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Lingas EC. Early-Onset Colon Cancer: A Narrative Review of Its Pathogenesis, Clinical Presentation, Treatment, and Prognosis. Cureus 2023; 15:e45404. [PMID: 37854763 PMCID: PMC10579844 DOI: 10.7759/cureus.45404] [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: 09/16/2023] [Indexed: 10/20/2023] Open
Abstract
Colon cancer remains a leading cause of cancer-related deaths, and there has been a rise in the incidence of early-onset colon cancer or colon cancer diagnosed before the age of 50 years old. Early-onset colon cancer has several differences in clinical presentation, as well as histopathology, genetic alteration, and molecular profiling. Early-onset colon cancer can be differentiated into familial type that includes hereditary familial syndrome and sporadic type. Demographic variance also exists in both developing and developed countries. Due to the rising incidence of colon cancer diagnosed in younger age, it is imperative to examine the available evidence regarding the mortality rate of early-onset colon cancer. Colon cancer is affected by numerous modifiable and non-modifiable risk factors. Increasing obesity and lifestyle disorders in the younger population, such as smoking, may influence this increasing trend. There are existing guidelines for colon cancer screening in both average-risk and high-risk individuals. This narrative review aims to highlight the pathogenesis of early-onset CRC; its clinical presentation, treatment, prognosis; and how it differs from late-onset CRC.
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Affiliation(s)
- Elvina C Lingas
- Hospital Medicine, New York University (NYU) Langone Health Long Island Community Hospital, Patchogue, USA
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2
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Bediako-Bowan AAA, Naalane N, Dakubo JCB. Morbidity and oncological outcomes after intersphincteric resection of the rectum for low-lying rectal cancer: experience of a single center in a lower-middle-income country. BMC Surg 2023; 23:39. [PMID: 36805711 PMCID: PMC9938915 DOI: 10.1186/s12893-023-01940-9] [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: 11/02/2022] [Accepted: 02/16/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Intersphincteric resection (ISR) of the rectum for low-lying rectal cancer with colo-anal anastomosis was introduced years ago, allowing for bowel continuity, and avoiding permanent stomas. The colorectal unit of Korle Bu Teaching Hospital adopted this procedure in 2014 when indicated, for the management of rectal cancers, where hitherto, abdominoperineal resection of the rectum with a permanent stoma was indicated. This study aimed to assess morbidity, mortality, and oncological outcomes associated with ISR of the rectum and determine the factors contributing to these. METHODS This was an observational study from prospectively stored data. All patients who underwent intersphincteric resection of the rectum due to low-lying rectal cancer from July 2014 to June 2021 were included in the study, and their records were assessed for intra-operative and 30-day postoperative complications, as well as mortality and their related risk factors and their oncological outcomes in terms of local recurrence at one year. RESULTS 102 patients were included in this analysis. Six percent (6/102) of patients had intra-operative complications, including bleeding, and 41% (42/102) had 30-day postoperative complications, which were associated with pelvic side wall attachment of tumor and intra-op complications. Mortality risk was 12.7% (13/102) in the early postoperative period, and nine patients had a local recurrence within the first year of surgery. CONCLUSION There is a high risk of early postoperative morbidity and mortality after intersphincteric resection of the rectum in our setting. The oncological outcomes are favorable in a population that abhors a permanent colostomy.
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Affiliation(s)
- Antoinette Afua Asiedua Bediako-Bowan
- Department of Surgery, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Accra, Ghana. .,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana. .,Mwin Tuba Hospital and Coloproctology Centre, Accra, Ghana.
| | - Narious Naalane
- grid.415489.50000 0004 0546 3805Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Jonathan C. B. Dakubo
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Accra, Ghana ,grid.415489.50000 0004 0546 3805Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana ,Mwin Tuba Hospital and Coloproctology Centre, Accra, Ghana
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3
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Kebede AG, Kebede T, Atnafu A. High Magnitude Advanced Colorectal Cancer at Diagnosis in Ethiopian Patients: Imaging Pattern and Associated Factors. Ethiop J Health Sci 2023; 33:81-90. [PMID: 36890929 PMCID: PMC9987274 DOI: 10.4314/ejhs.v33i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/12/2022] [Indexed: 03/10/2023] Open
Abstract
Background Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of the study was to determine the staging and imaging pattern of CRC at diagnosis. Methods This is a descriptive cross-sectional study including all consecutive cases of CRC found in the departments of radiology and oncology during the study period from March 2016 - February 2017. Results A total of 132 CRC cases were studied with M: F = 2.4:1, mean age of 46yrs and 67.4% </= 50yrs. Left-sided tumors were associated with rectal bleeding (p = 0.001) and bowel habit change (p =0.045) whereas right-side tumors were associated with weight loss (p = 0.02) and abdominal pain (p = 0.004). 84.5% of CRC presented at an advanced stage, and 32% had distant metastasis. Young age was associated with the advanced stage (P=0.006) whereas family history was associated with the lower stage (P=0.008). Distance metastasis was associated with Colonic lesions (P=0.003) and emergent presentation (P=0.008). Asymmetric wall thickening with luminal narrowing was significantly associated with left side tumor (95% vs 21.4%) whereas large mass with necrosis was significantly associated with right side tumor (50% vs 5%) (P= 0.004). Conclusions CRC is presented at a younger age and at an advanced stage. The majority of CRCs were left-sided and rectal. Increasing the index of suspicion for CRC in patients with rectal bleeding and, bowel habit change is recommended.
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Affiliation(s)
- Assefa Getachew Kebede
- Department of radiology, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Tesfaye Kebede
- Department of radiology, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Asfaw Atnafu
- Department of radiology, School of Medicine, College of Health Sciences, Addis Ababa University
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4
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Omolo BO, Manda SO. Editorial: Application of biostatistics and epidemiological methods for cancer research in Sub-Saharan Africa. Front Public Health 2022; 10:1069098. [PMID: 36457323 PMCID: PMC9706226 DOI: 10.3389/fpubh.2022.1069098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bernard O. Omolo
- Division of Mathematics and Computer Science, University of South Carolina—Upstate, Spartanburg, SC, United States,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,*Correspondence: Bernard O. Omolo
| | - Samuel O. Manda
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Chu KM, Bust L, Forgan T. Colorectal Surgery Practice, Training, and Research in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:410-416. [PMID: 36111082 PMCID: PMC9470283 DOI: 10.1055/s-0042-1746190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Colorectal surgery (CRS) practice, training, and research differ between low- and middle-income countries (LMICs) and high-income countries due to disparity in resources. LMIC CRS is primarily done by general surgeons due to the paucity of fully trained colorectal surgeons. The majority of colon and rectal resections are done using open techniques, and laparoscopy and robotic platforms are only available in select private or academic centers. Multi-disciplinary teams are not available in most hospitals, so surgeons must have a broad knowledge base, and learn to adapt their practice. Formal CRS training opportunities through accredited post-residency fellowships and professional colorectal surgical associations are limited in LMICs. CRS is less established as an academic field, and less data are generated in LMICs. There are fewer staff and less dedicated funding for CRS research. However, LMIC colorectal surgeons and researchers can contribute valuable clinical findings especially on conditions of higher prevalence in their settings such as anal squamous cell carcinoma and obstetric fistulas. Effective surgical care for colorectal conditions requires significant investment in infrastructure, training, and governance in LMICs. This is critical to improve access to safe surgical care for all.
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Affiliation(s)
- Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Lynn Bust
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
| | - Tim Forgan
- Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Francie van Zijl Drive Stellenbosch University, Tygerberg, South Africa
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The Insulin-like Growth Factor System and Colorectal Cancer. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081274. [PMID: 36013453 PMCID: PMC9410426 DOI: 10.3390/life12081274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Insulin-like growth factors (IGFs) are peptides which exert mitogenic, endocrine and cytokine activities. Together with their receptors, binding proteins and associated molecules, they participate in numerous pathophysiological processes, including cancer development. Colorectal cancer (CRC) is a disease with high incidence and mortality rates worldwide, whose etiology usually represents a combination of the environmental and genetic factors. IGFs are most often increased in CRC, enabling excessive autocrine/paracrine stimulation of the cell growth. Overexpression or increased activation/accessibility of IGF receptors is a coinciding step which transmits IGF-related signals. A number of molecules and biochemical mechanisms exert modulatory effects shaping the final outcome of the IGF-stimulated processes, frequently leading to neoplastic transformation in the case of irreparable disbalance. The IGF system and related molecules and pathways which participate in the development of CRC are the focus of this review.
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7
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Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Objective Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. Methods The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. Results In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. Conclusion High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States
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8
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Sharma R, Aashima, Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, Arhin ND, Oh J, Amponsah-Manu F, Ssentongo P. Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Front Public Health 2022; 10:839835. [PMID: 35548083 PMCID: PMC9082420 DOI: 10.3389/fpubh.2022.839835 10.3389/fpubh.2022.839835/full#:~:text=we%20examined%20the%20burden%20of,29)%20to%20711%2c000%20in%202020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. Methods The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. Results In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. Conclusion High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aashima
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kelsey Yenney
- Washington State University Elson S. Floyd College of Medicine, Seattle, WA, United States
| | - Nina D. Arhin
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John Oh
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,Center for Neural Engineering, The Pennsylvania State University, State College, PA, United States,*Correspondence: Paddy Ssentongo
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9
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Alatise OI, Knapp GC, Sharma A, Chatila WK, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe OO, Katung AI, Ibikunle DE, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun OA, Adeyeye A, Kolawole OA, Olakanmi AO, Arora K, Constable J, Shah R, Basunia A, Sylvester B, Wu C, Weiser MR, Seier K, Gonen M, Stadler ZK, Kemel Y, Vakiani E, Berger MF, Chan TA, Solit DB, Shia J, Sanchez-Vega F, Schultz N, Brennan M, Smith JJ, Kingham TP. Molecular and phenotypic profiling of colorectal cancer patients in West Africa reveals biological insights. Nat Commun 2021; 12:6821. [PMID: 34819518 PMCID: PMC8613248 DOI: 10.1038/s41467-021-27106-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P < 0.001). In microsatellite-stable cases, tumors from Nigerian patients are less likely to have APC mutations (39.1% vs. 76.0% MSKCC P < 0.001) and WNT pathway alterations (47.8% vs. 81.9% MSKCC, P < 0.001); whereas RAS pathway alteration is more prevalent (76.1% vs. 59.6%, P = 0.03). Nigerian CRC patients are also younger and more likely to present with rectal disease (50.8% vs. 33.7% MSKCC, P < 0.001). The findings suggest a unique biology of CRC in Nigeria, which emphasizes the need for regional data to guide diagnostic and treatment approaches for patients in West Africa. Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is important for early detection and treatment. Here, the authors use a multigene next-generation sequencing panel to identify genomic differences in Nigerian CRCs compared to those from TCGA and MSKCC cohorts.
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Affiliation(s)
- Olusegun Isaac Alatise
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Gregory C Knapp
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Avinash Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Tri-Institutional Program in Computational Biology and Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Olukayode A Arowolo
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusola C Famurewa
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adeleye D Omisore
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akinwumi O Komolafe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaejinrinde O Olaofe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Aba I Katung
- Federal Medical Centre, Owo, Ondo State, Nigeria
| | | | | | - Samuel A Olatoke
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Sulaiman O Agodirin
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olusola A Adesiyun
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ademola Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Oladapo A Kolawole
- Department of Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Akinwumi O Olakanmi
- Department of Surgery, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Kanika Arora
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronak Shah
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Azfar Basunia
- Marie-Jose and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brooke Sylvester
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chao Wu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ken Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia K Stadler
- Clinical Genetics Service and the Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yelena Kemel
- Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francisco Sanchez-Vega
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray Brennan
- Bobst International Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Wekha G, Ssewante N, Iradukunda A, Jurua M, Nalwoga S, Lanyero S, Olum R, Bongomin F. Colorectal Cancer in Uganda: A 10-Year, Facility-Based, Retrospective Study. Cancer Manag Res 2021; 13:7697-7707. [PMID: 34675666 PMCID: PMC8504868 DOI: 10.2147/cmar.s334226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Colorectal cancer (CRC) is the most common type of gastrointestinal malignancies and the third leading cause of cancer-related deaths for both sexes worldwide. Although the burden of CRC is highest in developed countries, reports are indicating a rise in the incidence of early-onset CRC in developing countries. In this study, we aimed to determine the prevalence of CRC among patients hospitalized with lower gastrointestinal complaints at a tertiary health facility in Uganda. Methods We conducted a 10-year retrospective chart review of patients admitted to Mulago National Referral Hospital in Kampala, Uganda, between 1st January 2010 and 31st December 2020. We reviewed all charts of patients admitted to the lower gastrointestinal tract (GIT) ward. Charts with grossly missing data, pediatric patients, and those from other non-lower GIT specialties were excluded. Results Data of 1476 unique eligible patients were analyzed. Of these,138 had a diagnosis of CRC (prevalence: 9.3%, 95% confidence interval (95% CI): 6.5-11.7%). Among patients with CRC, the female:male ratio was 1:1. The most common site for CRC was the rectum (59.8%, n= 79). For the 138 participants with CRC, 44 had staging data with 72.8% (n=32) having advanced disease, that is, stage 3 or 4. Factors independently associated with CRC were age ≥50 years (adjusted odds ratio (aOR): 4.3, 95% CI: 2.6-7.1, p < 0.001), female sex (aOR: 1.8, 95% CI: 1.2 -2.8, p = 0.005), being widowed (aOR: 2.5, 95% CI: 1.3-5.0, p = 0.006), and presence of any risk factor for CRC (aOR: 5.3, 95% CI: 2.9-9.9, p < 0.001). Conclusion CRC is relatively common among patients hospitalized with lower GIT complaints, particularly among women and those with known risk factors for CRC. Awareness creation and screening programs should be instituted to allow early diagnosis of CRC in our setting.
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Affiliation(s)
- Godfrey Wekha
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angelique Iradukunda
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Micheal Jurua
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shadia Nalwoga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Lanyero
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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11
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Herman AM, Hawkins AT, Misso K, Issangya C, Tarmohamed M, Mremi A, Serventi F, Msuya D, Philemon R. Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges. JCO Glob Oncol 2021; 6:375-381. [PMID: 32125898 PMCID: PMC7113073 DOI: 10.1200/jgo.19.00301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.
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Affiliation(s)
- Ayesiga M Herman
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alexander T Hawkins
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kennedy Misso
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Murad Tarmohamed
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Furaha Serventi
- Department of Oncology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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12
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Labaeka EO, Irabor AE, Irabor DO. Fecal Immunochemical Test as a Screening Method for Colorectal Cancer in University College Hospital Ibadan, Nigeria. JCO Glob Oncol 2021; 6:525-531. [PMID: 32216652 PMCID: PMC7113128 DOI: 10.1200/jgo.19.00340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) is a disease of public health importance because of the increasing incidence of the disease and presentation in advanced stage of the disease in Western Africa. CRC is amenable to screening because of the long course of premalignant lesions before final development of the disease. Despite this, the practice of CRC screening is inadequate at the sites in this study. The fecal immunochemical test (FIT) is one of the recommended noninvasive methods for CRC screening. It has a sensitivity of 96%, specificity of 90%, and an overall accuracy of 95%. We aimed to determine the practicability of FIT for CRC screening in patients aged 40 to 75 years who attended primary care clinics in the University College Hospital, Ibadan, Nigeria. PATIENTS AND METHODS A total of 422 patients selected by systematic random sampling were recruited and offered free FIT screening. Participants with a positive finding had additional GI examination, including a digital rectal examination, proctoscopy, and colonoscopy, if no lesion was biopsied during proctoscopy. RESULTS The mean (± standard deviation) age of the respondents was 62 ± 9.61 years. The prevalence of a positive FIT in the study was 10.1%. The FIT was not completed by 3.8% of patients, and the rate of completion of additional evaluation after a positive FIT reduced as the investigations became invasive, with 36.8% and 71.1% noncompletion rates for proctoscopy and colonoscopy, respectively. CONCLUSION A FIT-based screening for age and risk-appropriate patients is practical in this environment, where the capacity and acceptability of colonoscopy are limited.
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Affiliation(s)
- Elizabeth O Labaeka
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - Achiaka E Irabor
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - David O Irabor
- Department of Surgery, Division of Gastrointestinal Surgery, University College Hospital Ibadan, Ibadan, Nigeria
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13
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Selemane C, Jamisse L, Arroz J, Túlsidas S, Morais AG, Carrilho C, Modcoicar P, Sidat M, Rodrigues J, Moreira-Gonçalves D, Ismail M, Santos LL. Demographic, clinical and pathological characterisation of patients with colorectal and anal cancer followed between 2013 and 2016 at Maputo Central Hospital, Mozambique. Ecancermedicalscience 2021; 15:1205. [PMID: 33912230 PMCID: PMC8057776 DOI: 10.3332/ecancer.2021.1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to investigate colorectal cancer (CRC) data and anal cancer data from Maputo Central Hospital (MCH), the largest hospital and a reference for oncological diseases in Mozambique, with the aim of characterising the disease profile in view to define an appropriate control programme. Methods MCH records from the Pathology and Surgery Services and MCH Cancer Registry database were assessed to obtain retrospective clinical and pathologic data of patients with CRC or anal cancer admitted to and treated between 13 December 2013 and 23 March 2016. Results The female gender was more prevalent (54.8%), even when anal cancers were excluded. Median age was 54 years (20–99). Most patients (51.6%) lived in the city of Maputo. The most common presenting symptom was found to be rectal bleeding. Adenocarcinoma was the most frequent histological type, and the most prevalent anatomical site was the rectum. Most of the cases were diagnosed at MCH in advanced stages. Colostomy was the most frequent surgical procedure and performed in 38.7% of the patients. Most cases of anal cancer occurred in human immunodeficiency virus-infected patients. Most patients had a poor prognosis due to advanced stage at first diagnosis. Conclusion We observed an increase in cases of CRC and anal cancer in Mozambique and mostly diagnosed at advanced stages, which anticipates a dismal prognosis. Our data supports the urgent need of a comprehensive public health programme dedicated to solving this growing concern.
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Affiliation(s)
- Carlos Selemane
- Surgical Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Luisa Jamisse
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Jorge Arroz
- Save the Children, P.O.Box 1854, Rua de Tchamba nº 398, Maputo, Mozambique
| | - Satish Túlsidas
- Medical Oncology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - António Gudo Morais
- Radiotherapy Service, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Prassad Modcoicar
- Gastroenterology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon,R. da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Jessica Rodrigues
- Epidemiology Service, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.,Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Mamudo Ismail
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,Surgical Oncology Department, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,ONCOCIR-Education and Care in Oncology, Lusophone , Africa, Rua de Quires 168-10J, Moreira da Maia , Portugal
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14
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Grossheim L, Ruff P, Ngoma T, Vanderpuye V, Mwango G, Ochieng P, Palmer D, Kouya F, Lasebikan N, Ntekim A, Ngoma M, Bih N, Malloum A, Elzawawy A, Kerr D, Ngwa W. Cancer and COVID-19 Experiences at African Cancer Centers: The Silver Lining. JCO Glob Oncol 2021; 7:410-415. [PMID: 33760639 PMCID: PMC8081519 DOI: 10.1200/go.20.00564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 pandemic significantly disrupted cancer care in Africa, further exposing major health disparities. This paper compares and contrasts the experiences of 15 clinicians in six different African cancer centers to highlight the positive aspects (silver linings) in an otherwise negative situation. METHODS Data are from personal experience of the clinicians working at the six cancer centers blended with what is available in the literature. RESULTS The impact of COVID-19 on cancer care appeared to vary not only across the continent but also over cancer centers. Different factors such as clinic location, services offered, available resources, and level of restrictions imposed because of COVID-19 were associated with these variations. Collectively, delays in treatment and limited access to cancer care were commonly reported in the different regions. CONCLUSION There is a lack of data on cancer patients with COVID-19 and online COVID-19 and cancer registries for Africa. Analysis of the available data, however, suggests a higher mortality rate for cancer patients with COVID-19 compared with those without cancer. Positive or silver linings coming out of the pandemic include the adoption of hypofractionated radiation therapy and teleoncology to enhance access to care while protecting patients and staff members. Increasing collaborations using online technology with oncology health professionals across the world are also being seen as a silver lining, with valuable sharing of experiences and expertise to improve care, enhance learning, and reduce disparities. Advanced information and communication technologies are seen as vital for such collaborations and could avail efforts in dealing with the ongoing pandemic and potential future crises.
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Affiliation(s)
| | - Paul Ruff
- University of the Witwatersrand, Johannesburg, South Africa
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Verna Vanderpuye
- National Center for Radiotherapy, Korlebu Teaching Hospital, Accra, Ghana
| | | | | | | | | | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Noella Bih
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - David Kerr
- John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Wilfred Ngwa
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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Motsuku L, Chen WC, Muchengeti MM, Naidoo M, Quene TM, Kellett P, Mohlala MI, Chu KM, Singh E. Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002-2014. BMC Cancer 2021; 21:129. [PMID: 33549058 PMCID: PMC7866437 DOI: 10.1186/s12885-021-07853-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014. METHODS Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex. RESULTS A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6-4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1-2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9-6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5-5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0-6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0-4.8, p-value < 0.01) from 2002 to 2014, respectively. CONCLUSIONS The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.
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Affiliation(s)
- Lactatia Motsuku
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Department of Global Health, South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Mazvita Molleen Muchengeti
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Naidoo
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Patricia Kellett
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Matshediso Ivy Mohlala
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa.
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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16
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Knapp GC, Alatise O, Olopade B, Samson M, Olasehinde O, Wuraola F, Odujoko OO, Komolafe AO, Arije OO, Castle PE, Smith JJ, Weiser MR, Kingham TP. Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria. PLoS One 2021; 16:e0243587. [PMID: 33434195 PMCID: PMC7802943 DOI: 10.1371/journal.pone.0243587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction There is a paucity of prospective data on the performance of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening in sub-Saharan Africa. The aim of this exploratory analysis was to evaluate the feasibility and performance of FIT in Nigeria. Methods This was a prospective, single-arm study. A convenience sample of asymptomatic, average-risk individuals between 40–75 years of age were enrolled at Obafemi Awolowo University Teaching Hospital. Study participants returned in 48 hours with a specimen for ova and parasite (O&P) and qualitative FIT (50ug/g) testing. Participants with a positive FIT had follow-up colonoscopy and those with intestinal parasites were provided treatment. Results Between May-June 2019, 379 individuals enrolled with a median age of 51 years (IQR 46–58). In total, 87.6% (n = 332) returned for FIT testing. FIT positivity was 20.5% (95% CI = 16.3%-25.2%). Sixty-one (89.7%) of participants with a positive FIT had a follow-up colonoscopy (n = 61), of whom 9.8% (95%CI:3.7–20.2%) had an adenoma and 4.9% (95%CI:1.0–13.7%) had advanced adenomas. Presence of intestinal parasites was inversely related to FIT positivity (6.5% with vs. 21.1% without parasites, p = 0.05). Eighty-two percent of participants found the FIT easy to use and 100% would recommend the test to eligible family or friends if available. Conclusions Asymptomatic, FIT-based CRC screening was feasible and well tolerated in this exploratory analysis. However, the high FIT positivity and low positive predictive value for advanced neoplasia raises concerns about its practicality and cost effectiveness in a low-resource setting such as Nigeria.
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Affiliation(s)
- Gregory C. Knapp
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
| | - Olusegun Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bolatito Olopade
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Marguerite Samson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Olalekan Olasehinde
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluwole O. Odujoko
- Department of Morbid Anatomy and Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akinwunmi O. Komolafe
- Department of Morbid Anatomy and Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O. Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Philip E. Castle
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Martin R. Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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17
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Hull R, Francies FZ, Oyomno M, Dlamini Z. Colorectal Cancer Genetics, Incidence and Risk Factors: In Search for Targeted Therapies. Cancer Manag Res 2020; 12:9869-9882. [PMID: 33116845 PMCID: PMC7553623 DOI: 10.2147/cmar.s251223] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/21/2020] [Indexed: 01/04/2023] Open
Abstract
Each year, colorectal cancers (CRCs) affect over a quarter of a million people. The risk of developing CRC in industrialized nations is approximately 5%. When the disease is localised, treatment success rates range from 70-90%; however, advanced CRC has a high mortality rate, consistently ranking in the top three causes of cancer-related deaths. There is a large geographic difference in global distribution, and CRC is predominantly associated with developed countries and a Western lifestyle and diet. As such, the developed world accounts for more than 63% of all cases of CRC. Geographic variations also predict cancer outcomes, which differ between racial and ethnic groups. This variation is due to inequalities in wealth, differences in the exposure to risk factors and barriers to high-quality cancer prevention, early detection and treatment. The aim of this paper was to review CRC in low- and middle-income countries such as South Africa, India, Brazil and China, and compare them with high-income countries such as the United States of America and the United Kingdom. It is important to note that these economically less developed countries, with historically low CRC rates, are experiencing an increased frequency of CRC. The review also discusses biological markers and genetic pathways involved in the development of colorectal cancer. Genes known to be responsible for the most common forms of inherited CRCs have also been identified but more remain to be identified. This would provide more candidate genes to be added to known biomarkers. CRC burden can be controlled through the widespread application of existing knowledge, such as reduced smoking habits, vaccination, early detection and promoting physical activity, accompanied by a healthy diet. An increased understanding of the molecular mechanisms and events underlying colorectal carcinogenesis will enable the development of new targets and therapeutic drugs.
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Affiliation(s)
- Rodney Hull
- SAMRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences, Hatfield 0028, South Africa
| | - Flavia Zita Francies
- SAMRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences, Hatfield 0028, South Africa
| | - Meryl Oyomno
- Department of Surgery, Faculty of Health Sciences, Steve Biko Academic Hospital and the University of Pretoria, Pretoria 0007, South Africa
| | - Zodwa Dlamini
- SAMRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences, Hatfield 0028, South Africa.,Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Parktown 2193, South Africa
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18
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Madiba T, Moodley Y, Sartorius B, Sartorius K, Aldous C, Naidoo M, Govindasamy V, Bhadree S, Stopforth L, Ning Y, Kiran PR. Clinicopathological spectrum of colorectal cancer among the population of the KwaZulu-Natal Province in South Africa. Pan Afr Med J 2020; 37:74. [PMID: 33244337 PMCID: PMC7680225 DOI: 10.11604/pamj.2020.37.74.21313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction the burden of colorectal carcinoma (CRC), once considered rare in Africa, may be changing with the disease being increasingly diagnosed and there is a suggestion that age and race influence tumour behaviour. We sought to describe the clinicopathological spectrum of CRC among the different race and age groups in a South African setting. Methods analysis of prospectively collected data from an on-going colorectal cancer database, including demographics, clinical presentation, site, staging and grading on all patients enrolled over an 18-year period. Results a total of 2232 patients with CRC were accrued over the study period (Africans, 798; Indians, 890; Coloureds, 104; and Whites, 440). Mean age was 57.7 (SD 14.4) but varied considerably by race (p < 0.001) with Africans being significantly younger. Young adults (aged < 40 years) totalled 305 and older patients (aged > 40 years) totalled 1927. The proportion of young patients (< 40 years old) was 28%, 7%, 9% and 3% among Africans, Indian, Coloured and White patients respectively. There were minimal variations in anatomical sub-site distribution. There was no difference in tumour stage between the various races and between older and young adults. Mucinous differentiation was more common in Africans and in young patients and poor differentiation was more common in African patients. Africans had a significantly lower resection rate compared to the other race groups (p < 0.001). Younger patients had a significantly lower resection rate compared to the older age group (p < 0.001). Conclusion African patients were the youngest compared to the other race groups. Mucinous differentiation predominated in Africans and young adults. Poor differentiation predominated in Africans. Resection rate was lower for African patients and in young patients.
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Affiliation(s)
- Thandinkosi Madiba
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Yoshan Moodley
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Benn Sartorius
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,London School of Hygiene and Tropical Medicine, London, UK
| | - Kurt Sartorius
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Maseelan Naidoo
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Vishendran Govindasamy
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Shona Bhadree
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Department of Radiation and Oncology, University of KwaZulu-Natal, Durban, South Africa
| | - Laura Stopforth
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Department of Radiation and Oncology, University of KwaZulu-Natal, Durban, South Africa
| | - Yuming Ning
- Columbia University Medical Centre and Mailman School of Public Health, New York, USA
| | - Pokala Ravi Kiran
- Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Columbia University Medical Centre and Mailman School of Public Health, New York, USA
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19
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Knapp GC, Alatise OI, Olasehinde OO, Adeyeye A, Ayandipo OO, Weiser MR, Kingham TP. Is Colorectal Cancer Screening Appropriate in Nigeria? J Glob Oncol 2020; 5:1-10. [PMID: 31170018 PMCID: PMC6613663 DOI: 10.1200/jgo.19.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.
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20
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Knapp GC, Sharma A, Olopade B, Alatise OI, Olasehinde O, Arije OO, Castle PE, Kingham TP. An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria. World J Surg 2020; 43:2674-2680. [PMID: 31407091 DOI: 10.1007/s00268-019-05100-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The fecal immunochemical test (FIT) for hemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria. METHODS Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at -80 °C. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult blood were retested every two days to evaluate the impact of time and temperature on test performance. RESULTS Of 139 individuals, 69 (49.6%) were positive for intestinal parasites and 10 (7.2%) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6%). Among patients with intestinal parasites, 10.1% (7/69) had a positive FIT. Only 4.3% (3/70) of patients without parasites had a positive FIT (p = 0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage. CONCLUSION Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.
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Affiliation(s)
- Gregory C Knapp
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA.
| | - Avinash Sharma
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA
| | - Bolatito Olopade
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun I Alatise
- Department of Surgery College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Philip E Castle
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY, USA
| | - T Peter Kingham
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA
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21
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Herbst CL, Miot JK, Moch SL, Ruff P. Colorectal Cancer (CRC) treatment and associated costs in the public sector compared to the private sector in Johannesburg, South Africa. BMC Health Serv Res 2020; 20:290. [PMID: 32264964 PMCID: PMC7137465 DOI: 10.1186/s12913-020-05112-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/13/2020] [Indexed: 02/01/2023] Open
Abstract
Background South Africa’s divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar. The appropriateness of treatment received and in particular the cost of the same treatment between the sectors remains debatable and raises concerns around equitable healthcare. Colorectal cancer places considerable pressure on the funders, yet treatment utilization data and the associated costs of non-communicable diseases, in particular colorectal cancer, are limited for South Africa. Resources need to be appropriately managed while ensuring equitable healthcare is provided regardless of where the patient is able to receive their treatment. Therefore the aim of this study was to determine the cost of colorectal cancer treatment in a privately insured patient population in order to compare the costs and utilization to a previously published public sector patient cohort. Methods Private sector costs were determined using de-identified claim-based data for all newly diagnosed CRC patients between 2012 and 2014. The costs obtained from this patient cohort were compared to previously published public sector data for the same period. The costs compared were costs incurred by the relevant sector funder and didn’t include out-of-pocket costs. Results The comparison shows private sector patients gain access to more of the approved regimens (12 vs. 4) but the same regimens are more costly, for example CAPOX costs approximately €150 more per cycle. The cost difference between 5FU and capecitabine monotherapy is less than €30 per cycle however, irinotecan is cheaper in comparison to oxaliplatin in the private sector (FOLFOX approx. €500 vs. FOLFIRI aprox. €460). Administrative costs account for up to 45% of total costs compared to the previously published data of these costs totaling < 15% of the full treatment cost in South Africa’s public healthcare system. Conclusion This comparison highlights the disparities between sectors while illustrating the need for further research to improve resource management to attain equitable healthcare.
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Affiliation(s)
- Candice-Lee Herbst
- Division of Pharmacology, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Jacqueline K Miot
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, 39 Empire Road, Parktown, Johannesburg, 2193, South Africa
| | - Shirra L Moch
- Centre for Health Science Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Paul Ruff
- Division of Medical Oncology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.,University of Witwatersrand / Medical Research Council Common Epithelial Cancers Research Centre (WITS/MRC CECRC), 7 York Road, Parktown, Johannesburg, 2193, South Africa
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22
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Atinafu BT, Bulti FA, Demelew TM. Survival Status and Predictors of Mortality Among Colorectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Followup Study. J Cancer Prev 2020; 25:38-47. [PMID: 32266178 PMCID: PMC7113412 DOI: 10.15430/jcp.2020.25.1.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer is one of the commonest cancer types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the survival status of colorectal cancer patients was not well understood. Therefore, the aim of this study was to determine the survival status and predictors of mortality among colorectal cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. The institution-based retrospective follow-up study was conducted with 621 subjects who were selected from patients registered between January 1, 2013 and December 30, 2017 with follow-up until December 30th, 2018. Data were collected from patient record review charts. A Kaplan-Meier analysis with a log-rank test, and bivariate and multivariable analysis using the Cox proportional hazard model were used. Of the 621 colorectal cancer patients who were included in the analysis, 202 (32.5%) died. The overall mortality rate was 20.3% per year (95% CI: 17.7-23.3). The overall survival was 18.1% with median survival time of 34.8 months (95% CI: 30.4-36.8). Comorbidity (adjusted hazard ratio [AHR] = 1.8, 95% CI: 1.3-2.5); stage (II [AHR = 3.8, 95% CI: 1.3-11.1], III [AHR = 8.0, 95% CI: 2.8-23.3], IV [AHR = 17.6, 95% CI: 6.1-50.7]); smoking (AHR = 1.6, 95% CI: 1.1-2.3); alcohol consumption (AHR = 1.5, 95% CI: 1.07-2.2); age ≥ 70 (AHR = 1.7, 95% CI: 1.02-2.9); and marital status (married [AHR = 2.4, 95% CI: 1.5-3.8], widowed [AHR = 2.4, 95% CI: 1.2-4.6], divorced [AHR = 2.0, 95% CI: 1.1-3.7]) were significant predictors of colorectal cancer mortality. It is crucial to implement early detection and screening, giving priority to rural dweller, comorbid patients and advanced stage diagnosed patients.
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Affiliation(s)
- Bantalem Tilaye Atinafu
- Department of Nursing, Health Science College, Debre Berhan University, Debre Birhan, Ethiopia
| | - Fekadu Aga Bulti
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tefera Mulugeta Demelew
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Sharma A, Alatise OI, Adisa AO, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe O, Katung IA, Ibikunle DA, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun AO, Adeyeye A, Ibrahim K, Kolawole OA, Idris OL, Adejumobi MO, Ajayi IA, Olakanmi A, Constable JC, Seier K, Gonen M, Brennan M, Kingham T. Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry. J Surg Oncol 2020; 121:342-349. [PMID: 31742699 PMCID: PMC7405945 DOI: 10.1002/jso.25768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.
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Affiliation(s)
- A. Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A. O. Adisa
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | - O. Olaofe
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - A. Adeyeye
- University Teaching Hospital, Ilorin, Nigeria
| | - K. Ibrahim
- University Teaching Hospital, Ilorin, Nigeria
| | | | - O. L. Idris
- Lautech University Hospital, Osogbo, Nigeria
| | | | - I. A. Ajayi
- Lautech University Hospital, Osogbo, Nigeria
| | - A.O. Olakanmi
- Department of Surgery, University of Medical Sciences Teaching Hospitals’ Complex, Ondo, Nigeria
| | - J. C. Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K. Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M.F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T.P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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24
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Medhin LB, Achila OO, Abrham AT, Efrem B, Hailu K, Abraha DM, Gilazghi L, Meresie A, Said SM. Incidence of colorectal cancer in Eritrea: Data from the National Health Laboratory, 2011-2017. PLoS One 2019; 14:e0224045. [PMID: 31721763 PMCID: PMC6853305 DOI: 10.1371/journal.pone.0224045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/03/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Recent studies have reported a significant increase in the prevalence of colorectal cancer (CRC) in Sub-Saharan Africa (SSA). Further, several studies employing disparate modelling algorithms have projected a significant rise in the frequency of CRC cases in the region. However, lack of good quality data on multiple themes related to CRC including incidence, among others, continues to be a problem in the region. Therefore, this study was designed to collect data on the incidence of CRC in Eritrea. Methods We conducted a retrospective analysis using data captured between 2011 and 2017 at the National Health Laboratory (NHL) in Asmara, Eritrea. Results 241 colorectal cases were identified in the Eritrean National Health Laboratory (NHL) database between 2011 and 2017. In the final analysis we included 94 patients confirmed cases giving an average of 18.8 patients per annum. The average age ± Standard deviation (SD) was 57.62 ± 17.14 with a male: female ratio of 58/36 (1: 1.61). The minimum and maximum age of the patients was 19 and 90 years, respectively. The rectum to colon ratio was 47/47 (1:1). The proportion of patients < 50 years in this cohort was significant. The age-standardized incidence rate (ASIR) in the study period was between 0.97 per 100 000 to 2.21 per 100 000. Similarly, the cumulative ASIR was 9.97 per 100 000. Analysis of trends did not reveal shifts over the study period (P<0.05). However, a strong correlation between incidence and age was established. Conclusion This study suggests that the incidence of CRC in Eritrea is relatively low. A significant number of patients were less than 50 years of age. Even then it’s our opinion that this study may underestimate the incidence of CRC.
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Affiliation(s)
| | - Oliver Okoth Achila
- Clinical Laboratory Sciences, Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| | | | - Biniam Efrem
- Clinical Laboratory Sciences, Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| | - Kibrom Hailu
- Pathology, National Health Laboratory, Asmara, Eritrea
| | | | - Luwam Gilazghi
- Immunoserology, National Health Laboratory, Asmara, Eritrea
| | - Alay Meresie
- Clinical Chemistry, National Health Laboratory, Asmara, Eritrea
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25
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Parker RK, Ranketi SS, McNelly C, Ongondi M, Topazian HM, Dawsey SM, Murphy GA, White RE, Mwachiro M. Colorectal cancer is increasing in rural Kenya: challenges and perspectives. Gastrointest Endosc 2019; 89:1234-1237. [PMID: 30543780 PMCID: PMC7476216 DOI: 10.1016/j.gie.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/02/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Robert K Parker
- Department of Surgery; Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Calvin McNelly
- Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Matilda Ongondi
- Department of Medicine; Hemato-oncology Unit, Kenyatta National Hospital
| | - Hillary M Topazian
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gwen A Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Russell E White
- Department of Surgery; Tenwek Hospital, Bomet, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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26
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Asombang AW, Madsen R, Simuyandi M, Phiri G, Bechtold M, Ibdah JA, Lishimpi K, Banda L. Descriptive analysis of colorectal cancer in Zambia, Southern Africa using the National Cancer Disease Hospital Database. Pan Afr Med J 2018; 30:248. [PMID: 30627309 PMCID: PMC6307926 DOI: 10.11604/pamj.2018.30.248.12464] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/05/2018] [Indexed: 01/28/2023] Open
Abstract
Introduction Colon cancer is preventable. There is a plethora of data regarding epidemiology and screening guidelines, however this data is sparse from the African continent. Objective: we aim to evaluate the trends of colorectal cancer (CRC) in a native African population based on age at diagnosis, gender and stage at diagnosis. Methods We conducted a retrospective analysis of the Cancer Disease Hospital (CDH) registry in Zambia, Southern Africa. Results 377 charts were identified in the CDH registry between 2007 and 2015, of which 234 were included in the final analysis. The mean age at diagnosis was 48.6 years and 62% are males. Using descriptive analysis for patterns: mode of diagnosis was surgical in 195 subjects (84%), histology adenocarcinoma in 225 (96.5%), most common location is rectum 124 (53%) followed by sigmoid 31 (13.4%), and cecum 26 (11%). 122 subjects (54%) were stage 4 at diagnosis. Using the Spearman rank correlation, we see no association between year and stage at diagnosis (p = 0.30) or year and age at diagnosis (p = 0.92). Conclusion Colorectal cancer was diagnosed at a young age and late stage in the Zambian patients.
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Affiliation(s)
- Akwi Wasi Asombang
- Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Richard Madsen
- Department of Statistics, University of Missouri-Columbia School of Medicine, Missouri, USA
| | - Michelo Simuyandi
- Center of Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Matthew Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri-Columbia School of Medicine, Missouri, USA
| | - Jamal Ahmad Ibdah
- Division of Gastroenterology and Hepatology, University of Missouri-Columbia School of Medicine, Missouri, USA
| | | | - Lewis Banda
- Cancer Disease Hospital (CDH), Lusaka, Zambia
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27
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Kayamba V, Nicholls K, Morgan C, Kelly P. A seven-year retrospective review of colonoscopy records from a single centre in Zambia. Malawi Med J 2018; 30:17-21. [PMID: 29868154 PMCID: PMC5974381 DOI: 10.4314/mmj.v30i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Colorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia. Methods We retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis. Results Included in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001). Conclusion This audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Kate Nicholls
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Catrin Morgan
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom
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Bebington B, Singh E, Fabian J, Jan Kruger C, Prodehl L, Surridge D, Penny C, McNamara L, Ruff P. Design and methodology of a study on colorectal cancer in Johannesburg, South Africa. JGH OPEN 2018; 2:139-143. [PMID: 30483579 PMCID: PMC6152464 DOI: 10.1002/jgh3.12061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/27/2017] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Abstract
Background and Aim Cancer is one of the foremost causes of morbidity and mortality worldwide. Globally, colorectal cancer (CRC) is the third most diagnosed and fourth most important cause of cancer death. A total of 70% of all CRC‐related deaths occur in low‐ and middle‐income countries. In Sub‐Saharan Africa (SSA), estimating the burden of CRC is difficult. Only 27 of 43 SSA countries have formalized cancer registration systems; data quality is variable and national coverage rare. Methods This is a multidisciplinary, longitudinal cohort study started in January 2016. Patients >18 years with histologically confirmed primary adenocarcinoma of the colon and rectum, diagnosed within the previous 12 months, are eligible. Participants were assessed and were followed up for 3 years. Baseline information, including demographics, socioeconomic status, family history, medical and surgical non‐cancer‐related history, dietary history, colonoscopic findings, staging at presentation, treatment, and disease recurrence, is collected, as well as blood tests and histology results. Outcomes include disease recurrence (local and metastatic) and survival. Results and Conclusion This study aims to describe the clinical presentation, management, and outcomes of adults with CRC in a multiethnic, urban South African population. It will be the first prospective study to describe clinical presentation, demographics, risk factors, treatment, and outcomes according to population group, from both private and state health‐care facilities in Johannesburg, South Africa. The results of this study will be relevant not only to South Africa but also to other SSA countries undergoing similar rates of rapid urbanization and epidemiological transition. This paper summarizes the design and methodology being used for a prospective cohort study of colorectal cancer (CRC) in Johannesburg, South Africa. It aims to describe the clinical presentation, management and outcomes of adults with CRC in a multi‐ethnic, urban South African population. It will be the first prospective study to describe clinical presentation, demographics, risk factors, treatment and outcomes according to population group, from both private and state healthcare facilities.
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Affiliation(s)
- Brendan Bebington
- Department of Surgery, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,Wits Donald Gordon Medical Center Johannesburg South Africa
| | - Elvira Singh
- National Cancer Registry National Health Laboratory Service Johannesburg South Africa.,School of Public Health University of the Witwatersrand Johannesburg South Africa
| | - June Fabian
- Wits Donald Gordon Medical Center Johannesburg South Africa.,Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Christine Jan Kruger
- Department of Surgery, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Leanne Prodehl
- Department of Surgery, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Daniel Surridge
- Department of Surgery, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Clem Penny
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Lynne McNamara
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Paul Ruff
- Wits Donald Gordon Medical Center Johannesburg South Africa.,Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
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Vania L, Rebelo TM, Ferreira E, Weiss SFT. Knock-down of LRP/LR promotes apoptosis in early and late stage colorectal carcinoma cells via caspase activation. BMC Cancer 2018; 18:602. [PMID: 29843646 PMCID: PMC5975593 DOI: 10.1186/s12885-018-4531-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Cancer remains one of the leading causes of death around the world, where incidence and mortality rates are at a constant increase. Tumourigenic cells are characteristically seen to over-express the 37 kDa/67 kDa laminin receptor (LRP/LR) compared to their normal cell counterparts. This receptor has numerous roles in tumourigenesis including metastasis, angiogenic enhancement, telomerase activation, cell viability and apoptotic evasion. This study aimed to expose the role of LRP/LR on the cellular viability of early (SW-480) and late (DLD-1) stage colorectal cancer cells. Methods siRNA were used to down-regulate the expression of LRP/LR in SW-480 and DLD-1 cells which was assessed using western blotting. Subsequently, cell survival was evaluated using the MTT cell survival assay and confocal microscopy. Thereafter, Annexin V-FITC/PI staining and caspase activity assays were used to investigate the mechanism underlying the cell death observed upon LRP/LR knockdown. The data was analysed using Student’s t-test with a confidence interval of 95%, with p-values of less than 0.05 seen as significant. Results Here we reveal that siRNA-mediated knock-down of LRP led to notable decreases in cell viability through increased levels of apoptosis, apparent by compromised membrane integrity and significantly high caspase-3 activity. Down-regulated LRP resulted in a significant increase in caspase-8 and -9 activity in both cell lines. Conclusions These findings show that the receptor is critically implicated in apoptosis and that LRP/LR down-regulation induces apoptosis in early and late stage colorectal cancer cells through both apoptotic pathways. Thus, this study suggests that siRNA-mediated knock-down of LRP could be a possible therapeutic strategy for the treatment of early and late stage colorectal carcinoma. Electronic supplementary material The online version of this article (10.1186/s12885-018-4531-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leila Vania
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Wits 2050, Johannesburg, Republic of South Africa
| | - Thalia M Rebelo
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Wits 2050, Johannesburg, Republic of South Africa
| | - Eloise Ferreira
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Wits 2050, Johannesburg, Republic of South Africa
| | - Stefan F T Weiss
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Wits 2050, Johannesburg, Republic of South Africa.
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30
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Agyemang-Yeboah F, Yorke J, Obirikorang C, Batu EN, Acheampong E, Frempong EA, Anto EO, Amankwaa B. Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana. Pan Afr Med J 2017. [PMID: 29515739 PMCID: PMC5837135 DOI: 10.11604/pamj.2017.28.121.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Colorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study determined the incidence, clinical features and the histopathological patterns of colorectal cancer at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods A retrospective review of all colorectal cancer cases over a six year period from (2009-2015) presented to the Surgical and Oncological Department of KATH. Patients' records were retrieved and information on their demographics, clinical and pathological presentations recorded. Results In all, 221 cases of colorectal cancer were identified over the study period. The mean age was 54 ± 16.8 and ranged from 16 to 90 years. Sixteen (7.24%) had family history of cancer and the prevalence of comorbidities was (24.89%). The commonest clinical symptoms presented were weight loss (44.80%), bleeding per rectum (39.82%) and abdominal pain (38.91%) Majority of the patients presented with rectal cancers (48.87%). Microscopically, adenocarcinoma (68.33%) was the most common histopathological type. According to Tumour Node Metastasis (TNM) staging of cancer, majority of the patients 89(40.27%) were identified as being in late stage (TNM Stage III). The overall crude annual incidence was 4.62 per 100000 populations. The age specific standardized incidence rate was 7.93 per 100,000 population Conclusion This study has clearly showed a high incidence in colorectal cancer at KATH, with similar trends in clinico-pathological patterns comparable to that of most African countries. These include predominance of rectal cancers, high incidence among younger people and delayed presentation of the disease at advanced stage.
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Affiliation(s)
- Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Joseph Yorke
- Department of Surgery, School of Medical Science Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuella Nsenbah Batu
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Bright Amankwaa
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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31
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Odutola MK, Jedy-Agba EE, Dareng EO, Adebamowo SN, Oga EA, Igbinoba F, Otu T, Ezeome E, Hassan R, Adebamowo CA. Cancers Attributable to Alcohol Consumption in Nigeria: 2012-2014. Front Oncol 2017; 7:183. [PMID: 28971062 PMCID: PMC5609586 DOI: 10.3389/fonc.2017.00183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/08/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction Alcohol consumption has been identified as a risk factor for many cancers but less attention has been paid to the fraction of those cancers that are attributable to alcohol consumption. In this study, we evaluated the incidence and population attributable fraction (PAF) of cancers associated with alcohol consumption in Nigeria. Methods We obtained data on incidence of cancers from two population-based cancer registries (PBCRs) in Nigeria and identified cancer sites for which there is strong evidence of an association with alcohol consumption based on the International Agency for Research on Cancer Monograph 100E. We computed the PAF for each cancer site by age and sex, using prevalence and relative risk estimates from previous studies. Results Between 2012 and 2014 study period, the PBCRs reported 4,336 cancer cases of which 1,627 occurred in males, and 2,709 occurred in females. Of these, a total of 1,808 cancer cases, 339 in males and 1,469 in females, were associated with alcohol intake. The age standardized incidence rate (ASR) of alcohol associated cancers was 77.3 per 100,000. Only 4.3% (186/4,336) of all cancer cases or 10.3% (186/1,808) of alcohol associated cancers were attributable to alcohol consumption. Some 42.5% (79/186) of these cancers occurred in males while 57.5% (107/186) occurred in females. The ASR of cancers attributable to alcohol in this population was 7.2 per 100,000. The commonest cancers attributable to alcohol consumption were cancers of the oral cavity and pharynx in men and cancer of the breast in women. Conclusion Our study shows that 4.3% of incident cancers in Nigeria can be prevented by avoiding alcohol consumption. While the incidence of cancers associated with alcohol intake is high, the proportion attributable to alcohol consumption is much lower suggesting that the number of cancers that may be prevented by eliminating alcohol intake in this population is relatively low.
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Affiliation(s)
| | - Elima E Jedy-Agba
- Institute of Human Virology, Abuja, Nigeria.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eileen O Dareng
- Center for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Emmanuel A Oga
- Battelle Memorial Institute, Baltimore, MD, United States
| | | | - Theresa Otu
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | | | | | - Clement A Adebamowo
- Institute of Human Virology, Abuja, Nigeria.,Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
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Abstract
It seems not too long ago that colon and rectal cancer is a "rare" disease in rural Africa; however, over the last 30 years in West Africa, published evidence has shown decade by decade increases in the incidence of colorectal cancer (CRC). Therefore, CRC should now be accepted as a recognized disease in native Africans; nevertheless, we must acknowledge that the incidence is a fraction of what obtains in the developed countries of Europe and America. This presentation will attempt to examine the emergence of CRC within the West African axis over the last four decades.
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Affiliation(s)
- David O. Irabor
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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33
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Abudu EK, Akinbami OS. Colorectal Carcinomas in Uyo City, Southern Geopolitical Zone of Nigeria: A Review of Clinicopathological Characteristics and Literature. Rare Tumors 2016; 8:6175. [PMID: 27441074 PMCID: PMC4935823 DOI: 10.4081/rt.2016.6175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022] Open
Abstract
Colorectal carcinomas (CRC) were initially thought to be rare in Africa including Nigeria, but recent studies have shown a reverse trend in our environment. This study is aimed to identify the clinical and pathological characteristics of CRC diagnosed between July 2006 and June 2015 in the University of Uyo Teaching Hospital, and a Private Specialist Laboratory, Uyo, Akwa Ibom State, Nigeria. All histological diagnosed cases of CRC seen in the two laboratories (University teaching and a private facility) in Uyo, Akwa-Ibom state, Nigeria during the study period were retrieved noting their bio-data, pathological and clinical variables. A total of 45 patients of age range 26-80 years with a mean of 55.9 years (SD 3.9) and a male to female ratio of 1.4:1 were seen. The two most common age groups affected in CRCs were 61-70 years (28.9%) and 51-60 years (24.4%) respectively. Majority of CRC patients were older than 40 years (86.7%) with identifiable predisposing factors being tubulo-villous adenoma (4 cases, 8.8%), villous adenoma (2 cases 4.4%), polyposis syndromes (2 cases, 4.4%) and schistosomiasis (1 case, 2.2%). Features of large intestinal obstruction were the most common presenting symptom of CRC (53.3%). Rectal bleeding, alteration in bowel habit and fecal incontinence were other symptoms, accounting for 33.3%, 8.9% and 4.4% of cases respectively. Left-sided CRCs were commoner (68.9%) with the majority appearing as annular-constricting type macroscopically (60.0%). Recto-sigmoid region was the preponderant site involved in CRC (29 cases, 64.5%). Adenocarcinoma (84.4%) was the most frequent histological subtype. Mucinous carcinoma, signet ring carcinoma and carcinoid tumor were other histologic subtypes seen in 8.9, 4.4 and 2.2% of cases respectively. The 22.0% of CRC patients presented at advanced stages of the disease. It can be concluded that majority of CRC patients were older than 40 years (86.7%) with features of intestinal obstruction (53.3%) and adenocarcinoma (84.4%) being the predominant mode of clinical presentation and histological subtype respectively.
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Affiliation(s)
- Emmanuel K Abudu
- Department of Histopathology, University of Uyo Teaching Hospital , Uyo, Akwa-Ibom State, Nigeria
| | - Oluyinka S Akinbami
- Department of Family Medicine, University of Uyo Teaching Hospital , Uyo, Akwa-Ibom State, Nigeria
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34
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Laiyemo AO, Brawley O, Irabor D, Boutall A, Ramesar RS, Madiba TE. Toward colorectal cancer control in Africa. Int J Cancer 2015; 138:1033-4. [PMID: 26355906 DOI: 10.1002/ijc.29843] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Adeyinka O Laiyemo
- Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, Washington, D.C
| | | | - David Irabor
- Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | | | - Rajkumar S Ramesar
- UCT/SA MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Katsidzira L, Gangaidzo IT, Mapingure MP, Matenga JA. Retrospective study of colorectal cancer in Zimbabwe: Colonoscopic and clinical correlates. World J Gastroenterol 2015; 21:2374-2380. [PMID: 25741144 PMCID: PMC4342913 DOI: 10.3748/wjg.v21.i8.2374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/25/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare differences in the frequency of colorectal cancer at colonoscopy in Zimbabwe according to ethnicity.
METHODS: All lower gastrointestinal endoscopic procedures performed between January 2006 and December 2011 at a gastroenterology clinic in Harare, Zimbabwe were reviewed. The demographic characteristics, clinical indications, differences in bowel preparation and the endoscopic and histological diagnoses were compared between different ethnic groups with emphasis on colorectal cancer. The clinical and demographic characteristics and the endoscopic findings were compared using the student t-test and the χ2 test, while the clinical indications associated with a diagnosis of colorectal cancer were determined by logistic regression.
RESULTS: All colonoscopies and sigmoidoscopies performed in 1236 Caucasians, 460 black Africans and 109 Asians were analysed. Colorectal cancer was diagnosed more frequently in the black African patients compared to Caucasians or Asians (10% vs 3%, 10% vs 2%, P < 0.001). However, polyps were less common among black Africans (5%) compared to both Caucasians (8%) and Asians (9%) (P = 0.03). Among patients with colorectal cancer, black Africans tended to be younger than Caucasians, who were over-represented in the oldest age category; 32 % vs 2% were less than 50 years and 41% vs 78% were older than 60 years (P < 0.001). Anaemia and weight loss were associated with colorectal cancer in both black African [odds ratio (OR): 2.73 (95%CI: 1.33-5.61) and 3.09 (1.35-7.07)] and Caucasian patients [OR: 6.65 (95%CI: 2.93-15.09) and 3.47 (1.52-7.94)].
CONCLUSION: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians.
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Cancer incidence in Ghana, 2012: evidence from a population-based cancer registry. BMC Cancer 2014; 14:362. [PMID: 24884730 PMCID: PMC4046022 DOI: 10.1186/1471-2407-14-362] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background Data on cancers is a challenge in most developing countries. Population-based cancer registries are also not common in developing countries despite the usefulness of such registries in informing cancer prevention and control programmes. The availability of population-based data on cancers in Africa varies across different countries. In Ghana, data and research on cancer have focussed on specific cancers and have been hospital-based with no reference population. The Kumasi Cancer Registry was established as the first population-based cancer registry in Ghana in 2012 to provide information on cancer cases seen in the city of Kumasi. Methods This paper reviews data from the Kumasi Cancer Registry for the year 2012. The reference geographic area for the registry is the city of Kumasi as designated by the 2010 Ghana Population and Housing Census. Data was from all clinical departments of the Komfo Anokye Teaching Hospital, Pathology Laboratory Results, Death Certificates and the Kumasi South Regional Hospital. Data was abstracted and entered into Canreg 5 database. Analysis was conducted using Canreg 5, Microsoft Excel and Epi Info Version 7.1.2.0. Results The majority of cancers were recorded among females accounting for 69.6% of all cases. The mean age at diagnosis for all cases was 51.6 years. Among males, the mean age at diagnosis was 48.4 compared with 53.0 years for females. The commonest cancers among males were cancers of the Liver (21.1%), Prostate (13.2%), Lung (5.3%) and Stomach (5.3%). Among females, the commonest cancers were cancers of the Breast (33.9%), Cervix (29.4%), Ovary (11.3%) and Endometrium (4.5%). Histology of the primary tumour was the basis of diagnosis in 74% of cases with clinical and other investigations accounting for 17% and 9% respectively. The estimated cancer incidence Age Adjusted Standardised Rate for males was 10.9/100,000 and 22.4/100, 000 for females. Conclusion This first attempt at population-based cancer registration in Ghana indicates that such registries are feasible in resource limited settings as ours. Strengthening Public Health Surveillance and establishing more Population-based Cancer Registries will help improve data quality and national efforts at cancer prevention and control in Ghana.
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Kokki I, Papana A, Campbell H, Theodoratou E. Estimating the incidence of colorectal cancer in South East Asia. Croat Med J 2014; 54:532-40. [PMID: 24382847 PMCID: PMC3893985 DOI: 10.3325/cmj.2013.54.532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim To estimate the burden of colorectal cancer (CRC) in South East Asia. Methods We reviewed the evidence from the published literature found through a systematic review in Medline, Embase, and Global Health and from unpublished data on cancer registries, which were sourced from the International Agency for Research on Cancer. Incidence rates were summarized by calculating descriptive statistics and meta-analysis estimates. Results The crude mean incidence of CRC in South East Asia for both sexes was 6.95/100 000 population and the incidence increased with age. The crude meta-analysis estimate was 6.12/100 000 population (95% confidence interval 5.64-6.60/100 000) and the number of new CRC cases for 2000 was 32 058 (29 544-34 573). Conclusion The rates of CRC in South East Asia were much lower than those reported for high-income countries, but higher than those reported for Sub Saharan Africa.
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Affiliation(s)
| | | | | | - Evropi Theodoratou
- Evropi Theodoratou, Centre for Population Health Sciences,College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK,
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38
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Brim H, Yooseph S, Zoetendal EG, Lee E, Torralbo M, Laiyemo AO, Shokrani B, Nelson K, Ashktorab H. Microbiome analysis of stool samples from African Americans with colon polyps. PLoS One 2013; 8:e81352. [PMID: 24376500 PMCID: PMC3869648 DOI: 10.1371/journal.pone.0081352] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/11/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Colonic polyps are common tumors occurring in ~50% of Western populations with ~10% risk of malignant progression. Dietary agents have been considered the primary environmental exposure to promote colorectal cancer (CRC) development. However, the colonic mucosa is permanently in contact with the microbiota and its metabolic products including toxins that also have the potential to trigger oncogenic transformation. AIM To analyze fecal DNA for microbiota composition and functional potential in African Americans with pre-neoplastic lesions. MATERIALS & METHODS We analyzed the bacterial composition of stool samples from 6 healthy individuals and 6 patients with colon polyps using 16S ribosomal RNA-based phylogenetic microarray; the Human intestinal Tract Chip (HITChip) and 16S rRNA gene barcoded 454 pyrosequencing. The functional potential was determined by sequence-based metagenomics using 454 pyrosequencing. RESULTS Fecal microbiota profiling of samples from the healthy and polyp patients using both a phylogenetic microarraying (HITChip) and barcoded 454 pyrosequencing generated similar results. A distinction between both sets of samples was only obtained when the analysis was performed at the sub-genus level. Most of the species leading to the dissociation were from the Bacteroides group. The metagenomic analysis did not reveal major differences in bacterial gene prevalence/abundances between the two groups even when the analysis and comparisons were restricted to available Bacteroides genomes. CONCLUSION This study reveals that at the pre-neoplastic stages, there is a trend showing microbiota changes between healthy and colon polyp patients at the sub-genus level. These differences were not reflected at the genome/functions levels. Bacteria and associated functions within the Bacteroides group need to be further analyzed and dissected to pinpoint potential actors in the early colon oncogenic transformation in a large sample size.
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Affiliation(s)
- Hassan Brim
- Department of Pathology, Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, District of Columbia, United States of America
- * E-mail:
| | - Shibu Yooseph
- JCVI, San Diego, California, United States of America
| | - Erwin G. Zoetendal
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Edward Lee
- Department of Pathology, Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, District of Columbia, United States of America
| | | | - Adeyinka O. Laiyemo
- Department of Pathology, Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, District of Columbia, United States of America
| | - Babak Shokrani
- Department of Pathology, Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, District of Columbia, United States of America
| | - Karen Nelson
- JCVI, Rockville, Maryland, United States of America
| | - Hassan Ashktorab
- Department of Pathology, Department of Medicine and Cancer Center, Howard University, College of Medicine, Washington, District of Columbia, United States of America
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Chan KY, Adeloye D, Grant L, Kolčić I, Marušić A. How big is the 'next big thing'? Estimating the burden of non-communicable diseases in low- and middle-income countries. J Glob Health 2013; 2:020101. [PMID: 23289068 PMCID: PMC3529319 DOI: 10.7189/jogh.02.020101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia ; Department of Health Policy and Management, School of Public Health, Peking University Health Science Centre, Beijing, China
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