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Terasawa T, Tadano T, Abe K, Sasaki S, Hosono S, Katayama T, Hoshi K, Nakayama T, Hamashima C. Single-round performance of colorectal cancer screening programs: a network meta-analysis of randomized clinical trials. BMC Med 2025; 23:110. [PMID: 39985068 PMCID: PMC11846209 DOI: 10.1186/s12916-025-03948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 02/13/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Demonstrating mortality reduction in new colorectal cancer (CRC) screening programs through randomized clinical trials (RCTs) is challenging. We systematically reviewed single-round program performance outcomes using a stepwise approach proposed by the World Endoscopy Organization CRC Screening Committee framework. METHODS The MEDLINE, EMBASE, Central, and Ichushi Web databases were searched until October 28, 2024, to find RCTs comparing guaiac-based and immunochemical fecal occult blood testing (gFOBT and FIT), flexible sigmoidoscopy (FS), computed tomographic colonography (CTC), and total colonoscopy (TCS). Paired reviewers screened studies, extracted data, and assessed bias risk. A Bayesian random-effects network meta-analysis was conducted, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The primary outcome was advanced neoplasia (AN) detection, and the secondary outcomes were participation and colorectal cancer (CRC) detection, all during the first screening round. RESULTS Eighteen RCTs (437,072 invitees) were included. The risk of bias was low or raised some concerns for screening participation, but it was high for detection outcomes. In the network meta-analysis of 15 RCTs not allowing crossover, the FIT-based program had a higher AN detection rate than the gFOBT-based program (relative risk [RR] 2.48; 95% credible interval [CrI] 1.52-4.21; moderate certainty). AN detection rates were not different in the CTC- (RR 1.01; CrI 0.43-2.23; very low certainty) and TCS-based (RR 1.03; CrI 0.54-1.78; low certainty) programs compared with the FS-based program. All the visualization modality programs had higher AN detection rates than the FIT-based program (FS: RR 2.13 [CrI 1.38-3.77]; CTC 2.16 [1.11-4.51]; and TCS 2.19 [1.43-3.48]; all with low certainty). Low event rates precluded definitive conclusions regarding CRC detection (very low to low certainty). The TCS-based program had the worst participation rate (very low to low certainty). Comparative data allowing crossover were limited. CONCLUSIONS This is the first network meta-analysis that evaluates program-level initial performance indicators. FIT-based programs likely detect more AN cases than gFOBT-based programs, while FS-, CTC-, and TCS-based programs may outperform FIT. Due to limitations in first-round results, long-term outcomes should be assessed after 10-15 years.
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Affiliation(s)
- Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
| | | | - Koichiro Abe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiju Sasaki
- Center for Preventive Medicine, St. Luke's International Hospital Affiliated Clinic, Tokyo, Japan
| | - Satoyo Hosono
- Division of Cancer Screening Assessment and Management, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takafumi Katayama
- Department of Statistics and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan
| | - Keika Hoshi
- Center for Health Informatics Policy, National Institute of Public Health, Wako, Japan
| | - Tomio Nakayama
- Division of Cancer Screening Assessment and Management, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Chisato Hamashima
- Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Mehta SJ, Palat S, McDonald C, Reitz C, Okorie E, Williams K, Tao J, Shaw PA, Glanz K, Asch DA. A Randomized Trial of Choice Architecture and Mailed Colorectal Cancer Screening Outreach in a Community Health Setting. Clin Gastroenterol Hepatol 2024; 22:2117-2124.e2. [PMID: 38697235 PMCID: PMC11424265 DOI: 10.1016/j.cgh.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND & AIMS Mailed outreach for colorectal cancer (CRC) screening increases uptake but it is unclear how to offer the choice of testing. We evaluated if the active choice between colonoscopy and fecal immunochemical test (FIT), or FIT alone, increased response compared with colonoscopy alone. METHODS This pragmatic, randomized, controlled trial at a community health center included patients between ages 50 and 74 who were not up to date with CRC screening. Patients were randomized 1:1:1 to the following: (1) colonoscopy only, (2) active choice of colonoscopy or FIT, or (3) FIT only. Patients received an outreach letter with instructions for testing (colonoscopy referral and/or an enclosed FIT kit), a reminder letter at 2 months, and another reminder at 3 to 5 months via text message or automated voice recording. The primary outcome was CRC screening completion within 6 months. RESULTS Among 738 patients in the final analysis, the mean age was 58.7 years (SD, 6.2 y); 48.6% were insured by Medicaid and 24.3% were insured by Medicare; and 71.7% were White, 16.9% were Black, and 7.3% were Hispanic/Latino. At 6 months, 5.6% (95% CI, 2.8-8.5) completed screening in the colonoscopy-only arm, 12.8% (95% CI, 8.6-17.0) in the active-choice arm, and 11.3% (95% CI, 7.4-15.3) in the FIT-only arm. Compared with colonoscopy only, there was a significant increase in screening in active choice (absolute difference, 7.1%; 95% CI, 2.0-12.2; P = .006) and FIT only (absolute difference, 5.7%; 95% CI, 0.8-10.6; P = .02). CONCLUSIONS Both choice of testing and FIT alone increased response and may align with patient preferences. TRIAL REGISTRATION clinicaltrials.gov NCT04711473.
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Affiliation(s)
- Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Sanjay Palat
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin McDonald
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Reitz
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evelyn Okorie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keyirah Williams
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jinming Tao
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pamela A Shaw
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Glanz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ali O, Gupta S, Brain K, Lifford KJ, Paranjothy S, Dolwani S. Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review. J Med Screen 2023; 30:14-27. [PMID: 36039489 PMCID: PMC9925898 DOI: 10.1177/09691413221109999] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults. METHOD Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3rd, 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted. RESULTS Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities. CONCLUSION Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.
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Affiliation(s)
- Omar Ali
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Sunnia Gupta
- Guy's and St Thomas’ NHS Foundation
Trust, London, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Kate J Lifford
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Sunil Dolwani
- Division of Population Medicine, Cardiff University, Cardiff, UK
- Department of Gastroenterology, Cardiff and Vale University Health
Board, Cardiff, UK
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Carlisle S, Ayling K, Jia R, Buchanan H, Vedhara K. The effect of choice interventions on retention-related, behavioural and mood outcomes: a systematic review with meta-analysis. Health Psychol Rev 2021; 16:220-256. [PMID: 34423744 DOI: 10.1080/17437199.2021.1962386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The provision of choice within interventions has been associated with increased motivation, engagement and interest, as well as improved clinical outcomes. Existing reviews are limited by their wide inclusion criteria or by not assessing behaviour change and mood outcomes. This review examines whether participant-driven choice-based interventions specifically are more likely to be enjoyed and accepted by participants compared to no-choice interventions, and whether this impacts on intervention outcomes in terms of behaviour change or mood. Forty-four randomised controlled trials were identified for inclusion. Random effects meta-analyses were performed for retention-related outcomes (drop-out, adherence and satisfaction), and aggregate behaviour change and mood outcomes. Choice-based interventions resulted in significantly less participant drop-out and increased adherence compared to interventions not offering choice. Results for the behaviour change and mood analyses were mixed. This meta-analytic review demonstrates that choice-based interventions may enhance participant retention and adherence, thus researchers and clinicians alike should consider the provision of choice when designing research and interventions. The evidence for the role of choice in behaviour change and mood is less convincing, and there is a need for more, higher quality research in this area.
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Affiliation(s)
- Sophie Carlisle
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kieran Ayling
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ru Jia
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Han A, Maratt J, Kahi C. Colorectal Cancer Screening Decisions in the Opportunistic Setting. Gastrointest Endosc Clin N Am 2020; 30:413-422. [PMID: 32439079 DOI: 10.1016/j.giec.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer incidence and mortality have decreased in the United States in recent decades, largely through opportunistic screening. Although certain organizations have improved internal screening rates by implementing programmatic screening, most of the United States undergoes opportunistic screening. Much effort and resources have been expended comparing screening tests to determine the most effective; however, deeper analysis of the US population has revealed subsets of ethnicities may be grossly underscreened. The most effective screening test remains the test that is completed and adhered to, and a better question may concern the best method of discussing screening.
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Affiliation(s)
- Andrew Han
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA.
| | - Jennifer Maratt
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, 1481 West 10th Street, 111G, Indianapolis, IN 46202, USA
| | - Charles Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, 1481 West 10th Street, 111G, Indianapolis, IN 46202, USA
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Rex DK. The Case for High-Quality Colonoscopy Remaining a Premier Colorectal Cancer Screening Strategy in the United States. Gastrointest Endosc Clin N Am 2020; 30:527-540. [PMID: 32439086 DOI: 10.1016/j.giec.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Most colorectal cancer screening in the United States occurs in the opportunistic setting, where screening is initiated by a patient-provider interaction. Colonoscopy provides the longest-interval protection, and high-quality colonoscopy is ideally suited to the opportunistic setting. Both detection and colonoscopic resection have improved as a result of intense scientific investigation. Further improvements in detection are expected with the introduction of artificial intelligence programs into colonoscopy platforms. We may expect recommended intervals or colonoscopy after negative examinations performed by high-quality detectors to expand beyond 10 years. Thus, high-quality colonoscopy remains an excellent approach to colorectal cancer screening in the opportunistic setting.
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100, Indianapolis, IN 46202, USA.
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Plumb AA, Halligan S, Mallett S. The choice and definition of summary measure for meta-analysis of clinical studies with binary outcomes: effect on clinical interpretation. Br J Radiol 2020; 93:20190976. [PMID: 31957472 DOI: 10.1259/bjr.20190976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Many systematic reviews and meta-analyses concern the effect of a healthcare intervention on a binary outcome i.e. occurrence (or not) of a particular event. Usually, the overall effect, pooled across all studies included in the meta-analysis, is summarised using the odds ratio (OR) or the relative risk (RR). Under most circumstances, it is obvious how to identify what should be considered as the event of interest-for example, death or a clinically important side-effect. However, on occasion it may not be clear in which "direction" the event should be specified-such as attendance (vs non-attendance) at cancer screening. Usually, this choice is not critical to the overall conclusion of the meta-analysis, but occasionally it can lead to differences in how the included studies are pooled, ultimately affecting the overall meta-analytic result, particularly when using RRs rather than ORs. In this commentary, we will explain this phenomenon in more detail using examples from the literature, and explore how analysts and readers can avoid some potential pitfalls.
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Affiliation(s)
- Andrew A Plumb
- Centre for Medical Imaging, University College London, 43-45 Foley St, London, W1W 7TS, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 43-45 Foley St, London, W1W 7TS, UK
| | - Susan Mallett
- Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
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Zhu H, Li F, Tao K, Wang J, Scurlock C, Zhang X, Xu H. Comparison of the participation rate between CT colonography and colonoscopy in screening population: a systematic review and meta-analysis of randomized controlled trials. Br J Radiol 2020; 93:20190240. [PMID: 31651188 PMCID: PMC6948079 DOI: 10.1259/bjr.20190240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/02/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To compare the participation rate between CT colonography (CTC) and colonoscopy in screening population in randomized controlled trials (RCTs). METHODS A search was performed using the PubMed, Web of Science, and Cochrane databases. RCTs that included screening populations and reported participation number were assessed. Cochrane risk of bias tool was used to assess the bias and quality. Risk ratio (RR) was used to present the results. The non-participation rate was analyzed to verify the results of participation rate. RESULTS Five of 760 studies, with a total of 15,974 invitees, were included. The participation rate was higher at CTC (28.8%) than colonoscopy (20.8%), although the difference did not reach statistical significance (RR = 1.26; p = 0.070; I2 = 90.3%). The non-participation rate at CTC was significantly lower than colonoscopy (RR = 0.92; p = 0.012; I2 = 86.7%). Subgroup analysis suggested both the participation and non-participation rate were with significant difference between reduced/no cathartic preparation CTC and colonoscopy. Cumulative meta-analysis showed both the participation rate and non-participation rate exhibited a trend over time and sample size. CONCLUSION The participation rate was higher at CTC than colonoscopy, although the difference did not reach statistical significance. But the non-participation rate was with statistical difference. Screening population seemed more likely to participate the reduced/no cathartic preparation CTC. Statistical evidence was provided for more large RCTs are needed in the future. ADVANCES IN KNOWLEDGE The screening populations seem more likely to participate in the CTC, especially the reduced/no cathartic preparation CTC. The statistical evidence was provided for more large RCTs are needed in the future.
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Affiliation(s)
- He Zhu
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Fudong Li
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Ke Tao
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Jing Wang
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
| | - Carissa Scurlock
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital Affiliated With Tsinghua University, Beijing, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, ChangChun, China
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van der Meulen MP, Lansdorp-Vogelaar I, Goede SL, Kuipers EJ, Dekker E, Stoker J, van Ballegooijen M. Colorectal Cancer: Cost-effectiveness of Colonoscopy versus CT Colonography Screening with Participation Rates and Costs. Radiology 2018; 287:901-911. [PMID: 29485322 DOI: 10.1148/radiol.2017162359] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To compare the cost-effectiveness of computed tomographic (CT) colonography and colonoscopy screening by using data on unit costs and participation rates from a randomized controlled screening trial in a dedicated screening setting. Materials and Methods Observed participation rates and screening costs from the Colonoscopy or Colonography for Screening, or COCOS, trial were used in a microsimulation model to estimate costs and quality-adjusted life-years (QALYs) gained with colonoscopy and CT colonography screening. For both tests, the authors determined optimal age range and screening interval combinations assuming a 100% participation rate. Assuming observed participation for these combinations, the cost-effectiveness of both tests was compared. Extracolonic findings were not included because long-term follow-up data are lacking. Results The participation rates for colonoscopy and CT colonography were 21.5% (1276 of 5924 invitees) and 33.6% (982 of 2920 invitees), respectively. Colonoscopy was more cost-effective in the screening strategies with one or two lifetime screenings, whereas CT colonography was more cost-effective in strategies with more lifetime screenings. CT colonography was the preferred test for willingness-to-pay-thresholds of €3200 per QALY gained and higher, which is lower than the Dutch willingness-to-pay threshold of €20 000. With equal participation, colonoscopy was the preferred test independent of willingness-to-pay thresholds. The findings were robust for most of the sensitivity analyses, except with regard to relative screening costs and subsequent participation. Conclusion Because of the higher participation rates, CT colonography screening for colorectal cancer is more cost-effective than colonoscopy screening. The implementation of CT colonography screening requires previous satisfactory resolution to the question as to how best to deal with extracolonic findings. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Miriam P van der Meulen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - S Lucas Goede
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Ernst J Kuipers
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Evelien Dekker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Jaap Stoker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Marjolein van Ballegooijen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
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Duarte RB, Bernardo WM, Sakai CM, Silva GL, Guedes HG, Kuga R, Ide E, Ishida RK, Sakai P, de Moura EG. Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis. Ther Clin Risk Manag 2018; 14:349-360. [PMID: 29503554 PMCID: PMC5826249 DOI: 10.2147/tcrm.s152147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was −0.02 (with a 95% CI between −0.04 and −0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.
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Affiliation(s)
- Ralph B Duarte
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Wanderley M Bernardo
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Christiano M Sakai
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Gustavo Lr Silva
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Hugo G Guedes
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Rogerio Kuga
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Edson Ide
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Robson K Ishida
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Paulo Sakai
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
| | - Eduardo Gh de Moura
- Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil
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Liao Y, Li S, Chen C, He X, Lin F, Wang J, Yang Z, Lan P. Screening for colorectal cancer in Tianhe, Guangzhou: results of combining fecal immunochemical tests and risk factors for selecting patients requiring colonoscopy. Gastroenterol Rep (Oxf) 2017; 6:132-136. [PMID: 29780602 PMCID: PMC5952940 DOI: 10.1093/gastro/gox030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 01/16/2023] Open
Abstract
Objective To explore the performance of a protocol combining fecal immunochemical test (FIT) and a high-risk factor questionnaire (HRFQ) for selecting patients requiring colonoscopy as part of a population-based colorectal cancer (CRC) screening program in China. Methods From 2015 to 2016, we conducted a CRC screening program for all residents aged 45 years or older in Tianhe District, Guangzhou City, China. Participants underwent an FIT and received an HRFQ as part of primary screening. Those with positive FIT and/or HRFQ results were considered to be at high risk and were recommended to undergo colonoscopy. Results A total of 10 074 subjects were recruited and enrolled in the screening program. In the enrolled population, 17.5% had positive FIT results and 19.4% had positive HRFQ results. Of those recommended to undergo diagnostic colonoscopy, 773 did so. The screening method’s overall positive predictive value (PPV) was 4.9% for non-adenomatous polyps, 11.4% for low-risk adenomas (LRAs), 15.9% for high-risk adenomas (HRAs) and 1.6% for CRC. The PPVs of positive FIT results for non-adenomatous polyps, LRAs, HRAs and CRC were 5.2%, 15.9%, 22.5% and 2.5%, respectively. The PPVs of positive HRFQ results for non-adenomatous polyps, LRA, HRA and CRC were 4.1%, 10.2%, 14.3% and 1.4%, respectively. The PPVs associated with combined positive FIT and HRFQ results for non-adenomatous polyps, LRAs, HRAs and CRC were 4.5%, 16.4%, 23.7% and 2.8%, respectively. Conclusion Our results suggest that this two-step CRC screening strategy, involving a combination of FIT and HRFQ followed by colonoscopy, is useful to identify early-stage CRC. The high detection rates and PPVs for CRC and adenomas encourage this strategy’s use in ongoing screening programs.
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Affiliation(s)
- Yi Liao
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Senmao Li
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Chunyu Chen
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Xuan He
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Feng Lin
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Jianping Wang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease.,Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
| | - Zuli Yang
- Department of Gastrointestinal Surgery.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease
| | - Ping Lan
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease.,Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
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Smith MA, Weiss JM, Potvien A, Schumacher JR, Gangnon RE, Kim DH, Weeth-Feinstein LA, Pickhardt PJ. Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates. Radiology 2017; 284:717-724. [PMID: 28696184 DOI: 10.1148/radiol.2017170924] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
RSNA, 2017.
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Affiliation(s)
- Maureen A Smith
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Jennifer M Weiss
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Aaron Potvien
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Jessica R Schumacher
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Ronald E Gangnon
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - David H Kim
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Lauren A Weeth-Feinstein
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Perry J Pickhardt
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017; 153:307-323. [PMID: 28600072 DOI: 10.1053/j.gastro.2017.05.013] [Citation(s) in RCA: 507] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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14
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 112:1016-1030. [PMID: 28555630 DOI: 10.1038/ajg.2017.174] [Citation(s) in RCA: 465] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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15
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Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2017; 86:18-33. [PMID: 28600070 DOI: 10.1016/j.gie.2017.04.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Sali L, Mascalchi M, Falchini M, Ventura L, Carozzi F, Castiglione G, Delsanto S, Mallardi B, Mantellini P, Milani S, Zappa M, Grazzini G. Reduced and Full-Preparation CT Colonography, Fecal Immunochemical Test, and Colonoscopy for Population Screening of Colorectal Cancer: A Randomized Trial. J Natl Cancer Inst 2016; 108:djv319. [PMID: 26719225 DOI: 10.1093/jnci/djv319] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/05/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Population screening for colorectal cancer (CRC) is widely adopted, but the preferred strategy is still under debate. We aimed to compare reduced (r-CTC) and full cathartic preparation CT colonography (f-CTC), fecal immunochemical test (FIT), and optical colonoscopy (OC) as primary screening tests for CRC. METHODS Citizens of a district of Florence, Italy, age 54 to 65 years, were allocated (8:2.5:2.5:1) with simple randomization to be invited by mail to one of four screening interventions: 1) biennial FIT for three rounds, 2) r-CTC, 3) f-CTC, 4) OC. Patients tested positive to FIT or CTC (at least one polyp ≥6mm) were referred to OC work-up. The primary outcomes were participation rate and detection rate (DR) for cancer or advanced adenoma (advanced neoplasia). All statistical tests were two-sided. RESULTS Sixteen thousand eighty-seven randomly assigned subjects were invited to the assigned screening test. Participation rates were 50.4% (4677/9288) for first-round FIT, 28.1% (674/2395) for r-CTC, 25.2% (612/2430) for f-CTC, and 14.8% (153/1036) for OC. All differences between groups were statistically significant (P = .047 for r-CTC vs f-CTC; P < .001 for all others). DRs for advanced neoplasia were 1.7% (79/4677) for first-round FIT, 5.5% (37/674) for r-CTC, 4.9% (30/612) for f-CTC, and 7.2% (11/153) for OC. Differences in DR between CTC groups and FIT were statistically significant (P < .001), but not between r-CTC and f-CTC (P = .65). CONCLUSIONS Reduced preparation increases participation in CTC. Lower attendance and higher DR of CTC as compared with FIT are key factors for the optimization of its role in population screening of CRC.
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Affiliation(s)
- Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
| | - Mario Mascalchi
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Massimo Falchini
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Leonardo Ventura
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Francesca Carozzi
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Guido Castiglione
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Silvia Delsanto
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Beatrice Mallardi
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Paola Mantellini
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Stefano Milani
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Marco Zappa
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
| | - Grazia Grazzini
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD)
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Kuipers EJ, Spaander MCW. Colorectal Cancer Screening by Colonoscopy, CT-Colonography, or Fecal Immunochemical Test. J Natl Cancer Inst 2015; 108:djv383. [PMID: 26719226 DOI: 10.1093/jnci/djv383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (EJK, MCWS).
| | - Manon C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (EJK, MCWS)
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Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJY, Young GP, Kuipers EJ. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64:1637-49. [PMID: 26041752 DOI: 10.1136/gutjnl-2014-309086] [Citation(s) in RCA: 903] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/13/2015] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) ranks third among the most commonly diagnosed cancers worldwide, with wide geographical variation in incidence and mortality across the world. Despite proof that screening can decrease CRC incidence and mortality, CRC screening is only offered to a small proportion of the target population worldwide. Throughout the world there are widespread differences in CRC screening implementation status and strategy. Differences can be attributed to geographical variation in CRC incidence, economic resources, healthcare structure and infrastructure to support screening such as the ability to identify the target population at risk and cancer registry availability. This review highlights issues to consider when implementing a CRC screening programme and gives a worldwide overview of CRC burden and the current status of screening programmes, with focus on international differences.
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Affiliation(s)
- Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Arlinda Ruco
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert E Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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Affiliation(s)
- Andrew A Plumb
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK
| | - Steve Halligan
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK.
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Cho JH, Lee HK, Kim HJ, Heo YC, Lee JH, Hong IS. A study on the usefulness of methylcellulose in rectal CT based on the analysis of the differences in absorption of radiation-permeable and radiation-impermeable materials. Jpn J Radiol 2014; 32:650-6. [PMID: 25245589 DOI: 10.1007/s11604-014-0359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to use various radiation-permeable and radiation-impermeable materials, used to facilitate the observation of a lesion during a rectal computed tomography (CT) scan, in order to determine the best material to use. MATERIALS AND METHODS In regard to the study method, the radiation-permeable and radiation-impermeable materials of physiological saline, methylcellulose, contrast medium, ultrasound gel, and air were used to perform scanning with scan parameters that were used in general abdominal scanning. The GSI mode was used for material analysis. RESULTS According to the results of the phantom study, the average CT value was 25.5 ± 5.9 HU for physiological saline, 77.6 ± 7.3 HU for methylcellulose, 3,070 ± 0.1 HU for contrast medium, 74.1 ± 11.9 HU for ultrasound gel, and -954.1 ± 10.3 HU for air. According to the analysis of materials by energy, contrast medium and physiological saline showed a dramatic decrease in the CT value as energy increased. Methylcellulose showed a gradual decrease in CT value, whereas air showed a small change in CT value according to the graph. CONCLUSIONS Out of these materials, methylcellulose had the advantage of reducing discomfort in patients, and was more convenient for examiners before and after the rectal CT scan.
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Affiliation(s)
- Jae-Hwan Cho
- Department of International Radiological Science, Hallym University of Graduate Studies, Seoul, Republic of Korea,
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Gupta M, Beebe TJ, Dunagan KT, Schleck CD, Zinsmeister AR, Talley NJ, Locke GR, Iyer PG. Screening for Barrett's esophagus: results from a population-based survey. Dig Dis Sci 2014; 59:1831-50. [PMID: 24652109 PMCID: PMC4387565 DOI: 10.1007/s10620-014-3092-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Screening for Barrett's esophagus (BE) and adenocarcinoma (EAC) is controversial, but interest remains in finding the optimal method. Attitudes on screening within the community are unknown. We aimed to assess these attitudes via a survey. STUDY A mixed-mode survey was conducted in adults >50 years to assess awareness regarding BE, willingness to participate in screening, and preferences regarding method of screening. Methods evaluated were sedated endoscopy (sEGD), unsedated transnasal endoscopy (uTNE) and video capsule (VCE). RESULTS A total of 136 from 413 (33%) adults responded [47% males, mean (SD) age 63 (10.2) years], and 26% of responders knew of BE at baseline. After reading the information on BE, 72% were interested in screening. A history of undergoing screening tests and GI symptoms were predictive of interest. Unsedated techniques were preferred by 64% (VCE: 56% and uTNE: 8%) versus sEGD (36%). CONCLUSIONS The majority of adults were willing to undergo screening for BE/EAC, with a preference for unsedated techniques.
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Affiliation(s)
- Milli Gupta
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
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22
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Informed choice vs. no choice in colorectal cancer screening tests: a prospective cohort study in real-life screening practice. Am J Gastroenterol 2014; 109:1072-9. [PMID: 24935273 DOI: 10.1038/ajg.2014.136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/25/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to compare the level of adherence to colorectal cancer (CRC) screening programs among screening participants offered vs. not offered informed choices on screening modality. METHODS We recruited 10,606 screening participants aged 50-70 years, including 6,397 subjects who were offered a choice of yearly fecal immunochemical test (FIT) for up to 3 years vs. one colonoscopy, and 4,209 subjects who were offered either FIT or colonoscopy without choice. They were prospectively followed up for 3 years. The proportion of screening participants who returned their specimens in all subsequent years (FIT group) and the attendance rate of scheduled endoscopy appointment (colonoscopy group) were compared between those with vs. without choice. RESULTS The adherence rate with FIT was 97.6%, 84.1%, and 72.6% in the first 3 years of follow-up, respectively, among those who were offered a choice. The adherence rate with FIT was 97.5%, 78.4%, and 62.8%, respectively, among those without choices. The proportion of subjects attending colonoscopy was 95.7% (choice offered) and 90.6% (no choice). From binary logistic regression analysis, participants who were offered informed choice were significantly more likely to adhere to the program when compared with those without test choices (odds ratio (OR)=2.54, 95% confidence interval (CI): 2.30-2.82, P<0.001). The respective adjusted OR for the FIT and colonoscopy groups was 1.60 (95% CI: 1.42-1.80, P<0.001) and 2.53 (95% CI: 1.94-3.31, P<0.001). CONCLUSIONS This study found that patients who were offered an informed choice for screening had higher adherence rates than patients who were not offered a choice in real-life practices, suggesting that providing screening test options for CRC screening is preferred.
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van Dam L, Bretthauer M. Ethical issues in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2014; 28:315-26. [PMID: 24810192 DOI: 10.1016/j.bpg.2014.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 02/07/2023]
Abstract
In many countries, colorectal cancer screening is currently an established population screening program due to the evidence on its reduction of colorectal cancer mortality. There is general consensus that colorectal cancer screening meets the screening criteria as proposed by Wilson and Jungner. However, as for all population screening programs, colorectal cancer screening also has disadvantages and thereby entails ethical issues. There are the general issues concerning the introduction of screening programs (e.g. medicalization, overdiagnosis and overtreatment, information provision to screenees), evaluation of cancer screening programs (e.g. lead time and length bias), chosen screening method (e.g. false-positive and false-negative test results, reduction of all-cause mortality, choice between different screening methods). The different colorectal cancer screening methods and the ethical issues concerning colorectal cancer screening will be discussed in this review.
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Affiliation(s)
- Leonie van Dam
- Department of Gastroenterology and Hepatology, University Medical Centre Rotterdam, The Netherlands; Department of Medical Ethics and Philosophy, University Medical Centre Rotterdam, The Netherlands.
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Oslo, Norway.
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, Kuipers EJ, Fockens P, Kraaijenhagen RA, Bossuyt PM. Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy. Gut 2014; 63:466-71. [PMID: 23964098 DOI: 10.1136/gutjnl-2013-305013] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Faecal immunochemical testing (FIT) is increasingly used in colorectal cancer (CRC) screening but has a less than perfect sensitivity. Combining risk stratification, based on established risk factors for advanced neoplasia, with the FIT result for allocating screenees to colonoscopy could increase the sensitivity and diagnostic yield of FIT-based screening. We explored the use of a risk prediction model in CRC screening. DESIGN We collected data in the colonoscopy arm of the Colonoscopy or Colonography for Screening study, a multicentre screening trial. For this study 6600 randomly selected, asymptomatic men and women between 50 years and 75 years of age were invited to undergo colonoscopy. Screening participants were asked for one sample FIT (OC-sensor) and to complete a risk questionnaire prior to colonoscopy. Based on the questionnaire data and the FIT results, we developed a multivariable risk model with the following factors: total calcium intake, family history, age and FIT result. We evaluated goodness-of-fit, calibration and discrimination, and compared it with a model based on primary screening with FIT only. RESULTS Of the 1426 screening participants, 1112 (78%) completed the questionnaire and FIT. Of these, 101 (9.1%) had advanced neoplasia. The risk based model significantly increased the goodness-of-fit compared with a model based on FIT only (p<0.001). Discrimination improved significantly with the risk-based model (area under the receiver operating characteristic (ROC) curve: from 0.69 to 0.76, (p=0.02)). Calibration was good (Hosmer-Lemeshow test; p=0.94). By offering colonoscopy to the 102 patients at highest risk, rather than to the 102 cases with a FIT result >50 ng/mL, 5 more cases of advanced neoplasia would be detected (net reclassification improvement 0.054, p=0.073). CONCLUSIONS Adding risk based stratification increases the accuracy FIT-based CRC screening and could be used in preselection for colonoscopy in CRC screening programmes.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, , Amsterdam, The Netherlands
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Robbins JB, Kim DH. Computed tomographic colonography: evidence and techniques for screening. Semin Roentgenol 2013; 48:264-72. [PMID: 23796377 DOI: 10.1053/j.ro.2013.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53729, USA.
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Affiliation(s)
- Otto S Lin
- Digestive Disease Institute, Virginia Mason Medical Center, and Gastroenterology Division, University of Washington School of Medicine, Seattle, WA 98101, USA.
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Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. Am J Gastroenterol 2012; 107:1777-83. [PMID: 23211845 DOI: 10.1038/ajg.2012.140] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We compared reported reasons for participation and nonparticipation in colorectal cancer (CRC) screening between colonoscopy and computed tomographic (CT) colonography in a randomized controlled trial. METHODS We randomly invited 8,844 people for screening by colonoscopy or CT colonography. On a questionnaire, invitees indicated reasons for participation or nonparticipation and indicated the most decisive reason. RESULTS The most frequently cited reasons to accept screening were early detection of precursor lesions and CRC, and contribution to science. The most frequently cited reasons to decline were the unpleasantness of the examination, the inconvenience of the preparation, a lack of symptoms, and "no time/too much effort." Among colonoscopy nonparticipants, elderly invitees cited inconvenience less often, and absence of symptoms more often, than did the group overall. The reason reported most frequently as the most decisive reason not to participate was the unpleasantness of the examination among colonoscopy nonparticipants, and "no time/too much effort" and lack of symptoms among CT colonography nonparticipants. CONCLUSIONS In light of these results, future screening programs could tailor the information provided to invitees.
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Lin OS, Kozarek RA, Gluck M, Jiranek GC, Koch J, Kowdley KV, Irani S, Nguyen M, Dominitz JA. Preference for colonoscopy versus computerized tomographic colonography: a systematic review and meta-analysis of observational studies. J Gen Intern Med 2012; 27:1349-1360. [PMID: 22700393 PMCID: PMC3445696 DOI: 10.1007/s11606-012-2115-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 12/13/2022]
Abstract
In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [-0.015-0.451]) or general medicine journals (-0.158 [-0.389-0.072]) to report preference for CTC (p<0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using "masked" and "unmasked" preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.
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Affiliation(s)
- Otto S Lin
- C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA.
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A survey of potential adherence to capsule colonoscopy in patients who have accepted or declined conventional colonoscopy. J Clin Gastroenterol 2012; 46:691-5. [PMID: 22334223 DOI: 10.1097/mcg.0b013e31824432df] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Capsule colonoscopy might improve adherence to colorectal cancer screening. OBJECTIVE Measure attractiveness of capsule colonoscopy in patients who have declined conventional colonoscopy, using patients who have undergone colonoscopy as a control group. DESIGN Internet-based survey. SETTING United States. SUBJECTS A total of 308 geographically diverse, high school or higher educated, middle to upper income, insured internet users who had been offered colonoscopy previously. INTERVENTIONS Survey. MAIN OUTCOME MEASUREMENTS Preferences for colonoscopy, capsule colonoscopy, fecal occult blood test, or no screening. RESULTS After a description of capsule technology features relative to colonoscopy, including "no need for a ride," "no time off work," "approximately 5% less accurate," "booster preparation needed," and "follow-up colonoscopy needed in 20% of patients," preference for capsule colonoscopy was shown by 24% of those who had undergone colonoscopy and 49% of those who had not. "No need for a ride" and "no time off work" were considered positive features of capsule colonoscopy. The potential to undergo capsule colonoscopy during the weekend was also considered attractive. LIMITATIONS Restricted population. CONCLUSIONS The availability of capsule colonoscopy could potentially increase colorectal cancer screening adherence rates among patients who decline screening colonoscopy.
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Stoop EM, de Wijkerslooth TR, Bossuyt PM, Stoker J, Fockens P, Kuipers EJ, Dekker E, van Leerdam ME. Face-to-face vs telephone pre-colonoscopy consultation in colorectal cancer screening; a randomised trial. Br J Cancer 2012; 107:1051-8. [PMID: 22918392 PMCID: PMC3461154 DOI: 10.1038/bjc.2012.358] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: A pre-colonoscopy consultation in colorectal cancer (CRC) screening is necessary to assess a screenee’s general health status and to explain benefits and risks of screening. The first option allows for personal attention, whereas a telephone consultation does not require travelling. We hypothesised that a telephone consultation would lead to higher response and participation in CRC screening compared with a face-to-face consultation. Methods: A total of 6600 persons (50–75 years) were 1 : 1 randomised for primary colonoscopy screening with a pre-colonoscopy consultation either face-to-face or by telephone. In both arms, we counted the number of invitees who attended a pre-colonoscopy consultation (response) and the number of those who subsequently attended colonoscopy (participation), relative to the number invited for screening. A questionnaire regarding satisfaction with the consultation and expected burden of the colonoscopy (scored on five-point rating scales) was sent to invitees. Besides, a questionnaire to assess the perceived burden of colonoscopy was sent to participants, 14 days after the procedure. Results: In all, 3302 invitees were allocated to the telephone group and 3298 to the face-to-face group, of which 794 (24%) attended a telephone consultation and 822 (25%) a face-to-face consultation (P=0.41). Subsequently, 674 (20%) participants in the telephone group and 752 (23%) in the face-to-face group attended colonoscopy (P=0.018). Invitees and responders in the telephone group expected the bowel preparation to be more painful than those in the face-to-face group while perceived burden scores for the full screening procedure were comparable. More subjects in the face-to-face group than in the telephone group were satisfied by the consultation in general: (99.8% vs 98.5%, P=0.014). Conclusion: Using a telephone rather than a face-to-face consultation in a population-based CRC colonoscopy screening programme leads to similar response rates but significantly lower colonoscopy participation.
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Affiliation(s)
- E M Stoop
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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de Haan MC, Halligan S, Stoker J. Does CT colonography have a role for population-based colorectal cancer screening? Eur Radiol 2012; 22:1495-503. [PMID: 22549102 PMCID: PMC3366291 DOI: 10.1007/s00330-012-2449-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/13/2012] [Accepted: 03/22/2012] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. CRC screening has been proven to reduce disease-specific mortality and several European countries employ national screening programmes. These almost exclusively rely on stool tests, with endoscopy used as an adjunct in some countries. Computed tomographic colonography (CTC) is a potential screening test, with an estimated sensitivity of 88 % for advanced neoplasia ≥10 mm. Recent randomised studies have shown that CTC and colonoscopy have similar yields of advanced neoplasia per screened invitee, indicating that CTC is potentially viable as a primary screening test. However, the evidence is not fully elaborated. It is unclear whether CTC screening is cost-effective and the impact of extracolonic findings, both medical and economic, remains unknown. Furthermore, the effect of CTC screening on CRC-related mortality is unknown, as it is also unknown for colonoscopy. It is plausible that both techniques could lead to decreased mortality, as for sigmoidoscopy and gFOBT. Although radiation exposure is a drawback, this disadvantage may be over-emphasised. In conclusion, the detection characteristics and acceptability of CTC suggest it is a viable screening investigation. Implementation will depend on detection of extracolonic disease and health-economic impact. Key Points • Meta-analysis of CT colonographic screening showed high sensitivity for advanced neoplasia ≥10mm. • CTC, colonoscopy and sigmoidoscopy screening all have similar yields for advanced neoplasia. • Good quality information regarding the cost-effectiveness of CTC screening is lacking. • There is little good quality data regarding the impact of extracolonic findings. • CTC triage is not clinically effective in first round gFOBT/FIT positives.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, G1-228, Academic Medical Centre Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 2012; 13:55-64. [DOI: 10.1016/s1470-2045(11)70283-2] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Analysis of barriers to and patients' preferences for CT colonography for colorectal cancer screening in a nonadherent urban population. AJR Am J Roentgenol 2010; 195:393-7. [PMID: 20651195 DOI: 10.2214/ajr.09.3500] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate patients' barriers against colorectal cancer screening tests and to assess patients' preferences and cost influences for CT colonography (CTC) in a nonadherent urban subpopulation. SUBJECTS AND METHODS Patients who had been offered colorectal cancer screening but were nonadherent were asked to participate in this questionnaire study. Patients' demographic information was obtained, and patients' reasons for not being screened were explored. Subjects were given an information sheet that described a CTC procedure and then were asked about their willingness to undergo CTC and about other relevant factors, such as fees. RESULTS One hundred seventy-five patients were invited to participate; 53 declined and 54 did not respond, which left 68 subjects to be included in the analysis. After being informed about CTC screening, most (83%) subjects stated that they would be willing to undergo a CTC study. However, 70% stated that they would not be willing to pay out-of-pocket fees if insurance did not cover the study, and even among the 30% who were willing to pay the fees, the average amount they were willing to pay (mean, $244; median, $150) was well below currently charged rates. CONCLUSION Our study suggests that most nonadherent patients would be willing to undergo CTC as long as out-of-pocket fees are reasonable.
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Abstract
Colorectal cancer (CRC) is one of the most common cancers in both Japan and the USA. Age-adjusted incidence of CRC has been in decline in the USA since 1985, while rates in Japan have been increasing. The decline in the USA is commonly attributed to CRC screening programs but there is little direct evidence to support this assertion. The current screening recommendations in the USA cover several options including colonoscopy and computerized tomographic colonography (CTC). The Japanese CRC screening program is centered on fecal immunochemistry testing (FIT). The US government Medicare program's approval of colonoscopy as a primary screening test has lead to a large increase in the number of patients undergoing the procedure. However, the benefit achieved from this change in screening program emphasis is not clear. Simulation models demonstrate that a screening program centered on FIT achieves 94% of the benefit that an all-colonoscopy program is able to accomplish but at a lower cost per life year gained. Clinical studies of colonoscopy have failed to demonstrate the 76-90% declines in CRC incidence predicted by the National Polyp Study published in 1993. A potential reason for this failure is the quality of colonoscopy performance. Until more compelling data becomes available demonstrating the utility of colonoscopy as a primary screening modality, there is little incentive to alter the proven cost-effective approach to CRC screening currently in practice in Japan.
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Affiliation(s)
- William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Menees SB, Carlos R, Scheiman J, Elta GH, Fendrick AM. CT colonography: Friend or foe of practicing endoscopists. World J Gastrointest Endosc 2009; 1:51-5. [PMID: 21160651 PMCID: PMC2998846 DOI: 10.4253/wjge.v1.i1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 08/31/2009] [Accepted: 09/07/2009] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the perceived impact of computed tomographic colonography (CTC) on endoscopists' current and future practice. METHODS A 21-question survey was mailed to 1570 randomly chosen American Society for Gastrointestinal Endoscopy (ASGE) members. Participants reported socio-demographics, colonoscopy volume, percentage of colonoscopies performed for screening, and likelihood of integration of CTC into their practice. RESULTS A total of 367 ASGE members (23%) returned the questionnaire. Respondents were predominantly male (> 90%) and white (83%) with an average age of 49 years. Most respondents (58%) had no plans to incorporate CTC into daily practice and only 7% had already incorporated CTC into daily practice. Private practice respondents were the least likely to incorporate this modality into their daily practice (P = 0.047). Forty-three percent of participants were willing to take courses on CTC reading, particularly those with the highest volume of colonoscopy (P = 0.049). Forty percent of participants were unsure of CTC's impact on future colonoscopy volume while 21% and 18% projected a decreased and increased volume, respectively. The estimated impact of CTC volume varied significantly by age (P = 0.002). Respondents > 60 years felt that CTC would increase colonoscopy, whereas those < 40 years thought CTC would ultimately decrease colonoscopy. CONCLUSION Practicing endoscopists are not enthusiastic about the incorporation of CTC into their daily practice and are unsure of its future impact on their practice.
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Affiliation(s)
- Stacy B Menees
- Stacy B Menees, James Scheiman, Grace H Elta, Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, United States
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Young GP. Population-based screening for colorectal cancer: Australian research and implementation. J Gastroenterol Hepatol 2009; 24 Suppl 3:S33-42. [PMID: 19799696 DOI: 10.1111/j.1440-1746.2009.06069.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Australia is one of the first countries in the world to implement an organized whole-of-population screening program for colorectal cancer (CRC). Australians have made broad contributions to CRC in general ranging from primary prevention through genetics, secondary prevention and treatment, to palliation. This overview focuses on some of the contributions of direct relevance to population-based screening, stretching from technology development to population-based controlled studies and health services research. In terms of simple screening tests in a two-step screening strategy, the evidence is overwhelming that fecal immunochemical tests for hemoglobin (FITs) improve detection and are more acceptable. FIT-based screening is clearly acceptable to Australians and it has been demonstrated that a national organized screening program is feasible. In terms of benefit for Australians, with full roll out and high uptake by the population we could see the number of cases dying from CRC halved by this strategy. To this will be added the extra-screening benefits of improved diagnosis, improved treatment and improved public awareness, all benefits of other screening programs. CRC screening has progressed from a matter of irrelevance and distaste, to commonwealth government policy in the context of an organized program for all Australians.
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Affiliation(s)
- Graeme P Young
- Flinders University Centre for Cancer Prevention and Control, Adelaide, South Australia, Australia.
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van Gils P, van den Berg M, van Kranen H, de Wit AG. A literature review of assumptions on test characteristics and adherence in economic evaluations of colonoscopy and CT-colonography screening. Eur J Cancer 2009; 45:1554-9. [DOI: 10.1016/j.ejca.2009.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 01/22/2009] [Accepted: 01/28/2009] [Indexed: 12/23/2022]
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CT colonography can be an adjunct to optical colonoscopy in CRC screening. Dig Dis Sci 2009; 54:212-7. [PMID: 18612821 DOI: 10.1007/s10620-008-0360-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 06/03/2008] [Indexed: 01/22/2023]
Abstract
CT colonography or virtual colonoscopy is a fairly new modality that has the potential to play a significant role in screening for colon cancer. CT colonography is an attractive option for two specific reasons. First, it is non-invasive and, second, it obviates the need for sedation. It thus overcomes the two major drawbacks of optical colonoscopy. CT colonography cannot be a stand-alone technique for colorectal cancer screening because, unlike conventional colonoscopy, it does not possess a therapeutic option or a definite diagnostic capability. However, CT colonography can be a cost-effective complement to traditional colonoscopy if it is reasonably priced and if appropriate cut-off levels (>6 mm polyp) are used to increase its sensitivity.
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Kahi CJ, Rex DK, Imperiale TF. Screening, surveillance, and primary prevention for colorectal cancer: a review of the recent literature. Gastroenterology 2008; 135:380-99. [PMID: 18582467 DOI: 10.1053/j.gastro.2008.06.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 05/12/2008] [Accepted: 06/03/2008] [Indexed: 02/06/2023]
Affiliation(s)
- Charles J Kahi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Rex DK, Eid E. Considerations regarding the present and future roles of colonoscopy in colorectal cancer prevention. Clin Gastroenterol Hepatol 2008; 6:506-14. [PMID: 18455696 DOI: 10.1016/j.cgh.2008.02.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/08/2008] [Accepted: 02/16/2008] [Indexed: 02/07/2023]
Abstract
Effective and safe colonoscopy is essential to colorectal cancer prevention, regardless of the method used for colorectal cancer screening. The level of colorectal cancer incidence reduction provided by colonoscopy and polypectomy varies widely in available studies. There are several mechanisms by which colonoscopy might fail to prevent colorectal cancer, and some of the mechanisms might be overcome by simple currently available measures. Further, advances in colonoscope technology could enhance the effectiveness of colonoscopy or render it less operator-dependent. The large market for colorectal cancer screening in the United States has spawned innovative noncolonoscopic technologies for colorectal cancer and polyp detection. Because these technologies are diagnosis only, their overall impact on outcomes ultimately may be determined by whether they successfully increase adherence to screening (which should reduce colorectal cancer incidence) versus displace patients from colonoscopy screening (which potentially could increase colorectal cancer incidence), as well as their cost effectiveness and the extent to which they reduce colonoscopy complications. As these strategies emerge, monitoring their effects on adherence, cancer prevention, and procedural complications will be needed to optimize their roles relative to primary colonoscopy screening.
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Affiliation(s)
- Douglas K Rex
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Abstract
The past decade has seen major advances internationally in the implementation of colorectal cancer screening, influenced in differing ways by the profession, the public and by government. Relatively unique to colorectal cancer screening is the availability of so many test alternatives, which have substantial variation in methodology. While perhaps spoilt for choice, discerning the key advantages and disadvantages of each test is often difficult, depending on the perspective from which screening is viewed. Accordingly, this article provides an evaluation of screening tests as might be perceived by governments, the patient and the profession. Aligned issues such as choosing a screening test and provision of informed consent are discussed. Finally, the article identifies current problems with various screening tests that, if attended to, might change the perception of a test's value to a particular interest group.
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Affiliation(s)
- Geoffrey M Forbes
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Box X2213 GPO, Perth, Western Australia 6000, Australia.
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Baker ME, Bogoni L, Obuchowski NA, Dass C, Kendzierski RM, Remer EM, Einstein DM, Cathier P, Jerebko A, Lakare S, Blum A, Caroline DF, Macari M. Computer-aided detection of colorectal polyps: can it improve sensitivity of less-experienced readers? Preliminary findings. Radiology 2007; 245:140-9. [PMID: 17885187 DOI: 10.1148/radiol.2451061116] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether computer-aided detection (CAD) applied to computed tomographic (CT) colonography can help improve sensitivity of polyp detection by less-experienced radiologist readers, with colonoscopy or consensus used as the reference standard. MATERIALS AND METHODS The release of the CT colonographic studies was approved by the individual institutional review boards of each institution. Institutions from the United States were HIPAA compliant. Written informed consent was waived at all institutions. The CT colonographic studies in 30 patients from six institutions were collected; 24 images depicted at least one confirmed polyp 6 mm or larger (39 total polyps) and six depicted no polyps. By using an investigational software package, seven less-experienced readers from two institutions evaluated the CT colonographic images and marked or scored polyps by using a five-point scale before and after CAD. The time needed to interpret the CT colonographic findings without CAD and then to re-evaluate them with CAD was recorded. For each reader, the McNemar test, adjusted for clustered data, was used to compare sensitivities for readers without and with CAD; a Wilcoxon signed-rank test was used to analyze the number of false-positive results per patient. RESULTS The average sensitivity of the seven readers for polyp detection was significantly improved with CAD-from 0.810 to 0.908 (P=.0152). The number of false-positive results per patient without and with CAD increased from 0.70 to 0.96 (95% confidence interval for the increase: -0.39, 0.91). The mean total time for the readings was 17 minutes 54 seconds; for interpretation of CT colonographic findings alone, the mean time was 14 minutes 16 seconds; and for review of CAD findings, the mean time was 3 minutes 38 seconds. CONCLUSION Results of this feasibility study suggest that CAD for CT colonography significantly improves per-polyp detection for less-experienced readers.
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Affiliation(s)
- Mark E Baker
- Department of Radiology, the Cleveland Clinic Foundation, 9500 Euclid Ave, Hb6, Cleveland, OH 44195, USA.
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Abstract
Colorectal cancer (CRC) screening is widely recommended as part of standard preventive care. All average risk persons over the age of 50 y are eligible. Various authorities have advocated fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy at varying intervals as acceptable screening options. Despite the array of choices, CRC screening lags in frequency behind other cancer screening maneuvers like mammography or Pap smear. Of late, there is growing interest in CT colonography (CTC) as another screening option. CTC, or virtual colonoscopy, may represent an attractive, non-invasive method of CRC screening that provides images akin to traditional colonoscopy. Improvements in CTC performance, especially when coupled with declining costs, suggest that CTC's role in average risk screening will increase in the future. This review summarizes available data about the efficacy of CTC in average and high risk screening populations. Current indications as well as limitations to this technology are discussed, as are practical issues like the cost-effectiveness of CTC for widespread use.
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Affiliation(s)
- Nikhil Deshpande
- Department of Gastroenterology, Temple University Medical School, Philadelphia, Pennsylvania, USA
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Rex DK. Colonoscopy: the dominant and preferred colorectal cancer screening strategy in the United States. Mayo Clin Proc 2007; 82:662-4. [PMID: 17550743 DOI: 10.4065/82.6.662] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hassan C, Zullo A, Laghi A, Reitano I, Taggi F, Cerro P, Iafrate F, Giustini M, Winn S, Morini S. Colon cancer prevention in Italy: cost-effectiveness analysis with CT colonography and endoscopy. Dig Liver Dis 2007; 39:242-50. [PMID: 17112797 DOI: 10.1016/j.dld.2006.09.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 09/05/2006] [Accepted: 09/18/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is a major cause of mortality in Italy. Although prevention of CRC is possible, its cost-effectiveness when applied to the Italian population is unknown. Recently, computerized tomographic colonography (CTC) has been proposed for CRC screening. AIM To compare the efficacy and cost-effectiveness of CTC screening in a simulated Italian population with those of colonoscopy and flexible sigmoidoscopy (FS). METHODS The cost-effectiveness of different screening strategies was compared using a Markov process computer model, in which in a hypothetical population of 100,000 50 year-olds were investigated by CTC, colonoscopy or FS every decade. Outcomes were projected to the Italian national level. RESULTS CRC incidence reduction was calculated at 40.9%, 38.2%, and 31.8% with colonoscopy, CTC and FS, respectively. As compared to no screening, all screening programs were shown to be cost-saving, allowing a saving of 11 Euro, 17 Euro, and 48 Euro per person with colonoscopy, FS and CTC, respectively. FS appeared to be less cost-effective than CTC, whilst colonoscopy appeared to be an expensive option as compared to CTC. Undiscounted national expenditure was calculated to be 1,042,489,512 Euro, 1,093,268,285 Euro, and 1,198,783,428 Euro for FS, CTC and colonoscopy, respectively, as compared to 695,818,078 Euro without screening. CONCLUSION CRC screening is cost-saving in Italy, irrespective of the technique applied. CTC appeared to be more cost-effective than FS, and it may also become a valid alternative to colonoscopy.
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Affiliation(s)
- C Hassan
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
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Purkayastha S, Athanasiou T, Tekkis PP, Constantinides V, Teare J, Darzi AW. Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison. Colorectal Dis 2007; 9:100-11. [PMID: 17223933 DOI: 10.1111/j.1463-1318.2006.01126.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The primary aim of this study was to use meta-regression techniques to compare the diagnostic accuracy of computed tomography colonography (CTC) and magnetic resonance colonography (MRC), compared with conventional colonoscopy for patients presenting with colorectal cancer (CRC). METHOD Quantitative meta-analysis was performed using prospective studies reporting comparative data between CTC and MRC individually to conventional colonoscopy. Study quality was assessed and sensitivities, specificities, diagnostic odds ratios (DOR) were calculated. Summary receiver operating characteristic (SROC) curves and sensitivity analysis were utilized. Meta-regression was used to indirectly compare the two modalities following adjustment for patient and study characteristics. RESULTS Overall sensitivity and specificity for CTC (0.96, 95% CI 0.92-0.99; 1.00, 95% CI 0.99-1.00 respectively) and MRC (0.91, 95% CI 0.79-0.97; 0.98, 95% CI 0.96-0.99 respectively) for the detection of CRC was similar. Meta-regression analysis showed no significant difference in the diagnostic accuracy of both modalities (beta=-0.64, P=0.37 and 95% CI of 0.12-2.39). Both tests showed high area under the SROC curve (CTC=0.99; MRC=0.98), with high DORs (CTC=1461.90, 95% CI 544.89-3922.30; MRC=576.41, 95% CI 135.00-2448.56). Factors that enhanced the overall accuracy of MRC were the use intravenous contrast, faecal tagging and exclusion of low-quality studies. No factors improved diagnostic accuracy from CTC except studies with more than 100 patients (AUC=1.00, DOR=2938.35, 95%CI 701.84-12 302.91). CONCLUSION This meta-analysis suggested that CTC and MRC have similar diagnostic accuracy for detecting CRC. Study quality, size and intravenous/intra-luminal contrast agents affect diagnostic accuracies. For an exact comparison to be made, studies evaluating CTC, MRC and colonoscopy in the same patient cohort would be necessary.
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Affiliation(s)
- S Purkayastha
- Department of Biosurgery & Surgical Technology, Imperial College, St Mary's Hospital, London, UK
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McLoughlin RM, O'Morain CA. Colorectal cancer screening. World J Gastroenterol 2006; 12:6747-6750. [PMID: 17106920 PMCID: PMC4087426 DOI: 10.3748/wjg.v12.i42.6747] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/01/2006] [Accepted: 09/09/2006] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is a major public health burden worldwide. There is clear-cut evidence that screening will reduce colorectal cancer mortality and the only contentious issue is which screening tool to use. Most evidence points towards screening with fecal occult blood testing. The immunochemical fecal occult blood tests have a higher sensitivity than the guaiac-based tests. In addition, their automation and haemoglobin quantification allows a threshold for colonoscopy to be selected that can be accommodated within individual health care systems.
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Sewitch MJ, Burtin P, Dawes M, Yaffe M, Snell L, Roper M, Zanelli P, Pavilanis A. Colorectal cancer screening: physicians' knowledge of risk assessment and guidelines, practice, and description of barriers and facilitators. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:713-718. [PMID: 17111053 PMCID: PMC2660826 DOI: 10.1155/2006/609746] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 03/02/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening. OBJECTIVE To assess physicians' knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours. METHODS Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours. RESULTS All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities. CONCLUSIONS Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Canada.
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Segarajasingam DS, Ang EBH, Fritschi L, Foster NM, Mendelson RM, Forbes GM. Seasonal variation of participation in colorectal neoplasia screening by colonoscopy or CT colonography. Aust N Z J Public Health 2006; 30:287-8. [PMID: 16800210 DOI: 10.1111/j.1467-842x.2006.tb00874.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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