1
|
Luan Z, Liu F, Zhang L, Chen J, Zhao Y, Li C, Liu Z, Li H, Dong L, Zang F, Han L, Zhao T, Wang Q, Sun G, Wang S. A self-reported symptom-based decision-making model helps to rule out outpatient cases at low risk for CRC before colonoscopy. Heliyon 2024; 10:e33619. [PMID: 39091940 PMCID: PMC11292515 DOI: 10.1016/j.heliyon.2024.e33619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives Effective exclusion of low-risk symptomatic outpatient cases for colorectal cancer (CRC) remains diagnostic challenges. We aimed to develop a self-reported symptom-based decision-making model for application in outpatient scenarios. Methods In total, 8233 symptomatic cases at risk for CRC, as judged by outpatient physicians, were involved in this study at seven medical centers. A decision-making model was constructed using 60 self-reported symptom parameters collected from the questionnaire. Further internal and external validation cohorts were built to evaluate the discriminatory power of the CRC model. The discriminatory power of the CRC model was assessed by the C-index and calibration plot. After that, the clinical utility and user experience of the CRC model were evaluated. Results Nine symptom parameters were identified as valuable predictors used for modeling. Internal and external validation cohorts verified the adequate discriminatory power of the CRC model. In the clinical application step, all 17 physicians found the model easy to grasp, 99.9 % of the patients were satisfied with the survey form. Application of this model detected all CRC cases. The total consistency ratio of outpatient cases undergoing colonoscopy was 81.4 %. None of the low-risk patients defined by the CRC model had been diagnosed with CRC. Conclusion This multicenter study developed and validated a simple and user-friendly decision-making model covering self-reported information. The CRC model has been demonstrated to perform well in terms of rapid outpatient decision-making scenarios and clinical utility, particularly because it can better rule out low-risk outpatient cases.
Collapse
Affiliation(s)
- Zhe Luan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fangfang Liu
- Department of Oncology, 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Zhang
- Department of Gastroenterology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, 030009, China
| | - Jun Chen
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yiming Zhao
- Department of Gastroenterology and Hepatology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, China
| | - Congyong Li
- Sixth Health Care Department, Second Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Zhaoyun Liu
- Department of Gastroenterology, Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Ningde, 352100, China
| | - Huawei Li
- Department of Gastroenterology, Panjin Central Hospital, Panjin, 124013, China
| | - Li Dong
- Department of Gastroenterology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, 030009, China
| | - Funing Zang
- Department of Gastroenterology, Pizhou City Hospital of Traditional Chinese Medicine, Pizhou, 221300, China
| | - Lingyan Han
- Department of Gastroenterology, Shanxi Traditional Chinese Medical Hospital, Taiyuan, 030012, China
| | - Tianyue Zhao
- Department of Gastroenterology, Panjin Central Hospital, Panjin, 124013, China
| | - Qiao Wang
- Department of Gastroenterology, Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Ningde, 352100, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shufang Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| |
Collapse
|
2
|
Hentzien M, Frossard J, Kouyos R, Prendki V, Damas J, Hofmann E, Braun D, Schmid P, Bernasconi E, Ragozzino S, Efthimiou O, Delpierre C, Allavena C, Bani-Sadr F, Calmy A. External validation of the Dat'AIDS score: A risk score for predicting 5-year overall mortality in people living with HIV aged 60 years or older. HIV Med 2024; 25:72-82. [PMID: 37619609 DOI: 10.1111/hiv.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To perform an external validation of the Dat'AIDS score for predicting 5-year overall mortality among people with HIV (PWH) aged 60 years or older. METHODS This was a multi-centre prospective cohort study at all sites participating in the Swiss HIV Cohort Study (SHCS). We calculated the Dat'AIDS score in PWH aged 60 years or older at their first visit between 1 January 2015 and 1 January 2020. People living with HIV-2 and those whose Dat'AIDS score could not be calculated were excluded. Patients were followed until 1 January 2020. The primary endpoint was all-cause mortality. Vital status was collected throughout the study period. We obtained population and score descriptive statistics and assessed the score's discrimination and calibration. RESULTS We included 2205 participants (82% male) of median [interquartile range (IQR)] age 62.0 (60.3-67.0) years, mostly with viraemia <50 copies/mL (92.7%). Median follow-up time was 15.9 years and median (IQR) CD4 cell count at enrolment was 586 (420-782) cells/μL. In all, 152 deaths were recorded during a total follow-up period of 7147 patient-years. The median (IQR) observed Dat'AIDS score was 3 (0-8). Discriminative capacities were good as the C-statistic was 0.73 (95% CI: 0.69-0.77) and consistent across all subgroups. Comparison of observed and expected survival probabilities showed good calibration. CONCLUSIONS External validation of the Dat'AIDS score in patients aged 60 years or older showed that it could be a useful tool not only for research purposes, but also to identify older patients at a higher mortality risk and to tailor the most appropriate interventions.
Collapse
Affiliation(s)
- Maxime Hentzien
- HIV/AIDS Research Unit, Division of infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
- UR 3797 "Vieillissement, Fragilité," Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Jaromil Frossard
- HIV/AIDS Research Unit, Division of infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Roger Kouyos
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - José Damas
- Infectious Diseases Service, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Eveline Hofmann
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, and University of Southern Switzerland, Lugano, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Silvio Ragozzino
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Cyrille Delpierre
- INSERM, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Alexandra Calmy
- HIV/AIDS Research Unit, Division of infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
3
|
Zhang M, Zhang Y, Zhang W, Zhao L, Jing H, Wu X, Guo L, Zhang H, Zhang Y, Zhu S, Zhang S, Zhang X. Reply: Request for clarification on symptom assessment methodology in high-risk population colonoscopy study. Cancer Med 2023; 12:15629-15631. [PMID: 37264753 PMCID: PMC10417086 DOI: 10.1002/cam4.6164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Mingqing Zhang
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Yongdan Zhang
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Wen Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Lizhong Zhao
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Haoren Jing
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
| | - Xiaojing Wu
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Lu Guo
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Haixiang Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Yong Zhang
- Center for Applied MathematicsTianjin UniversityTianjinChina
| | - Siwei Zhu
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| | - Shiwu Zhang
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
- Department of PathologyTianjin Union Medical CenterTianjinChina
| | - Xipeng Zhang
- Nankai University School of MedicineNankai UniversityTianjinChina
- Department of Colorectal SurgeryTianjin Union Medical CenterTianjinChina
- Tianjin Institute of ColoproctologyTianjinChina
- The Institute of Translational MedicineTianjin Union Medical Center of Nankai UniversityTianjinChina
| |
Collapse
|
4
|
Xu JY, Wang YT, Li XL, Shao Y, Han ZY, Zhang J, Yang LB, Deng J, Li T, Wu T, Lu XL, Cheng Y. Prediction Model Using Readily Available Clinical Data for Colorectal Cancer in Chinese Population. Am J Med Sci 2022; 364:59-65. [PMID: 35120920 DOI: 10.1016/j.amjms.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/16/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In China, health screening has become common, although colonoscopy is not always available or acceptable. We sought to develop a prediction model of colorectal cancer (CRC) for health screening population based on readily available clinical data to reduce labor and economic costs. METHODS We conducted a cross-sectional study based on a health screening population in Karamay Central Hospital. By collecting clinical data and basic information from participants, we identified independent risk factors and established a prediction model of CRC. Internal and external validation, calibration plot, and decision curve analysis were employed to test discriminating ability, calibration ability, and clinical practicability. RESULTS Independent risk factors of CRC, which were readily available in basic public health institutions, included high-density lipoprotein cholesterol, male sex, total cholesterol, advanced age, and hemoglobin. These factors were successfully incorporated into the prediction model (AUC 0.740, 95% CI 0.713-0.767). The model demonstrated a high degree of discrimination and calibration, in addition to a high degree of clinical practicability in high-risk people. CONCLUSIONS The prediction model exhibits good discrimination and calibration and is pragmatic for CRC screening in rural areas and basic public health institutions.
Collapse
Affiliation(s)
- Jing-Yuan Xu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ya-Tao Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xiao-Ling Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yong Shao
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Zhi-Yi Han
- Karamay Central Hospital of Xinjiang, Karamay 834000, China
| | - Jie Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Long-Bao Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Jiang Deng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ting Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ting Wu
- Community Health Service Center of Jinxi Town, Kunshan 215300, China
| | - Xiao-Lan Lu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China; Department of Gastroenterology, Shanghai Pudong Hospital of Fudan University, Shanghai 201399, China.
| | - Yan Cheng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
| |
Collapse
|
5
|
Li JB, Qiu ZY, Deng YX, Li Y, Lin ZC, Wu YP, Weng F, Tian H, Ou QJ, Gong CH, Pan ZZ, Wan DS, Peng JH, Fang YJ. Factors associated with positive predictive value of preliminary screening in a two-step screening strategy for colorectal neoplasms in China. Discov Oncol 2022; 13:4. [PMID: 35201502 PMCID: PMC8777551 DOI: 10.1007/s12672-022-00463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. We aim to explore independent factors associated with PPVs of HRFQ combined FIT for selecting high risk individuals for colonoscopy. METHODS A total of 6971 residents were enrolled in a community-based screening program. Participants who had positive results of HRFQ and/or FIT and subsequently received colonoscopy were involved. The associations of socio-demographic factors, lifestyle behaviors, and high risk factors of colorectal cancer with PPVs of HRFQ, FIT, and their combination were evaluated by multivariable logistic regression models. RESULTS Among 572 involved cases, 249 (43.5%) colorectal neoplasms were detected by colonoscopy, including 71 advanced adenoma (12.4%) and 9 colorectal cancer (CRC) (1.6%). The PPVs of preliminary screening were 43.5% for total colorectal neoplasms, 14.0% for advanced neoplasm, and 1.6% for CRC. Adding positive HRFQ to FIT could improve the PPV from 3.5 to 8.0% for detecting CRC. Preliminarily screened positive individuals who were males [adjusted odds ratio (AOR): 1.95, 95% CI 1.31, 2.90; p < 0.001], elders (> 60 years) (AOR: 1.70, 95% CI 1.17, 2.46; p = 0.005), or ex-/current smokers (AOR: 3.04, 95% CI 1.31, 7.09; p = 0.10) had higher odds of PPVs of detecting colorectal neoplasms. CONCLUSIONS Combining HRFQ and FIT could largely improve PPVs for screening advanced neoplasm and CRC. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm.
Collapse
Affiliation(s)
- Ji-Bin Li
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhi-Yu Qiu
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yu-Xiang Deng
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Yin Li
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Zhuo-Chen Lin
- Department of Medical Records, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
| | - Yan-Ping Wu
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Fan Weng
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Huan Tian
- Dadong Street Community Health Service Center, Guangzhou, 510000, People's Republic of China
| | - Qing-Jian Ou
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Cheng-Hua Gong
- Yuexiu District Center for Disease Control and Prevention, Guangzhou, 510055, People's Republic of China
| | - Zhi-Zhong Pan
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - De-Sen Wan
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Jian-Hong Peng
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - Yu-Jing Fang
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| |
Collapse
|
6
|
A user-friendly objective prediction model in predicting colorectal cancer based on 234 044 Asian adults in a prospective cohort. ESMO Open 2021; 6:100288. [PMID: 34808523 PMCID: PMC8609147 DOI: 10.1016/j.esmoop.2021.100288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prediction models of colorectal cancer (CRC) had limited application for not being user-friendly. Whether fecal immunochemical tests (FITs) can help predict CRC has been overlooked. PATIENTS AND METHODS With 1972 CRCs identified, 234 044 adults aged ≥40 years were successively enrolled between 1994 and 2008. Prediction models were developed by questionnaire/medical screening and quantitative FIT. NNS (number needed to scope to find one cancer) is time dependent, spanning entire study period. Significant 'risk factors' were family history, body mass index, smoking, drinking, inactivity, hypertension, diabetes, carcinoembryonic antigen, and C-reactive protein. RESULTS Positive FIT (≥20 μg/g hemoglobin/feces) had cancer risk 10-fold larger than negative FIT, and within each age group, another 10-fold difference. The C statistic of FIT (0.81) with age and sex alone was superior to the 'common risk-factors' model (0.73). NNS, stratified by age and by FIT values, demonstrated a scorecard of cancer risks, like 1/15 or 1/25, in 5 years. When FIT was negative, cancer risk was small (1/750-1/3000 annually). The larger the FIT, the sooner the appearance of CRC. For every 80-μg/g increase of FIT, there were 1.5-year earlier development of CRC incidence and 1-year earlier development of CRC mortality, respectively. Given the same FIT value, CRC events appeared in the proximal colon sooner than the distal colon. CONCLUSIONS A simple user-friendly model based on a single FIT value to predict CRC risk was developed. When positive, NNS offered a simple quantitative value, with a better precision than most risk factors, even combined. When FIT is negative, risk is very small, but requiring a repeat every other year to rule out false negative. FIT values correlated well with CRC prognosis, with worst for proximal CRC.
Collapse
|
7
|
New scoring systems for predicting advanced proximal neoplasia in asymptomatic adults with or without knowing distal colorectal findings: a prospective, cross-sectional study. Eur J Cancer Prev 2021; 31:318-325. [PMID: 34545024 DOI: 10.1097/cej.0000000000000715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Models estimating risk for advanced proximal colorectal neoplasia (APN) may be used to select colorectal cancer (CRC) screening test, either prior to knowing distal colorectal findings or afterward. Current models have only fair discrimination and nearly all require knowing distal findings. OBJECTIVE Derive and test risk prediction models for APN with and without distal findings. SETTING Selected endoscopy centers within central Indiana, USA. PARTICIPANTS Average-risk persons undergoing first-time screening colonoscopy. INTERVENTIONS Demographics, personal and family medical history, lifestyle factors and physical measures were linked to the most advanced finding in proximal and distal colorectal segments. For both models, logistic regression identified factors independently associated with APN on a derivation set. Based on equation coefficients, points were assigned to each factor, and risk for APN was examined for each score. Scores with comparable risks were collapsed into risk categories. Both models and their scoring systems were tested on the validation set. MAIN OUTCOME APN, defined as any adenoma or sessile serrated lesion ≥1 cm, one with villous histology or high-grade dysplasia, or CRC proximal to the descending colon. RESULTS Among 3025 subjects in the derivation set (mean age 57.3 ± 6.5 years; 52% women), APN prevalence was 4.5%; 2859 (94.5%) had complete data on risk factors. Independently associated with APN were age, sex, cigarette smoking, cohabitation status, metabolic syndrome, non-steroidal anti-inflammatory drug use and physical activity. This model (without distal findings) was well-calibrated (P = 0.62) and had good discrimination (c-statistic = 0.73). In low-, intermediate- and high-risk groups that comprised 21, 58 and 21% of the sample, respectively, APN risks were 1.47% (95% CI, 0.67-2.77%), 3.09% (CI, 2.31-4.04%) and 11.6% (CI, 9.10-14.4%), respectively (P < 0.0001), with no proximal CRCs in the low-risk group and 2 in the intermediate-risk group. When tested in the validation set of 1455, the model retained good metrics (calibration P = 0.85; c-statistic = 0.83), with APN risks in low- (22%), intermediate- (56%) and high-risk (22%) subgroups of 0.62% (CI, 0.08-2.23%) 2.20% (CI, 1.31-3.46%) and 13.0% (CI, 9.50-17.2%), respectively (P < 0.0001). There were no proximal CRCs in the low-risk group, and two in the intermediate-risk group. The model with distal findings performed comparably, with validation set metrics of 0.18 for calibration, 0.76 for discrimination and APN risk (% sample) in low-, intermediate-, and high-risk groups of 1.1 (69%), 8.3 (22%) and 22.3% (9%). CONCLUSION These models stratify large proportions of average-risk persons into clinically meaningful risk groups, and could improve screening efficiency, particularly for noncolonoscopy-based programs.
Collapse
|
8
|
ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol 2021; 116:458-479. [PMID: 33657038 DOI: 10.14309/ajg.0000000000001122] [Citation(s) in RCA: 308] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC. The purpose of this article is to update the 2009 American College of Gastroenterology CRC screening guidelines. The guideline is framed around several key questions. We conducted a comprehensive literature search to include studies through October 2020. The inclusion criteria were studies of any design with men and women age 40 years and older. Detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed. We also provide recommendations on the role of aspirin for chemoprevention, quality indicators for colonoscopy, approaches to organized CRC screening and improving adherence to CRC screening. CRC screening must be optimized to allow effective and sustained reduction of CRC incidence and mortality. This can be accomplished by achieving high rates of adherence, quality monitoring and improvement, following evidence-based guidelines, and removing barriers through the spectrum of care from noninvasive screening tests to screening and diagnostic colonoscopy. The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal.
Collapse
|
9
|
Wong MCS, Rerknimitr R, Lee Goh K, Matsuda T, Kim HS, Wu DC, Wu KC, Yeoh KG, Chong VH, Ahmed F, Sollano JD, Menon J, Chiu HM, Li J, Ching JYL, Sung JJY. Development and Validation of the Asia-Pacific Proximal Colon Neoplasia Risk Score. Clin Gastroenterol Hepatol 2021; 19:119-127.e1. [PMID: 31923642 DOI: 10.1016/j.cgh.2019.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients found to be at high risk of advanced proximal neoplasia (APN) after flexible sigmoidoscopy screening should be considered for colonoscopy examination. We developed and validated a scoring system to identify persons at risk for APN. METHODS We collected data from 7954 asymptomatic subjects (age, 50-75 y) who received screening colonoscopy examinations at 14 sites in Asia. We randomly assigned 5303 subjects to the derivation cohort and the remaining 2651 to the validation cohort. We collected data from the derivation cohort on age, sex, family history of colorectal cancer, smoking, drinking, body mass index, medical conditions, and use of nonsteroidal anti-inflammatory drugs or aspirin. Associations between the colonoscopic findings of APN and each risk factor were examined using the Pearson χ2 test, and we assigned each participant a risk score (0-15), with scores of 0 to 3 as average risk and scores of 4 or higher as high risk. The scoring system was tested in the validation cohort. We used the Cochran-Armitage test of trend to compare the prevalence of APN among subjects in each group. RESULTS In the validation cohort, 79.5% of patients were classified as average risk and 20.5% were classified as high risk. The prevalence of APN in the average-risk group was 1.9% and in the high-risk group was 9.4% (adjusted relative risk, 5.08; 95% CI, 3.38-7.62; P < .001). The score included age (61-70 y, 3; ≥70 y, 4), smoking habits (current/past, 2), family history of colorectal cancer (present in a first-degree relative, 2), and the presence of neoplasia in the distal colorectum (nonadvanced adenoma 5-9 mm, 2; advanced neoplasia, 7). The c-statistic of the score was 0.74 (95% CI, 0.68-0.79), and for distal findings alone was 0.67 (95% CI, 0.60-0.74). The Hosmer-Lemeshow goodness-of-fit test statistic was greater than 0.05, indicating the reliability of the validation set. The number needed to refer was 11 (95% CI, 10-13), and the number needed to screen was 15 (95% CI, 12-17). CONCLUSIONS We developed and validated a scoring system to identify persons at risk for APN. Screening participants who undergo flexible sigmoidoscopy screening with a score of 4 points or higher should undergo colonoscopy evaluation.
Collapse
Affiliation(s)
- Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Rungsun Rerknimitr
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khean Lee Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai Chun Wu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Khay Guan Yeoh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vui Heng Chong
- Division of Gastroenterology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Furqaan Ahmed
- Division of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Jose D Sollano
- Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines
| | - Jayaram Menon
- Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong; The Institute of Digestive Disease, The Chinese University of Hong Kong
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong; The Institute of Digestive Disease, The Chinese University of Hong Kong; The State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
10
|
Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test. BMC Gastroenterol 2019; 19:226. [PMID: 31881948 PMCID: PMC6935212 DOI: 10.1186/s12876-019-1146-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/17/2019] [Indexed: 02/08/2023] Open
Abstract
Background The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT). This paper aimed to improve the APCS score and evaluate its use with the FIT in stratifying the risk of ACN. Methods This prospective and multicenter study enrolled 955 and 1201 asymptomatic Chinese participants to form the derivation and validation set, respectively. Participants received the risk factor questionnaire, colonoscopy and FIT. Multiple logistic regression was applied, and C-statistic, sensitivity and negative predictive values (NPVs) were used to compare the screening efficiency. Results A modified model was developed incorporating age, body mass index (BMI), family history, diabetes, smoking and drinking as risk factors, stratifying subjects into average risk (AR) or high risk (HR). In the validation set, the HR tier group had a 3.4-fold (95% CI 1.8–6.4) increased risk for ACN. The C-statistic for the modified score was 0.69 ± 0.04, and 0.67 ± 0.04 for the original score. The sensitivity of the modified APCS score combined with FIT for screening ACN high-risk cohorts was 76.7% compared with 36.7% of FIT alone and 70.0% of the modified APCS score alone. The NPVs of the modified score combined with FIT for ACN were 98.0% compared with 97.0% of FIT alone and 97.9% of the modified APCS score alone. Conclusions The modified score and its use with the FIT are efficient in selecting the HR group from a Chinese asymptomatic population.
Collapse
|
11
|
Chen P, Huang JL, Yuan X, Huang J, Wang HH, Tse G, Wong MCS, Wu Y. Capability of four sigmoidoscopy-based screening strategies to predict proximal neoplasia in an asymptomatic Chinese population. J Gastroenterol Hepatol 2019; 34:707-712. [PMID: 29969515 DOI: 10.1111/jgh.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM A proper colonoscopy referral criterion is essential for flexible sigmoidoscopy-based colorectal cancer screening. We aimed to compare the predictive capability of four existing criteria to detect proximal neoplasia (PN) and advanced proximal neoplasia (APN) in a Chinese population. METHODS Asymptomatic Chinese participants aged 50-75 years, who received screening colonoscopy, were consecutively recruited. The four criteria included (i) UK flexible sigmoidoscopy; (ii) Italian Screening for COlon REctum; (iii) NORwegian Colorectal Cancer Prevention trial; and (iv) US clinical index. The sensitivity, specificity, positive/negative predictive value, and the number of subjects needed to screen (NNS)/refer (NNR) to detect one APN/PN were examined. The area under receiver operating characteristic curve was evaluated. RESULTS Among 5833 subjects, 749 (12.8%) and 151 (2.6%) cases were found to have PN and APN, respectively. US criteria achieved the highest sensitivity for PN (49%) and APN (66%), while UK criteria attained the highest specificity (93%) for PN/APN. The lowest NNS was required by US criteria for PN (16 vs 19-38) and APN (58 vs 69-86), while the lowest NNR was required by UK criteria for PN (3.2 vs 4.0-4.8) and APN (7 vs 10-16). The receiver operating characteristic of all four criteria was 0.57-0.61 for PN and 0.68-0.70 for APN. CONCLUSIONS Among all the four criteria, US criteria had the highest sensitivity and lowest NNS, while UK criteria achieved the highest specificity and lowest NNR. Their limited discriminatory capability highlighted the need for a new score to predict PN/APN in Chinese populations.
Collapse
Affiliation(s)
- Ping Chen
- Department of Gastroenterology, Shanghai Jiaotong University, Shanghai, China
| | - Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Xiaoqin Yuan
- Department of Gastroenterology, Shanghai Jiaotong University, Shanghai, China
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yunlin Wu
- Department of Gastroenterology, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
12
|
Li W, Zhao LZ, Ma DW, Wang DZ, Shi L, Wang HL, Dong M, Zhang SY, Cao L, Zhang WH, Zhang XP, Zhang QH, Yu L, Qin H, Wang XM, Chen SLS. Predicting the risk for colorectal cancer with personal characteristics and fecal immunochemical test. Medicine (Baltimore) 2018; 97:e0529. [PMID: 29718843 PMCID: PMC6392567 DOI: 10.1097/md.0000000000010529] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We aimed to predict colorectal cancer (CRC) based on the demographic features and clinical correlates of personal symptoms and signs from Tianjin community-based CRC screening data.A total of 891,199 residents who were aged 60 to 74 and were screened in 2012 were enrolled. The Lasso logistic regression model was used to identify the predictors for CRC. Predictive validity was assessed by the receiver operating characteristic (ROC) curve. Bootstrapping method was also performed to validate this prediction model.CRC was best predicted by a model that included age, sex, education level, occupations, diarrhea, constipation, colon mucosa and bleeding, gallbladder disease, a stressful life event, family history of CRC, and a positive fecal immunochemical test (FIT). The area under curve (AUC) for the questionnaire with a FIT was 84% (95% CI: 82%-86%), followed by 76% (95% CI: 74%-79%) for a FIT alone, and 73% (95% CI: 71%-76%) for the questionnaire alone. With 500 bootstrap replications, the estimated optimism (<0.005) shows good discrimination in validation of prediction model.A risk prediction model for CRC based on a series of symptoms and signs related to enteric diseases in combination with a FIT was developed from first round of screening. The results of the current study are useful for increasing the awareness of high-risk subjects and for individual-risk-guided invitations or strategies to achieve mass screening for CRC.
Collapse
Affiliation(s)
- Wen Li
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Li-Zhong Zhao
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Dong-Wang Ma
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - De-Zheng Wang
- Non-Communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention
| | - Lei Shi
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Hong-Lei Wang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Mo Dong
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Shu-Yi Zhang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Lei Cao
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Wei-Hua Zhang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Xi-Peng Zhang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Qing-Huai Zhang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Lin Yu
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Hai Qin
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Union Medical Center
| | - Xi-Mo Wang
- Department of Epidemiology, Tianjin Colorectal and Anal Disease Research Institute
- Department of Gastroenterology, Tianjin Nankai Hospital, Tianjin, P.R. China
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taiwan
| |
Collapse
|
13
|
Xie X, Xing J, Kong N, Li C, Li J, Zhang S. Improving Colorectal Polyp Classification Based on Physical Examination Data—An Ensemble Learning Approach. IEEE Robot Autom Lett 2018. [DOI: 10.1109/lra.2017.2746918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
14
|
Sung JJY, Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Cheung W, Ching JYL. A modified colorectal screening score for prediction of advanced neoplasia: A prospective study of 5744 subjects. J Gastroenterol Hepatol 2018; 33:187-194. [PMID: 28561279 DOI: 10.1111/jgh.13835] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM We validated a modified risk algorithm based on the Asia-Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia. METHODS Among 5744 Chinese asymptomatic screening participants undergoing a colonoscopy in Hong Kong from 2008 to 2012, a random sample of 3829 participants acted as the derivation cohort. The odds ratios for significant risk factors identified by binary logistic regression analysis were used to build a scoring system ranging from 0 to 6, divided into "average risk" (AR): 0; "moderate risk" (MR): 1-2; and "high risk" (HR): 3-6. The other 1915 subjects formed a validation cohort, and the performance of the score was assessed. RESULTS The prevalence of advanced neoplasia in the derivation and validation cohorts was 5.4% and 6.0%, respectively (P = 0.395). Old age, male gender, family history of colorectal cancer, smoking, and BMI were significant predictors in multivariate regression analysis. A BMI cut-off at > 23 kg/m2 had better predictive capability and lower number needed to screen than that of > 25 kg/m2 . Utilizing the score developed, 8.4%, 57.4%, and 34.2% in the validation cohort were categorized as AR, MR, and HR, respectively. The corresponding prevalence of advanced neoplasia was 3.8%, 4.3%, and 9.3%. Subjects in the HR group had 2.48-fold increased prevalence of advanced neoplasia than the AR group. The c-statistics of the modified score had better discriminatory capability than that using predictors of APCS alone (c-statistics = 0.65 vs 0.60). CONCLUSIONS Incorporating BMI into the predictors of APCS score was found to improve risk prediction of advanced neoplasia and reduce colonoscopy resources.
Collapse
Affiliation(s)
- Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Wilson Cheung
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
15
|
Hong SN, Son HJ, Choi SK, Chang DK, Kim YH, Jung SH, Rhee PL. A prediction model for advanced colorectal neoplasia in an asymptomatic screening population. PLoS One 2017; 12:e0181040. [PMID: 28841657 PMCID: PMC5571924 DOI: 10.1371/journal.pone.0181040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background An electronic medical record (EMR) database of a large unselected population who received screening colonoscopies may minimize sampling error and represent real-world estimates of risk for screening target lesions of advanced colorectal neoplasia (CRN). Our aim was to develop and validate a prediction model for assessing the probability of advanced CRN using a clinical data warehouse. Methods A total of 49,450 screenees underwent their first colonoscopy as part of a health check-up from 2002 to 2012 at Samsung Medical Center, and the dataset was constructed by means of natural language processing from the computerized EMR system. The screenees were randomized into training and validation sets. The prediction model was developed using logistic regression. The model performance was validated and compared with existing models using area under receiver operating curve (AUC) analysis. Results In the training set, age, gender, smoking duration, drinking frequency, and aspirin use were identified as independent predictors for advanced CRN (adjusted P < .01). The developed model had good discrimination (AUC = 0.726) and was internally validated (AUC = 0.713). The high-risk group had a 3.7-fold increased risk of advanced CRN compared to the low-risk group (1.1% vs. 4.0%, P < .001). The discrimination performance of the present model for high-risk patients with advanced CRN was better than that of the Asia-Pacific Colorectal Screening score (AUC = 0.678, P < .001) and Schroy’s CAN index (AUC = 0.672, P < .001). Conclusion The present 5-item risk model can be calculated readily using a simple questionnaire and can identify the low- and high-risk groups of advanced CRN at the first screening colonoscopy. This model may increase colorectal cancer risk awareness and assist healthcare providers in encouraging the high-risk group to undergo a colonoscopy.
Collapse
Affiliation(s)
- Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jung Son
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Center for Health Promotion, Samsung Medical Center, Seoul, South Korea
| | - Sun Kyu Choi
- Biostatistics and Bioinformatics Center, Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sin-Ho Jung
- Biostatistics and Bioinformatics Center, Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
16
|
The Association between Distal Findings and Proximal Colorectal Neoplasia: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:1234-1245. [PMID: 28555635 DOI: 10.1038/ajg.2017.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. METHODS We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with the I2 statistics. RESULTS We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89-1.51, P=0.14, I2=40%) or APN (OR=1.09, 95% CI=0.87-1.36, P=0.39, I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger's regression tests showed all P>0.05. CONCLUSIONS Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered.
Collapse
|
17
|
Adenoma Prevalence and Distribution Among US Latino Subgroups Undergoing Screening Colonoscopy. Dig Dis Sci 2017; 62:1637-1646. [PMID: 27913995 PMCID: PMC5731829 DOI: 10.1007/s10620-016-4381-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading malignancy diagnosed among US Latinos. Latinos in the USA represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Little is known about the frequency of CRC precursor lesions found at screening colonoscopy among Latino subgroups. AIM The aim was to determine the prevalence and distribution of histologically confirmed adenomas found at screening colonoscopy among average-risk, asymptomatic US Latinos according to their subgroup and socio-demographic background. METHODS Cross-sectional analysis of pathological findings resulting from screening colonoscopy among average-risk, asymptomatic US Latinos aged ≥50 in two prospective randomized controlled trials at an academic medical center. RESULTS Among the 561 Latinos who completed screening colonoscopy, the two largest subgroups were Puerto Ricans and Dominicans. The findings among both subgroups were: adenomas 30.6%, proximal adenomas 23.5%, advanced adenomas 12.0%, and proximal advanced adenomas 8.9%. These rates are at least as high as those found at screening colonoscopy among US whites. While Puerto Ricans were more likely than Dominicans to be born in the USA, speak English, be acculturated, have a smoking history, and be obese, there were no significant differences in adenoma rates between these subgroups. CONCLUSIONS The prevalence of adenomas, advanced adenomas, and proximal neoplasia was high among both subgroups. These findings have implications for CRC screening and surveillance among the increasingly growing Latino population in the USA.
Collapse
|
18
|
Liu Y, Wang Y, Hu F, Sun H, Zhang Z, Wang X, Luo X, Zhu L, Huang R, Li Y, Li G, Li X, Lin S, Wang F, Liu Y, Rong J, Yuan H, Zhao Y. Multiple gene-specific DNA methylation in blood leukocytes and colorectal cancer risk: a case-control study in China. Oncotarget 2017; 8:61239-61252. [PMID: 28977860 PMCID: PMC5617420 DOI: 10.18632/oncotarget.18054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
The relationship between gene-specific DNA methylation in peripheral blood leukocytes and colorectal cancer (CRC) susceptibility is unclear. In this case-control study, the methylation status of a panel of 10 CRC-related genes in 428 CRC cases and 428 cancer-free controls were detected with methylation-sensitive high-resolution melting analysis. We calculated a weighted methylation risk score (MRS) that comprehensively combined the methylation status of the panel of 10 genes and found that the MRS_10 was significantly associated with CRC risk. Compared with MRS-Low group, MRS-High group and MRS-Medium group exhibited a 6.51-fold (95% CI, 3.77-11.27) and 3.85-fold (95% CI, 2.72-5.45) increased risk of CRC, respectively. Moreover, the CRC risk increased with increasing MRS_10 (Ptrend < 0.0001). Stratified analyses demonstrated that the significant association retained in both men and women, younger and older, and normal weight or underweight and overweight or obese subjects. The area under the receiver operating characteristic curves for the MRS_10 model was 69.04% (95% CI, 65.57-72.66%) and the combined EF and MRS_10 model yielded an AUC of 79.12% (95% CI, 76.22-82.15%). Together, the panel of 10 gene-specific DNA methylation in leukocytes was strongly associated with the risk of CRC and might be a useful marker of susceptibility for CRC.
Collapse
Affiliation(s)
- Yupeng Liu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yibaina Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Fulan Hu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Hongru Sun
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Zuoming Zhang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xuan Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xiang Luo
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Lin Zhu
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Rong Huang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yan Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Guangxiao Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Xia Li
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Shangqun Lin
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Fan Wang
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yanhong Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Jiesheng Rong
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Huiping Yuan
- Key Laboratory of Ophthalmology, Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| | - Yashuang Zhao
- Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, Heilongjiang Province, The People's Republic of China
| |
Collapse
|
19
|
Magrath M, Yang E, Singal AG. Personalizing Colon Cancer Screening: Role of Age and Comorbid Conditions. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
Liwen Huang J, Chen P, Yuan X, Wu Y, Haoxiang Wang H, Chisang Wong M. An algorithm to predict advanced proximal colorectal neoplasia in Chinese asymptomatic population. Sci Rep 2017; 7:46493. [PMID: 28418028 PMCID: PMC5394471 DOI: 10.1038/srep46493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/15/2017] [Indexed: 12/22/2022] Open
Abstract
This study aims to develop and validate a new algorithm that incorporates distal colonoscopic findings to predict advanced proximal neoplasia (APN) in a Chinese asymptomatic population. We collected age, gender, and colonoscopic findings from a prospectively performed colonoscopy study between 2013 and 2015 in a large hospital-based endoscopy unit in Shanghai, China. Eligible subjects were allocated to a derivation group (n = 3,889) and validation group (n = 1,944) by random sampling. A new index for APN and its cut-off level were evaluated from the derivation cohort by binary logistic regression. The model performance was tested in the validation cohort using area under the curve (AUC). Age, gender, and distal finding were found to be independent predictors of APN in the derivation cohort (p < 0.001). Subjects were categorized into Average Risk (AR) and High Risk (HR) based on a cut-off score of 2. The AUC of the derivation and validation cohorts were 0.801 (0.754-0.847) and 0.722 (0.649-0.794), respectively. In the validation cohort, those in the HR group had a 3.57 fold higher risk of APN when compared with the AR group (P < 0.001), requiring 18 (95% CI = 12-28) follow-up colonoscopies to detect 1 APN. This new clinical index is useful to stratify APN risk in Chinese population.
Collapse
Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chen
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Xiaoqin Yuan
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Yunlin Wu
- Ruijin Hospital North, Shanghai Jiaotong University, Shanghai 201801, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Martin Chisang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People’s Republic of China
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, The People’s Republic of China
| |
Collapse
|
21
|
A New Scoring System to Predict the Risk for High-risk Adenoma and Comparison of Existing Risk Calculators. J Clin Gastroenterol 2017; 51:345-351. [PMID: 27322531 DOI: 10.1097/mcg.0000000000000576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans are not up to date with screening, and there is growing incidence of CRC in younger patients. GOALS We developed a practical prediction model for high-risk colon adenomas in an average-risk population, including an expanded definition of high-risk polyps (≥3 nonadvanced adenomas), exposing higher than average-risk patients. We also compared results with previously created calculators. STUDY Patients aged 40 to 59 years, undergoing first-time average-risk screening or diagnostic colonoscopies were evaluated. Risk calculators for advanced adenomas and high-risk adenomas were created based on age, body mass index, sex, race, and smoking history. Previously established calculators with similar risk factors were selected for comparison of concordance statistic (c-statistic) and external validation. RESULTS A total of 5063 patients were included. Advanced adenomas, and high-risk adenomas were seen in 5.7% and 7.4% of the patient population, respectively. The c-statistic for our calculator was 0.639 for the prediction of advanced adenomas, and 0.650 for high-risk adenomas. When applied to our population, all previous models had lower c-statistic results although one performed similarly. CONCLUSIONS Our model compares favorably to previously established prediction models. Age and body mass index were used as continuous variables, likely improving the c-statistic. It also reports absolute predictive probabilities of advanced and high-risk polyps, allowing for more individualized risk assessment of CRC.
Collapse
|
22
|
Barzi A, Lenz HJ, Quinn DI, Sadeghi S. Comparative effectiveness of screening strategies for colorectal cancer. Cancer 2017; 123:1516-1527. [PMID: 28117881 DOI: 10.1002/cncr.30518] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/24/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Screening for colorectal cancer (CRC) has been successful in decreasing the incidence and mortality from CRC. Although new screening tests have become available, their relative impact on CRC outcomes remains unexplored. This study compares the outcomes of various screening strategies on CRC outcomes. METHODS A Markov model representing the natural history of CRC was built and validated against empiric data from screening trials as well as the Microstimulation Screening Analysis (MISCAN) model. Thirteen screening strategies based on colonoscopy, sigmoidoscopy, computed tomographic colonography, as well as fecal immunochemical, occult blood, and stool DNA testing were compared with no screening. A simulated sample of the US general population ages 50 to 75 years with an average risk of CRC was followed for up to 35 years or until death. Effectiveness was measured by discounted life years gained and the number of CRCs prevented. Discounted costs and cost-effectiveness ratios were calculated. A discount rate of 3% was used in calculations. The study took a societal perspective. RESULTS Colonoscopy emerged as the most effective screening strategy with the highest life years gained (0.022 life years) and CRCs prevented (n = 1068) and the lowest total costs ($2861). These values were 0.012 life years gained, 574 CRCs prevented, and a total cost of $3164, respectively, for FOBT; and 0.011 life years gained, 647 CRCs prevented, and a total cost of $4296, respectively, for DNA testing. Improved sensitivity or specificity of a screening test for CRC detection was not sufficient to close the outcomes gap compared with colonoscopy. CONCLUSIONS Improvement in CRC-detection performance is not sufficient to improve screening outcomes. Special attention must be directed to detecting precancerous adenomas. Cancer 2017;123:1516-1527. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Afsaneh Barzi
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Heinz-Josef Lenz
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - David I Quinn
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Sarmad Sadeghi
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| |
Collapse
|
23
|
Lee JY, Park HW, Kim MJ, Lee JS, Lee HS, Chang HS, Choe J, Hwang SW, Yang DH, Myung SJ, Yang SK, Byeon JS. Prediction of the Risk of a Metachronous Advanced Colorectal Neoplasm Using a Novel Scoring System. Dig Dis Sci 2016; 61:3016-3025. [PMID: 27358228 DOI: 10.1007/s10620-016-4237-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/21/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM This study aimed to develop and validate a risk score model to estimate the probability of a metachronous advanced colorectal neoplasm (ACRN) at surveillance colonoscopy. METHODS A retrospective analysis of a prospectively obtained database of 11,042 asymptomatic subjects who underwent surveillance colonoscopy after a screening colonoscopy was conducted. Subjects were randomly divided into derivation (n = 7730) and validation sets (n = 3312). From the derivation cohort, risk factors for a metachronous ACRN were identified by a multivariable analysis. Risk points were allocated to each risk factor based on the hazard ratio to develop the Metachronous Advanced colorectal neoplasm Prediction Scoring (MAPS) model, the performance of which was assessed in the validation cohort. RESULTS In the derivation cohort, age, male, sessile serrated adenoma/polyp, and a high-risk CRN (ACRN or ≥3 adenomas) at screening colonoscopy were independent risk factors for a metachronous ACRN. These variables were incorporated into the MAPS model, and the risk score ranged 0-17 (high MAPS risk arbitrarily defined as 10-17). At the 3-year surveillance colonoscopy, ACRN was found in 5.1 % of the high MAPS risk group versus 3.9 % of the high-risk CRN group. The colonoscopy number needed to detect one metachronous ACRN at the 3-year surveillance was 19.5 (95 % CI 11.7-33.2) for the high MAPS risk group versus 25.8 (95 % CI 15.4-44.0) for the high-risk CRN group. These findings were similarly confirmed in the validation cohort. CONCLUSIONS Our MAPS model based on clinical and colonoscopic parameters effectively predicts the risk of a metachronous ACRN.
Collapse
Affiliation(s)
- Ji Young Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Hye Won Park
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Jong-Soo Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho-Su Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Hye-Sook Chang
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
| |
Collapse
|
24
|
Ladabaum U, Patel A, Mannalithara A, Sundaram V, Mitani A, Desai M. Predicting advanced neoplasia at colonoscopy in a diverse population with the National Cancer Institute colorectal cancer risk-assessment tool. Cancer 2016; 122:2663-70. [PMID: 27219715 DOI: 10.1002/cncr.30096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tailoring screening to colorectal cancer (CRC) risk could improve screening effectiveness. Most CRCs arise from advanced neoplasia (AN) that dwells for years. To date, no available colorectal neoplasia risk score has been validated externally in a diverse population. The authors explored whether the National Cancer Institute (NCI) CRC risk-assessment tool, which was developed to predict future CRC risk, could predict current AN prevalence in a diverse population, thereby allowing its use in risk stratification for screening. METHODS This was a prospective examination of the relation between predicted 10-year CRC risk and the prevalence of AN, defined as advanced or multiple (≥3 adenomatous, ≥5 serrated) adenomatous or sessile serrated polyps, in individuals undergoing screening colonoscopy. RESULTS Among 509 screenees (50% women; median age, 58 years; 61% white, 5% black, 10% Hispanic, and 24% Asian), 58 (11%) had AN. The prevalence of AN increased progressively from 6% in the lowest risk-score quintile to 17% in the highest risk-score quintile (P = .002). Risk-score distributions in individuals with versus without AN differed significantly (median, 1.38 [0.90-1.87] vs 1.02 [0.62-1.57], respectively; P = .003), with substantial overlap. The discriminatory accuracy of the tool was modest, with areas under the curve of 0.61 (95% confidence interval [CI], 0.54-0.69) overall, 0.59 (95% CI, 0.49-0.70) for women, and 0.63 (95% CI, 0.53-0.73) for men. The results did not change substantively when the analysis was restricted to adenomatous lesions or to screening procedures without any additional incidental indication. CONCLUSIONS The NCI CRC risk-assessment tool displays modest discriminatory accuracy in predicting AN at screening colonoscopy in a diverse population. This tool may aid shared decision-making in clinical practice. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2663-2670. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ashley Patel
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Vandana Sundaram
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Aya Mitani
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Manisha Desai
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
25
|
Nor Hashim NA, Ramzi NH, Velapasamy S, Alex L, Chahil JK, Lye SH, Munretnam K, Haron MR, Ler LW. Identification of genetic and non-genetic risk factors for nasopharyngeal carcinoma in a Southeast Asian population. Asian Pac J Cancer Prev 2016; 13:6005-10. [PMID: 23464394 DOI: 10.7314/apjcp.2012.13.12.6005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is endemic in Southern Chinese and Southeast Asian populations. Geographical and ethnic clustering of the cancer is due to genetic, environmental, and lifestyle risk factors. This case-control study aimed to identify or confirm both genetic and non-genetic risk factors for NPC in one of the endemic countries, Malaysia. MATERIALS AND METHOD A panel of 768 single-nucleotide polymorphisms (SNPs) previously associated with various cancers and known non-genetic risk factors for NPC were selected and analyzed for their associations with NPC in a case-control study. RESULTS Statistical analysis identified 40 SNPs associated with NPC risk in our population, including 5 documented previously by genome-wide association studies (GWAS) and other case-control studies; the associations of the remaining 35 SNPs with NPC were novel. In addition, consistent with previous studies, exposure to occupational hazards, overconsumption of salt-cured foods, red meat, as well as low intake of fruits and vegetables were also associated with NPC risk. CONCLUSIONS In short, this study confirmed and/or identified genetic, environmental and dietary risk factors associated with NPC susceptibility in a Southeast Asian population.
Collapse
Affiliation(s)
- Nikman Adli Nor Hashim
- Molecular Research and Services Laboratory, INFOVALLEY® Life Sciences Sdn. Mines Resort City, Selangor, Malaysia.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ruco A, Stock D, Hilsden RJ, McGregor SE, Paszat LF, Saskin R, Rabeneck L. Evaluation of a risk index for advanced proximal neoplasia of the colon. Gastrointest Endosc 2016; 81:1427-32. [PMID: 25771065 DOI: 10.1016/j.gie.2014.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/07/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND A clinical risk index that uses distal colorectal findings at flexible sigmoidoscopy (FS) in conjunction with easily determined risk factors for advanced proximal neoplasia (APN) may be useful for tailoring or prioritizing screening with colonoscopy. OBJECTIVE To conduct an external evaluation of a previously published risk index in a large, well-characterized cohort. DESIGN Cross-sectional. SETTING Teaching hospital and colorectal cancer screening center. PATIENTS A total of 5139 asymptomatic persons aged 50 to 74 (54.9% women) with a mean age (±SD) of 58.3 (±6.2) years. INTERVENTIONS Between 2003 and 2011, all participants underwent a complete screening colonoscopy and removal of all polyps. MAIN OUTCOME MEASUREMENTS Participants were classified as low, intermediate, or high risk for APN, based on their composite risk index scores. The concordance or c-statistic was used to measure discriminating ability of the risk index. RESULTS A total of 167 persons (3.2%) had APN. The prevalence of those with APN among low-, intermediate-, and high-risk categories was 2.1%, 2.9%, and 6.5%, respectively. High-risk individuals were 3.2 times more likely to have APN compared with those in the low-risk category. The index did not discriminate well between those in the low- and intermediate-risk categories. The c-statistic for the overall index was 0.62 (95% confidence interval, 0.58-0.66). LIMITATIONS Distal colorectal findings were derived from colonoscopies and not FS itself. CONCLUSION The risk index discriminated between those at low risk and those at high risk, but it had limited ability to discriminate between low- and intermediate-risk categories for prevalent APN. Information on other risk factors may be needed to tailor, or prioritize, access to screening colonoscopy.
Collapse
Affiliation(s)
- Arlinda Ruco
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - David Stock
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - S Elizabeth McGregor
- Population, Public & Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Lawrence F Paszat
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Colorectal Cancer Screening Based on Age and Gender: A Cost-Effectiveness Analysis. Medicine (Baltimore) 2016; 95:e2739. [PMID: 26962772 PMCID: PMC4998853 DOI: 10.1097/md.0000000000002739] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 01/27/2023] Open
Abstract
We evaluated whether age- and gender-based colorectal cancer screening is cost-effective.Recent studies in the United States identified age and gender as 2 important variables predicting advanced proximal neoplasia, and that women aged <60 to 70 years were more suited for sigmoidoscopy screening due to their low risk of proximal neoplasia. Yet, quantitative assessment of the incremental benefits, risks, and cost remains to be performed.Primary care screening practice (2008-2015).A Markov modeling was constructed using data from a screening cohort. The following strategies were compared according to the Incremental Cost Effectiveness Ratio (ICER) for 1 life-year saved: flexible sigmoidoscopy (FS) 5 yearly; colonoscopy 10 yearly; FS for each woman at 50- and 55-year old followed by colonoscopy at 60- and 70-year old; FS for each woman at 50-, 55-, 60-, and 65-year old followed by colonoscopy at 70-year old; FS for each woman at 50-, 55-, 60-, 65-, and 70-year old. All male subjects received colonoscopy at 50-, 60-, and 70-year old under strategies 3 to 5.From a hypothetical population of 100,000 asymptomatic subjects, strategy 2 could save the largest number of life-years (4226 vs 2268 to 3841 by other strategies). When compared with no screening, strategy 5 had the lowest ICER (US$42,515), followed by strategy 3 (US$43,517), strategy 2 (US$43,739), strategy 4 (US$47,710), and strategy 1 (US$56,510). Strategy 2 leads to the highest number of bleeding and perforations, and required a prohibitive number of colonoscopy procedures. Strategy 5 remains the most cost-effective when assessed with a wide range of deterministic sensitivity analyses around the base case.From the cost effectiveness analysis, FS for women and colonoscopy for men represent an economically favorable screening strategy. These findings could inform physicians and policy-makers in triaging eligible subjects for risk-based screening, especially in countries with limited colonoscopic resources. Future research should study the acceptability, feasibility, and feasibility of this risk-based strategy in different populations.
Collapse
Affiliation(s)
- Martin C S Wong
- From the Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China (MCSW, JYLC, VCWC, TYTL, AKCL, SHW, SCN, SSN, JCYW, FKLC, JJYS), and School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China (MCSW)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Wong MC, Ching JY, Chan VC, Tang RS, Luk AK, Lam TY, Wong SS, Ng SC, Ng SS, Wu JC, Chan FK, Sung JJ. Validation of a risk prediction score for proximal neoplasia in colorectal cancer screening: a prospective colonoscopy study. Sci Rep 2016; 6:20396. [PMID: 26854201 PMCID: PMC4745041 DOI: 10.1038/srep20396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/08/2015] [Indexed: 01/14/2023] Open
Abstract
This study developed a clinical scoring system to predict the risks of PN among screening participants for colorectal cancer. We recruited 5,789 Chinese asymptomatic screening participants who received colonoscopy in Hong Kong (2008-2014). From random sampling of 2,000 participants, the independent risk factors were evaluated for PN using binary regression analysis. The odds ratios for significant risk factors were used to develop a scoring system, with scores stratified into 'average risk' (AR):0-2 and 'high risk' (HR):3-5. The other 3,789 subjects formed an independent validation cohort. Each participant received a score calculated based on their risk factors. The performance of the scoring system was evaluated. The proportion of PN in the derivation and validation cohorts was 12.6% and 12.9%, respectively. Based on age, gender, family history, body mass index and self-reported ischaemic heart disease, 85.0% and 15.0% in the validation cohort were classified as AR and HR, respectively. Their prevalence of PN was 12.0% and 18.1%, respectively. Participants in the HR group had 1.51-fold (95% CI = 1.24-1.84, p < 0.001) higher risk of PN than the AR group. The overall c-statistics of the prediction model was 0.71(0.02). The scoring system is useful in predicting the risk of PN to prioritize patients for colonoscopy.
Collapse
Affiliation(s)
- Martin C.S. Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
- School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jessica Y.L. Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C.W. Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Raymond S.Y. Tang
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K.C. Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y.T. Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Sunny S.H. Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Siew C. Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Simon S.M. Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Justin C.Y. Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Francis K.L. Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J.Y. Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| |
Collapse
|
29
|
Wong MCS, Ching JYL, Ng S, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. The discriminatory capability of existing scores to predict advanced colorectal neoplasia: a prospective colonoscopy study of 5,899 screening participants. Sci Rep 2016; 6:20080. [PMID: 26838178 PMCID: PMC4738273 DOI: 10.1038/srep20080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/25/2015] [Indexed: 12/13/2022] Open
Abstract
We evaluated the performance of seven existing risk scoring systems in predicting advanced colorectal neoplasia in an asymptomatic Chinese cohort. We prospectively recruited 5,899 Chinese subjects aged 50–70 years in a colonoscopy screening programme(2008–2014). Scoring systems under evaluation included two scoring tools from the US; one each from Spain, Germany, and Poland; the Korean Colorectal Screening(KCS) scores; and the modified Asia Pacific Colorectal Screening(APCS) scores. The c-statistics, sensitivity, specificity, positive predictive values(PPVs), and negative predictive values(NPVs) of these systems were evaluated. The resources required were estimated based on the Number Needed to Screen(NNS) and the Number Needed to Refer for colonoscopy(NNR). Advanced neoplasia was detected in 364 (6.2%) subjects. The German system referred the least proportion of subjects (11.2%) for colonoscopy, whilst the KCS scoring system referred the highest (27.4%). The c-statistics of all systems ranged from 0.56–0.65, with sensitivities ranging from 0.04–0.44 and specificities from 0.74–0.99. The modified APCS scoring system had the highest c-statistics (0.65, 95% C.I. 0.58–0.72). The NNS (12–19) and NNR (5-10) were similar among the scoring systems. The existing scoring systems have variable capability to predict advanced neoplasia among asymptomatic Chinese subjects, and further external validation should be performed.
Collapse
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Simpson Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| |
Collapse
|
30
|
Wong MCS, Wong SH, Ng SC, Wu JCY, Chan FKL, Sung JJY. Targeted screening for colorectal cancer in high-risk individuals. Best Pract Res Clin Gastroenterol 2015; 29:941-51. [PMID: 26651255 DOI: 10.1016/j.bpg.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/02/2015] [Indexed: 01/31/2023]
Abstract
The idea of targeted screening for colorectal cancer based on risk profiles originates from its benefits to improve detection yield and optimize screening efficiency. Clinically, it allows individuals to be more aware of their own risk and make informed decisions on screening choice. From a public health perspective, the implementation of risk stratification strategies may better justify utilization of colonoscopic resources, and facilitate resource-planning in the formulation of population-based screening programmes. There are several at-risk groups who should receive earlier screening, and colonoscopy is more preferred. This review summarizes the currently recommended CRC screening strategies among subjects with different risk factors, and introduces existing risk scoring systems. Additional genetic, epidemiological, and clinical parameters may be needed to enhance their performance to risk-stratify screening participants. Future research studies should refine these scoring systems, and explore the adaptability, feasibility, acceptability, and user-friendliness of their use in clinical practice among different population groups.
Collapse
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China; JC School of Public Health and Primary Care, Chinese University of Hong Kong, 4/F, School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| |
Collapse
|
31
|
Ruco A, Stock D, Hilsden RJ, McGregor SE, Paszat LF, Saskin R, Rabeneck L. Evaluation of a clinical risk index for advanced colorectal neoplasia among a North American population of screening age. BMC Gastroenterol 2015; 15:162. [PMID: 26585867 PMCID: PMC4653881 DOI: 10.1186/s12876-015-0395-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022] Open
Abstract
Background A clinical risk index employing age, sex, family history of colorectal cancer (CRC), smoking history and body mass index (BMI) may be useful for prioritizing screening with colonoscopy. The aim of this study was to conduct an external evaluation of a previously published risk index for advanced neoplasia (AN) in a large, well-characterized cohort. Methods Five thousand one hundred thirty-seven asymptomatic persons aged 50 to 74 (54.9 % women) with a mean age (SD) of 58.3 (6.2) years were recruited for the study from a teaching hospital and colorectal cancer screening centre between 2003 and 2011. All participants underwent a complete screening colonoscopy and removal of all polyps. AN was defined as cancer or a tubular adenoma, traditional serrated adenoma (TSA), or sessile serrated adenoma (SSA) with villous characteristics (≥25% villous component), and/or high-grade dysplasia and/or diameter ≥10 mm. Risk scores for each participant were summed to derive an overall score (0–8). The c-statistic was used to measure discriminating ability of the risk index. Results The prevalence of AN in the study cohort was 6.8 %. The likelihood of detecting AN increased from 3.6 to 13.1 % for those with a risk score of 1 to 6 respectively. The c-statistic for the multivariable logistic model in our cohort was 0.64 (95 % CI = 0.61–067) indicating modest overlap between risk scores. Conclusions The risk index for AN using age, sex, family history, smoking history and BMI was found to be of limited discriminating ability upon external validation. The index requires further refinement to better predict AN in average risk persons of screening age.
Collapse
Affiliation(s)
- Arlinda Ruco
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - David Stock
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Robert J Hilsden
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - S Elizabeth McGregor
- Alberta Health Services - Population, Public & Aboriginal Health, Calgary, AB, Canada.
| | - Lawrence F Paszat
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, M5G 2L7, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
32
|
Han PKJ, Duarte CW, Daggett S, Siewers A, Killam B, Smith KA, Freedman AN. Effects of personalized colorectal cancer risk information on laypersons' interest in colorectal cancer screening: The importance of individual differences. PATIENT EDUCATION AND COUNSELING 2015; 98:1280-1286. [PMID: 26227576 PMCID: PMC4573248 DOI: 10.1016/j.pec.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/06/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate how personalized quantitative colorectal cancer (CRC) risk information affects laypersons' interest in CRC screening, and to explore factors influencing these effects. METHODS An online pre-post experiment was conducted in which a convenience sample (N=578) of laypersons, aged >50, were provided quantitative personalized estimates of lifetime CRC risk, calculated by the National Cancer Institute Colorectal Cancer Risk Assessment Tool (CCRAT). Self-reported interest in CRC screening was measured immediately before and after CCRAT use; sociodemographic characteristics and prior CRC screening history were also assessed. Multivariable analyses assessed participants' change in interest in screening, and subgroup differences in this change. RESULTS Personalized CRC risk information had no overall effect on CRC screening interest, but significant subgroup differences were observed. Change in screening interest was greater among individuals with recent screening (p=.015), higher model-estimated cancer risk (p=.0002), and lower baseline interest (p<.0001), with individuals at highest baseline interest demonstrating negative (not neutral) change in interest. CONCLUSION Effects of quantitative personalized CRC risk information on laypersons' interest in CRC screening differ among individuals depending on prior screening history, estimated cancer risk, and baseline screening interest. PRACTICE IMPLICATIONS Personalized cancer risk information has personalized effects-increasing and decreasing screening interest in different individuals.
Collapse
Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, USA.
| | - Christine W Duarte
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, USA
| | | | - Andrea Siewers
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, USA
| | | | - Kahsi A Smith
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, USA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
33
|
Imperiale TF, Monahan PO, Stump TE, Glowinski EA, Ransohoff DF. Derivation and Validation of a Scoring System to Stratify Risk for Advanced Colorectal Neoplasia in Asymptomatic Adults: A Cross-sectional Study. Ann Intern Med 2015; 163:339-46. [PMID: 26259154 PMCID: PMC4840411 DOI: 10.7326/m14-1720] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several methods are recommended equally strongly for colorectal cancer screening in average-risk persons. Risk stratification would enable tailoring of screening within this group, with less invasive tests (sigmoidoscopy or occult blood tests) for lower-risk persons and colonoscopy for higher-risk persons. OBJECTIVE To create a risk index for advanced neoplasia (colorectal cancer and adenomas or serrated polyps ≥1.0 cm, villous histology, or high-grade dysplasia) anywhere in the colorectum, using the most common risk factors for colorectal neoplasia. DESIGN Cross-sectional study. SETTING Multiple endoscopy units, primarily in the Midwest. PATIENTS Persons aged 50 to 80 years undergoing initial screening colonoscopy (December 2004 to September 2011). MEASUREMENTS Derivation and validation of a risk index based on points from regression coefficients for age, sex, waist circumference, cigarette smoking, and family history of colorectal cancer. RESULTS Among 2993 persons in the derivation set, prevalence of advanced neoplasia was 9.4%. Risks for advanced neoplasia in persons at very low, low, intermediate, and high risk were 1.92% (95% CI, 0.63% to 4.43%), 4.88% (CI, 3.79% to 6.18%), 9.93% (CI, 8.09% to 12.0%), and 24.9% (CI, 21.1% to 29.1%), respectively (P < 0.001). Sigmoidoscopy to the descending colon in the low-risk groups would have detected 51 of 70 (73% [CI, 61% to 83%]) advanced neoplasms. Among 1467 persons in the validation set, corresponding risks for advanced neoplasia were 1.65% (CI, 0.20% to 5.84%), 3.31% (CI, 2.08% to 4.97%), 10.9% (CI, 8.26% to 14.1%), and 22.3% (CI, 16.9% to 28.5%), respectively (P < 0.001). Sigmoidoscopy would have detected 21 of 24 (87.5% [CI, 68% to 97%]) advanced neoplasms. LIMITATIONS Split-sample validation; results apply to first-time screening. CONCLUSION This index stratifies risk for advanced neoplasia among average-risk persons by identifying lower-risk groups for which noncolonoscopy strategies may be effective and efficient and a higher-risk group for which colonoscopy may be preferred. PRIMARY FUNDING SOURCE National Cancer Institute, Walther Cancer Institute, Indiana University Simon Cancer Center, and Indiana Clinical and Translational Sciences Institute.
Collapse
Affiliation(s)
- Thomas F. Imperiale
- From Indiana University School of Medicine, Regenstrief Institute, Indiana University Melvin and Bren Simon Cancer Center, Richard L. Roudebush Veterans Affairs Medical Center, and Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick O. Monahan
- From Indiana University School of Medicine, Regenstrief Institute, Indiana University Melvin and Bren Simon Cancer Center, Richard L. Roudebush Veterans Affairs Medical Center, and Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy E. Stump
- From Indiana University School of Medicine, Regenstrief Institute, Indiana University Melvin and Bren Simon Cancer Center, Richard L. Roudebush Veterans Affairs Medical Center, and Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth A. Glowinski
- From Indiana University School of Medicine, Regenstrief Institute, Indiana University Melvin and Bren Simon Cancer Center, Richard L. Roudebush Veterans Affairs Medical Center, and Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David F. Ransohoff
- From Indiana University School of Medicine, Regenstrief Institute, Indiana University Melvin and Bren Simon Cancer Center, Richard L. Roudebush Veterans Affairs Medical Center, and Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
34
|
Wong MCS, Ching JYL, Ng SC, Wong S, Chan VCW, Shum JP, Lam TYT, Luk AKC, Sung JJY. Prediction of proximal advanced neoplasia: a comparison of four existing sigmoidoscopy-based strategies in a Chinese population. Gut 2015; 64:776-83. [PMID: 25179812 DOI: 10.1136/gutjnl-2014-308002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/12/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the performance of existing sigmoidoscopy-based strategies in predicting advanced proximal neoplasia (APN) in an asymptomatic Chinese cohort. DESIGN We included all screening participants aged 50-70 years who received colonoscopy between 2008 and 2014 in Hong Kong. Sigmoidoscopy yield was estimated from the colonoscopic findings based on the: (1) UK flexible sigmoidoscopy; (2) Screening for COlon REctum (SCORE); (3) NORwegian Colorectal Cancer Prevention (NORCCAP) trials and (4) US clinical index based on age, gender and distal findings. The sensitivity, specificity, the number of subjects needed to screen (NNS) and the number of subjects needed to refer (NNR) for colonoscopy to detect one APN were evaluated. Binary logistic regression modelling identified the distal findings associated with APN. RESULTS From 5879 eligible subjects, 132 (2.2%) had APN. The US strategy achieved the highest sensitivity for APN detection (42.0%) and the UK criteria attained the highest specificity (96%). The US criteria led to the lowest NNS (92 vs 103-267) and the UK criteria required the least NNR (12 vs 16-21). Using the US strategy, the rates of APN detected were 1.4% (low-risk group), 2.2% (intermediate risk) and 5.9% (high risk). The c-statistics of the UK, SCORE, NORCCAP and the US criteria were 0.55±0.03; 0.59±0.03; 0.59±0.03 and 0.62±0.05 respectively. CONCLUSIONS The US criteria had the highest sensitivity for detection of APN and lowest NNS and the UK score had the highest specificity and the lowest NNR. The performance of all these four criteria to predict APN is limited, highlighting an urgent need to devise a novel APN prediction system for Asian subjects.
Collapse
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Therapeutics, State Key laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Therapeutics, State Key laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeffrey P Shum
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
35
|
Cao Y, Rosner BA, Ma J, Tamimi RM, Chan AT, Fuchs CS, Wu K, Giovannucci EL. Assessing individual risk for high-risk colorectal adenoma at first-time screening colonoscopy. Int J Cancer 2015; 137:1719-1728. [PMID: 25820865 DOI: 10.1002/ijc.29533] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/26/2015] [Accepted: 03/12/2015] [Indexed: 12/13/2022]
Abstract
Assessing risk of colorectal adenoma at first-time colonoscopy that are of higher likelihood of developing advanced neoplasia during surveillance could help tailor first-line colorectal cancer screening. We developed prediction models for high-risk colorectal adenoma (at least one adenoma ≥1 cm, or with advanced histology, or ≥3 adenomas) among 4,881 asymptomatic white men and 17,970 women who underwent colonoscopy as their first-time screening for colorectal cancer in two prospective US studies using logistic regressions. C-statistics and Hosmer-Lemeshow tests were used to evaluate discrimination and calibration. Ten-fold cross-validation was used for internal validation. A total of 330 (6.7%) men and 678 (3.8%) women were diagnosed with high-risk adenoma at first-time screening colonoscopy. The model for men included age, family history of colorectal cancer, BMI, smoking, sitting watching TV/VCR, regular aspirin/NSAID use, physical activity, and a joint term of multivitamin and alcohol. For women, the model included age, family history of colorectal cancer, BMI, smoking, alcohol, beef/pork/lamb as main dish, regular aspirin/NSAID, calcium, and oral contraceptive use. The C-statistic of the model for men was 0.67 and 0.60 for women (0.64 and 0.57 in cross-validation). Both models calibrated well. The predicted risk of high-risk adenoma for men in the top decile was 15.4% vs. 1.8% for men in the bottom decile (Odds Ratio [OR] = 9.41), and 6.6% vs. 2.1% for women (OR = 3.48). In summary, we developed and internally validated an absolute risk assessment tool for high-risk colorectal adenoma among the US population that may provide guidance for first-time colorectal cancer screening.
Collapse
Affiliation(s)
- Yin Cao
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jing Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andrew T Chan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Charles S Fuchs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
36
|
Shaukat A, Church TR, Shanley R, Kauff ND, O'Brien MJ, Mills GM, Jordan PA, Allen JA, Kim A, Feld AD, Zauber AG, Winawer SJ. Development and validation of a clinical score for predicting risk of adenoma at screening colonoscopy. Cancer Epidemiol Biomarkers Prev 2015; 24:913-20. [PMID: 25800242 DOI: 10.1158/1055-9965.epi-14-1321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/09/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Currently, no clinical tools use demographic and risk factor information to predict the risk of finding an adenoma in individuals undergoing colon cancer screening. Such a tool would be valuable for identifying those who would most benefit from screening colonoscopy. METHODS We used baseline data from men and women who underwent screening colonoscopy from the randomized, multicenter National Colonoscopy Study (NCS) to develop and validate an adenoma risk model. The study, conducted at three sites in the United States (Minneapolis, MN; Seattle, WA; and Shreveport, LA) asked all participants to complete baseline questionnaires on clinical risk factors and family history. Model parameters estimated from logistic regression yielded an area under the receiver operating characteristic curve (AUROCC) used to assess prediction. RESULTS Five hundred forty-one subjects were included in the development model, and 1,334 in the validation of the risk score. Variables in the prediction of adenoma risk for colonoscopy screening were age (likelihood ratio test for overall contribution to model, P < 0.001), male sex (P < 0.001), body mass index (P < 0.001), family history of at least one first-degree relative with colorectal cancer (P = 0.036), and smoking history (P < 0.001). The adjusted AUROCC of 0.67 [95% confidence interval (CI), 0.61-0.74] for the derivation cohort was not statistically significantly different from that in the validation cohort. The adjusted AUROCC for the entire cohort was 0.64 (95% CI, 0.60-0.67). CONCLUSION We developed and validated a simple well-calibrated risk score. IMPACT This tool may be useful for estimating risk of adenomas in screening eligible men and women.
Collapse
Affiliation(s)
- Aasma Shaukat
- Section of Gastroenterology, VA Medical Center, Minneapolis, Minnesota. Department of Medicine, Yale University, New Haven, Connecticut.
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Ryan Shanley
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Noah D Kauff
- Ovarian Cancer Screening and Prevention, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michael J O'Brien
- Department of Pathology and Laboratory Medicine, Boston University, Boston, Massachusetts
| | - Glenn M Mills
- Section of Hematology and Oncology, Louisiana State University Health, Shreveport, Louisiana
| | - Paul A Jordan
- Department of Medicine, Louisiana State University Health, Shreveport, Louisiana
| | - John A Allen
- Department of Medicine, Yale University, New Haven, Connecticut. Minnesota Gastroenterology, PA, Minneapolis, Minnesota
| | - Adam Kim
- Minnesota Gastroenterology, PA, Minneapolis, Minnesota
| | - Andrew D Feld
- Department of Gastroenterology, Group Health Cooperative, Seattle, Washington
| | - Ann Graham Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sidney J Winawer
- Department of Gastroenterology and Nutrition Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
37
|
Bortniker E, Anderson JC. Do recent epidemiologic observations impact who and how we should screen for CRC? Dig Dis Sci 2015; 60:781-94. [PMID: 25492505 DOI: 10.1007/s10620-014-3467-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/26/2014] [Indexed: 12/18/2022]
Abstract
Colorectal cancer (CRC) screening is recommended to begin at age 50 for those patients with no significant family history of CRC. However, even within this group of average-risk patients, there is data to suggest that there may be variation in CRC risk. These observations suggest that perhaps CRC screening should be tailored to target those patients at higher risk for earlier or more invasive screening as compared to those individuals at lower risk. The strategy of how to identify those higher-risk patients may not be straightforward. One method might be to use single risk factors such as smoking or elevated BMI as has been suggested in the recent American College of Gastroenterology CRC screening guidelines. Another paradigm involves the use of models which incorporate several risk factors to stratify patients by risk. This article will highlight recent large studies that examine recognized CRC risk factors as well as review recently developed CRC risk models. There will also be a discussion of the application of these factors and models in an effort to make CRC screening more efficient.
Collapse
Affiliation(s)
- Ethan Bortniker
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | | |
Collapse
|
38
|
Benamouzig R. Prediction of Colorectal Cancer or Colonic Neoplasia Risk: From Symptoms to Scores. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-014-0254-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
39
|
Olsen CM, Neale RE, Green AC, Webb PM, The QSkin Study, The Epigene Study, Whiteman DC. Independent validation of six melanoma risk prediction models. J Invest Dermatol 2014; 135:1377-1384. [PMID: 25548858 DOI: 10.1038/jid.2014.533] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/18/2014] [Accepted: 12/09/2014] [Indexed: 11/10/2022]
Abstract
Identifying people at high risk of melanoma is important for targeted prevention activities and surveillance. Several tools have been developed to classify melanoma risk, but few have been independently validated. We assessed the discriminatory performance of six melanoma prediction tools by applying them to individuals from two independent data sets, one comprising 762 melanoma cases and the second a population-based sample of 42,116 people without melanoma. We compared the model predictions with actual melanoma status to measure sensitivity and specificity. The performance of the models was variable with sensitivity ranging from 97.7 to 10.5% and specificity from 99.6 to 1.3%. The ability of all the models to discriminate between cases and controls, however, was generally high. The model developed by MacKie et al. (1989) had higher sensitivity and specificity for men (0.89 and 0.88) than women (0.79 and 0.72). The tool developed by Cho et al. (2005) was highly specific (men, 0.92; women, 0.99) but considerably less sensitive (men, 0.64; women, 0.37). Other models were either highly specific but lacked sensitivity or had low to very low specificity and higher sensitivity. Poor performance was partly attributable to the use of non-standardized assessment items and various differing interpretations of what constitutes "high risk".
Collapse
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rachel E Neale
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adèle C Green
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Cancer Research UK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Penelope M Webb
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - The QSkin Study
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - The Epigene Study
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David C Whiteman
- Cancer Control Group, Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| |
Collapse
|
40
|
Wong MCS, Ching JYL, Chan VCW, Shum JP, Lam TYT, Luk AKC, Sung JJY. Should prior FIT results be incorporated as an additional variable to estimate risk of colorectal neoplasia? A prospective study of 5,813 screening colonoscopies. PLoS One 2014; 9:e114332. [PMID: 25479102 PMCID: PMC4257562 DOI: 10.1371/journal.pone.0114332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/06/2014] [Indexed: 02/06/2023] Open
Abstract
Background Recent studies showed that previous negative results from faecal immunochemical tests (FITs) for colorectal cancer (CRC) screening was associated with lower risk of advanced neoplasia (AN). We evaluated whether prior FIT results should be included to estimate the risk of AN in 2008–2012. Methods A community-based screening practice recruited 5,813 asymptomatic residents aged 50 to 70 years in Hong Kong for CRC screening. We included study participants who had (1). positive FIT with subsequent colonoscopy workup (FIT+ group; n = 356); (2). negative FIT in three consecutive years and received a colonoscopy (FIT- group; n = 857); (3). received colonoscopy without FIT (colonoscopy group; n = 473); and (4). received both colonoscopy and FIT at the same time (combined group; n = 4,127). One binary logistic regression model evaluated whether prior FIT results were associated with colonoscopy findings of AN. Results The proportion of participants having AN/CRC was 18.0% (FIT+), 5.5% (FIT-), 8.0% (colonoscopy group), and 4.3% (combined group), respectively. When compared with the colonoscopy group, those in the FIT- group were not significantly more or less likely to have AN/CRC (AOR = 0.77, 95% C.I. = 0.51 to 1.18, p = 0.230). Having one (AOR = 0.73, 95% C.I. 0.48–1.12, p = 0.151) or three consecutive negative FIT result (AOR = 0.98, 95% C.I. 0.60–1.62, p = 0.944) were not associated with lower risks of AN/CRC. Subjects in the FIT+ group was 3.32-fold (95% C.I. 2.07 to 5.32, p<0.001) more likely to have AN/CRC. Conclusions These findings indicated that subjects with negative FIT findings could be risk stratified similarly as those who had not previously received FIT.
Collapse
Affiliation(s)
- Martin C. S. Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
| | - Jessica Y. L. Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Victor C. W. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey P. Shum
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y. T. Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Arthur K. C. Luk
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J. Y. Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
41
|
Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Identification of subjects at risk of proximal advanced neoplasia for colorectal cancer screening. Eur J Cancer 2014; 51:37-44. [PMID: 25459390 DOI: 10.1016/j.ejca.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
Flexible sigmoidoscopy (FS) and colonoscopy are two commonly used screening tools for colorectal cancer (CRC), and FS mainly detects distal lesions. Colonoscopy resource is limited, yet there is no definite evidence on when flexible sigmoidoscopy is suitable as a screening alternative. This study evaluated the optimal cut-off score from a validated risk stratification system which best predicts proximal advanced neoplasia (PAN) by comparing the sensitivity, specificity and relative risk of PAN according to various cut-off scores. 5819 asymptomatic subjects aged between 50 and 70years (average age 57.7years, standard deviation (SD) 4.9) received colonoscopy between 2008 and 2014 in Hong Kong. Their prevalence of PAN was evaluated according to a prediction tool for colorectal neoplasia based on age, gender, smoking status, family history of CRC, body mass index (BMI) and diabetes (ranging from 0 to 6). One binary logistic regression model was performed with PAN as the outcome variable and the risk score as the variable tested for association. In multivariate regression analysis, risk score ⩾3 was associated with significantly higher risk of PAN (3.4-9.1%; AOR=3.18-8.09, p<0.001) when compared with those scoring 0. Risk scores 0-2 were associated with either insignificant or lower risks of PAN compared to the overall risk. Applying FS for screening those who scored 0-2 and colonoscopy for those who scored ⩾3 led to a very small proportion of PAN being missed (1.60%), whilst maintaining a high level of specificity (81.9%). Clinicians may use this scoring system to inform subjects and facilitate their choice between colonoscopy and FS.
Collapse
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region; School of Public Health and Primary Care, Chinese University of Hong Kong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region.
| |
Collapse
|
42
|
Abstract
The incidence of melanoma continues to rise in most fair-skinned populations. Strategies to curb the toll from melanoma include targeting the patients who are at highest risk with the aim of either preventing the onset of cancer or intervening early in order to improve survival. The challenge has been to synthesize the available information on risk factors into prediction tools with clinical utility, such that 'high-risk' patients can be identified with accuracy. While a number of risk prediction tools for melanoma have been developed, few have undergone rigorous evaluation of their performance in order to assess calibration or discrimination, and even fewer have been validated in independent populations. Future research should assess the validity of existing tools and seek to integrate the increasing volumes of data being generated by genomic studies.
Collapse
Affiliation(s)
- David Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, PO Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
43
|
Ma GK, Ladabaum U. Personalizing colorectal cancer screening: a systematic review of models to predict risk of colorectal neoplasia. Clin Gastroenterol Hepatol 2014; 12:1624-34.e1. [PMID: 24534546 DOI: 10.1016/j.cgh.2014.01.042] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A valid risk prediction model for colorectal neoplasia would allow patients to be screened for colorectal cancer (CRC) on the basis of risk. We performed a systematic review of studies reporting risk prediction models for colorectal neoplasia. METHODS We conducted a systematic search of MEDLINE, Scopus, and Cochrane Library databases from January 1990 through March 2013 and of references in identified studies. Case-control, cohort, and cross-sectional studies that developed or attempted to validate a model to predict risk of colorectal neoplasia were included. Two reviewers independently extracted data and assessed model quality. Model quality was considered to be good for studies that included external validation, fair for studies that included internal validation, and poor for studies with neither. RESULTS Nine studies developed a new prediction model, and 2 tested existing models. The models varied with regard to population, predictors, risk tiers, outcomes (CRC or advanced neoplasia), and range of predicted risk. Several included age, sex, smoking, a measure of obesity, and/or family history of CRC among the predictors. Quality was good for 6 models, fair for 2 models, and poor for 1 model. The tier with the largest population fraction (low, intermediate, or high risk) depended on the model. For most models that defined risk tiers, the risk difference between the highest and lowest tier ranged from 2-fold to 4-fold. Two models reached the 0.70 threshold for the C statistic, typically considered to indicate good discriminatory power. CONCLUSIONS Most current colorectal neoplasia risk prediction models have relatively weak discriminatory power and have not demonstrated generalizability. It remains to be determined how risk prediction models could inform CRC screening strategies.
Collapse
Affiliation(s)
- Gene K Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Uri Ladabaum
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
44
|
Advanced proximal neoplasia of the colon in average-risk adults. Gastrointest Endosc 2014; 80:660-667. [PMID: 24679656 DOI: 10.1016/j.gie.2014.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Estimating risk for advanced proximal neoplasia (APN) based on distal colon findings can help identify asymptomatic persons who should undergo examination of the proximal colon after flexible sigmoidoscopy (FS) screening. OBJECTIVE We aimed to determine the risk of APN by most advanced distal finding among an average-risk screening population. DESIGN Prospective, cross-sectional study. SETTING Teaching hospital and colorectal cancer screening center. PATIENTS A total of 4651 asymptomatic persons at average risk for colorectal cancer aged 50 to 74 years (54.4% women [n = 2529] with a mean [± standard deviation] age of 58.4 ± 6.2 years). INTERVENTIONS All participants underwent a complete colonoscopy, including endoscopic removal of all polyps. MAIN OUTCOME MEASUREMENTS We explored associations between several risk factors and APN. Logistic regression was used to identify independent predictors of APN. RESULTS A total of 142 persons (3.1%) had APN, of whom 85 (1.8%) had isolated APN (with no distal findings). APN was associated with older age, a BMI >27 kg/m(2), smoking, distal advanced adenoma and/or cancer, and distal non-advanced tubular adenoma. Those with a distal advanced neoplasm were more than twice as likely to have APN compared with those without distal lesions. LIMITATIONS Distal findings used to estimate risk of APN were derived from colonoscopy rather than FS itself. CONCLUSION In persons at average risk for colorectal cancer, the prevalence of isolated APN was low (1.8%). Use of distal findings to predict APN may not be the most effective strategy. However, incorporating factors such as age (>65 years), sex, BMI (>27 kg/m(2)), and smoking status, in addition to distal findings, should be considered for tailoring colonoscopy recommendations. Further evaluation of risk stratification approaches in other asymptomatic screening populations is warranted.
Collapse
|
45
|
Imperiale TF, Juluri R, Sherer EA, Glowinski EA, Johnson CS, Morelli MS. A risk index for advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps. Gastrointest Endosc 2014; 80:471-8. [PMID: 24890416 DOI: 10.1016/j.gie.2014.03.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting the risk of advanced colorectal neoplasia on the second surveillance colonoscopy could help tailor surveillance. OBJECTIVE To derive and validate a risk index for advanced neoplasia on the second surveillance colonoscopy. DESIGN Retrospective cohort. SETTING Single-specialty practice; Veterans Affairs Medical Center. PATIENTS A total of 965 patients with baseline adenomatous polyps, 2 surveillance colonoscopies, and no reported family history of colorectal cancer; validation cohort of 372. INTERVENTIONS Multivariable logistic regression including demographics and previous colonoscopy results; derivation and validation of a risk index. MAIN OUTCOME MEASUREMENTS Advanced adenoma (≥1 cm in size, villous histology, or high-grade dysplasia) on the second surveillance colonoscopy. RESULTS Mean age was 57.8 ± 9.8 years, 62% were men, and 36% had an advanced adenoma on the index colonoscopy. Associated with advanced adenoma on the second surveillance colonoscopy were age at index colonoscopy (scored 0 for younger than 55 years of age, 1 for 55-59 years of age, 2 for 60-64 years of age, and 3 for older than 65 years of age) and previous findings (non-neoplastic, nonadvanced, advanced [scored 0, 1, and 2, respectively]) on index colonoscopy and the first surveillance colonoscopy, with scores ranging from 1 to 7. Risks of advanced adenoma on the second surveillance colonoscopy with scores of 5 or less and more than 5 were 4.8% (95% confidence interval, 3.5%-6.4%) and 14.9% (95% confidence interval, 7.4%-25.7%), respectively, comprising 93% and 7%, respectively, of the cohort. Corresponding results in the validation cohort were 5.6% and 19.2%, respectively, comprising 86.1% and 13.9%, respectively, of the cohort. LIMITATIONS Retrospective study with potential for selection bias. CONCLUSION This index stratifies the risk of advanced adenoma on the second surveillance colonoscopy. If validated independently, it may be useful for tailoring surveillance.
Collapse
Affiliation(s)
- Thomas F Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Inc, Indianapolis, Indiana, USA; Center of Excellence for Implementation of Evidence-based Practice, Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Ravi Juluri
- Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Eric A Sherer
- Department of Chemical Engineering, Louisiana Tech University, Ruston, Louisiana, USA
| | - Elizabeth A Glowinski
- Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| | - Michael S Morelli
- Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
46
|
Talluri R, Wilkinson AV, Spitz MR, Shete S. A risk prediction model for smoking experimentation in Mexican American youth. Cancer Epidemiol Biomarkers Prev 2014; 23:2165-74. [PMID: 25063521 DOI: 10.1158/1055-9965.epi-14-0467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation. METHODS A prospective population-based cohort of 1,179 adolescents of Mexican descent was followed for 5 years starting in 2005-06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008-09 and 2010-11. The primary endpoint of interest in this study was smoking experimentation. Information about social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, and household influences) was collected at baseline using validated questionnaires. RESULTS Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.719 (95% confidence interval, 0.637-0.801) for predicting absolute risk for smoking experimentation within 1 year. CONCLUSIONS The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents. IMPACT Accurately identifying Mexican American adolescents who are at higher risk for smoking experimentation who can be intervened will substantially reduce the incidence of smoking and thereby subsequent health risks.
Collapse
Affiliation(s)
- Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna V Wilkinson
- The University of Texas School of Public Health, Austin Regional Campus, Austin, Texas
| | | | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
47
|
Wong MCS, Lam TYT, Tsoi KKF, Hirai HW, Chan VCW, Ching JYL, Chan FKL, Sung JJY. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects. Gut 2014; 63:1130-6. [PMID: 24045331 DOI: 10.1136/gutjnl-2013-305639] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aim to develop and validate a clinical scoring system to predict the risks of colorectal neoplasia to better inform screening participants and facilitate their screening test choice. DESIGN We recruited 5220 Chinese asymptomatic screening participants who underwent colonoscopy in Hong Kong during 2008-2012. From random sampling of 2000 participants, independent risk factors were evaluated for colorectal neoplasia, defined as adenoma, advanced neoplasia, colorectal cancer or any combination thereof using binary regression analysis. The ORs for significant risk factors were used to develop a scoring system ranging from 0 to 6: 0-2 'average risk' (AR) and 3-6 'high risk' (HR). The other 3220 screening participants prospectively enrolled between 2008 and 2012 for screening colonoscopy formed an independent validation cohort. The performance of the scoring system for predicting colorectal neoplasia was evaluated. RESULTS The prevalence of colorectal neoplasia in the derivation and validation cohorts was 31.4% and 30.8%, respectively. Using the scoring system developed, 78.9% and 21.1% in the validation cohort were classified as AR and HR, respectively. The prevalence of colorectal neoplasia in the AR and HR groups was 27.1% and 44.6%, respectively. The subjects in the HR group had 1.65-fold (95% CI 1.49 to 1.83) increased prevalence of colorectal neoplasia than the AR group. CONCLUSIONS The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia.
Collapse
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kelvin K F Tsoi
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoyee W Hirai
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
48
|
Kiedrowski M, Mroz A, Kaminski MF, Kraszewska E, Orlowska J, Regula J. Predictive factors of proximal advanced neoplasia in the large bowel. Arch Med Sci 2014; 10:484-9. [PMID: 25097578 PMCID: PMC4107244 DOI: 10.5114/aoms.2013.38394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/15/2013] [Accepted: 06/23/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the impact of sex, age, family history and distal findings on the risk of proximal advanced neoplasia (cancer or advanced adenoma) in the large bowel. MATERIAL AND METHODS Records for 10 111 asymptomatic participants of the Colonoscopy Screening Program (CSP), recruited from the Warsaw region between 2000 and 2004, were analyzed. A multivariate logistic regression model was used to estimate the impact of sex, age, family history and most advanced distal lesions on the occurrence of proximal advanced neoplasia. To enhance comparability of the study two definitions of the proximal colon were applied - either the splenic flexure (1(st)) or the bend between the descending and sigmoid colon (2(nd) definition) represented the boundary. RESULTS One hundred and thirty-three (1(st)) and 167 patients (2(nd) definition) were found to have at least one advanced neoplastic lesion in the proximal part, respectively. Eleven and 14 patients were found to have carcinoma, while in 130 and 163 patients at least one proximal advanced adenoma appeared. Men were at twice as high risk of having advanced neoplasia in the proximal colon than women (OR = 1.94, 95% CI: 1.31-2.87, p = 0.001 or OR = 1.69, 95% CI: 1.20-2.40, p = 0.003, respectively). The presence of distal advanced neoplastic lesions was associated with 3.5 times higher risk of proximal advanced neoplasia (OR = 3.58, 95% CI: 2.00-6.43, p < 0.0001 or OR = 3.41, 95% CI: 1.95-5.96, p < 0.0001), respectively. CONCLUSIONS The results may confirm some limitation of flexible sigmoidoscopy in the screening settings in comparison with colonoscopy, at least in men and people with distal advanced neoplasia.
Collapse
Affiliation(s)
- Miroslaw Kiedrowski
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Andrzej Mroz
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Michal F. Kaminski
- Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Ewa Kraszewska
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Janina Orlowska
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jaroslaw Regula
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
- Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| |
Collapse
|
49
|
Ait Ouakrim D, Lockett T, Boussioutas A, Hopper JL, Jenkins MA. Screening participation for people at increased risk of colorectal cancer due to family history: a systematic review and meta-analysis. Fam Cancer 2014; 12:459-72. [PMID: 23700069 DOI: 10.1007/s10689-013-9658-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a systematic review and a meta-analysis of observational studies to identify and summarise the level of colorectal cancer (CRC) screening participation for people at increased risk due to family history of the disease. Medline, Cinhal, Embase and PsychInfo databases were comprehensively searched between January 1995 and May 2012 to identify relevant articles. To be included, studies had to report on screening for people who had at least one first-degree relative with CRC and no previous personal diagnosis of the disease. Pooled screening participation levels were calculated for each screening modality. Seventeen studies, accounting for a total of 13,269 subjects with a family history of CRC met the inclusion criteria. Seven studies, including a total of 6,901 subjects had a pooled faecal occult blood testing screening participation (at least once) of 25 % (95 % CI 12-38). Five studies including a total of 5,091 subjects had a pooled sigmoidoscopy-based screening participation (at least once) of 16 % (95 % CI 7-27). Seven studies including a total of 9,965 subjects had pooled participation colonoscopy-based screening (at least once) of 40 % (95 % CI 26-54). There was a significant level of screening heterogeneity between studies. This review identified a substantial underuse of CRC screening for people at increased risk of developing the disease. It highlights the potential opportunity that exists for increasing screening participation among this segment of the population and the need to adjust the current CRC screening policies towards that objective.
Collapse
Affiliation(s)
- Driss Ait Ouakrim
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Carlton, VIC, 3010, Australia,
| | | | | | | | | |
Collapse
|
50
|
Cap-assisted gastroscope versus cap-assisted colonoscope for examination of difficult sigmoid colons in a nonsedated Asian population: a randomized study. Gastrointest Endosc 2014; 79:790-7. [PMID: 24210653 DOI: 10.1016/j.gie.2013.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies have estimated that cecal intubation failure occurs with conventional colonoscopy in about 10% of cases. Various methods have been adopted to improve the cecal intubation rate, including a transparent cap and special colonoscopes. OBJECTIVE To assess the efficacy of using a cap-assisted gastroscope (E-cap) compared with a cap-assisted colonoscope (C-cap) for the complete examination of the colon in nonsedated patients with technically difficult sigmoid colons. DESIGN Randomized, controlled study. SETTING Tertiary-care referral center. PATIENTS One hundred thirty-nine patients with technically difficult sigmoid colons were studied. INTERVENTION Colonoscopy with either an E-cap (n = 69) or a C-cap (n = 70). MAIN OUTCOME MEASUREMENTS Cecal intubation rate, cecal intubation time, patient-assessed pain score, and endoscopist-assessed pain score. RESULTS The cecal intubation rate was significantly higher in the E-cap (65/69, 94.2%) than in the C-cap group (50/70, 71.4%; P < .0001). Patient-assessed pain (moderate to severe) was more frequently reported in the C-cap (14/70, 20.0%) than in the E-cap group (5/69, 7.2%; P = .029). Endoscopist-assessed pain (moderate to severe) was more frequently reported in the C-cap (13/70, 18.6%) than in the E-cap group (3/69, 7.2%; P = .009). For patients with a low body mass index (≤ 22 kg/m(2)), the cecal intubation rate was significantly higher in the E-cap (37/38, 97.4%) than in the C-cap group (15/29, 51.7%; P < .0001). LIMITATIONS Single-center experience, lack of a gastroscope control group without a cap. CONCLUSION The cap-assisted gastroscope is more tolerable and effective than cap-assisted colonoscope for the complete examination of the colon in patients with technically difficult sigmoid colons. ( CLINICAL TRIAL REGISTRATION NUMBER KCT0000744.).
Collapse
|