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Pring ET, Gould LE, Malietzis G, Lung P, Mai DVC, Drami I, Athanasiou T, Jenkins JT. Sarcopenia in colorectal cancer is related to socio-economic deprivation and Body Mass Index alone misrepresents underlying muscle loss in the deprived. Clin Nutr ESPEN 2024; 63:13-19. [PMID: 38889008 DOI: 10.1016/j.clnesp.2024.06.005] [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: 05/16/2023] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND & AIMS Patients with colorectal cancer who are more socio-economically deprived have worse outcomes; deprivation is also associated with higher obesity rates, defined as a body mass index (BMI) of greater than thirty. Body composition (BC) factors such as sarcopenia and myosteatosis are also known to predispose to poorer outcomes following colorectal cancer surgery. There is limited evidence to date to relate the effect of deprivation upon these host characteristics that are linked to prognosis. We aimed to examine the relationship between deprivation and body composition in colorectal cancer. METHODS Analysis was performed on a prospectively collected database of preoperative primary colorectal cancer patients at St Mark's - The National Bowel Hospital, UK. Body composition characteristics were identified by analysing the L3 axial slices of Computer Tomogram (CT) slices of preoperative staging using Slice-O-Matic software with Automatic Body composition Analyser using Computed tomography image Segmentation (ABACS) L3 plug-in. Deprivation status for each patient was determined using their postal code which was linked to the Index of Multiple Deprivation (IMD). Each domain of the IMD was examined individually in relation to BC characteristics. Binary logistic regression analysis was performed on the data using a model developed from previous published analyses of this dataset. RESULTS Four hundred and nineteen patients were included in the final analysis, the median age was 69 years and 57% of the patient population was male. Patients who were more deprived were significantly more likely to be sarcopenic [OR 1.56 (95% CI 1.01-2.41, p = 0.045)] and myosteatotic [OR 1.69 (95% CI 1.019-2.81, p = 0.042)]. More deprived patients were also more likely to have a lower BMI [OR 0.60 (95% CI 0.38-0.94, p = 0.026)] despite no significant difference in visceral obesity between the most and least deprived. CONCLUSIONS Deprivation is an important independent determinant of sarcopenia in the colorectal cancer population. Identifying these patients early and addressing reversible factors may help improve post-operative surgical outcomes in this poor prognostic group. Sarcopenia may be a premorbid state in the deprived colorectal cancer patient that may not be wholly driven by tumour characteristics.
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Affiliation(s)
- Edward T Pring
- George Davies Research Fellowship, St Mark's Hospital, The National Bowel Hospital, Harrow, UK; Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK.
| | - Laura E Gould
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; The BiCyCLE Research Group, London, UK
| | - George Malietzis
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Phillip Lung
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; The BiCyCLE Research Group, London, UK
| | - Dinh V C Mai
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Ioanna Drami
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - John T Jenkins
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
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Luo Z, Dong X, Wang C, Cao W, Zheng Y, Wu Z, Xu Y, Zhao L, Wang F, Li J, Ren J, Shi J, Chen W, Li N. Association Between Socioeconomic Status and Adherence to Fecal Occult Blood Tests in Colorectal Cancer Screening Programs: Systematic Review and Meta-Analysis of Observational Studies. JMIR Public Health Surveill 2023; 9:e48150. [PMID: 37906212 PMCID: PMC10646673 DOI: 10.2196/48150] [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: 04/15/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Screening adherence is important in reducing colorectal cancer (CRC) incidence and mortality. Disparity in CRC screening adherence was observed in populations of different socioeconomic status (SES), but the direction and strength of the association remained unclear. OBJECTIVE We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests. METHODS We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES. RESULTS Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95% CI 1.42-2.10; adjusted OR 1.53, 95% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95% CI 1.43-2.42) than in the late group (OR 1.26, 95% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95% CI 1.21-1.43) than the overall estimate (OR 1.53, 95% CI 1.28-1.82). CONCLUSIONS The higher-SES population had higher adherence to fecal occult blood test-based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association.
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Affiliation(s)
- Zilin Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesi Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenran Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Wu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jibin Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Ren
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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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: 0] [Impact Index Per Article: 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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Schliemann D, Ramanathan K, Ibrahim Tamin NSB, O'Neill C, Cardwell CR, Ismail R, Kassim Z, Kee F, Su TT, Donnelly M. Implementation of a home-based colorectal cancer screening intervention in Malaysia (CRC-SIM). BMC Cancer 2023; 23:22. [PMID: 36609260 PMCID: PMC9817284 DOI: 10.1186/s12885-022-10487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia. METHODS This quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with the RE-AIM framework. Trained data collectors recruited by phone, randomly selected, asymptomatic adults aged 50-75 years from Segamat District, who previously completed a health census form for the South East Asia Community Observatory (SEACO). Participants were posted an iFOBT kit and asked to return a photo of the completed test for screening by health care professionals. A regression analysis of evaluation data was conducted to identify which variables were associated with the outcome indicators of 'study participation' and 'iFOBT completion' and the CRC-SIM was evaluated in terms of its appropriateness, feasibility and acceptability. RESULTS Seven hundred forty-seven eligible adults (52%) agreed to participate in this study and received an iFOBT kit. Participation was significantly lower amongst Chinese Malaysians (adjusted OR 0.45, 95% CI 0.35 - 0.59, p<0.001) compared to Malays and amongst participants from the rural sub-district (Gemereh) (adjusted OR 0.71, 95% CI 0.54 - 0.92, p=0.011) compared to the urban sub-district (Sungai Segamat). Less than half of participants (42%, n=311/747) completed the iFOBT. Test-kit completion was significantly higher amongst Chinese Malaysians (adjusted OR 3.15, 95% CI 2.11 - 4.69, p<0.001) and lower amongst participants with a monthly household income ≥RM 4,850 (adjusted OR 0.58, 95% CI 0.39 - 0.87, p=0.009) compared to participants with a lower household income. The main reported reason for non-participation was 'not interested' (58.6%) and main implementation challenges related to invalid photographs from participants and engaging iFOBT positive participants in further clinic consultations and procedures. CONCLUSION Home-testing for CRC (test completion) appeared to be acceptable to only around one-fifth of the target population in Malaysia. However, mindful of the challenging circumstances surrounding the pandemic, the CRC-SIM merits consideration by public health planners as a method of increasing screening in Malaysia, and other low- and middle-income countries.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
| | - Kogila Ramanathan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | | | - Ciaran O'Neill
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Christopher R Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Roshidi Ismail
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | - Zaid Kassim
- Segamat District Health Office, Johor, Malaysia
| | - Frank Kee
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Tin Tin Su
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Petaling Jaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, 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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Trends in Hospitalization and Mortality from Cervical Cancer in Brazil Are Linked to Socioeconomic and Care Indicators. WOMEN 2022. [DOI: 10.3390/women2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed, through an ecological survey of cervical cancer outcomes in Brazil, to analyze the influence of socioeconomic and care indicators of social vulnerability. The study sample (2010–2015) is composed of women diagnosed with cervical cancer, in different regions of the country. Data were collected from the Department of Health, in addition to searching the social vulnerability database of the Institute of Applied Economic Research. The incidence of age-standardized hospital admission declined over the years of the study in almost all regions but only one region showed a significant decline in indices of social vulnerability. In two other regions, one important indicator (human capital) significantly decreased. There was a positive correlation between vulnerability indices and age-standardized hospital admissions in most of the country. Decreasing vulnerability by easy access to cancer screening and early treatment improves cervical cancer outcomes.
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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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Botteri E, Hoff G, Randel KR, Holme Ø, de Lange T, Bernklev T, Aas E, Berthelsen M, Natvig E, Kirkøen B, Knudsen MD, Kvaerner AS, Schult AL, Ursin G, Jørgensen A, Berstad P. Characteristics of non-participants in a randomized colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing. Int J Cancer 2022; 151:361-371. [PMID: 35411554 PMCID: PMC9324830 DOI: 10.1002/ijc.34025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once‐only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty‐four thousand one hundred and fifty‐nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.
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Affiliation(s)
- Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Skien, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin R Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.,Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Sahlgrenska University Hospital- Mölndal, Region Västra Götaland, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Tomm Bernklev
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital, Tønsberg, Norway
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Erik Natvig
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Benedicte Kirkøen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway
| | - Markus D Knudsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway.,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ane S Kvaerner
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Anna L Schult
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anita Jørgensen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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9
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Knudsen MD, Kvaerner AS, Botteri E, Holme Ø, Hjartåker A, Song M, Thiis-Evensen E, Randel KR, Hoff G, Berstad P. Lifestyle predictors for inconsistent participation to fecal based colorectal cancer screening. BMC Cancer 2022; 22:172. [PMID: 35168592 PMCID: PMC8848967 DOI: 10.1186/s12885-022-09287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Consistent participation in colorectal cancer (CRC) screening with repeated fecal immunochemical test (FIT) is important for the success of the screening program. We investigated whether lifestyle risk factors for CRC were related to inconsistent participation in up to four rounds of FIT-screening. METHOD We included data from 3,051 individuals who participated in up to four FIT-screening rounds and returned a lifestyle questionnaire. Using logistic regression analyses, we estimated associations between smoking habits, body mass index (BMI), physical activity, alcohol consumption, diet and a healthy lifestyle score (from least favorable 0 to most favorable 5), and inconsistent participation (i.e. not participating in all rounds of eligible FIT screening invitations). RESULTS Altogether 721 (24%) individuals were categorized as inconsistent participants Current smoking and BMI ≥30 kg/m2 were associated with inconsistent participation; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.54 (1.21-2.95) and 1.54 (1.20-1.97), respectively. A significant trend towards inconsistent participation by a lower healthy lifestyle score was observed (p < 0.05). CONCLUSIONS Lifestyle behaviors were associated with inconsistent participation in FIT-screening. Initiatives aimed at increasing participation rates among those with the unhealthiest lifestyle have a potential to improve the efficiency of screening.
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Affiliation(s)
- Markus Dines Knudsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway. .,Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, P.O. Box 4950, 0424, Rikshospitalet, Nydalen, Oslo, Norway. .,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA.
| | - Ane Sørlie Kvaerner
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway.,Department of Research, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital Kristiansand, P.O. Box 416, 4604, Lundsiden, Kristiansand, Norway.,Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046, 0317, Blindern, Oslo, Norway
| | - Mingyang Song
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, MA, Boston, USA
| | - Espen Thiis-Evensen
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, P.O. Box 4950, 0424, Rikshospitalet, Nydalen, Oslo, Norway
| | - Kristin Ranheim Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway.,Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710, Skien, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
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10
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Colorectal Cancer Screening in Castilla La Mancha, Spain: The Influence of Social, Economic, Demographic and Geographic Factors. J Community Health 2022; 47:446-453. [PMID: 35124785 PMCID: PMC8817942 DOI: 10.1007/s10900-022-01071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) is a health problem with a significant social impact, accounting for 700,000 deaths a year globally. CRC survival rates are increasing as a result of early detection and improvements in society and labor conditions. Differences in CRC have been found depending on place of residence (urban or rural), socioeconomic situation and unemployment, although studies in this regard are limited. The aims of the present study were to determine whether differences exist in diagnostic delay according to place of residence, to analyze the association between socioeconomic level and colonoscopy results and to evaluate CRC risk according to place of residence, income level and unemployment. Retrospective, descriptive and observational study based on colonoscopies performed between May 2015 and November 2018, analyzing relationships between colonoscopy findings of a population screening program and various socioeconomic and demographic variables included in the study (sex, age, place of residence, average annual income, unemployment rate, etc.), and determining any association between such factors and related increases in adenocarcinoma risk. A total of 1422 patients were included in the study. The difference in participation according to sex was greater in rural population (63,4% men/36,6% women in rural areas, 58% men/42% women in urban areas). The mean delayed diagnosis was 59,26 days in both groups. Adenocarcinoma risk was 1.216 times higher in rural population. High-grade dysplasic lesions and adenocarcinoma were more common in municipalities with income < 9000€. However, advanced stage adenocarcinoma was higher in municipalities with income > 9000€. Adenocarcinoma risk was 1,088 times higher in municipalities with an unemployment rate of > 10%. Living in rural areas is not a barrier to access to health care, with no disadvantages identified regarding diagnosis and treatment, thanks to public health policies and the large number of small municipalities near the referral hospital in Cuenca.
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11
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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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12
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Coma E, Guiriguet C, Mora N, Marzo-Castillejo M, Benítez M, Méndez-Boo L, Fina F, Fàbregas M, Mercadé A, Medina M. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people. BMJ Open 2021; 11:e047567. [PMID: 34006554 PMCID: PMC8130761 DOI: 10.1136/bmjopen-2020-047567] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/06/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The objective of our study is to evaluate the impact of the pandemic on the incidence of cancer diagnoses in primary care. DESIGN Time-series study of malignant neoplasms and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020. SETTING Primary care, Catalonia, Spain. PARTICIPANTS People older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm. MAIN OUTCOME MEASURES We obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms was defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer and socioeconomic status. RESULTS Between March and September 2020 we observed 8766 (95% CI 4135 to 13 397) fewer malignant neoplasm diagnoses, representing a reduction of 34% (95% CI 19.5% to 44.1%) compared with the expected. This underdiagnosis was greater in individuals aged older than 64 years, men and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that). CONCLUSIONS Reduction in cancer incidence has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of the COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Carolina Guiriguet
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Nuria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mercè Marzo-Castillejo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Sud, Direcció d'Atenció Primària Costa de Ponent, ICS, Barcelona, Spain
| | - Mencia Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
- Equip d'Atenció Primària Gòtic, Institut Catala De La Salut, Barcelona, Spain
| | - Leonardo Méndez-Boo
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Catala De La Salut, Barcelona, Spain
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13
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Pallesen AVJ, Herrstedt J, Westendorp RGJ, Mortensen LH, Kristiansen M. Do we know the effects of colorectal cancer screening? A short communication on selective uptake and differential effects of colorectal cancer screening in Scandinavia. Scand J Public Health 2020; 49:841-844. [PMID: 33016227 DOI: 10.1177/1403494820960641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Colorectal cancer (CRC) contributes extensively to the overall cancer burden, with substantial and increasing social inequality in both incidence and survival. In several countries, this social inequality in incidence and survival has been increasing over time, and the increase is expected to continue. To overcome this, it is advised to implement nationwide CRC screening programmes, as these are effective in detecting possible signs of CRC, hence identifying earlier-stage cancer and reducing mortality. However, little is known about the distribution of these effects across population groups. It is possible that the outcomes of CRC screening are not equally distributed among participants, but rather that the screening programme serves some population groups better than others. The aim of this short communication based on published data is to describe the status of selective uptake according to sociodemographic and economic factors in CRC screening in Scandinavia. Furthermore, we raise questions that need to be addressed in future research in order to grasp the full effects of the screening programme and ultimately to ensure high uptake as well as participation in subsequent diagnostic procedures across population groups.
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Affiliation(s)
- Anna Vera Jørring Pallesen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care Units, Zealand University Hospital, Denmark
| | - Rudi G J Westendorp
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Denmark
| | - Maria Kristiansen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Denmark
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14
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Lal N, Singh HK, Majeed A, Pawa N. The impact of socioeconomic deprivation on the uptake of colorectal cancer screening in London. J Med Screen 2020; 28:114-121. [PMID: 32295488 DOI: 10.1177/0969141320916206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Screening programmes based on the faecal occult blood test (FOBT) can reduce mortality from colorectal cancer (CRC). However, a significant variation exists in uptake of the test within the UK. Disproportionate uptake risks increasing inequity during staging at diagnosis and survival from CRC. This study aims to evaluate the impact of socioeconomic deprivation on the uptake of CRC screening (FOBT) in London. METHODS A retrospective review of the "Vanguard RM Informatics" database was performed to identify eligible individuals for CRC screening across all general practices across London over 30 months (2014-2017). The postcodes of the general practices were used to obtain the deprivation data via the "Indices of Deprivation" database. A Spearman's rho correlation was performed to quantify the impact of the deprivation variables on FOBT uptake. RESULTS Overall, 697,402 individuals were eligible for screening across 1359 London general practices, within 5 Clinical Commissioning Groups (CCGs); 48.4% (range: 13%-74%) participated in CRC screening with the lowest participation rates in North West (46%) and North East (47%) London CCGs. All indices of deprivation had a significant correlation with the uptake of FOBT (p < 0.01). CONCLUSION This is the largest study across London to date demonstrating a significant positive correlation between deprivation indices and FOBT uptake, highlighting areas of particular risk. Further studies are imperative to quantify the impact of deprivation on CRC morbidity and mortality, together with focused strategies to reduce socioeconomic inequalities in screening in these high risk areas.
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Affiliation(s)
- Nikhil Lal
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Harpreet Ksi Singh
- Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nikhil Pawa
- Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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15
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Associations between cervical, breast and colorectal cancer screening uptake, chronic diseases and health-related behaviours: Data from the Italian PASSI nationwide surveillance. Prev Med 2019; 120:60-70. [PMID: 30659908 DOI: 10.1016/j.ypmed.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/30/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022]
Abstract
Screening programmes have been proposed as a privileged setting for health promotion interventions. We aim to assess the associations between behavioural risk factors, chronic conditions and diseases and cervical, breast and colorectal cancer screening uptake. Secondly, we aim to assess whether these associations are due to underlying differences in socioeconomic characteristics. In Italy, a random sample was interviewed by the PASSI surveillance (106,000 interviews) in 2014-2016. Screening uptake adjusted for age and gender alone and for age, gender and socioeconomic characteristics (educational attainment and self-reported economic difficulties) were estimated using multivariate Poisson regression models. Screening uptake was 79%, 73% and 45% for cervical (age 25-64), breast (women aged 50-69) and colorectal cancer (both sexes age 50-69), respectively. People with low consumption of vegetables and fruits and those with insufficient physical activity had lower uptake than people with healthy behaviours (20-22% and 8-15% lower, respectively), as did those obese and diabetic compared to healthier people (7-10% and 5-8% lower, respectively). Those with high-risk drinking behaviour, self-reported driving after drinking alcohol, and former smokers had higher screening uptake (3-7%, 3-6%, and 7-14% higher, respectively). Differences in uptake decreased after adjusting for socioeconomic characteristics, but trends were unvaried. In conclusion, screening uptake is negatively associated with unfavourable behaviours and health conditions that are also risk factors for breast and colorectal cancer incidence. Socioeconomic characteristics do not fully explain these differences. Health promotion interventions targeting diet and physical activity nested in screening programmes might miss part of the at-risk population.
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16
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Gingold-Belfer R, Leibovitzh H, Boltin D, Issa N, Tsadok Perets T, Dickman R, Niv Y. The compliance rate for the second diagnostic evaluation after a positive fecal occult blood test: A systematic review and meta-analysis. United European Gastroenterol J 2019; 7:424-448. [PMID: 31019712 DOI: 10.1177/2050640619828185] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for colorectal cancer (CRC) prevention. We aimed to obtain a precise estimation of this problem and also assess the diagnostic yield of CRC and adenomas by colonoscopy in these patients. Methods Literature searches were conducted for "compliance" OR "adherence" AND "fecal occult blood test" OR "fecal immunohistochemical test" AND "colonoscopy." Comprehensive meta-analysis software was used. Results The search resulted in 42 studies (512,496 patients with positive FOBT), published through December 31, 2017. A funnel plot demonstrates a moderate publication bias. Compliance with any second procedure, colonoscopy, or combination of double-contrast barium enema with or without sigmoidoscopy in patients with a positive FOBT was 0.725 with 95% confidence interval (CI) 0.649-0.790 (p = 0.000), 0.804 with 95% CI 0.740-0.856 (p = 0.000) and 0.197 with 95% CI 0.096-0.361 (p = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050-0.068 (p = 0.000), 0.242 with 95% CI 0.188-0.306 (p = 0.000) and 0.147 with 95% CI 0.116-0.184 (p < 0.001), respectively. Discussion Compliance with diagnostic evaluation after a positive FOBT is still suboptimal. Therefore, measures to increase compliance need to be taken given the increased risk of CRC in these patients.
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Affiliation(s)
- Rachel Gingold-Belfer
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Leibovitzh
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nidal Issa
- Department of Surgery B, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
| | - Tsachi Tsadok Perets
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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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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Buron A, Román M, Augé JM, Macià F, Grau J, Sala M, Louro J, Martinez-Alonso M, Alvarez-Urturi C, Andreu M, Bessa X, Zaffalon D, Castells A, Pellisé M, Aldea M, Rivero L, Hernández C, Torá-Rocamora I, Castells X. Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program. Eur J Cancer 2019; 107:53-59. [DOI: 10.1016/j.ejca.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022]
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Gabel P, Larsen MB, Kirkegaard P, Edwards A, Andersen B. The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial. Trials 2018; 19:543. [PMID: 30305114 PMCID: PMC6180588 DOI: 10.1186/s13063-018-2921-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Colorectal cancer screening participation is a preference-sensitive choice, in which trade-offs between benefits and harms must be made by individual citizens. Often the decision is made without any contact with healthcare professionals. Citizens with lower educational attainment tend to participate less in colorectal cancer screening than citizens with average educational attainment. Further, they tend to have lower levels of knowledge about colorectal cancer screening. Providing lower educational attainment citizens with a targeted decision aid embracing their diverse information needs might increase these citizens' ability to make informed decisions. The aim of this trial is to test the effectiveness of such a newly developed self-administered decision aid. METHODS The LEAD (Lower Educational Attainment Decision aid) trial will be conducted as a two-arm randomized controlled trial among 10,000 50-74-year-old citizens, resident in the Central Denmark Region not yet invited to take up colorectal cancer screening. Citizens will receive a baseline questionnaire. Respondents will be allocated into the intervention or the control groups. Citizens in the intervention group will receive the decision aid whereas the control group will not. Those who return a stool sample within 45 days after receiving the screening invitation and those with medium or higher educational attainment are excluded. Both groups will receive a follow-up questionnaire 90 days after being invited to colorectal cancer screening. A historic cohort consisting of 5000 50-74-year-old citizens resident in the Central Denmark Region, having received their screening invitation in the beginning of 2017 will be included. This cohort will receive a follow-up questionnaire 6-9 months after they received the screening invitation. Informed choice will be evaluated by assessing levels of knowledge, attitudes, and screening uptake. Analyses will be conducted as intention-to-treat analyses. Additionally, differences between levels of worry and decisional conflict between groups will be assessed as secondary outcomes. DISCUSSION This trial will evaluate whether a targeted decision aid is a feasible way of enhancing informed choice among lower educational attainment citizens in colorectal cancer screening. Further, it may guide decisions about providing information material in cancer screening in general. TRIAL REGISTRATION ClinicalTrials.gov, NCT03253888 . Registered on 17 August 2017.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, 8930, Randers NØ, Denmark
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Colussi D, Fabbri M, Zagari RM, Montale A, Bazzoli F, Ricciardiello L. Lifestyle factors and risk for colorectal polyps and cancer at index colonoscopy in a FIT-positive screening population. United European Gastroenterol J 2018; 6:935-942. [PMID: 30023072 DOI: 10.1177/2050640618764711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/18/2018] [Indexed: 01/24/2023] Open
Abstract
Background Many countries have adopted the fecal immunochemical test (FIT) as the primary colorectal cancer (CRC) screening tool; however, its accuracy is limited. Epidemiological studies have shown that obesity and type 2 diabetes increase risk for the disease. Objective The objective of this article is to evaluate the association of colorectal polyps and cancer with comorbidities and lifestyle factors in a population that is part of a FIT-based CRC screening program. Methods Between 2005 and 2013, we analyzed 3894 FIT + patients who underwent total colonoscopy. The impact of lifestyle factors on polyps and cancer was assessed using individuals with a negative colonoscopy as the control group. A multivariate logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results We collected data from 3894 FIT + patients. Obesity (OR 1.29; 95% CI 1.05-1.60) and smoking (OR 1.45; 95% CI 1.24-1.71) were significantly associated with high-risk adenomas. Smoking and heavy alcohol drinking were both independently associated with high risk of CRC (OR 1.50; 95% CI 1.10-2.04 and OR 2.29; 95% CI 1.15-4.58) and colon cancer alone (OR 1.43; 95% CI 1.01-2.02 and OR 3.09; 95% CI 1.53-6.23). Positivity to first round of FIT was associated with high-risk adenomas (OR 1.47; CI 95% 1.26-1.71) and CRC (OR 1.74; 95% CI 1.29-2.36). No associations were found for diabetes. Conclusion In our FIT + population, lifestyle factors are significantly associated with the risk of carrying high-risk adenomas and CRC. In the future, studies could be aimed at finding better screening strategies through the development of clinical algorithms based on lifestyle changes/comorbidities.
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Affiliation(s)
- Dora Colussi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Margherita Fabbri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Amedeo Montale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Morère JF, Eisinger F, Touboul C, Lhomel C, Couraud S, Viguier J. Decline in Cancer Screening in Vulnerable Populations? Results of the EDIFICE Surveys. Curr Oncol Rep 2018; 20:17. [DOI: 10.1007/s11912-017-0649-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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