive FIT and 45.5% by other means. The 3-year CRC survival was significantly lower in group 3 (69.5%) than groups 1 (93%; p = 0.007) or 2 (87.5%; p = 0.02). The risk of death was lower in groups 1 (HR 0.42, 95% CI 0.30–0.58) and 2 (HR 0.51; 95% CI 0.29–0.87). Conclusion: Half of CRC cases in 50- to 69-year-olds are diagnosed outside screening. Use of the FIT as a diagnostic strategy in symptomatic patients may improve survival.
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22
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Luque-Fernandez MA, Redondo-Sánchez D, Rodríguez-Barranco M, Chang-Chan YL, Salamanca-Fernández E, Núñez O, Fernandez-Navarro P, Pollán M, Sánchez MJ. Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study. Clin Epidemiol 2020; 12:797-806. [PMID: 32801917 PMCID: PMC7383045 DOI: 10.2147/clep.s261355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain. METHODS We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation. RESULTS Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3). CONCLUSIONS We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- London School of Hygiene and Tropical Medicine, Non-Communicable Disease Epidemiology, London, UK
| | - Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | - Yoe-Ling Chang-Chan
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
| | - Elena Salamanca-Fernández
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Olivier Núñez
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Health Institute Carlos III (CNE-ISCIII), Madrid, Spain
| | - Pablo Fernandez-Navarro
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Health Institute Carlos III (CNE-ISCIII), Madrid, Spain
| | - Marina Pollán
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Health Institute Carlos III (CNE-ISCIII), Madrid, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria de Granada, Non-Communicable Disease and Cancer Epidemiology Group, ibs.GRANADA, University of Granada, Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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23
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Mar J, Arrospide A, Larrañaga I, Iruretagoiena ML, Imaz L, Gorostiza A, Ibarrondo O. Impact of an organised population screening programme for colorectal cancer: Measurement after first and second rounds. J Med Screen 2020; 28:122-130. [PMID: 32380931 DOI: 10.1177/0969141320921893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The first and second rounds of the Basque programme for organised colorectal cancer screening were implemented between 2009 and 2014. Our objective was to measure the changes in incidence, tumour, node, metastasis staging distribution and tumour, node, metastasis-adjusted survival of patients with colorectal cancer from 2003 to 2014. METHOD Colorectal cancer cases with screening (patients <70 years old) and without screening (patients ≥70 years old) were compared during three four-year periods: 2003-2006, 2007-2010 and 2011-2014 (fully implemented phase). Cox regression, five-year relative survival and cancer probability of death were calculated for each four-year period, age group and tumour, node, metastasis stage. Adjusted incidence rates were analysed by joinpoint regression. RESULTS In an analysis of 23,301 cases of colorectal cancer, the incidence in patients younger than 70 years in 2013 showed a 17% annual decrease. The survival hazard ratios for stages I, II and III for 2003-2006 and 2007-2010 were compared to those for 2011-2014. From the first to the third period, diagnosis in the early stages (I and II) rose from 45.1% to 50.9% in the younger patient group and remained stable in the older group (49.6% and 49.4%). Additionally, the five-year relative survival rate increased significantly from 0.67 to 0.82 in those patients younger than 70 years, whereas in patients 70 years or older the rate did not change significantly (0.61 and 0.65). CONCLUSION The screening reduced incidence and improved survival by anticipating the diagnosis and by reducing mortality for each tumour, node, metastasis stage in the target population. The effect on survival could also be due to lead-time bias.
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Affiliation(s)
- Javier Mar
- AP-OSIs Research Unit, OSI Alto Deba, Arrasate-Mondragón, España.,Public Health Area, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España.,Research Network in Health Services in Chronic Diseases (REDISSEC), Bilbao, España
| | - Arantzazu Arrospide
- AP-OSIs Research Unit, OSI Alto Deba, Arrasate-Mondragón, España.,Public Health Area, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España.,Research Network in Health Services in Chronic Diseases (REDISSEC), Bilbao, España
| | - Igor Larrañaga
- AP-OSIs Research Unit, OSI Alto Deba, Arrasate-Mondragón, España.,Research Network in Health Services in Chronic Diseases (REDISSEC), Bilbao, España
| | - Maria Luisa Iruretagoiena
- Public Health and Patient Safety Programs Coordination Department, Basque Health Service Osakidetza, Vitoria-Gasteiz, España
| | - Liher Imaz
- Public Health Area, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España.,Gipuzkoa Public Health Division, Basque Government Health Department, Donostia-San Sebastián, España
| | - Ania Gorostiza
- AP-OSIs Research Unit, OSI Alto Deba, Arrasate-Mondragón, España.,Public Health Area, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Oliver Ibarrondo
- AP-OSIs Research Unit, OSI Alto Deba, Arrasate-Mondragón, España.,Public Health Area, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España.,Research Network in Health Services in Chronic Diseases (REDISSEC), Bilbao, España
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24
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ÖZDEMIR R, TÜRKMEN ÇEVIK F, KES D, KARACALI M, ÖZGÜNER S. Level and Factors Associated with Participation in Population-Based Cancer Screening in Safranbolu District of Karabuk, Turkey. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:663-672. [PMID: 32548046 PMCID: PMC7283187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervix, breast and colorectal cancers are included in the national population-based screening (PBS) program in Turkey. This study aimed to assess participation in PBSs for these cancers and to identify factors associated with participation in screenings in Safranbolu district of Karabuk, Turkey in 2016-2017. METHODS In this cross-sectional study, separate studying groups for cervix, breast and colorectal cancers were identified, taking into account the target age range specified in the national screening standards. The sample size was determined to be 374 for cervical cancer, 371 for breast cancer and 373 for colorectal cancer in the Epi-Info StatCalc program with a prevalence of 50%, a 95% Confidence Interval (CI) and a 5% error margin. The results of the data collected through face-to-face interview using questionnaires were evaluated with Chi-square tests (P<0.05) and included in the binary logistic regression model. RESULTS Participation in PBS at least once between 2011 and 2016 years was 26.2% for cervical cancer, 27.6% for breast cancer and 31.6% for colorectal cancer, whereas the level of PBS or opportunistic screening at least once was 51.1%, 42.7% and 32.2%, respectively. A 2.9-fold increase in participation for the cervical cancer screening was associated with informing women about cervical cancer by the family physicians. Being married and living in the district center showed associations with a higher rate of participation for colorectal cancer screening. CONCLUSION Participation in PBS was low for the 5.5-year period. More effort is needed to increase the effectiveness of the program.
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Affiliation(s)
- Raziye ÖZDEMIR
- Department of Occupational Health and Safety, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey,Corresponding author:
| | | | - Duygu KES
- Department of Nursing, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey
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Duque I, Domínguez-Berjón MF, Cebrecos A, Prieto-Salceda MD, Esnaola S, Calvo Sánchez M, Marí-Dell'Olmo M. [Deprivation index by enumeration district in Spain, 2011]. GACETA SANITARIA 2020; 35:113-122. [PMID: 32014314 DOI: 10.1016/j.gaceta.2019.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011. METHOD The unit of analysis was the enumeration district (N=35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions. RESULTS Using the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east. CONCLUSIONS The socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.
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Affiliation(s)
- Ignacio Duque
- Subdirección General de Tecnologías de la Información y las Comunicaciones, Instituto Nacional de Estadística, Madrid, España.
| | | | - Alba Cebrecos
- Grupo de Investigación Social y Cardiovascular, Universidad de Alcalá de Henares, Alcalá de Henares (Madrid), España; Departamento de Geología, Geografía y Ciencias Ambientales, Alcalá de Henares (Madrid), España
| | - María Dolores Prieto-Salceda
- Observatorio de Salud Pública de Cantabria, Fundación Marqués de Valdecilla, Consejería de Sanidad, Santander, España
| | - Santiago Esnaola
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Montserrat Calvo Sánchez
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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26
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Cobo-Cuenca AI, Laredo-Aguilera JA, Rodríguez-Borrego MA, Santacruz-Salas E, Carmona-Torres JM. Temporal Trends in Fecal Occult Blood Test: Associated Factors (2009-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2120. [PMID: 31207996 PMCID: PMC6616453 DOI: 10.3390/ijerph16122120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
A cross-sectional study with 27,821 records of non-institutionalized people in Spain aged between 50-69 years old (59.94 ± 5.8 years), who participated in the European Health Survey in Spain (2009, 2014) and National Health Survey (2011/12, 2017). Fecal occult testing, the reason for performing the test, age, sex, nationality, social status, marital status, education level, body mass index (BMI), and place of residence. Overall, 54% were women, 93.9% were Spanish, 47.8% had a secondary study, and 66.4% were married. Across the years, the rate of the fecal occult blood test (FOBT) increased significantly (p < 0.001). This increase can be accounted for a letter campaign advising testing (45%, p < 0.001). FOBT was associated with more age (odds ratio-OR 1.04, 95% confidence interval-CI 1.04-1.05, p < 0.001), Spanish nationality (OR 1.91, 95% CI 1.25-2.93, p = 0.003), being married (OR 1.13, 95% CI 1.02-1.25, p = 0.025), having a higher level of education (OR 2.46, 95% CI 2.17-2.81, p < 0.001), belonging to high social classes (OR 1.35, 95% CI 1.12-1.64, p = 0.001), and BMI <25 (OR 1.72, 95% CI 1.25-2.37). Frequency of FOBT has increased in recent years. Performing FOBT is associated with age, nationality, marital status, higher education level, and social class.
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Affiliation(s)
- Ana Isabel Cobo-Cuenca
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha (UCLM), 45071 Toledo, Spain.
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), UCLM. Av. Carlos III s/n., 45071 Toledo, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain.
| | - José Alberto Laredo-Aguilera
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha (UCLM), 45071 Toledo, Spain.
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), UCLM. Av. Carlos III s/n., 45071 Toledo, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain.
| | - María-Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain.
- Departamento de Enfermería. Universidad de Córdoba (UCO), 14004 Córdoba, Spain.
| | - Esmeralda Santacruz-Salas
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha (UCLM), 45071 Toledo, Spain.
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), UCLM. Av. Carlos III s/n., 45071 Toledo, Spain.
| | - Juan Manuel Carmona-Torres
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha (UCLM), 45071 Toledo, Spain.
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), UCLM. Av. Carlos III s/n., 45071 Toledo, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain.
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Participation in a population-based screening for colorectal cancer using the faecal immunochemical test decreases mortality in 5 years. Eur J Gastroenterol Hepatol 2019; 31:197-204. [PMID: 30543575 DOI: 10.1097/meg.0000000000001338] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The steady increase in colorectal cancer (CRC) could be reversed through timely secondary prevention (screening) as a main strategy. The aims of this study were to determine the main features of CRC, survival rate and related factors for different types of identified CRCs in a population-based screening programme using the faecal immunochemical test (FIT). MATERIALS AND METHODS The CRCs in the susceptible population to be screened between 2009 and 2014 were identified and classified into four groups: (a) nonscreening-detected CRC (diagnosed before first screening invitation and nonparticipants), (b) screening-detected CRC, (c) interval cancer (IC) FIT (diagnosed between screening rounds after a negative FIT) and (d) IC colonoscopy (diagnosed before the colonoscopy surveillance, which is recommended after the screening colonoscopy). Patient demographics and epidemiological characteristics, tumour characteristics and survival were compared between the four groups. RESULTS 5909 individuals were diagnosed with a CRC. The median follow-up of survival was 4.6 years (range: 0-9 years). The study highlights a significant difference (P<0.0001) in the 5-year survival in the screening-detected CRC group compared with those who had nonscreening-detected CRCs (90.1 vs. 66.7%). Although ICs are not desirable events, the 5-year survival rate is significantly higher with respect to nonparticipants (P<0.0001) (76.3 vs. 60.5%), this being the group with the lowest survival rate. CONCLUSION The significantly higher 5-year survival rate of 23.4% of the participants in the screening programme suggests that incidence and mortality rates of CRC will decrease in the near future for participants in screening programmes. A high participation rate is essential to achieve health benefits, irrespective of the type of participation.
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28
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Thomsen MK, Rasmussen M, Njor SH, Mikkelsen EM. Demographic and comorbidity predictors of adherence to diagnostic colonoscopy in the Danish Colorectal Cancer Screening Program: a nationwide cross-sectional study. Clin Epidemiol 2018; 10:1733-1742. [PMID: 30538577 PMCID: PMC6257139 DOI: 10.2147/clep.s176923] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Predictors of participation in colorectal cancer screening with a stool sample screening modality have been widely studied, but adherence to subsequent diagnostic colonoscopy after a positive screening test has received less attention. We aimed to determine predictors of adherence to diagnostic colonoscopy in the Danish Colorectal Cancer Screening Program. METHODS We conducted a cross-sectional study using data from National Health Service registries. We included 8,112 individuals invited to screening between March 3, 2014, and August 31, 2014, who had a positive immunochemical fecal occult blood test. Potential predictors were gender, age, region of residence, Charlson Comorbidity Index (CCI) score, specific diseases (cardiovascular disease, chronic pulmonary disease, diabetes, and cancer), and number of prior hospital stays. We estimated prevalence proportion differences (PPDs) for the associations between potential predictors and adherence. RESULTS Overall, adherence to diagnostic colonoscopy was 88.6%. Adherence was lower in individuals aged 75 years compared with those aged <70 years, PPD=-4.20 (95% confidence interval [CI]: -6.19; -2.20). Adherence decreased with a higher level of comorbidity: PPD=-2.30 (95% CI: -3.87; -0.74) for a CCI score of 1-2 and PPD=-9.24 (95% CI: -12.30; -6.19) for a CCI score of ≥3 compared to 0. For specific diseases, adherence was decreased in those with a diagnosis of cardiovascular disease, chronic pulmonary disease, or diabetes, but less for cancer. When comorbidity was measured as number of prior hospital stays, the adjusted PPDs were -2.41 (95% CI: -4.43;-0.39) for one to two stays and -14.50 (95% CI: -20.30; -8.74) for three or more stays compared with no in-hospital stays. CONCLUSION Major predictors of nonadherence to diagnostic colonoscopy after a positive immunochemical fecal occult blood test were older age, a CCI score of 1 or more, cardiovascular disease, chronic pulmonary disease, diabetes, and one or more in-hospital stays within the last year.
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Affiliation(s)
| | - Morten Rasmussen
- Department of Digestive Diseases K, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sisse Helle Njor
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
- Department of Public Health Programs, Randers Regional Hospital, Randers, Denmark
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Toes-Zoutendijk E, Kooyker AI, Elferink MA, Spaander MCW, Dekker E, Koning HJD, Lemmens VE, van Leerdam ME, Lansdorp-Vogelaar I. Stage distribution of screen-detected colorectal cancers in the Netherlands. Gut 2018; 67:1745-1746. [PMID: 29055907 DOI: 10.1136/gutjnl-2017-315111] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/20/2017] [Accepted: 10/08/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Arthur I Kooyker
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Marloes A Elferink
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Valery E Lemmens
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Arrospide A, Idigoras I, Mar J, de Koning H, van der Meulen M, Soto-Gordoa M, Martinez-Llorente JM, Portillo I, Arana-Arri E, Ibarrondo O, Lansdorp-Vogelaar I. Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model. BMC Cancer 2018; 18:464. [PMID: 29695234 PMCID: PMC5918894 DOI: 10.1186/s12885-018-4362-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. Methods We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. Results The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. Conclusions This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis. Electronic supplementary material The online version of this article (10.1186/s12885-018-4362-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arantzazu Arrospide
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain. .,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain.
| | - Isabel Idigoras
- Basque Country Colorectal Cancer Screening Programme, Basque Health Service, Bilbao, Bizkaia, Spain
| | - Javier Mar
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain.,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain.,Clinical Management Unit, Alto Deba Integrated Health Care Organisation, Arrasate - Mondragón, Gipuzkoa, Spain
| | - Harry de Koning
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Miriam van der Meulen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Myriam Soto-Gordoa
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain.,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain
| | | | - Isabel Portillo
- Basque Country Colorectal Cancer Screening Programme, Basque Health Service, Bilbao, Bizkaia, Spain
| | | | - Oliver Ibarrondo
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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de Klerk CM, Gupta S, Dekker E, Essink-Bot ML. Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide. Gut 2018; 67:679-687. [PMID: 28073892 DOI: 10.1136/gutjnl-2016-313311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening programmes can reduce CRC mortality. However, the implementation of a screening programme may create or exacerbate socioeconomic and ethnic health inequities if participation varies by subgroup. We determined which organised programmes characterise participation inequities by socioeconomic and ethnic subgroups, and assessed the variation in subgroup participation among programmes collecting group-specific data. DESIGN Employing a literature review and survey among leaders of national or regional screening programmes, this study identified published and unpublished data on participation by socioeconomic status and ethnicity. We assessed programmes offering faecal occult blood tests (FOBT) for screening. Primary outcome was screening participation rate. RESULTS Across 24 organised FOBT-screening programmes meeting the inclusion criteria, participation rates ranged from 21% to 73%. Most programmes (13/24, 54%) did not collect data on participation by socioeconomic status and ethnicity. Among the 11 programmes with data on participation by socioeconomic status, 90% (28/31 publications) reported lower participation among lower socioeconomic groups. Differences across socioeconomic gradients were moderate (66% vs 71%) to severe (35% vs 61%). Only six programmes reported participation results by ethnicity. Ethnic differences were moderate, though only limited data were available for evaluation. CONCLUSIONS Across organised CRC screening programmes worldwide, variation in participation by socioeconomic status and ethnicity is often not assessed. However, when measured, marked disparities in participation by socioeconomic status have been observed. Limited data were available to assess inequities by ethnicity. To avoid exacerbating health inequities, screening programmes should systematically monitor participation by socioeconomic status and ethnicity, and investigate and address determinants of low participation.
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Affiliation(s)
- C M de Klerk
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, San Diego, California, USA
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Temam S, Varraso R, Pornet C, Sanchez M, Affret A, Jacquemin B, Clavel-Chapelon F, Rey G, Rican S, Le Moual N. Ability of ecological deprivation indices to measure social inequalities in a French cohort. BMC Public Health 2017; 17:956. [PMID: 29246202 PMCID: PMC5732455 DOI: 10.1186/s12889-017-4967-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort. Methods We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS. Results The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively). Conclusion FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations. Electronic supplementary material The online version of this article (10.1186/s12889-017-4967-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sofia Temam
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France. .,Univ Paris Sud, Le Kremlin-Bicêtre, France. .,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Carole Pornet
- Agence Régionale de Santé (ARS) Basse-Normandie, Caen, France
| | - Margaux Sanchez
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Paris Sud, Le Kremlin-Bicêtre, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Aurélie Affret
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | - Bénédicte Jacquemin
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France.,Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Françoise Clavel-Chapelon
- Univ Paris Sud, Le Kremlin-Bicêtre, France.,Centre for Research in Epidemiology and Population Health (CESP), Mode de vie, gènes et santé: épidémiologie intégrée trans-générationnelle, INSERM, U1018, Villejuif, France
| | | | - Stéphane Rican
- LADYSS, Laboratoire dynamiques sociales et recompositions des espaces, Université Paris Ouest Nanterre La Défense, Nanterre, France
| | - Nicole Le Moual
- INSERM, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, 16 Avenue Paul-Vaillant Couturier, F-94807, VILLEJUIF, Cedex, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Vanaclocha-Espi M, Ibáñez J, Molina-Barceló A, Pérez E, Nolasco A, Font R, Pérez-Riquelme F, de la Vega M, Arana-Arri E, Oceja M, Espinàs JA, Portillo I, Salas D. Factors influencing participation in colorectal cancer screening programs in Spain. Prev Med 2017; 105:190-196. [PMID: 28887191 DOI: 10.1016/j.ypmed.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/10/2017] [Accepted: 08/16/2017] [Indexed: 12/31/2022]
Abstract
To analyze the sociodemographic and organizational factors influencing participation in population-based colorectal cancer screening programs (CRCSP) in Spain, a retrospective study was conducted in a cohort of people invited to participate in the first 3 screening rounds of 6 CRCSP from 2000 to 2012. Mixed logistic regression models were used to analyze the relationship between sociodemographic and organizational factors, such as the type of fecal occult blood test (FOBT) used and the FOBT delivery type. The analysis was performed separately in groups (Initial screening-first invitation, Subsequent invitation for previous never-responders, Subsequent invitation-regular, Subsequent invitation-irregular intervals). The results showed that, in the Initial screening-first invitation group, participation was higher in women than in men in all age groups (OR 1.05 in persons aged 50-59years and OR 1.12 in those aged 60-69years). Participation was also higher when no action was required to receive the FOBT kit, independently of the type of screening (Initial screening-first invitation [OR 2.24], Subsequent invitation for previous never-responders [OR 2.14], Subsequent invitation-regular [OR 2.03], Subsequent invitation-irregular intervals [OR 9.38]) and when quantitative rather than qualitative immunological FOBT (FIT) was offered (Initial screening-first invitation [OR 0.70], Subsequent invitation for previous never-responders [OR 0.12], Subsequent invitation-regular [OR 0.20]) or guaiac testing (Initial screening-first invitation [OR 0.81], Subsequent invitation for previous never-responders [OR 0.88], Subsequent invitation-regular [OR 0.73]). In conclusion, the results of this study show that screening participation could be enhanced by inclusion of the FOBT kit with the screening invitation and the use of the quantitative FIT.
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Affiliation(s)
| | - Josefa Ibáñez
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain
| | | | - Elena Pérez
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain
| | | | - Rebeca Font
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain; Biomedical Research Institute, Bellvitge, (IDIBELL) - L'Hospitalet de LLob, Barcelona, Spain
| | - Francisco Pérez-Riquelme
- General Directorate Public Health, Murcia, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Spain
| | | | | | | | - Josep Alfons Espinàs
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain; Biomedical Research Institute, Bellvitge, (IDIBELL) - L'Hospitalet de LLob, Barcelona, Spain
| | | | - Dolores Salas
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain.
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Rat C, Pogu C, Le Donné D, Latour C, Bianco G, Nanin F, Cowppli-Bony A, Gaultier A, Nguyen JM. Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial. JAMA 2017; 318:816-824. [PMID: 28873160 PMCID: PMC5817465 DOI: 10.1001/jama.2017.11387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs. OBJECTIVE To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT). DESIGN, SETTING, AND PARTICIPANTS A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016. INTERVENTIONS General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients). MAIN OUTCOMES AND MEASURES The primary end point was patient participation in CRC screening 1 year after the intervention. RESULTS Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group. CONCLUSIONS AND RELEVANCE Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02515344.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes, France
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
| | - Corinne Pogu
- Association in charge of colorectal cancer screening program, CAPSANTE 44, Nantes, France
| | | | - Chloé Latour
- Department of General Practice, Faculty of Medicine, Nantes, France
| | - Gaelle Bianco
- Association in charge of colorectal cancer screening program, AUDACE, La Roche sur Yon, France
| | - France Nanin
- French Health Insurance System, Division of Nantes, Nantes, France
| | - Anne Cowppli-Bony
- Cancer registry for Loire-Atlantique and Vendée geographic areas, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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Buron A, Auge JM, Sala M, Román M, Castells A, Macià F, Comas M, Guiriguet C, Bessa X, Castells X. Association between socioeconomic deprivation and colorectal cancer screening outcomes: Low uptake rates among the most and least deprived people. PLoS One 2017. [PMID: 28622365 PMCID: PMC5473580 DOI: 10.1371/journal.pone.0179864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Screening with faecal occult blood tests reduces colorectal cancer-related mortality; however, age, sex and socioeconomic factors affect screening outcomes and could lead to unequal mortality benefits. The aim of this study was to describe the main outcomes of the population-based Barcelona colorectal cancer screening programme (BCRCSP) by deprivation. Methods Retrospective study of the eligible population of the first round of the BCRCSP. Participants’ postal addresses were linked with the MEDEA database to obtain the deprivation quintiles (Dq). Chi-squared tests were used to compare proportions across variables and logistic regression was used to estimate the adjusted effects of age, sex and deprivation on uptake, FIT positivity, colonoscopy adherence and advanced neoplasia detection rate. Results Overall uptake was 44.7%, higher in Dq2, 3 and 4 (OR 1.251, 1.250 and 1.276, respectively) than in the least deprived quintile (Dq 1), and lowest in Dq5 (OR 0.84). Faecal immunochemical test (FIT) positivity and the percentage of people with detectable faecal haemoglobin below the positivity threshold increased with deprivation. The advanced neoplasia detection rate was highest in Dq4. Conclusion Unlike most regions where inequalities are graded along the socioeconomic continuum, inequalities in the uptake of colorectal cancer screening in Spain seem to be concentrated first in the most disadvantaged group and second in the least deprived group. The correlation of deprivation with FIT-positivity and faecal haemoglobin below the positivity threshold is worrying due to its association with colorectal cancer and overall mortality.
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Affiliation(s)
- Andrea Buron
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
- * E-mail:
| | - Josep M. Auge
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS (August Pi i Sunyer Biomedical Research Institute), Barcelona, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Marta Román
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Antoni Castells
- IDIBAPS (August Pi i Sunyer Biomedical Research Institute), Barcelona, Spain
- Gastroenterology Department, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERehd (CIBER for Digestive and Liver Diseases), Madrid, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Carolina Guiriguet
- Gòtic Primary Care Center, Catalan Institute of Health, Barcelona, Spain
- IDIAP Jordi Gol (Institute in Primary Care Research), Barcelona, Spain
| | - Xavier Bessa
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
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Hofmann B. Ethical issues with colorectal cancer screening-a systematic review. J Eval Clin Pract 2017; 23:631-641. [PMID: 28026076 DOI: 10.1111/jep.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. METHODS An axiological question-based method is used for exposing and elucidating ethical issues relevant in HTA. A literature search in MEDLINE, Embase, PsycINFO, PubMed Bioethics subset, ISI Web of Knowledge, Bioethics Literature Database (BELIT), Ethics in Medicine (ETHMED), SIBIL Base dati di bioetica, LEWI Bibliographic Database on Ethics in the Sciences and Humanities, and EUROETHICS identified 870 references of which 114 were found relevant according to title and abstract. The content of the included papers were subject to ethical analysis to highlight the ethical issues, concerns, and arguments. RESULTS A wide range of important ethical issues were identified. The main benefits are reduced relative CRC mortality rate, and potentially incidence rate, but there is no evidence of reduced absolute mortality rate. Potential harms are bleeding, perforation, false test results, overdetection, overdiagnosis, overtreatment (including unnecessary removal of polyps), and (rarely) death. Other important issues are related to autonomy and informed choice equity, justice, medicalization, and expanding disease. CONCLUSION A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Science, the Norwegian University for Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics at the University of Oslo, Norway
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37
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Askari A, Nachiappan S, Currie A, Bottle A, Abercrombie J, Athanasiou T, Faiz O. Who requires emergency surgery for colorectal cancer and can national screening programmes reduce this need? Int J Surg 2017; 42:60-68. [PMID: 28456708 DOI: 10.1016/j.ijsu.2017.04.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/16/2017] [Accepted: 04/22/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Patients undergoing emergency colorectal cancer (CRC) surgery are at higher risk of poor outcome than those managed electively. The aim of this national study is to identify groups at high risk of undergoing unplanned CRC surgery and assess short and long-term outcome in this cohort subsequent morbidity and mortality as well as quantify their long-term survival. The aim of this national study is to identify groups at high risk of undergoing unplanned CRC surgery and assess short and long-term outcome, subsequent morbidity and mortality as well as quantify their long-term survival. METHODS The Hospital Episode Statistics (HES) database between the years of 1997-2012 was used to identify all patients that had undergone surgery for colorectal cancer. Multivariable logistic regression analysis and cox regression analyses were undertaken to identify patient factors predictive of undergoing emergency and quantify their long-term survival. RESULTS A total of 286,591 patients underwent resection for CRC between April 1997 and April 2012, of which 24.3% (69,718 patients) were admitted as emergencies and underwent emergency surgery. Independent predictors of undergoing emergency surgery were female gender (OR 1.23, CI: 1.21-1.25, p < 0.001), older age (>79 years old OR 1.55, CI: 1.50-1.60, p < 0.001), social deprivation (most deprived quintile, OR 1.64, CI: 1.50-1.80, p < 0.001) and Black African/Caribbean ethnicity (OR 1.36, CI: 1.21-1.66, p < 0.001). All cause 30- and 90-day mortality within the emergency group was significantly higher than that for the electively managed patients group (13.3% versus compared with 3.4% at 30-days) as was 90-day (20.0% versus compared with 5.8% at 90-days). Amongst patients eligible for bowel screening there was an approximate 40% significant reduction in the proportion of patients requiring emergency surgery before and after its introduction in 2006 (23.4%-14.9%, p < 0.001). This reduction in emergency surgery included both proximal and distal cancer resections. CONCLUSION Older, socially deprived and ethnic minority patients with colorectal cancer are more likely to present as emergencies requiring CRC surgery. Public health initiatives, such as bowel cancer screening, appear to have concomitantly reduced emergency and increased elective surgical rates within the eligible cohort. This is likely to have a beneficial impact on population survival. Strategies aimed at preventing emergency presentation by identifying patients at specific risk could improve survival outcome for colorectal cancer surgery in England.
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Affiliation(s)
- Alan Askari
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom.
| | - Subramanian Nachiappan
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - Andrew Currie
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - Alex Bottle
- Faculty of Medicine, School of Public Health, Dr Foster Unit, Imperial College London, United Kingdom
| | | | - Thanos Athanasiou
- Faculty of Medicine, Department of Surgery & Cancer, St Mary's Hospital, Praed Street, London, W21NY, United Kingdom
| | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery, Imperial College, St Mary's Hospital, Praed Street, London, W21NY, United Kingdom
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Portillo I, Arana-Arri E, Idigoras I, Bilbao I, Martínez-Indart L, Bujanda L, Gutierrez-Ibarluzea I. Colorectal and interval cancers of the Colorectal Cancer Screening Program in the Basque Country (Spain). World J Gastroenterol 2017; 23:2731-2742. [PMID: 28487610 PMCID: PMC5403752 DOI: 10.3748/wjg.v23.i15.2731] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/23/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To assess proportions, related conditions and survival of interval cancer (IC). METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test (FIT), interval cancer FIT (IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer (CRC) detected and before the following recommended colonoscopy, IC-colonoscopy. We conducted a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme (participation rate of 68.6%). RESULTS Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up (43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal (OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers (SCs) with ICs, significant differences in survival were found (P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%. CONCLUSION These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.
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Zheng Z, Zhu Y, Li X, Hu W, Jiang J. Impact of marital status during diagnosis on cancer-caused specific survival in acute myeloid leukemia patients: a case-control and population-based study. Oncotarget 2017; 8:62666-62680. [PMID: 28977979 PMCID: PMC5617539 DOI: 10.18632/oncotarget.16989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/28/2017] [Indexed: 12/27/2022] Open
Abstract
Objective This study investigated the impact of marital status on cancer-caused specific mortality among acute myeloid leukemia (AML) patients in the United States. Methods We used the Surveillance, Epidemiology and End Results program to identify 50,825 patients who had their clinical and follow-up information available and were diagnosed for AML between the years 1988 and 2015. The univariate and multivariable Cox regression models were used to analyze the patient data, and to minimize the group differences due to covariates between groups, a 1:1 propensity score matching was used in subsequent subgroup analysis. Results Our study demonstrated that married patients were less likely to die due to AML after adjusting for demographic and clinicopathological variables, than patients with variable unmarried status. Further analysis indicated that widowed, divorced and never married status correlated with poor cancer-cause specific survival than being married in almost all subgroups after being adjusted for the aforementioned variables (P<0.05). However, the difference between married and separated was not apparent. Moreover, similar survival analysis results were also observed in the 1:1 matched subgroups of marital status, but they displayed varied prognostic factors between them. The association of survival benefit with marriage in AML was consistent with the published survival benefit of conventional therapeutic approaches. Conclusion Overall, our study concluded that unmarried AML patients were at greater risk of cancer-specific mortality than married, and thus indicated that physicians should focus on health care strategies that target social support, in order to reduce the cancer-specific mortality in unmarried patients.
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Affiliation(s)
- Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China
| | - Yuandong Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaodong Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenwei Hu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China.,Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jingting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Cancer Immunotherapy Engineering Research Center of Jiangsu Province, Changzhou, China.,Institute of Cell Therapy Soochow University, Changzhou, China
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van der Vlugt M, Grobbee EJ, Bossuyt PMM, Bongers E, Spijker W, Kuipers EJ, Lansdorp-Vogelaar I, Essink-Bot ML, Spaander MCW, Dekker E. Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening. Br J Cancer 2017; 116:44-49. [PMID: 27923037 PMCID: PMC5220157 DOI: 10.1038/bjc.2016.399] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effectiveness of faecal immunochemical test (FIT)-based screening programs is highly dependent on consistent participation over multiple rounds. We evaluated adherence to FIT screening over four rounds and aimed to identify determinants of participation behaviour. METHODS A total of 23 339 randomly selected asymptomatic persons aged 50-74 years were invited for biennial FIT-based colorectal cancer screening between 2006 and 2014. All were invited for every consecutive round, except for those who had moved out of the area, passed the upper age limit, or had tested positive in a previous screening round. A reminder letter was sent to non-responders. We calculated participation rates per round, response rates to a reminder letter, and differences in participation between subgroups defined by age, sex, and socioeconomic status (SES). RESULTS Over the four rounds, participation rates increased significantly, from 60% (95% CI 60-61), 60% (95% CI 59-60), 62% (95% CI 61-63) to 63% (95% CI 62-64; P for trend<0.001) with significantly higher participation rates in women in all rounds (P<0.001). Of the 17 312 invitees eligible for at least two rounds of FIT screening, 12 455 (72%) participated at least once, whereas 4857 (28%) never participated; 8271 (48%) attended all rounds when eligible. Consistent participation was associated with older age, female sex, and higher SES. Offering a reminder letter after the initial invite in the first round increased uptake with 12%; in subsequent screening rounds this resulted in an additional uptake of up to 10%. CONCLUSIONS In four rounds of a pilot biennial FIT-screening program, we observed a consistently high and increasing participation rate, whereas sending reminders remain effective. The substantial proportion of inconsistent participants suggests the existence of incidental barriers to participation, which, if possible, should be identified and removed.
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Affiliation(s)
- Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Patrick MM Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Evelien Bongers
- Regional Organization for Population Screening Mid-West Netherlands, Hoogoorddreef 54 E, Amsterdam 1101 BE, The Netherlands
| | - Wolfert Spijker
- Regional Organization for Population Screening South-West Netherlands, Maasstadweg 124, Rotterdam 3079 DZ, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Centre, Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Marie-Louise Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, 's-Gravendijkwal 230, Amsterdam 3015 CE, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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[Monitoring social determinants of health]. GACETA SANITARIA 2016; 30 Suppl 1:38-44. [PMID: 27837795 DOI: 10.1016/j.gaceta.2016.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/11/2023]
Abstract
Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.
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Binefa G, García M, Peiró R, Molina-Barceló A, Ibáñez R. Cómo evaluar y reducir desigualdades sociales en los programas de cribado de cáncer. GACETA SANITARIA 2016; 30:232-4. [DOI: 10.1016/j.gaceta.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 01/10/2023]
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