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Tanadi C, Tandarto K, Stella MM, Sutanto KW, Steffanus M, Tenggara R, Bestari MB. Colorectal cancer screening guidelines for average-risk and high-risk individuals: A systematic review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:101-123. [PMID: 38153878 DOI: 10.2478/rjim-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Indexed: 12/30/2023]
Abstract
AIMS This review aims to summarize the different colorectal cancer guidelines for average-risk and high-risk individuals from various countries. METHODS A comprehensive literature search regarding guidelines, consensus recommendations, or position statements about colorectal cancer screening published within the last 10 years (1st January 2012 to 27th August 2022), was performed at EBSCOhost, JSTOR, PubMed, ProQuest, SAGE, and ScienceDirect. RESULTS A total of 18 guidelines were included in this review. Most guidelines recommended screening between 45 and 75 years for average-risk individuals. Recommendations regarding colorectal cancer screening in high-risk individuals were more varied and depended on the risk factor. For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40. Some frequently suggested screening modalities in order of frequency are colonoscopy, FIT, and CTC. Furthermore, several screening intervals were suggested, including colonoscopy every 10 years for average-risk and every 5-10 years for high-risk individuals, FIT annually in average-risk and every 1-2 years in high-risk individuals, and CTC every five years for all individuals. CONCLUSION All individuals with average-risk should undergo colorectal cancer screening between 45 and 75. Meanwhile, individuals with higher risks, such as those with a positive family history, should begin screening at age 40. Several recommended screening modalities were suggested, including colonoscopy every 10 years in average-risk and every 5-10 years in high-risk, FIT annually in average-risk and every 1-2 years in high-risk, and CTC every five years.
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Affiliation(s)
- Caroline Tanadi
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kevin Tandarto
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Maureen Miracle Stella
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kenny Wijaya Sutanto
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Mario Steffanus
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Riki Tenggara
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Yu M, Ouyang Y, Yuan Z, Wang S, Pang W, Yan S, Liu X, Wang W, Yi B, Han Q, Yao Y, Liu Y, Song J, Chu T, Feng Z, Zhang Q, Zhang X, Zhang C. Derivation and validation of a nomogram incorporating modifiable lifestyle factors to predict development of colorectal adenomas after negative index colonoscopy. Sci Rep 2024; 14:11633. [PMID: 38773186 PMCID: PMC11109095 DOI: 10.1038/s41598-024-62348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
This retrospective cohort study aimed to identify baseline patient characteristics involving modifiable lifestyle factors that are associated with the development of colorectal adenomas, and establish and validate a nomogram for risk predictions among high-risk populations with negative index colonoscopy. A total of 83,076 participants who underwent an index colonoscopy at the Tianjin Union Medical Center between 2004 and 2019 were collected. According to meticulous inclusion and exclusion criteria, 249 subjects were enrolled and categorized into the primary and validation cohorts. Based on the primary cohort, we utilized the LASSO-Cox regression and the univariate/multivariate Cox proportional hazards (Cox-PH) regression parallelly to select variables, and incorporated selected variables into two nomogram models established using the multivariate Cox-PH regression. Comparison of the Akaike information criterion and the area under the receiver operating characteristic curve of the two models demonstrated that the nomogram model constituted by four covariates retained by the LASSO-Cox regression, including baseline age, body mass index, physical activity and family history of colorectal cancer (CRC) in first-degree relatives, performed better at predicting adenoma-free survival probabilities. Further validation including the concordance index, calibration plots, decision curve analysis and Kaplan-Meier survival curves also revealed good predictive accuracy, discriminating ability, clinical utility and risk stratification capacity of the nomogram model. Our nomogram will assist high-risk individuals with negative index colonoscopy to prevent colorectal adenoma occurrence and CRC morbidity with improved cost-effectiveness.
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Affiliation(s)
- Mingqian Yu
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yiben Ouyang
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Wenwen Pang
- Department of Clinical Laboratory, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Xinyu Liu
- Tianjin Medical University, Tianjin, 300041, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Ben Yi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Qiurong Han
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yao Yao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Yanfei Liu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Jiachun Song
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Tianhao Chu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Zhiqiang Feng
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, 300121, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
| | - Chunze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, 300121, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
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Zhang Y, Gu F, Liu X, Ding S. A novel nomogram for the prediction of perforation during endoscopic submucosal dissection for colorectal neoplasms. Saudi J Gastroenterol 2024:00936815-990000000-00077. [PMID: 38708876 DOI: 10.4103/sjg.sjg_417_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND High perforation risk hinders the widespread adoption of ESD for colorectal neoplasms. This study was performed to determine the risk factors of colorectal endoscopic submucosal dissection (ESD)-induced perforation and develop a predictive model. METHODS A total of 1046 colorectal neoplasms in 1011 patients were retrospectively enrolled from January 2011 to December 2021, in a single tertiary center as the derivation cohort. We identified independent risk factors for perforation using univariate analysis and multi-variate logistic regression. A nomogram was developed based on the logistic regression model and prospectively applied to 266 colorectal neoplasms as the validation cohort. The performance of the predictive model was evaluated with the receiver operating characteristic curve, calibration plot, and decision curve analysis. RESULTS Independent pre-operative factors for colorectal ESD-induced perforation were tumor located in the left colon [odds ratio (OR) 2.39, P = 0.040], size ≥ 40 mm (OR 3.36, P < 0.001), ≥2/3 circumference (OR 7.55, P = 0.004), located across folds (OR 6.26, P < 0.001), and laterally spreading tumor (non-granular type, OR 2.34, P = 0.029; granular type, OR 2.46, P = 0.021). The nomogram model incorporating the pre-operative factors performed well in both the derivation and validation cohorts (areas under the curve of 0.750 and 0.806, respectively). Decision curve analysis demonstrated that the clinical benefit of the nomogram was favorable. CONCLUSIONS The novel nomogram, developed and prospectively validated, incorporating tumor size, location, and morphology can successfully predict perforation during ESD for colorectal neoplasms.
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Affiliation(s)
- Yuxin Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Fang Gu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Xun Liu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Shigang Ding
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
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Liang Q, Mukama T, Sundquist K, Sundquist J, Brenner H, Kharazmi E, Fallah M. Longer Interval Between First Colonoscopy With Negative Findings for Colorectal Cancer and Repeat Colonoscopy. JAMA Oncol 2024:2818448. [PMID: 38696176 PMCID: PMC11066766 DOI: 10.1001/jamaoncol.2024.0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/14/2023] [Indexed: 05/05/2024]
Abstract
Importance For individuals without a family history of colorectal cancer (CRC), colonoscopy screening every 10 years is recommended to reduce CRC incidence and mortality. However, debate exists about whether and for how long this 10-year interval could be safely expanded. Objective To assess how many years after a first colonoscopy with findings negative for CRC a second colonoscopy can be performed. Design, Setting, and Participants This cohort study leveraged Swedish nationwide register-based data to examine CRC diagnoses and CRC-specific mortality among individuals without a family history of CRC. The exposed group included individuals who had a first colonoscopy with findings negative for CRC at age 45 to 69 years between 1990 and 2016. The control group included individuals matched by sex, birth year, and baseline age (ie, the age of their matched exposed individual when the exposed individual's first colonoscopy with findings negative for CRC was performed). Individuals in the control group either did not have a colonoscopy during the follow-up or underwent colonoscopy that resulted in a CRC diagnosis. Up to 18 controls were matched with each exposed individual. Individuals were followed up from 1990 to 2018, and data were analyzed from November 2022 to November 2023. Exposure A first colonoscopy with findings negative for CRC, defined as a first colonoscopy without a diagnosis of colorectal polyp, adenoma, carcinoma in situ, or CRC before or within 6 months after screening. Main Outcomes and Measures The primary outcomes were CRC diagnosis and CRC-specific death. The 10-year standardized incidence ratio and standardized mortality ratio were calculated to compare risks of CRC and CRC-specific death in the exposed and control groups based on different follow-up screening intervals. Results The sample included 110 074 individuals (65 147 females [59.2%]) in the exposed group and 1 981 332 (1 172 646 females [59.2%]) in the control group. The median (IQR) age for individuals in both groups was 59 (52-64) years. During up to 29 years of follow-up of individuals with a first colonoscopy with findings negative for CRC, 484 incident CRCs and 112 CRC-specific deaths occurred. After a first colonoscopy with findings negative for CRC, the risks of CRC and CRC-specific death in the exposed group were significantly lower than those in their matched controls for 15 years. At 15 years after a first colonoscopy with findings negative for CRC, the 10-year standardized incidence ratio was 0.72 (95% CI, 0.54-0.94) and the 10-year standardized mortality ratio was 0.55 (95% CI, 0.29-0.94). In other words, the 10-year cumulative risk of CRC in year 15 in the exposed group was 72% that of the 10-year cumulative risk of CRC in the control group. Extending the colonoscopy screening interval from 10 to 15 years in individuals with a first colonoscopy with findings negative for CRC could miss the early detection of only 2 CRC cases and the prevention of 1 CRC-specific death per 1000 individuals, while potentially avoiding 1000 colonoscopies. Conclusions and Relevance This cohort study found that for the population without a family history of CRC, the 10-year interval between colonoscopy screenings for individuals with a first colonoscopy with findings negative for CRC could potentially be extended to 15 years. A longer interval between colonoscopy screenings could be beneficial in avoiding unnecessary invasive examinations.
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Affiliation(s)
- Qunfeng Liang
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Trasias Mukama
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Community-based Healthcare Research and Education, Department of Functional Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Community-based Healthcare Research and Education, Department of Functional Pathology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Hermann Brenner
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elham Kharazmi
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Mahdi Fallah
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Zhang J, Zhu S, Liu C, Xiao X, Xie H, Zhang Y, Hong Y. Colorectal cancer and its attributable risk factors in East Asia, 1990-2030. J Gastroenterol Hepatol 2024; 39:880-892. [PMID: 38221664 DOI: 10.1111/jgh.16467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The disease burden of colorectal cancer in East Asia has been at a high level. However, the epidemiological characteristics of the disease burden in this region have not been systematically studied. METHOD Data were obtained from the Global Burden of Disease 2019 program. Joinpoint analysis was used to identify long-term trends in mortality of colorectal cancer. Independent effects of age, period, and cohort were detected by the age-period-cohort model. The Bayesian age-period-cohort model was performed to predict the burden of colorectal cancer across East Asia by 2030. RESULTS From 1990 to 2019, the average annual percentage change (AAPC) showed upward trends in mainland China (1.05 [95% confidence interval (CI)], 0.82, 1.28) as well as Taiwan Province of China (1.81 [95% CI], 1.51, 2.10) but downward in Japan (-0.60 [95% CI], -0.70, -0.49) (P < 0.05). Attributable risk factors for colorectal cancer in East Asia remained stable over 30 years, while the risk of metabolic factors is noteworthy in the future. In the next decade, the age-standardized death rate (ASDR) of colorectal cancer in China was predicted to surpass that of Japan and South Korea in expectation. CONCLUSION The mortality of colorectal cancer is escalating in developing countries, while it is gradually declining in high-income countries across East Asia. Nonetheless, the disease burden of colorectal cancer in high-income countries remains substantial level.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Chunlong Liu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Xiong Xiao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haojie Xie
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yonghui Zhang
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
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Vishwanath A, Krishna S, Manudhane AP, Hart PA, Krishna SG. Early-Onset Gastrointestinal Malignancies: An Investigation into a Rising Concern. Cancers (Basel) 2024; 16:1553. [PMID: 38672634 PMCID: PMC11049592 DOI: 10.3390/cancers16081553] [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: 03/12/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
There is growing recognition of early-onset gastrointestinal (GI) malignancies in young adults < 50 years of age. While much of the literature has emphasized colorectal cancer, these also include esophageal, gastric, liver, pancreatic, and biliary tract malignancies. Various factors, including lifestyle, hereditary, and environmental elements, have been proposed to explain the rising incidence of GI malignancies in the younger population. This review aims to provide an overview of the recent literature, including global trends and information regarding genetic and environmental risk factors.
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Affiliation(s)
- Aayush Vishwanath
- Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA;
| | - Shreyas Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH 43210, USA; (S.K.); (A.P.M.)
| | - Albert P. Manudhane
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH 43210, USA; (S.K.); (A.P.M.)
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH 43210, USA; (S.K.); (A.P.M.)
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH 43210, USA; (S.K.); (A.P.M.)
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Liang Q, Sundquist K, Sundquist J, Brenner H, Kharazmi E, Fallah M. Colonoscopy screening interval in relatives of patients with late-onset colorectal cancer: A nationwide matched cohort study. Sci Bull (Beijing) 2024; 69:732-736. [PMID: 38278709 DOI: 10.1016/j.scib.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Qunfeng Liang
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg 69120, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg 69120, Germany
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö 202 13, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö 202 13, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Center for Community-based Healthcare Research and Education, Department of Functional Pathology, School of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Hermann Brenner
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg 69120, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg 69120, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg 69120, Germany
| | - Elham Kharazmi
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg 69120, Germany; Center for Primary Health Care Research, Lund University, Malmö 202 13, Sweden
| | - Mahdi Fallah
- Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg 69120, Germany; Center for Primary Health Care Research, Lund University, Malmö 202 13, Sweden; Institute of Primary Health Care, University of Bern, Bern 3012, Switzerland.
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Santucci C, Mignozzi S, Malvezzi M, Boffetta P, Collatuzzo G, Levi F, La Vecchia C, Negri E. European cancer mortality predictions for the year 2024 with focus on colorectal cancer. Ann Oncol 2024; 35:308-316. [PMID: 38286716 DOI: 10.1016/j.annonc.2023.12.003] [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: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND We predicted cancer mortality figures for 2024 for the European Union (EU), its five most populous countries, and the UK. We focused on mortality from colorectal cancer (CRC). MATERIALS AND METHODS Based on cancer death certification and population data from the World Health Organization and Eurostat databases from 1970 until the most available year, we predicted deaths and age-standardized rates (ASRs) for 2024 for all cancers and the 10 most common cancer sites. We fitted a linear regression to the most recent trend segment identified by the joinpoint model. The number of avoided deaths since the peak in 1988-2024 was estimated for all cancers and CRC. RESULTS We predicted 1 270 800 cancer deaths for 2024 in the EU, corresponding to ASRs of 123.2/100 000 men (-6.5% versus 2018) and 79.0/100 000 women (-4.3%). Since 1988, about 6.2 million cancer deaths have been avoided in the EU and 1.3 million in the UK. Pancreatic cancer displayed unfavorable predicted rates for both sexes (+1.6% in men and +4.0% in women) and lung cancer for women (+0.3%). The focus on CRC showed falls in mortality at all ages in the EU, by 4.8% for men and 9.5% for women since 2018. The largest declines in CRC mortality are predicted among those 70+ years old. In the UK, projected ASRs for CRC at all ages are favorable for men (-3.4% versus 2018) but not for women (+0.3%). Below age 50 years, CRC mortality showed unfavorable trends in Italy and the UK, in Poland and Spain for men, and in Germany for women. CONCLUSIONS Predicted cancer mortality rates remain favorable in the EU and the UK, mainly in males due to earlier smoking cessation compared to females, underlining the persisting major role of tobacco on cancer mortality in Europe. Attention should be paid to the predicted increases in CRC mortality in young adults.
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Affiliation(s)
- C Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - S Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - M Malvezzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - P Boffetta
- Stony Brook Cancer Center and Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - F Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan.
| | - E Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Imanbayev N, Iztleuov Y, Koishybaev AK, Kereyeva N, Tulyayeva A, Zholmukhamedova D, Zharylgapov A. The Role of Tumor Parenchymal and Stromal Ratios in Colorectal Cancer. J Family Reprod Health 2024; 18:1-8. [PMID: 38863846 PMCID: PMC11162885 DOI: 10.18502/jfrh.v18i1.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Objective To evaluate the implications and significant role of parenchymal and stromal ratio in colorectal cancer (CRC). Materials and methods In our review, we involved English studies from common databases such as Web of Science, Scopus, Google Scholar, PubMed, and the Cochrane Library using the following keywords "colorectal cancer", "tumor stromal ratio", "tumor parenchymal ratio", and "prognostic marker" till December 2023. Results The majority of CRC patients are usually diagnosed at late stages, which may lead to missing out on the chance to get radical therapy. Patients with unfavorable prognosis have epithelial malignant tumors with a high amount of stroma, more than 50% stroma, while tumors with a low amount of stroma, less than 50%, and abundant carcinoma tissue have a better prognosis. Conclusion Tumor-stromal ratio is a valuable, cheap, and fast modality that provides valuable prognostic data of colorectal carcinoma and other cancers.
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Affiliation(s)
- Nauryzbay Imanbayev
- Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Yerbolat Iztleuov
- Department of Radiologists of the NJSC ZKMU named after Marat Ospanov, MC NCJSC Marat Ospanov Western-Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Arip K. Koishybaev
- Department of Oncology of the NJSC ZKMU named after M. Ospanov MC NCJSC Marat Ospanov Western-Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Nurgul Kereyeva
- Department of Oncology ZKMU named after Marat Ospanova, MC NCJSC Marat Ospanov Western-Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Anar Tulyayeva
- Department of Oncology Medical Center of West Kazakhstan Medical University named after Marat Ospanov, Aktobe, Kazakhstan
| | - Dinara Zholmukhamedova
- Department Oncology MC NCJSC Marat Ospanov Western-Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Azamat Zharylgapov
- Department Oncology MC NCJSC Marat Ospanov Western-Kazakhstan Medical University, Aktobe, Kazakhstan
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Juul FE, Cross AJ, Schoen RE, Senore C, Pinsky PF, Miller EA, Segnan N, Wooldrage K, Wieszczy-Szczepanik P, Armaroli P, Garborg KK, Adami HO, Hoff G, Kalager M, Bretthauer M, Holme Ø, Løberg M. Effectiveness of Colonoscopy Screening vs Sigmoidoscopy Screening in Colorectal Cancer. JAMA Netw Open 2024; 7:e240007. [PMID: 38421651 PMCID: PMC10905314 DOI: 10.1001/jamanetworkopen.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Randomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking. Objective To estimate the additional screening benefit of colonoscopy compared with sigmoidoscopy. Design, Setting, and Participants This comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021. Intervention Invitation to endoscopic screening. Main Outcomes and Measures Primary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimated assuming that the efficacy of colonoscopy in the proximal colon was similar to that observed in the distal colon in the sigmoidoscopy screening trials. The simulation model was validated using data from Norwegian participants in a colonoscopy screening trial. Results This analysis included 358 204 individuals (181 971 women [51%]) aged 55 to 64 years at inclusion with a median follow-up time ranging from 15 to 17 years. Compared with usual care, colonoscopy prevented an estimated 50 (95% CI, 42-58) CRC cases per 100 000 person-years, corresponding to 30% incidence reduction (rate ratio, 0.70 [95% CI, 0.66-0.75]), and prevented an estimated 15 (95% CI, 11-19) CRC deaths per 100 000 person-years, corresponding to 32% mortality reduction (rate ratio, 0.68 [95% CI, 0.61-0.76]). The additional benefit of colonoscopy screening compared with sigmoidoscopy was 12 (95% CI, 10-14) fewer CRC cases and 4 (95% CI, 3-5) fewer CRC deaths per 100 000 person-years, corresponding to percentage point reductions of 6.9 (95% CI, 6.0-7.9) for CRC incidence and 7.6 (95% CI, 5.7-9.6) for CRC mortality. The number needed to switch from sigmoidoscopy to colonoscopy screening was 560 (95% CI, 486-661) to prevent 1 CRC case and 1611 (95% CI, 1275-2188) to prevent 1 CRC death. Conclusions and Relevance The findings of this comparative effectiveness study assessing long-term follow-up after CRC screening suggest that there was an additional preventive effect on CRC incidence and mortality associated with colonoscopy screening compared with sigmoidoscopy screening, but the additional preventive effect was less than what was achieved by introducing sigmoidoscopy screening where no screening existed. The results probably represent the upper limit of what may be achieved with colonoscopy screening compared with sigmoidoscopy screening.
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Affiliation(s)
- Frederik E. Juul
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Amanda J. Cross
- Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlo Senore
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eric A. Miller
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Nereo Segnan
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Kate Wooldrage
- Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Paulina Wieszczy-Szczepanik
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Paola Armaroli
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Kjetil K. Garborg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - 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
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Medicine, Sorlandet Hospital Health Trust, Kristiansand, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
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11
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Wu W, Tan S, Huang J, Chen Y, Wong MCS, Xu W. A qualitative interview study on colorectal cancer screening in China. Front Med (Lausanne) 2024; 11:1232134. [PMID: 38357645 PMCID: PMC10864664 DOI: 10.3389/fmed.2024.1232134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Background The effectiveness of triage screening for colorectal cancer (CRC) is not fully achieved in Chinese populations, mainly due to low compliance to colonoscopy follow-up. This study aimed to collect viewpoints of experts in China on ongoing screening programs and emerging screening tests for CRC, which may help to improve effectiveness of CRC screening in the country. Methods We conducted 15 semi-structured interviews with experts involving CRC screening in China during October to November of 2020. Interview topics included personal characteristics, work context, opinions on ongoing screening programs, challenges and opportunities in optimization of screening strategies, and prospects for CRC screening in near future. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding. Results This analysis revealed a total of 83 initial categories, 37 subcategories and 10 main categories, which included 4 core categories of current modality for CRC screening, factors influencing screening effectiveness, optimization of CRC screening modality, and prospects for development of CRC screening. The results provide insight into the factors underlying the challenges of the ongoing CRC screening programs in China: the most important concern is the low compliance to colonoscopy, followed by the low specificity of the currently-used initial tests. The experts proposed to use quantitative instead of qualitative fecal immunochemical test (FIT), and optimize risk assessment tools to improve specificity of initial tests. Regarding the emerging screening tests, 9 of 15 experts did not think that the novel techniques are good enough to replace the current tests, but can be used complementarily in opportunistic screening for CRC. Conclusion The viewpoints of Chinese experts suggested that use quantitative FIT or optimize risk assessment tools may help to identify high-risk individuals of CRC more accurately, improve adherence to colonoscopy, and thus fully achieve the effectiveness of screening.
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Affiliation(s)
- Weimiao Wu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Songsong Tan
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yingyao Chen
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wanghong Xu
- Global Health Institute, Fudan University School of Public Health, Shanghai, China
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12
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Kim GH, Lee YC, Kim TJ, Hong SN, Chang DK, Kim YH, Yang DH, Moon CM, Kim K, Kim HG, Kim ER. Trends in colorectal cancer incidence according to an increase in the number of colonoscopy cases in Korea. World J Gastrointest Oncol 2024; 16:51-60. [PMID: 38292837 PMCID: PMC10824123 DOI: 10.4251/wjgo.v16.i1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) and preinvasive CRC (e.g., early colon cancer and advanced adenoma) is gradually increasing in several countries. AIM To evaluate the trend in incidence of CRC and preinvasive CRC according to the increase in the number of colonoscopies performed in Korea. METHODS This retrospective cohort study enrolled Korean patients from 2002 to 2020 to evaluate the incidence of CRC and preinvasive CRC, and assess the numbers of diagnostic colonoscopies and colonoscopic polypectomies. Colonoscopy-related complications by age group were also determined. RESULTS The incidence of CRC showed a rapid increase, then decreased after 2012 in the 50-75 year-age group. During the study period, the rate of incidence of preinvasive CRC increased at a similar level in patients under 50 and 50-75 years of age. Since 2009, the increase has been rapid, showing a pattern similar to the increase in colonoscopies. The rate of colonoscopic polypectomy in patients aged under 50 was similar to the rate in patients over 75 years of age after 2007. The rate of complications after colonoscopy and related deaths within 3 mo was high for those over 75 years of age. CONCLUSION The diagnosis of preinvasive CRC increased with the increase in the number of colonoscopies performed. As the risk of colonoscopy-related hospitalization and death is high in the elderly, if early lesions at risk of developing CRC are diagnosed and treated under or at the age of 75, colonoscopy-related complications can be reduced for those aged 76 years or over.
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Affiliation(s)
- Ga Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Yeong Chan Lee
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Tae Jun Kim
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Sung Noh Hong
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Dong Kyung Chang
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Young-Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Dong-Hoon Yang
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Chang Mo Moon
- Division of Gastroenterology, Department of Internal Medicine, Ewha Womans University, Seoul 07985, South Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Samsung Medical Center, Seoul 06351, South Korea
| | - Hyun Gun Kim
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul 04401, South Korea
| | - Eun-Ran Kim
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
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Machlab S, Francia E, Mascort J, García-Iglesias P, Mendive JM, Riba F, Guarner-Argente C, Solanes M, Ortiz J, Calvet X. Risks, indications and technical aspects of colonoscopy in elderly or frail patients. Position paper of the Societat Catalana de Digestologia, the Societat Catalana de Geriatria i Gerontologia and the Societat Catalana de Medicina de Familia i Comunitaria. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:107-117. [PMID: 37209916 DOI: 10.1016/j.gastrohep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty.
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Affiliation(s)
- Salvador Machlab
- Servei d'Aparell Digestiu, Parc Taulí, Hospital Universitari, Institut de Recerca Parc Taulí, Sabadell, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Esther Francia
- Servei de Medicina Interna, Unitat de Geriatria, Hospital de Sant Pau, Barcelona, España
| | - Juanjo Mascort
- CAP Florida Sud, Institut Català de La Salut, Hospitalet de Llobregat, España; Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Pilar García-Iglesias
- Servei d'Aparell Digestiu, Parc Taulí, Hospital Universitari, Institut de Recerca Parc Taulí, Sabadell, España
| | | | - Francesc Riba
- Servei de Geriatria i Cures Pal·liatives, Hospital de la Santa Creu Jesús, Tortosa, España
| | - Carles Guarner-Argente
- Servei Aparell Digestiu, Hospital de Sant Pau, Barcelona, España; CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Mònica Solanes
- CAP Onze de Setembre, Institut Català de la Salut, Lleida, España
| | - Jordi Ortiz
- Servei d'Aparell Digestiu, Consorci Sanitari de Terrassa, Terrassa, España
| | - Xavier Calvet
- Servei d'Aparell Digestiu, Parc Taulí, Hospital Universitari, Institut de Recerca Parc Taulí, Sabadell, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; CIBEREHD, Instituto de Salud Carlos III, Madrid, España.
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14
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Rezkitha YAA, Panenggak NSR, Lusida MI, Rianda RV, Mahmudah I, Pradana AD, Uchida T, Miftahussurur M. Detecting colorectal cancer using genetic and epigenetic biomarkers: screening and diagnosis. J Med Life 2024; 17:4-14. [PMID: 38737656 PMCID: PMC11080499 DOI: 10.25122/jml-2023-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/01/2023] [Indexed: 05/14/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most frequent types of cancer, with high incidence rates and mortality globally. The extended timeframe for developing CRC allows for the potential screening and early identification of the disease. Furthermore, studies have shown that survival rates for patients with cancer are increased when diagnoses are made at earlier stages. Recent research suggests that the development of CRC, including its precancerous lesion, is influenced not only by genetic factors but also by epigenetic variables. Studies suggest epigenetics plays a significant role in cancer development, particularly CRC. While this approach is still in its early stages and faces challenges due to the variability of CRC, it shows promise as a potential method for understanding and addressing the disease. This review examined the current evidence supporting genetic and epigenetic biomarkers for screening and diagnosis. In addition, we also discussed the feasibility of translating these methodologies into clinical settings. Several markers show promising potential, including the methylation of vimentin (VIM), syndecan-2 (SDC2), and septin 9 (SEPT9). However, their application as screening and diagnostic tools, particularly for early-stage CRC, has not been fully optimized, and their effectiveness needs validation in large, multi-center patient populations. Extensive trials and further investigation are required to translate genetic and epigenetic biomarkers into practical clinical use. biomarkers, diagnostic biomarkers.
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Affiliation(s)
- Yudith Annisa Ayu Rezkitha
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Nur Syahadati Retno Panenggak
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Maria Inge Lusida
- Institute of Tropical Disease, Indonesia-Japan Collaborative Research Center for Emerging and Re-Emerging Infectious Diseases, Universitas Airlangga, Surabaya, Indonesia
| | - Raissa Virgy Rianda
- Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Isna Mahmudah
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Aditya Doni Pradana
- Department of Emergency Services, Kendal Islamic Hospital, Kendal, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Tomohisa Uchida
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Muhammad Miftahussurur
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
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15
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Zhang G, Wang Y, Zhao L, Zhang M, Zhang W, Zhang W, Zhang S, Zhang H, Wang D, Wang Y, Xie L, Qian B, Zhang X. Fecal Immunochemical Testing and the Risk of Advanced Colorectal Neoplasia: A Difference-In-Difference Analysis. JCO Glob Oncol 2024; 10:e2300188. [PMID: 38271647 PMCID: PMC10830093 DOI: 10.1200/go.23.00188] [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: 06/06/2023] [Revised: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To evaluate the effectiveness of fecal immunochemical testing (FIT) in colorectal cancer screening. METHODS We conducted a prospective cohort study among 5,598 participants age 40-74 years between 2012 and 2020 in Tianjin, China. Inverse probability weighting was adopted to adjust for potential imbalanced factors between groups. A Cox proportional hazards model was used to estimate the weighted associations between FIT screening and advanced colorectal neoplasia. A difference-in-difference (DID) model was adopted to compare the incidence rates of advanced colorectal neoplasia between groups. RESULTS In DID analysis, the rate of incidence was reduced by 0.34 cases per person-years in the screening group as compared with the historical FIT screening group (rate ratio [RR], 0.08 [95% CI, 0.07 to 0.10]) and by 0.06 cases per person-years in the non-FIT screening group as compared with the historical non-FIT screening group (RR, 0.37 [95% CI, 0.29 to 0.48]; P < .001 for both comparisons), with a relative reduction of 0.28. Similar benefit effect from FIT screening was observed in sex and age subgroups. CONCLUSION FIT screening was associated with a reduction in incidence density from advanced colorectal neoplasia.
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Affiliation(s)
- Guanglu Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiying Wang
- Department of Preventive and Health Care, Tianjin Union Medical Center, Nankai University, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Nankai University, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Nankai University, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Weihua Zhang
- Department of Colorectal Surgery, Tianjin Hospital, Tianjin, China
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiwu Zhang
- Department of Pathology, Tianjin Union Medical Center, Nankai University, Tianjin, China
| | - Huan Zhang
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dezheng Wang
- NCDs Preventive Department, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yijia Wang
- Laboratory of Oncologic Molecular Medicine, Tianjin Union Medical Center, Nankai University, Tianjin, China
| | - Li Xie
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Nankai University, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
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16
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Hamada Y, Ikenoyama Y, Umeda Y, Yukimoto H, Shigefuku A, Fujiwara Y, Beppu T, Nakamura M, Horiki N, Nakagawa H. Long-term outcomes after endoscopic submucosal dissection for colorectal epithelial neoplasms in patients with severe comorbidities. JGH Open 2023; 7:974-981. [PMID: 38162839 PMCID: PMC10757493 DOI: 10.1002/jgh3.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Long-term outcomes after endoscopic submucosal dissection (ESD) for colorectal epithelial neoplasms (CENs) in patients with severe comorbidities have not been clarified; the current study aimed to examine these long-term outcomes and compared them with those in patients with non-severe comorbidities. Methods We included 231 patients with CENs who underwent ESD between April 2005 and March 2023. Patients with comorbidities were categorized according to the American Society of Anesthesiologists Physical Status (ASA-PS). We conducted a propensity score-matched analysis and compared long-term outcomes of the two groups after ESD for CENs. Results Of the 156 patients enrolled in the study, 43 and 113 had severe (ASA-PS III) and non-severe (ASA-PS I/II) comorbidities, respectively. The 1:1 propensity score analysis matched 36 patients with severe comorbidities to 36 patients with non-severe comorbidities. After matching, there was no difference in the procedural outcomes of ESD between both groups. Regarding long-term outcomes, the 5-year overall survival rates after matching in the ASA-PS I/II and III groups were 100% and 73.5%, respectively, and patients in the ASA-PS III group exhibited significantly shorter overall survival than those in the ASA-PS I/II group (hazard ratio 7.209; 95% confidence interval 1.592-32.646; P = 0.010). No colorectal cancer-related deaths were noted in either group. Conclusion Overall survival after ESD for CENs was shorter in patients with severe comorbidities than in those with non-severe comorbidities. Clinicians should carefully determine whether the benefits of CEN resection with ESD outweigh the procedural risks in patients with severe comorbidities.
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Affiliation(s)
- Yasuhiko Hamada
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Yohei Ikenoyama
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Yuhei Umeda
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Hiroki Yukimoto
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Akina Shigefuku
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Yasuko Fujiwara
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Tsuyoshi Beppu
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Misaki Nakamura
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Noriyuki Horiki
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Hayato Nakagawa
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
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17
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Skrzypczak T, Mamak M. Assessing the Readability of Online Health Information for Colonoscopy - Analysis of Articles in 22 European Languages. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1865-1870. [PMID: 37493981 PMCID: PMC10656333 DOI: 10.1007/s13187-023-02344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 07/27/2023]
Abstract
Patients often search on the Internet information about different medical conditions and procedures. This study aimed to evaluate online health information on colonoscopy, focusing on quantity and comprehensibility of internet resources dedicated to the colonoscopy. This information could be used by European Union (EU) colorectal cancer (CRC) screening providers to address patient's unfilled educational needs, fear of colonoscopy, and other barriers that deter from CRC screening. The term "colonoscopy" translated into 22 official EU languages was searched using the Google search engine. For each translation, generated list of websites was assessed with Google Translate. The first 50 websites in each language were assessed for suitability. Records in other languages were excluded. Included websites were free, focused on patient education, and did not have password. Readability assessments were performed with Lix score. A total of 588 websites in Bulgarian, Croatian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Hungarian, Italian, Latvian, Lithuanian, Polish, Portuguese, Romanian, Slovak, Slovenian, Spanish, and Swedish were evaluated. The overall mean Lix score was 56 ± 8 and was classified as very hard to comprehend. There were significant differences in mean Lix scores across the included languages (P<.001). There was not significant correlation (R2 = 0.1, P = 0.142) between Lix score and number of search hits. Although there was a wealth of online patient information on colonoscopy, the comprehensibility of the available information is low. Physician guidance to reliable resources could increase patient's willingness to undergo a screening colonoscopy.
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Affiliation(s)
- Tomasz Skrzypczak
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland.
| | - Michał Mamak
- University Hospital in Wroclaw, Borowska 213, 50-556, Wrocław, Poland
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18
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Nguyen HT, Nguyen AQ. Willingness to Pay for Colorectal Cancer Screening in Vietnam: Policy Implications From a Contingent Valuation Survey. Value Health Reg Issues 2023; 38:29-37. [PMID: 37441860 DOI: 10.1016/j.vhri.2023.06.002] [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: 01/10/2023] [Revised: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To determine the willingness to pay (WTP) for the fecal occult blood test (FOBT) and colonoscopy among the general population to provide evidence for policymakers in deciding whether to include them in the social health insurance benefit package and facilitate the pricing practice. METHODS The conventional double-bounded dichotomous choice contingent valuation survey was used to determine the WTP. We recruited 402 people aged 50 to 75 who came to 3 primary healthcare clinics in Hanoi from February 2019 to April 2019. The questionnaire was built based on the pilot research with a 5-bid design, that is, the starting bids of US $4.05, 6.75, 13.51, 21.01, and 36.47 for FOBT and US $21.01, 40.52, 54.03, 81.04, and 182.34 for colonoscopy. The data analysis was performed using the DCchoice package version 3.5.1. Cost in Vietnam dong is converted to 2022 US $using purchasing power parity method. RESULTS A total of 7.2% of participants refused to pay for FOBT and colonoscopy. Analysis of the univariate model showed that the mean and median WTP for FOBT were US $62.08 and 45.28. The mean and median WTP for colonoscopy were US $101.61 and 78.61. When adjusting the WTP value by related factors, the mean and median WTP estimates for FOBT were almost the same. The choice of WTP for FOBT and colonoscopy was statistically associated with several variables. CONCLUSIONS This study supports the inclusion of FOBT and colonoscopy into the social health insurance benefits package. This study also supports policymakers in pricing practice to optimize the uptake rate of colorectal cancer screening tests.
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Affiliation(s)
- Ha Thu Nguyen
- Department of Health Policy and Economics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Anh Quynh Nguyen
- Department of Health Policy and Economics, Hanoi University of Public Health, Hanoi, Vietnam.
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19
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Al Hinai K, Fischer J, Al Mamari A, Hulme-Moir M. Improved stage and survival for patients in the Aotearoa New Zealand colorectal cancer screening program 2012-2019. ANZ J Surg 2023; 93:2669-2674. [PMID: 37287212 DOI: 10.1111/ans.18556] [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: 04/22/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening was introduced in Aotearoa New Zealand at Waitematā District Health Board (WDHB) in late 2011. This study reviewed patterns of disease, treatment received, and survival of patients with national bowel screening program (NBSP)-detected CRC versus non-NBSP patients at WDHB 2012-2019. METHODS Data collected retrospectively for all patients with adenocarcinoma of the colon or rectum at WDHB 2012-2019. Patient records were manually reviewed. Chi-square, Fisher's exact test and the Mann Whitney U-test used as appropriate. Kaplan-Meier and Cox proportional hazards regression modelling for survival analysis. RESULTS 1667 patients included (360 NBSP and 1307 non-NBSP). 863 (51.8%) were male. Median age at diagnosis 73 years (range 21-100); NBSP patients were younger (median 68 vs. 76 years, P < 0.001). NBSP patients had significantly lower T, N, M and overall TNM stage than non-BSP patients. Median survival estimate on Kaplan-Meier analysis was 94 months for all patients. Statistically significant (P < 0.05) predictors of mortality on multi-variate regression analysis included increasing overall TNM stage compared with stage I (stage II HR 1.63 (95% CI 1.14-2.34), stage III HR 2.86 (95% CI 2.03-4.03), stage IV HR 7.73 (95% CI 5.59-10.68)), diagnosis within NBSP (HR 0.51 (95% CI 0.37-0.71)), increasing age in years (HR 1.03 (95% CI 1.02-1.03)), urgent/emergency surgery (HR 1.66 (95% CI 1.36-2.01)) and formal resection of primary tumour (HR 0.31 (95% CI 0.25-0.38)). CONCLUSION Patients diagnosed within the Aotearoa New Zealand NBSP were found to be younger and have earlier stage CRC. Diagnosis within the NBSP is an independent predictor of survival for patients with CRC.
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Affiliation(s)
- Khalid Al Hinai
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland - Waikato Clinical Campus, Hamilton, New Zealand
| | | | - Mike Hulme-Moir
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
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Alenezi AM, Alshariyah MMH, Alanazi MN, Abdel-Salam DM, Al-Hazmi AH, Thirunavukkarasu A, Alhuwaydi AM, Alsabilah RH, Mohamed RA. Assessment of Psychosocial Correlates and Associated Factors of Colorectal Cancer Screening among Southwestern Saudi Population: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2791. [PMID: 37893864 PMCID: PMC10606086 DOI: 10.3390/healthcare11202791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Psychosocial correlates are one of the crucial determinants for the uptake of colorectal cancer (CRC) screening by the pre-eligible population. The present study aimed to identify the psychosocial correlates of colorectal cancer screening and determine their associated factors among the Saudi population in the Najran region, Saudi Arabia. Using a validated questionnaire, we assessed five constructs of psychosocial correlates of CRC screening among 790 participants aged 45 years and above. The five constructs were salience and coherence, cancer worries, perceived susceptibility, response efficacy, and social influence. Of the studied population, less than 50% agreed with most of the five constructs' statements, and 27.5% preferred to follow their family members' advice. Significantly higher mean scores (±SD) were identified for the male gender (7.38 ± 2.15, p = 0.027) and participants working in government sectors (7.60 ± 2.03, p = 0.027) in the cancer worries construct, while the mean (±SD) scores of perceived susceptibility were significantly higher among married participants (14.38 ± 4.10, p = 0.023) and smokers (14.95 ± 3.92, p = 0.041). Our survey results could help policymakers to implement focused health education programs for the pre-eligible population on the importance of the uptake of CRC screening. Furthermore, it is recommended to carry out exploratory mixed-method surveys in other regions of Saudi Arabia to understand the region's specific psychosocial correlates towards CRC screening.
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Affiliation(s)
| | | | - Maryam Nazal Alanazi
- Department of Psychological Counseling, College of Sciences and Arts, Qurrayat Campus, Jouf University, Qurrayat 77425, Saudi Arabia;
| | - Doaa Mazen Abdel-Salam
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ahmad Homoud Al-Hazmi
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (A.H.A.-H.); (A.T.)
| | - Ashokkumar Thirunavukkarasu
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (A.H.A.-H.); (A.T.)
| | - Ahmed M. Alhuwaydi
- Department of Internal Medicine, Division of Psychiatry, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | | | - Rehab A. Mohamed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
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21
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Dalmat RR, Ziebell RA, Kamineni A, Phipps AI, Weiss NS, Breslau ES, Burnett-Hartman AN, Corley DA, Doria-Rose VP, Green BB, Halm EA, Levin TR, Schottinger JE, Chubak J. Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning One Year after a Negative Fecal Occult Blood Test, among Screen-Eligible 76- to 85-Year-Olds. Cancer Epidemiol Biomarkers Prev 2023; 32:1382-1390. [PMID: 37450838 PMCID: PMC10592334 DOI: 10.1158/1055-9965.epi-23-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Colorectal cancer screening is universally recommended for adults ages 45 to 75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially for individuals with prior screening. METHODS This study used a retrospective cohort of older adults at three Kaiser Permanente integrated healthcare systems (Northern California, Southern California, Washington) and Parkland Health. Beginning 1 year following a negative stool-based screening test, cumulative risks of colorectal cancer incidence, colorectal cancer mortality (accounting for deaths from other causes), and non-colorectal cancer mortality were estimated. RESULTS Cumulative incidence of colorectal cancer in screen-eligible adults ages 76 to 85 with a negative fecal occult blood test 1 year ago (N = 118,269) was 0.23% [95% confidence interval (CI), 0.20%-0.26%] after 2 years and 1.21% (95% CI, 1.13%-1.30%) after 8 years. Cumulative colorectal cancer mortality was 0.03% (95% CI, 0.02%-0.04%) after 2 years and 0.33% (95% CI, 0.28%-0.39%) after 8 years. Cumulative risk of death from non-colorectal cancer causes was 4.81% (95% CI, 4.68%-4.96%) after 2 years and 28.40% (95% CI, 27.95%-28.85%) after 8 years. CONCLUSIONS Among 76- to 85-year-olds with a recent negative stool-based test, cumulative colorectal cancer incidence and mortality estimates were low, especially within 2 years; death from other causes was over 100 times more likely than death from colorectal cancer. IMPACT These findings of low absolute colorectal cancer risk, and comparatively higher risk of death from other causes, can inform decision-making regarding whether and when to continue colorectal cancer screening beyond age 75 among screen-eligible adults.
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Affiliation(s)
- Ronit R. Dalmat
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Ethan A. Halm
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, CA USA
| | - Joanne E. Schottinger
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Jessica Chubak
- Department of Epidemiology, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Agunwamba AA, Zhu X, Sauver JS, Thompson G, Helmueller L, Finney Rutten LJ. Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies. Prev Med Rep 2023; 35:102353. [PMID: 37576848 PMCID: PMC10415795 DOI: 10.1016/j.pmedr.2023.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/20/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023] Open
Abstract
Despite clear evidence that regular screening reduces colorectal cancer (CRC) mortality and the availability of multiple effective screening options, CRC screening continues to be underutilized in the US. A systematic literature search of four databases - Ovid, Medline, EBSCHOhost, and Web of Science - was conducted to identify US studies published after 2017 that reported on barriers and facilitators to CRC screening adherence. Articles were extracted to categorize relevant CRC screening barriers or facilitators that were assessed against CRC screening outcomes using the 5As dimensions: Access, Affordability, Acceptance, Awareness, Activation. Sixty-one studies were included. Fifty determinants of screening within the 5As framework and two additional dimensions including Sociodemographics and Health Status were identified. The Sociodemographics, Access, and Affordability dimensions had the greatest number of studies included. The most common factor in the Access dimension was contact with healthcare systems, within the Affordability dimension was insurance, within the Awareness dimension was knowledge CRC screening, within the Acceptance dimension was health beliefs, within the Activation dimension was prompts and reminders, within the Sociodemographics dimension was race/ethnicity, and among the Health Status dimension was chronic disease history. Among all studies, contact with healthcare systems, insurance, race/ethnicity, age, and education were the most common factors identified. CRC screening barriers and facilitators were identified across individual, clinical, and sociocontextual levels. Interventions that consider multilevel strategies will most effectively increase CRC screening adherence.
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Affiliation(s)
- Amenah A. Agunwamba
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jenny St. Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lila J. Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Exact Sciences Corporation, Madison WI, USA
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23
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Mülder DT, van den Puttelaar R, Meester RGS, O'Mahony JF, Lansdorp-Vogelaar I. Development and validation of colorectal cancer risk prediction tools: A comparison of models. Int J Med Inform 2023; 178:105194. [PMID: 37633115 DOI: 10.1016/j.ijmedinf.2023.105194] [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: 12/20/2022] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Identification of individuals at elevated risk can improve cancer screening programmes by permitting risk-adjusted screening intensities. Previous work introduced a prognostic model using sex, age and two preceding faecal haemoglobin concentrations to predict the risk of colorectal cancer (CRC) in the next screening round. Using data of 3 screening rounds, this model attained an area under the receiver-operating-characteristic curve (AUC) of 0.78 for predicting advanced neoplasia (AN). We validated this existing logistic regression (LR) model and attempted to improve it by applying a more flexible machine-learning approach. METHODS We trained an existing LR and a newly developed random forest (RF) model using updated data from 219,257 third-round participants of the Dutch CRC screening programme until 2018. For both models, we performed two separate out-of-sample validations using 1,137,599 third-round participants after 2018 and 192,793 fourth-round participants from 2020 onwards. We evaluated the AUC and relative risks of the predicted high-risk groups for the outcomes AN and CRC. RESULTS For third-round participants after 2018, the AUC for predicting AN was 0.77 (95% CI: 0.76-0.77) using LR and 0.77 (95% CI: 0.77-0.77) using RF. For fourth-round participants, the AUCs were 0.73 (95% CI: 0.72-0.74) and 0.73 (95% CI: 0.72-0.74) for the LR and RF models, respectively. For both models, the 5% with the highest predicted risk had a 7-fold risk of AN compared to average, whereas the lowest 80% had a risk below the population average for third-round participants. CONCLUSION The LR is a valid risk prediction method in stool-based screening programmes. Although predictive performance declined marginally, the LR model still effectively predicted risk in subsequent screening rounds. An RF did not improve CRC risk prediction compared to an LR, probably due to the limited number of available explanatory variables. The LR remains the preferred prediction tool because of its interpretability.
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Affiliation(s)
- Duco T Mülder
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Reinier G S Meester
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands; Health Economics & Outcomes Research, Freenome Holdings Inc., San Francisco, CA, USA
| | - James F O'Mahony
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands; Centre for Health Policy & Management, Trinity College Dublin, Dublin, Ireland
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24
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Klimeck L, Heisser T, Hoffmeister M, Brenner H. Colorectal cancer: A health and economic problem. Best Pract Res Clin Gastroenterol 2023; 66:101839. [PMID: 37852707 DOI: 10.1016/j.bpg.2023.101839] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 10/20/2023]
Abstract
Colorectal Cancer (CRC) is the third most commonly diagnosed form of cancer and accounts for approximately 1.9 million cancer cases each year (10% of all new cancer cases globally). Incidence strongly increases with age and has been traditionally highest in Western, affluent countries, but it is rapidly increasing in many less developed countries and in younger generations in both developed and developing countries. With demographic aging, CRC will pose a rapidly increasing challenge for many societies, which underlines the need for major efforts on primary and secondary prevention. A number of effective screening options are available, and implementation of well-organized screening programs could have a major impact on lowering the future burden of the disease.
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Affiliation(s)
- Leon Klimeck
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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25
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von Renteln D, Djinbachian R, Benard F, Barkun AN, Bouin M, Bouchard S, Deslandres É, Panzini B, Sidani S, Leduc R, Jobse BC, Pohl H. Incomplete resection of colorectal polyps of 4-20 mm in size when using a cold snare, and its associated factors. Endoscopy 2023; 55:929-937. [PMID: 36377124 DOI: 10.1055/a-1978-3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND : Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as the first-line modality for small (< 10 mm) polyps. This study aimed to evaluate incomplete resection rates (IRRs) when using CSP for colorectal polyps of 4-20 mm. METHODS : Adults (45-80 years) undergoing screening, surveillance, or diagnostic colonoscopy and CSP by one of nine endoscopists were included. The primary outcome was the IRR for colorectal polyps of 4-20 mm, defined as the presence of polyp tissue in marginal biopsies after resection of serrated polyps or adenomas. Secondary outcomes included the IRR for serrated polyps, ease of resection, and complications. RESULTS: 413 patients were included (mean age 63; 48 % women) and 182 polyps sized 4-20 mm were detected and removed by CSP. CSP required conversion to hot snare resection in < 1 % of polyps of < 10 mm and 44 % of polyps sized 10-20 mm. The IRRs for polyps < 10 mm and ≥ 10 mm were 18 % and 21 %. The IRR was higher for serrated polyps (26 %) compared with adenomas (16 %). The IRR was higher for flat (IIa) polyps (odds ratio [OR] 2.9, 95 %CI 1.1-7.4); and when resection was judged as difficult (OR 4.2, 95 %CI 1.5-12.1), piecemeal resection was performed (OR 6.6, 95 %CI 2.0-22.0), or visible residual polyp was present after the initial resection (OR 5.4, 95 %CI 2.0-14.9). Polyp location, use of a dedicated cold snare, and submucosal injection were not associated with incomplete resection. Intraprocedural bleeding requiring endoscopic intervention occurred in 4.7 %. CONCLUSIONS : CSP for polyps of 4-9 mm is safe and feasible; however, for lesions ≥ 10 mm, CSP failure occurs frequently, and the IRR remains high even after technical success. Incomplete resection was associated with flat polyps, visual residual polyp, piecemeal resection, and difficult polypectomies.
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Affiliation(s)
- Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Florence Benard
- Division of General Surgery, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mickael Bouin
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Simon Bouchard
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Érik Deslandres
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Benoit Panzini
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Sacha Sidani
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Raymond Leduc
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Bruce C Jobse
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
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26
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Bărbulescu LN, Rădulescu VM, Bărbulescu LF, Mogoantă SȘ. The Influence of the COVID-19 Pandemic on Colorectal Cancer Secondary Preventive Healthcare Measures. Healthcare (Basel) 2023; 11:2457. [PMID: 37685491 PMCID: PMC10487724 DOI: 10.3390/healthcare11172457] [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: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
This study aims to assess the impact of SARS-CoV-2 on a population enrolled in a pilot colorectal screening program started by a family doctor in Romania. This observational retrospective study was spread over 43 months, respectively, from October 2019 to April 2023, and included 169 patients. The primary objective was to compare the pre-pandemic, pandemic, and post-pandemic periods to observe significant changes. The secondary objective was to study the correlation between vaccination against SARS-CoV-2 and participation in the study, especially in the age range class of interest-50-74 years. These data are important because Romanian Healthcare policymakers can use them to estimate the participation rate in a future national colorectal cancer screening and how to adjust and facilitate their communications with the targeted population. The rise of COVID-19 significantly negatively impacted the number of patients adhering to the pilot colorectal cancer screening and the number of test results during the pandemic period. However, in the post-pandemic period, the number of patients who joined the study, and the number of fecal occult blood tests was greater than expected (128.74%). We observed that screening participation was associated with vaccination (78.11% of patients had a complete COVID-19 vaccine scheme).
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Affiliation(s)
- Linda-Nicoleta Bărbulescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Cabinet Medical Dr. Profir I. Mirela SRL, 200145 Craiova, Romania
| | - Virginia-Maria Rădulescu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Automation and Electronics, University of Craiova, 200585 Craiova, Romania
| | | | - Stelian-Ștefăniță Mogoantă
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department III of Surgery, University Emergency County Hospital, 200642 Craiova, Romania
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27
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Pokharel R, Lin YS, McFerran E, O'Mahony JF. A Systematic Review of Cost-Effectiveness Analyses of Colorectal Cancer Screening in Europe: Have Studies Included Optimal Screening Intensities? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:701-717. [PMID: 37380865 PMCID: PMC10403417 DOI: 10.1007/s40258-023-00819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To assess the range of strategies analysed in European cost-effectiveness analyses (CEAs) of colorectal cancer (CRC) screening with respect to the screening intervals, age ranges and test cut-offs used to define positivity, to examine how this might influence what strategies are found to be optimal, and compare them with the current screening policies with a focus on the screening interval. METHODS We searched PubMed, Web of Science and Scopus for peer-reviewed, model-based CEAs of CRC screening. We included studies on average-risk European populations using the guaiac faecal occult blood test (gFOBT) or faecal immunochemical test (FIT). We adapted Drummond's ten-point checklist to appraise study quality. RESULTS We included 39 studies that met the inclusion criteria. Biennial screening was the most frequently used interval which was analysed in 37 studies. Annual screening was assessed in 13 studies, all of which found it optimally cost-effective. Despite this, 25 of 26 European stool-based programmes use biennial screening. Many CEAs did not vary the age range, but the 14 that did generally found broader ranges optimal. Only 11 studies considered alternative FIT cut-offs, 9 of which found lower cut-offs superior. Conflicts between current policy and CEA evidence are less clear regarding age ranges and cut-offs. CONCLUSIONS The existing CEA evidence indicates that the widely adopted biennial frequency of stool-based testing in Europe is suboptimal. It is likely that many more lives could be saved throughout Europe if programmes could be offered with more intensive annual screening.
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Affiliation(s)
- Rajani Pokharel
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Yi-Shu Lin
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ethna McFerran
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Obadina D, Haider H, Micic D, Sakuraba A. Older Age at First Screening Colonoscopy is Associated With an Increased Risk of Colorectal Adenomas and Cancer. J Clin Gastroenterol 2023; 57:804-809. [PMID: 35997687 DOI: 10.1097/mcg.0000000000001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The goal of colorectal cancer (CRC) screening is to detect precancerous polyps before cancer development or identification of cancer at an early stage. Guidelines have recommended screening colonoscopy to start at age 45. Our aim was to determine the impact of delays in performing the first screening colonoscopy on the risk of adenoma or CRC detection. METHODS We analyzed colonoscopy and histopathology data of average CRC risk patients who had their first screening colonoscopy between 2010 and 2017. Univariate and multivariable logistic regression was performed to determine the association between demographic variables and the risk of adenomas or CRC. RESULTS A total of 1155 average risk patients underwent their initial screening colonoscopy during the study period. Median age was 54 years (range of 45-87) and 58.2% were females. In multivariable analysis, older age at first screening colonoscopy was significantly associated with the detection of adenomatous polyps (odds ratio 1.05, 95% confidence interval 1.04-1.07, P <0.001) and CRC (odds ratio 1.11, 95% confidence interval 1.06-1.16, P <0.001). The association between age and risk of adenomatous polyps (F-test 35.43, P =0.0019) and CRC (F-test 36.94, P =0.0017) fit an exponential growth model. It was estimated that the detection rate doubled every 14.20 years and 4.75 years for adenomas and CRC, respectively. CONCLUSION We found that older age at the initial performance of a screening colonoscopy was associated with increased detection of adenomatous polyps and CRC. This work highlights the need for guideline adherence for the prevention of CRC development.
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Affiliation(s)
- David Obadina
- Pritzker School of Medicine, The University of Chicago
| | - Haider Haider
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Dejan Micic
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
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Diedrich L, Brinkmann M, Dreier M, Rossol S, Schramm W, Krauth C. Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models. PLoS One 2023; 18:e0290353. [PMID: 37594967 PMCID: PMC10438011 DOI: 10.1371/journal.pone.0290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. METHODS A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. RESULTS Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. CONCLUSION The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
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Affiliation(s)
- Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Bărbulescu LN, Rădulescu VM, Mogoantă SȘ, Bărbulescu LF, Kamal C, Radu M, Cismaru L. A Scoring Method to Prioritize Fecal Occult Blood Testing as a First Step in Colorectal Cancer Screening in Resource-Limited Settings. Diagnostics (Basel) 2023; 13:2556. [PMID: 37568919 PMCID: PMC10417455 DOI: 10.3390/diagnostics13152556] [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: 06/29/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
This study aims to develop a scoring method that can be used by primary care physicians from remote areas or resource-limited settings to estimate the need for fecal occult blood testing (FOBT) as a first step in colorectal cancer screening. This method relies on several modifiable risk factors that can influence a positive FOBT, an indication of the presence of colorectal polyps, or even colorectal cancer. The scoring method considers, besides the age and gender of the patient, the body mass index (BMI), smoking status, and the diagnoses of diabetes mellitus (type 2 diabetes), dyslipidemia, and hypertension. It does not need any paraclinical exams, which is an advantage when access or material resources are limited. The retrospective study was spread over forty-three months, respectively, from October 2019 to April 2023, and included 112 patients. The score that we designed is a numerical value between 0 and 7. The values between 0 and 3 represent a smaller risk of a positive FOBT (9.68%), values 4 and 5 represent a medium risk (14.75%), while values 6 and 7 represent a greater risk (40%). Using this score, a physician can determine if a patient has a greater risk and recommend it to prioritize taking a FOB test.
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Affiliation(s)
- Linda-Nicoleta Bărbulescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Cabinet Medical Dr. Profir I. Mirela SRL, 200145 Craiova, Romania
| | - Virginia-Maria Rădulescu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Automation and Electronics, University of Craiova, 200585 Craiova, Romania
| | - Stelian-Ștefăniță Mogoantă
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department III of Surgery, University Emergency County Hospital, 200642 Craiova, Romania
| | | | - Constantin Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mirela Radu
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Liana Cismaru
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Feldman K, Nehme F. Beyond Clinical Accuracy: Considerations for the Use of Generative Artificial Intelligence Models in Gastrointestinal Care. Gastroenterology 2023; 165:336-338. [PMID: 37321355 DOI: 10.1053/j.gastro.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Keith Feldman
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Fredy Nehme
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
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Huang J, Chen Y, Liu G, Tu W, Bergquist R, P Ward M, Zhang J, Xiao S, Hong J, Zhao Z, Li X, Zhang Z. Optimizing allocation of colorectal cancer screening hospitals in Shanghai: a geospatial analysis. GEOSPATIAL HEALTH 2023; 18. [PMID: 37401409 DOI: 10.4081/gh.2023.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/21/2023] [Indexed: 07/05/2023]
Abstract
Screening programmes are important for early diagnosis and treatment of colorectal cancer (CRC) but they are not equally efficient in all locations. Depending on which hospital people belong to, they often are not willing to follow up even after a positive result, resulting in a lower-than-expected overall detection rate. Improved allocation of health resources would increase the program's efficiency and assist hospital accessibility. A target population exceeding 70,000 people and 18 local hospitals were included in the investigation of an optimization plan based on a locationallocation model. We calculated the hospital service areas and the accessibility for people in communities to CRC-screening hospitals using the Huff Model and the Two-Step Floating Catchment Area (2SFCA) approach. We found that only 28.2% of the residents with initially a positive screening result had chosen followup with colonoscopy and significant geographical differences in spatial accessibility to healthcare services indeed exist. The lowest accessibility was found in the Southeast, including the Zhangjiang, Jichang and Laogang communities with the best accessibility mainly distributed near the city centre of Lujiazui; the latter also had relatively a high level of what is called "ineffective screening" as it represents wasteful resource allocation. It is recommended that Hudong Hospital should be chosen instead of Punan Hospital as the optimization, which can improve the service population of each hospital and the populations served per colonoscope. Based on our results, changes in hospital configuration in colorectal cancer screening programme are needed to achieve adequate population coverage and equitable facility accessibility. Planning of medical services should be based on the spatial distribution trends of the population served.
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Affiliation(s)
- Jiaqi Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
| | - Yichen Chen
- Center for Disease Control and Prevention, Pudong New Area, Shanghai.
| | - Gu Liu
- Department of General Surgery, the first people's Hospital of Chenzhou, Hunan.
| | - Wei Tu
- Department of Geology and Geography, Georgia Southern University, Statesboro, GA.
| | | | - Michael P Ward
- Faculty of Veterinary Science, University of Sydney, NSW.
| | - Jun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
| | - Shuang Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
| | - Jie Hong
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
| | - Zheng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
| | - Xiaopan Li
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China; Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai.
| | - Zhijie Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, Shanghai.
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Skrzypczak T, Skrzypczak A, Skrzypczak M. Implications of Public Interest in Colonoscopy: Analysis of Google Trends Data From 12 European Countries. Cureus 2023; 15:e42395. [PMID: 37621831 PMCID: PMC10446506 DOI: 10.7759/cureus.42395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the deadliest diseases in the European Union. Colonoscopy remains the gold standard of CRC screening. Analysis of colonoscopy-related Google Trends (GT; Google LLC, Mountain View, California, United States) data could provide useful information regarding interest in colonoscopy and potential barriers making patients unwilling to attend screening programs. METHODS Data were collected using GT for the main search term "colonoscopy" and the two most related queries. Colonoscopy volumes were extracted from the Eurostat database. Due to limited Eurostat data availability, analysis was performed from January 2004 to December 2015 for each of the 12 included countries. RESULTS Univariate linear regression analysis demonstrated statistically significant correlations between annual search volumes of "colonoscopy" and the annual number of colonoscopies performed in included countries (R2 = 0.923, P<.001). Trend analysis showed that the cumulative search volumes for "colonoscopy" gradually increased through the analyzed period. The spectrum of the most related queries encompassed "preparation for colonoscopy", "endoscopy", "after endoscopy", "colon", "colonoscopy diet", "virtual colonoscopy", "colonoscopy under anesthesia", "waiting times for colonoscopy" and "colonoscopy price". For eight out of nine queries, statistically significant correlations with procedure volumes were revealed. CONCLUSIONS GT could be a useful tool in assessing public interest in colonoscopy. Potential barriers that prevent people from attending CRC screening programs were identified. The study demonstrated that the internet has become an important field for CRC screening promotion. GT utility for colonoscopy and CRC screening providers was highlighted. This was the first analysis of GT data in colonoscopy focused on European countries.
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Affiliation(s)
| | - Anna Skrzypczak
- Faculty of Dentistry, Wroclaw Medical University, Wroclaw, POL
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Zhao K, Wang S, Yuan Z, Pang W, Yan S, Liu X, Wang W, Yi B, Han Q, Yao Y, Liu Y, Chu T, Feng Z, Zhang Q, Zhang X, Zhang C. The accuracy of the FIT in detecting advanced neoplasm is highest in young people aged 40 to 49 years: an analysis based on sex and age. Int J Colorectal Dis 2023; 38:178. [PMID: 37358700 PMCID: PMC10293344 DOI: 10.1007/s00384-023-04470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers and is associated with high incidence and mortality rates worldwide. CRC has caused a tremendous loss of human health and wealth. The incidence and mortality of colorectal carcinoma are increasing in young adults. Early cancer detection and prevention are made possible through screening. At present, the faecal immunochemical test (FIT) is a noninvasive method that can be used for the large-scale clinical screening of CRC status. Therefore, this study, based on CRC screening results in Tianjin from 2012 to 2020, was conducted to analyse the major differences in diagnostic performance parameters according to sex and age. METHODS This study was based on 39,991 colonoscopies performed for individuals in the Tianjin CRC screening program from 2012 to 2020. Of these individuals, they had complete FIT and colonoscopy results. The differences in FIT results were analysed by sex and age. RESULTS According to this study, males were generally more likely to develop advanced neoplasms (ANs) than females, and the prevalence increased with age. Males with negative FIT results were more likely to have advanced neoplasms than females with positive results. The accuracy of the FIT in detecting ANs in each age group was 54.9%, 45.5%, 48.6% and 49.5% in the 40-49, 50-59, 60-69, and ≥ 70 age groups, respectively. CONCLUSIONS The FIT detected ANs with highest accuracy in the 40-49 age group. Our research can provide guidance to formulate CRC screening strategies.
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Affiliation(s)
- Kailong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Wenwen Pang
- Department of Clinical Laboratory, Tianjin Union Medical Center, Tianjin, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinyu Liu
- Tianjin Medical University, Tianjin, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ben Yi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiurong Han
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yao Yao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanfei Liu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tianhao Chu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhiqiang Feng
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
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Stürzlinger H, Conrads-Frank A, Eisenmann A, Invansits S, Jahn B, Janzic A, Jelenc M, Kostnapfel T, Mencej Bedrac S, Mühlberger N, Siebert U, Sroczynski G. Stool DNA testing for early detection of colorectal cancer: systematic review using the HTA Core Model ® for Rapid Relative Effectiveness Assessment. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2023; 21:Doc06. [PMID: 37426885 PMCID: PMC10326527 DOI: 10.3205/000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 07/11/2023]
Abstract
Background Stool DNA testing for early detection of colorectal cancer (CRC) is a non-invasive technology with the potential to supplement established CRC screening tests. The aim of this health technology assessment was to evaluate effectiveness and safety of currently CE-marked stool DNA tests, compared to other CRC tests in CRC screening strategies in an asymptomatic screening population. Methods The assessment was carried out following the guidelines of the European Network for Health Technology Assessment (EUnetHTA). This included a systematic literature search in MED-LINE, Cochrane and EMBASE in 2018. Manufacturers were asked to provide additional data. Five patient interviews helped assessing potential ethical or social aspects and patients' experiences and preferences. We assessed the risk of bias using QUADAS-2, and the quality of the body of evidence using GRADE. Results We identified three test accuracy studies, two of which investigated a multitarget stool DNA test (Cologuard®, compared fecal immunochemical test (FIT)) and one a combined DNA stool assay (ColoAlert®, compared to guaiac-based fecal occult blood test (gFOBT), Pyruvate Kinase Isoenzyme Type M2 (M2-PK) and combined gFOBT/M2-PK). We found five published surveys on patient satisfaction. No primary study investigating screening effects on CRC incidence or on overall mortality was found. Both stool DNA tests showed in direct comparison higher sensitivity for the detection of CRC and (advanced) adenoma compared to FIT, or gFOBT, respectively, but had lower specificity. However, these comparative results may depend on the exact type of FIT used. The reported test failure rates were higher for stool DNA testing than for FIT. The certainty of evidence was moderate to high for Cologuard® studies, and low to very low for the ColoAlert® study which refers to a former version of the product and yielded no direct evidence on the test accuracy for ad-vanced versus non-advanced adenoma. Conclusions ColoAlert® is the only stool DNA test currently sold in Europe and is available at a lower price than Cologuard®, but reliable evidence is lacking. A screening study including the current product version of ColoAlert® and suitable comparators would, therefore, help evaluate the effectiveness of this screening option in a European context.
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Affiliation(s)
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | | | | | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Andrej Janzic
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia (JAZMP), Ljubljana, Slovenia
| | - Marjetka Jelenc
- National Institute of Public Health (NIJZ), Ljubljana, Slovenia
| | | | - Simona Mencej Bedrac
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia (JAZMP), Ljubljana, Slovenia
| | - Nikolai Mühlberger
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Miles A, Paschalidi A, Sharma N. The effect of numeric information about the likelihood of receiving a false negative or false positive result on people's attitudes towards colorectal cancer screening using faecal immunochemical testing (FIT). PATIENT EDUCATION AND COUNSELING 2023; 114:107857. [PMID: 37348310 DOI: 10.1016/j.pec.2023.107857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the impact of numeric risk information about false negative (FN) and false positive (FP) rates in fecal immunochemical testing (FIT) on attitudes towards screening. METHODS 102 people aged 45-55, living in the UK, read 6 hypothetical vignettes presented online about the use of FIT kits to detect colorectal cancer, in which information about FN and FP rates was systematically varied. RESULTS Numeric FN risk information reduced people's interest in screening, perception of screening effectiveness and lowered trust in screening compared to verbal FN information. Verbal FN information reduced perceptions of screening effectiveness and trust compared to no FN information. People with high subjective numeracy reported lower trust in screening following the provision of numeric FN information but numeracy did not moderate any other associations. FP information did not affect attitudes towards FIT testing. CONCLUSION Numeric FN risk information decreased people's perceptions of screening effectiveness and trust in the results of screening. While it influenced people's interest in screening, the effect was small. PRACTICE IMPLICATIONS Numeric FN information has a small effect on interest in screening and could promote informed decision making without affecting screening uptake.
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Affiliation(s)
- Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.
| | - Alexandra Paschalidi
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Navya Sharma
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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Ahmed AM, Bacchus MW, Beal SG, Huber KN, Lee JH, Zhao J, George TJ, Sattari M. Colorectal cancer screening completion by patients due or overdue for screening after reminders: a retrospective study. BMC Cancer 2023; 23:391. [PMID: 37127588 PMCID: PMC10152700 DOI: 10.1186/s12885-023-10837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Patient and clinician reminders were implemented as part of an adherence improvement project at University of Florida (UF) Internal Medicine Clinics. We sought to assess colorectal cancer (CRC) screening completion rates among patients not up-to-date with screening following distribution of reminders and to identify characteristics correlated with screening outcomes. METHODS Retrospective chart review was performed for patients not up-to-date with CRC screening for whom at least one reminder (patient and/or clinician) was issued in June 2018. The primary endpoint, the completion of a CRC screening test, is characterized as the ratio of completed screening tests to the number of patients not up-to-date with screening. All analyses were performed using R 4.0 software. RESULTS Of the 926 patients included, 403 (44%; 95% CI, 0.40-0.47) completed a CRC screening test within 24 months following a reminder. Family history of CRC (relative risk (RR) 1.33; P = 0.007), flu immunization within two years of the reminder (RR 1.23; P = 0.019), and receiving a patient reminder either alone (RR 1.62; P < 0.001) or in combination with a clinician reminder (RR 1.55; P = 0.006) were positively associated with CRC screening completion. Reporting being divorced, separated, or widowed was negatively associated with screening completion (RR 0.70; P = 0.004). CONCLUSION Reminders, in particular patient reminders, seem to be an effective method to enhance screening among patients not up-to-date with CRC screening. This study suggests that reminder efforts should be focused at the level of the patients and provides insight on target populations for practical interventions to further increase CRC screening adherence.
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Affiliation(s)
| | | | - Stacy G Beal
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Katherine N Huber
- Division of General Internal Medicine, University of Florida College of Medicine, 1329 SW 16Th Street, Suite 5140, PO Box 103204, Gainesville, FL, 32610, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jing Zhao
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology-Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Maryam Sattari
- Division of General Internal Medicine, University of Florida College of Medicine, 1329 SW 16Th Street, Suite 5140, PO Box 103204, Gainesville, FL, 32610, USA.
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Ramos MC, Passone JADL, Lopes ACDF, Safatle-Ribeiro AV, Ribeiro Júnior U, de Soárez PC. Economic evaluations of colorectal cancer screening: A systematic review and quality assessment. Clinics (Sao Paulo) 2023; 78:100203. [PMID: 37099816 PMCID: PMC10182269 DOI: 10.1016/j.clinsp.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease.
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Affiliation(s)
- Marcela Castro Ramos
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Ana Carolina de Freitas Lopes
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Ulysses Ribeiro Júnior
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
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Heer E, Ruan Y, Pader J, Mah B, Ricci C, Nguyen T, Chow K, Ford-Sahibzada C, Gogna P, Poirier A, Forbes N, Heitman SJ, Hilsden RJ, Brenner DR. Performance of the fecal immunochemical test for colorectal cancer and advanced neoplasia in individuals under age 50. Prev Med Rep 2023; 32:102124. [PMID: 36875511 PMCID: PMC9981994 DOI: 10.1016/j.pmedr.2023.102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
The increased demand for colonoscopy combined with increased incidence of colorectal cancer (CRC) among younger populations presents a need to determine FIT performance among individuals in this age group. We conducted a systematic review to assess test performance characteristics of FIT in detecting CRC and advanced neoplasia in younger age populations. A search through December 2022 identified published articles assessing the sensitivity and specificity of FIT for advanced neoplasia or CRC among populations under age 50. Following the search, 3 studies were included in the systematic review. Sensitivity to detect advanced neoplasia ranged from 0.19 to 0.36 and specificity between 0.94 and 0.97 and the overall sensitivity and specificity were 0.23 (0.17-0.30) and 0.96 (0.94-0.98), respectively. Two studies that assessed these metrics in multiple age categories found similar sensitivity and specificity across all age groups 30-49. Sensitivity and specificity to detect CRC was assessed in one study and found no significant differences by age groups. These results suggest that FIT performance may be lower for younger individuals compared to those typically screened for CRC. However, there were few studies available for analysis. Given increasing recommendations to expand screening in younger age groups, more research is needed to determine whether FIT is an adequate screening tool in this population.
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Affiliation(s)
- Emily Heer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Yibing Ruan
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Brittany Mah
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | | | - Teresa Nguyen
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Kristian Chow
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chelsea Ford-Sahibzada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Abbey Poirier
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steve J. Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert J. Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darren R. Brenner
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Corresponding author at: Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, AB, Canada.
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Graversen SB, Nannsen AØ, Bjerg L, Larsen MB, Andersen B, Laurberg T. The impact of diabetes on cancer detection during the prevalence round of a national screening program for colorectal cancer. Diabet Med 2023; 40:e15043. [PMID: 36655559 DOI: 10.1111/dme.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
AIMS Diabetes is associated with a higher risk of colorectal cancer (CRC) and inferior survival after CRC. Screening may enable the early detection of CRC. We aimed to assess the impact of diabetes on cancer detection and disease stage during the prevalence round of a national CRC screening program. METHODS We performed a register-based cohort study based on the randomized procedure for inviting Danish residents aged 50-74 years to the prevalence round of national CRC screening program in 2014-2017. By comparing the random half of the population who had been invited by 1 May 2016 with the not yet invited half, the effect of screening was assessed by the detection of CRC and disease stage among individuals with and without diabetes. Further, the impact of diabetes on the screening participation rate was calculated. RESULTS By randomisation, 504,673 individuals had been invited to the CRC screening by 1 May 2016, and 549,359 individuals had not yet been invited. The diabetes prevalence was 10% in both groups. When comparing those not yet invited to those invited, the effect of screening on the number of detected cancers per 100,000 individuals was higher in those with diabetes (from 207 to 494 cancers) than in those without diabetes (from 147 to 364 cancers), and screening resulted in overall higher proportions of stage I cancer. Among those invited to screening, the participation rate was 9.1% lower (95% CI: 8.7%-9.5%) in individuals with versus without diabetes. CONCLUSIONS Despite a lower participation rate, the effect of CRC screening was higher in individuals with diabetes.
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Affiliation(s)
| | | | - Lasse Bjerg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers NØ, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
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Abbes S, Baldi S, Sellami H, Amedei A, Keskes L. Molecular methods for colorectal cancer screening: Progress with next-generation sequencing evolution. World J Gastrointest Oncol 2023; 15:425-442. [PMID: 37009313 PMCID: PMC10052664 DOI: 10.4251/wjgo.v15.i3.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 02/15/2023] [Indexed: 03/14/2023] Open
Abstract
Currently, colorectal cancer (CRC) represents the third most common malignancy and the second most deadly cancer worldwide, with a higher incidence in developed countries. Like other solid tumors, CRC is a heterogeneous genomic disease in which various alterations, such as point mutations, genomic rearrangements, gene fusions or chromosomal copy number alterations, can contribute to the disease development. However, because of its orderly natural history, easily accessible onset location and high lifetime incidence, CRC is ideally suited for preventive intervention, but the many screening efforts of the last decades have been compromised by performance limitations and low penetrance of the standard screening tools. The advent of next-generation sequencing (NGS) has both facilitated the identification of previously unrecognized CRC features such as its relationship with gut microbial pathogens and revolutionized the speed and throughput of cataloguing CRC-related genomic alterations. Hence, in this review, we summarized the several diagnostic tools used for CRC screening in the past and the present, focusing on recent NGS approaches and their revolutionary role in the identification of novel genomic CRC characteristics, the advancement of understanding the CRC carcinogenesis and the screening of clinically actionable targets for personalized medicine.
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Affiliation(s)
- Salma Abbes
- Laboratory of Parasitic and Fungal Molecular Biology, University of Sfax, Sfax 3029, Tunisia
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Hayet Sellami
- Drosophila Research Unit-Parasitology and Mycologie Laboratory, University of Sfax, Sfax 3029, Tunisia
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
- SOD of Interdisciplinary Internal Medicine, Careggi University Hospital, Florence 50134, Italy
| | - Leila Keskes
- Laboratory of Human Molecular Genetic, University of Sfax, Sfax 3029, Tunisia
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Heisser T, Kretschmann J, Hagen B, Niedermaier T, Hoffmeister M, Brenner H. Prevalence of Colorectal Neoplasia 10 or More Years After a Negative Screening Colonoscopy in 120 000 Repeated Screening Colonoscopies. JAMA Intern Med 2023; 183:183-190. [PMID: 36648785 PMCID: PMC9857826 DOI: 10.1001/jamainternmed.2022.6215] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 01/18/2023]
Abstract
Importance Screening colonoscopy to prevent and early detect colorectal cancer is recommended to be repeated in 10-year intervals, which goes along with high demands of capacities and costs. Evidence of findings at screening colonoscopies conducted 10 or more years after a negative colonoscopy result is sparse, and it remains unclear whether screening colonoscopy intervals could possibly be prolonged. Objective To assess the prevalence of advanced colorectal neoplasms (ADNs) at least 10 years after a negative screening colonoscopy in a very large cohort of repeated screening colonoscopy participants in Germany. Design, Setting, and Participants This registry-based cross-sectional study on screening colonoscopy findings reported to the German screening colonoscopy registry during January 2013 to December 2019 included data on screening colonoscopies that were offered to the German general population 55 years or older since 2002; virtually all screening colonoscopies among individuals covered by Statutory Health Insurance (approximately 90% of eligible adults) are reported to the national registry. A total of 120 298 repeat screening colonoscopy participants 65 years or older were identified who had a previous negative screening colonoscopy at least 10 years prior. The findings were compared with all screening colonoscopies conducted at 65 years or older during the same period (1.25 million). The data were analyzed from March to July 2022. Main Outcomes and Measures Prevalence of colorectal cancers and ADNs (advanced adenomas and cancers). Results Of 120 298 participants, 72 349 (60.1%) were women. Prevalence of ADN was 3.6% and 5.2% among women and men 10 years after a negative screening colonoscopy and gradually increased to 4.9% and 6.6%, respectively, among those who had a negative colonoscopy 14 years or longer prior compared with 7.1% and 11.6% among all screening colonoscopies. Sex-specific and age-specific prevalence of ADNs at repeated colonoscopies conducted 10 or more years after a negative colonoscopy were consistently at least 40% lower among women than among men, lower at younger vs older ages, and much lower than among all screening colonoscopies (standardized prevalence ratios for cancers: 0.22-0.38 among women, 0.15-0.24 among men; standardized prevalence ratios for ADNs: 0.49-0.62 among women, 0.50-0.56 among men). Conclusions and Relevance The results of this cross-sectional study suggest that ADN prevalence at screening colonoscopies conducted 10 or more years after a negative screening colonoscopy is low. Extension of the currently recommended 10-year screening intervals may be warranted, especially for female and younger participants without gastrointestinal symptoms.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Jens Kretschmann
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Bernd Hagen
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
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Abdul Rahman H, Ottom MA, Dinov ID. Machine learning-based colorectal cancer prediction using global dietary data. BMC Cancer 2023; 23:144. [PMID: 36765299 PMCID: PMC9921106 DOI: 10.1186/s12885-023-10587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Active health screening for CRC yielded detection of an increasingly younger adults. However, current machine learning algorithms that are trained using older adults and smaller datasets, may not perform well in practice for large populations. AIM To evaluate machine learning algorithms using large datasets accounting for both younger and older adults from multiple regions and diverse sociodemographics. METHODS A large dataset including 109,343 participants in a dietary-based colorectal cancer ase study from Canada, India, Italy, South Korea, Mexico, Sweden, and the United States was collected by the Center for Disease Control and Prevention. This global dietary database was augmented with other publicly accessible information from multiple sources. Nine supervised and unsupervised machine learning algorithms were evaluated on the aggregated dataset. RESULTS Both supervised and unsupervised models performed well in predicting CRC and non-CRC phenotypes. A prediction model based on an artificial neural network (ANN) was found to be the optimal algorithm with CRC misclassification of 1% and non-CRC misclassification of 3%. CONCLUSIONS ANN models trained on large heterogeneous datasets may be applicable for both younger and older adults. Such models provide a solid foundation for building effective clinical decision support systems assisting healthcare providers in dietary-related, non-invasive screening that can be applied in large studies. Using optimal algorithms coupled with high compliance to cancer screening is expected to significantly improve early diagnoses and boost the success rate of timely and appropriate cancer interventions.
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Affiliation(s)
- Hanif Abdul Rahman
- University of Michigan, Ann Arbor, USA. .,PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, , Bandar Seri Begawan, Brunei.
| | - Mohammad Ashraf Ottom
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, USA ,grid.14440.350000 0004 0622 5497Yarmouk University, Irbid, Jordan
| | - Ivo D. Dinov
- grid.214458.e0000000086837370University of Michigan, Ann Arbor, USA
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Bărbulescu LN, Mogoantă SȘ, Bărbulescu LF, Kamal C, Popa DL, Popa RT. A Pilot Colorectal Cancer Study Using Fecal Occult Blood Tests and Colonoscopy to Identify the Weaknesses of the Romanian Public Healthcare System before Implementing National Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2531. [PMID: 36767908 PMCID: PMC9915351 DOI: 10.3390/ijerph20032531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study is to investigate the feasibility of colorectal cancer (CRC) screening in the absence of a national screening program using the resources provided by the Romanian healthcare system. Study participants were recruited from adult patients (over 18 years old) registered with a general practitioner from an urban area over a period of 3 years (October 2019 to September 2022). Patients were recruited when they came for a consult at their family physician's office. The study excluded patients with a medical history of colorectal cancer. Written consent was obtained from the patients who agreed to participate. Patients who agreed to participate were recommended to undergo a fecal occult blood test (FOBT). For those with a positive FOBT result, a colonoscopy was recommended. The study identified a need and willingness of patients to participate in CRC screening when they were informed about it, especially when it involved a noninvasive test such as FOB. We did not anticipate the refusal to perform FOBT in the public healthcare system because the recommendation was made by a GP. We identified a deficit of specialists that can perform colonoscopies in the public healthcare system, insufficient health education, and a lack of dedicated pathways for screening.
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Affiliation(s)
- Linda-Nicoleta Bărbulescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Cabinet Medical Dr Profir I Mirela SRL, 200145 Craiova, Romania
| | - Stelian-Ștefăniță Mogoantă
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department III of Surgery, University Emergency County Hospital, 200642 Craiova, Romania
| | | | - Constantin Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Didi-Liliana Popa
- Department of Computers and Information Technology, University of Craiova, 200585 Craiova, Romania
- Doctoral School “Constantin Belea”, University of Craiova, 200585 Craiova, Romania
| | - Radu-Teodoru Popa
- Department of Computers and Information Technology, University of Craiova, 200585 Craiova, Romania
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Malvezzi M, Santucci C, Boffetta P, Collatuzzo G, Levi F, La Vecchia C, Negri E. EUROPEAN CANCER MORTALITY PREDICTIONS FOR THE YEAR 2023 WITH FOCUS ON LUNG CANCER. Ann Oncol 2023; 34:410-419. [PMID: 36882139 DOI: 10.1016/j.annonc.2023.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND We aimed to predict cancer mortality figures for 2023 for the European Union (EU-27), its five most populous countries, and the UK. We focused on mortality from lung cancer. MATERIALS AND METHODS Using cancer death certifications and population data from the World Health Organization and EUROSTAT databases for 1970-2018 we predicted numbers of deaths and age-standardized rates (ASR) for 2023 for all cancers combined and the ten most common cancer sites. We investigated the changes in trends over the observed period. The number of avoided deaths over the period 1989-2023 were estimated for all cancers as well as lung cancer. RESULTS We predicted 1,261,990 cancer deaths for 2023 in the EU-27, corresponding to ASRs of 123.8/100,000 men (-6.5% vs 2018) and 79.3 for women (-3.7%). Over 1989-2023, about 5,862,600 million cancer deaths were avoided in the EU-27 compared with peak rates in 1988. Most cancers displayed favourable predicted rates, with the exceptions of pancreatic cancer, that was stable in EU men (8.2/100,000) and rose 3.4% in EU women (5.9/100,000), and female lung cancer which however tends to level off (13.6/100,000). Steady declines are predicted for colorectal, breast prostate, leukemia, stomach in both sexes and male bladder cancers. The focus on lung cancer showed falls in mortality for all age groups in men. Female lung cancer mortality declined in the young -35.8% (ASR 0.8/100,000) and middle aged (-7%, ASR: 31.2/100,000) but still increased 10% in the elderly (65+ years). CONCLUSION The advancements in tobacco control are reflected in favorable lung cancer trends, and should be pushed further. Greater efforts on the control of overweight and obesity, alcohol consumption, infection and related neoplasms, together with improvements in screening, early diagnosis and treatments may achieve a further 35% reduction on cancer mortality in the EU by 2035.
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Affiliation(s)
- M Malvezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - F Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - E Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Guittet L, Quipourt V, Aparicio T, Carola E, Seitz JF, Paillaud E, Lievre A, Boulahssass R, Vitellius C, Bengrine L, Canoui-Poitrine F, Manfredi S. Should we screen for colorectal cancer in people aged 75 and over? A systematic review - collaborative work of the French geriatric oncology society (SOFOG) and the French federation of digestive oncology (FFCD). BMC Cancer 2023; 23:17. [PMID: 36604640 PMCID: PMC9817257 DOI: 10.1186/s12885-022-10418-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We have done a systematic literature review about CRC Screening over 75 years old in order to update knowledge and make recommendations. METHODS PUBMED database was searched in October 2021 for articles published on CRC screening in the elderly, and generated 249 articles. Further searches were made to find articles on the acceptability, efficacy, and harms of screening in this population, together with the state of international guidelines. RESULTS Most benefit-risk data on CRC screening in the over 75 s derived from simulation studies. Most guidelines recommend stopping cancer screening at the age of 75. In private health systems, extension of screening up to 80-85 years is, based on the life expectancy and the history of screening. Screening remains effective in populations without comorbidity given their better life-expectancy. Serious adverse events of colonoscopy increase with age and can outweigh the benefit of screening. The great majority of reviews concluded that screening between 75 and 85 years must be decided case by case. CONCLUSION The current literature does not allow Evidence-Based Medicine propositions for mass screening above 75 years old. As some subjects over 75 years may benefit from CRC screening, we discussed ways to introduce CRC screening in France in the 75-80 age group. IRB: An institutional review board composed of members of the 2 learned societies (SOFOG and FFCD) defined the issues of interest, followed the evolution of the work and reviewed and validated the report.
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Affiliation(s)
- Lydia Guittet
- grid.412043.00000 0001 2186 4076Public Health Unit, CHU Caen NormandieNormandie University, UNICAEN, INSERM U1086 ANTICIPE, Caen, France
| | - Valérie Quipourt
- grid.31151.37Geriatrics Department and Coordination Unit in Oncogeriatry in Burgundy, University Hospital of Dijon, Dijon, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Elisabeth Carola
- grid.418090.40000 0004 1772 4275Geriatric Oncology Unit, Groupe Hospitalier Public du Sud de L’Oise, Bd Laennec, 60100 Creil, France
| | - Jean-François Seitz
- grid.411266.60000 0001 0404 1115Department of Digestive Oncology & Gastroenterology, CHU Timone, Assistance Publique-Hôpitaux de Marseille (APHM) & Aix-Marseille-Univ, Marseille, France
| | - Elena Paillaud
- grid.414093.b0000 0001 2183 5849Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, inAP-HP, Paris, France
| | - Astrid Lievre
- grid.414271.5Department of Gastroenterology, INSERM U1242 “Chemistry Oncogenesis Stress Signaling”, University Hospital Pontchaillou, Rennes 1 University, Rennes, FFCD France
| | - Rabia Boulahssass
- grid.410528.a0000 0001 2322 4179Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; FHU ONCOAGE, Nice, France
| | - Carole Vitellius
- grid.411147.60000 0004 0472 0283Hepato-Gastroenterology Department, Angers University Hospital, Angers, France ,grid.7252.20000 0001 2248 3363HIFIH Laboratory UPRES EA3859, Angers University, SFR 4208, Angers, France
| | - Leila Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Florence Canoui-Poitrine
- grid.412116.10000 0004 1799 3934Public Health Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Sylvain Manfredi
- grid.31151.37Gastroenterology and Digestive Oncology Unit, University Hospital Dijon, INSERM U123-1 University of Bourgogne-Franche-Comté, FFCD (French Federation of Digestive Cancer), Dijon, France
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Brinkmann M, Diedrich L, Hemmerling M, Krauth C, Robra BP, Stahmeyer JT, Dreier M. Heterogeneous Preferences for Colorectal Cancer Screening in Germany: Results of a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:104-114. [PMID: 36031478 DOI: 10.1016/j.jval.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities. METHODS A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model. RESULTS From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2). CONCLUSION Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.
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Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | | | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Natalsky AA, Filimonov VB, Shadsky SO, Ivanov NA, Pashkin KP. [Endoscopic prevention of bleeding during resection of mucous membrane neoplasms of hollow organs of gastrointestinal tract]. Khirurgiia (Mosk) 2023:66-71. [PMID: 37707334 DOI: 10.17116/hirurgia202309166] [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] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To optimize endoscopic prevention of bleeding during resection of mucous membrane neoplasms of hollow organs of gastrointestinal tract and minimize the risk of intra- and postoperative complications. MATERIAL AND METHODS. A S Ystematic review and meta-analysis were made in accordance with the PRISMA recommendations. Statistical analysis was performed in Cohrane Review Manager ver. 5.4. RESULTS. THERE ARE 3 Methods of endoscopic prevention of bleeding during polypectomy, i.e. 0.01% adrenaline injection, endoscopic clip placement and endoscopic polyp band ligation. Endoscopic polyp band ligation is characterized by minimum complication rate. CONCLUSION Endoscopic polyp band ligation is preferable due to minimum complication rate. If ligation is impossible, prophylactic clip placement may be performed. Adrenaline injection is the least effective method and may be used only if two above-mentioned methods are ineffective.
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Affiliation(s)
- A A Natalsky
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - V B Filimonov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - S O Shadsky
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - N A Ivanov
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - K P Pashkin
- Pavlov Ryazan State Medical University, Ryazan, Russia
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Huang Y, Liu Y, Yin X, Zhang T, Hao Y, Zhang P, Yang Y, Gao Z, Liu S, Yu S, Li H, Wang G. Establishment of clinical predictive model based on the study of influence factors in patients with colorectal polyps. Front Surg 2023; 10:1077175. [PMID: 36911614 PMCID: PMC9995385 DOI: 10.3389/fsurg.2023.1077175] [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: 10/22/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023] Open
Abstract
Background Colorectal cancer (CRC) is the most common gastrointestinal malignancy and is generally thought to be caused by the transformation of colorectal polyps. It has been shown that early detection and removal of colorectal polyps may reduce the mortality and morbidity of colorectal cancer. Objective Based on the risk factors associated with colorectal polyps, an individualized clinical prediction model was built to predict and evaluate the possibility of developing colorectal polyp. Methods A case-control study was conducted. Clinical data were collected from 475 patients who underwent colonoscopy at the Third Hospital of Hebei Medical University from 2020 to 2021. All clinical data were then divided into training sets and validation sets by using R software (7:3). A multivariate logistic analysis was performed to identify the factors associated with colorectal polyps according to the training set, and a predictive nomogram was created by R software based on the multivariate analysis. The results were internally validated by receiver operating characteristic (ROC) curves, calibration curves, and externally validated by validation sets. Results Multivariate logistic regression analysis showed that age (OR = 1.047, 95% CI = 1.029-1.065), history of cystic polyp (OR = 7.596, 95% CI = 0.976-59.129), and history of colorectal diverticulums (OR = 2.548, 95% CI = 1.209-5.366) were independent risk factors for colorectal polyps. History of constipation (OR = 0.457, 95% CI = 0.268-0.799) and fruit consumption (OR = 0.613, 95% CI 0.350-1.037) were protective factors for colorectal polyps. The nomogram demonstrated good accuracy for predicting colorectal polyps, with both C index and AUC being 0.747 (95% CI = 0.692-0.801). The calibration curves showed good agreement between the predicted risk by the nomogram and real outcomes. Both internal and external validation of the model showed good results. Conclusion In our study, the nomogram prediction model is reliable and accurate, which can help early clinical screening of patients with high-risk colorectal polyps, improve polyp detection rate, and reduce the incidence of colorectal cancer (CRC).
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Affiliation(s)
- Yu Huang
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yating Liu
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu Yin
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tianpeng Zhang
- Department of Second Anorectal, Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Yaoguang Hao
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pengfei Zhang
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Yang
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhihan Gao
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Siyu Liu
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Suyang Yu
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongyan Li
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guiying Wang
- Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Alsadhan N, Almaiman A, Pujades-Rodriguez M, Brennan C, Shuweihdi F, Alhurishi SA, West RM. Statistical methods for measuring trends in colorectal cancer incidence in registries: A systematic review. Front Oncol 2022; 12:1049486. [DOI: 10.3389/fonc.2022.1049486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundMonitoring cancer trends in a population is essential for tracking the disease’s burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends.MethodsWe performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used.ResultsThis review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used.ConclusionThis review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.
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