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1
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Chatanaka MK, Diamandis EP. What does cancer screening have to do with tomato growing? Clin Chem Lab Med 2025; 63:1286-1291. [PMID: 39819368 DOI: 10.1515/cclm-2024-1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 01/07/2025] [Indexed: 01/19/2025]
Abstract
Cancer screening is considered to be a major strategy for combatting cancer. The United States Preventive Services Task Force (USPSTF) recommends screening for five cancers, but the strength of evidence about the effectiveness of screening is limited. To gain insights into the efficacy of early detection requires prospective, blinded, placebo-controlled clinical trials with decades of follow-up and inclusion of millions of participants. Recently, Bretthauer et al. estimated lifetime gained with cancer screening tests by using a meta-analysis of 18 large randomized clinical trials which included more than two million subjects. They asked if cancer screening tests are saving lives and how much life is extended due to commonly used cancer screening tests. Colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110 days, while fecal testing and mammography screening did not prolong life. A modest extension of 37 days was noted for prostate cancer screening with prostate-specific antigen testing and 107 days with lung cancer screening using computed tomography, but these estimates were not statistically significant. The authors concluded that current cancer screening strategies do not significantly prolong life. Based on these data, and the known biological behavior of some cancers, we hypothesized that the current strategies of treating cancer, after detection, could be modified to avoid the side effects of screening, which is a major determinant of the patient's overall survival.
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Affiliation(s)
- Miyo K Chatanaka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Eleftherios P Diamandis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Canada
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2
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Nur AM, Aljunid SM, Tolma EL, Annaka M, Alwotayan R, Elbasmi A, Alali WQ. Cost effectiveness analysis of three colorectal cancer screening modalities in Kuwait. Sci Rep 2025; 15:7354. [PMID: 40025065 PMCID: PMC11873134 DOI: 10.1038/s41598-025-91119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 02/18/2025] [Indexed: 03/04/2025] Open
Abstract
Colorectal cancer (CRC) poses a significant health challenge in Kuwait, ranking as the second most common cancer with the incidence rate 13.2 cases per 100,000 people in year 2019. This study aims to determine the cost-effectiveness of three colorectal cancer (CRC) screening methods in Kuwait from the perspective of Kuwait's healthcare providers. Using a Decision Tree Analysis Model, the study compared three screening modalities: Fecal Occult Blood Test (FOBT) followed by colonoscopy or sigmoidoscopy, colonoscopy alone, sigmoidoscopy alone and alongside no screening. Over a 10-year period post-diagnosis, the model tracked costs and outcomes based on CRC patients' life expectancy, expressing results using Incremental Cost Effectiveness Ratios (ICERs). Colorectal cancer screening using FOBT followed by colonoscopy or sigmoidoscopy resulted in 7.7 quality-adjusted life years (QALYs) at a cost of USD 3,573. In contrast, no screening achieved 7.2 QALYs but was more expensive, costing USD 4,084. Screening with only sigmoidoscopy or only colonoscopy provided 6.8 QALYs each, at costs of USD 4,905 and USD 5,002, respectively. Sensitivity analyses explored uncertainties in cost and outcome estimates. FOBT followed by colonoscopy or sigmoidoscopy can be considered as an efficient and effective approach towards early detection of CRC. This approach can be used by healthcare policymakers in Kuwait, in the development of population-based CRC screening programs to optimize resource allocation and improve public health outcomes.
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Affiliation(s)
- Amrizal Muhammad Nur
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam.
- Department of Health Policy and Management, College of Public Health, Health Sciences Center, Kuwait University, Shadadiya, Kuwait.
| | - Syed Mohamed Aljunid
- Department of Public Health and Community Medicine, IMU University, Kuala Lumpur, Malaysia
| | - Eleni L Tolma
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Mahmoud Annaka
- Department of International Health Relations, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Rihab Alwotayan
- Department of International Health Relations, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Amani Elbasmi
- Unit of Epidemiology and Cancer Registry, Cancer Control Center, Kuwait Ministry of Health, Shuwaikh, Kuwait City, Kuwait
| | - Walid Q Alali
- Department of Biostatistics & Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
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3
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Lopes SR, Martins C, Santos IC, Teixeira M, Gamito É, Alves AL. Colorectal cancer screening: A review of current knowledge and progress in research. World J Gastrointest Oncol 2024; 16:1119-1133. [PMID: 38660635 PMCID: PMC11037045 DOI: 10.4251/wjgo.v16.i4.1119] [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: 12/28/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, being the third most commonly diagnosed malignancy and the second leading cause of cancer-related deaths globally. Despite the progress in screening, early diagnosis, and treatment, approximately 20%-25% of CRC patients still present with metastatic disease at the time of their initial diagnosis. Furthermore, the burden of disease is still expected to increase, especially in individuals younger than 50 years old, among whom early-onset CRC incidence has been increasing. Screening and early detection are pivotal to improve CRC-related outcomes. It is well established that CRC screening not only reduces incidence, but also decreases deaths from CRC. Diverse screening strategies have proven effective in decreasing both CRC incidence and mortality, though variations in efficacy have been reported across the literature. However, uncertainties persist regarding the optimal screening method, age intervals and periodicity. Moreover, adherence to CRC screening remains globally low. In recent years, emerging technologies, notably artificial intelligence, and non-invasive biomarkers, have been developed to overcome these barriers. However, controversy exists over the actual impact of some of the new discoveries on CRC-related outcomes and how to effectively integrate them into daily practice. In this review, we aim to cover the current evidence surrounding CRC screening. We will further critically assess novel approaches under investigation, in an effort to differentiate promising innovations from mere novelties.
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Affiliation(s)
- Sara Ramos Lopes
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
| | - Claudio Martins
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
| | - Inês Costa Santos
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
| | - Madalena Teixeira
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
| | - Élia Gamito
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
| | - Ana Luisa Alves
- Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal
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Bae S, Lee K, Kim BC, Jun JK, Choi KS, Suh M. Cost-Utility Analysis for Colorectal Cancer Screening According to the Initiating Age of National Cancer Screening Program in Korea. J Korean Med Sci 2024; 39:e98. [PMID: 38501184 PMCID: PMC10948257 DOI: 10.3346/jkms.2024.39.e98] [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: 08/31/2023] [Accepted: 01/17/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND This study aimed to identify the most cost-effective strategy for colorectal cancer screening using the fecal immunochemical test (FIT), focusing on screening initiation age in Korea. METHODS We designed Markov simulation models targeting individuals aged 40 years or older. Twelve strategies combining screening initiation ages (40, 45, or 50 years old), termination ages (80 or no limit), and intervals (1 or 2 years) were modeled, and the most cost-effective strategy was selected. The robustness of the results was confirmed using one-way and probabilistic sensitivity analyses. Furthermore, the cost-effectiveness of the qualitative and quantitative FIT methods was verified using scenario analysis. RESULTS The 2-year interval strategy with a screening age range of 45-80 years was the most cost-effective (incremental cost-utility ratio = KRW 7,281,646/quality adjusted life years). The most sensitive variables in the results were transition rate from advanced adenoma to local cancer and discount rate. The uncertainty in the model was substantially low. Moreover, strategies starting at the age of 40 years were also cost-effective but considered suboptimal. The scenario analysis showed that there was no significant difference in cost-effectiveness between strategies with various relative screening ratio of quantitative and qualitative method. CONCLUSION The screening method for advancing the initiation age, as presented in the 2015 revised national screening recommendations, was superior regarding cost-effectiveness. This study provides a new paradigm for the development of a national cancer screening system in Korea, which can be utilized as a scientific basis for economic evaluations.
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Affiliation(s)
- Seowoo Bae
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Kyeongmin Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Blom J, Saraste D, Törnberg S, Jonsson H. Routine Fecal Occult Blood Screening and Colorectal Cancer Mortality in Sweden. JAMA Netw Open 2024; 7:e240516. [PMID: 38411959 PMCID: PMC10900849 DOI: 10.1001/jamanetworkopen.2024.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Importance Population-based colorectal cancer (CRC) screening programs are implemented worldwide, but there are difficulties evaluating their effectiveness. The magnitude of routine CRC screening effectiveness regarding cancer-specific mortality is unclear. Objective To evaluate cancer-specific mortality associated with early vs late or no invitation for routine CRC screening using fecal occult blood testing. Design, Setting, and Participants This prospective cohort study was performed in the region of Stockholm-Gotland, Sweden, between January 1, 2008, and December 31, 2021. All individuals of the target population of screening born from 1938 to 1954 were included. Data were analyzed from December 12, 2022, to June 25, 2023. Exposures Individuals were invited early (2008-2012), late (2013-2015), or not at all to screening with biennial guaiac-based fecal occult blood test. The early invitation group was considered the exposure group and the late or no invitation group was considered the control group. Main Outcomes and Measures The main outcome was cancer-specific mortality, defined as CRC registered in the Cancer Register with CRC as underlying cause of death in the Cause of Death Register. Excess mortality was calculated as all-cause deaths among the individuals with CRC subtracted from the expected number of deaths had they not had CRC. Poisson regression analysis based on deaths and person-years was used to estimated mortality rate ratio (RR) with 95% CIs, adjusted for follow-up years and attained age. Results In total, 379 448 individuals (193 436 [51.0%] female) were invited for CRC screening, including 203 670 individuals in the exposure group and 175 778 in the control group. The mean screening participation rate was 63.3%, and there was a maximum of 14 years follow-up. There were 834 CRC deaths in 2 190 589 person-years in the exposure group, compared with 889 CRC deaths in 2 249 939 person-years in the control group. Individuals who underwent early CRC screening had reduced adjusted risk of CRC mortality (RR, 0.86; 95% CI, 0.78-0.95) and excess mortality (RR, 0.84; 95% CI, 0.75-0.93). Conclusions and Relevance This prospective cohort study of routine screening with fecal occult blood testing found a 14% decrease in CRC mortality associated with screening. The true association of screening with reduced mortality is expected to be higher due to some coexistence of testing in the control group and CRC deaths diagnosed more than 2 years after screening.
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Affiliation(s)
- Johannes Blom
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Deborah Saraste
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Sven Törnberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Li Y, Li B, Jiang R, Liao L, Zheng C, Yuan J, Zeng L, Hu K, Zhang Y, Mei W, Hong Z, Xiao B, Kong L, Han K, Tang J, Jiang W, Pan Z, Zhang S, Ding P. A novel screening method of DNA methylation biomarkers helps to improve the detection of colorectal cancer and precancerous lesions. Cancer Med 2023; 12:20626-20638. [PMID: 37881109 PMCID: PMC10660402 DOI: 10.1002/cam4.6511] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/22/2023] [Accepted: 08/30/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common malignancies, and early detection plays a crucial role in enhancing curative outcomes. While colonoscopy is considered the gold standard for CRC diagnosis, noninvasive screening methods of DNA methylation biomarkers can improve the early detection of CRC and precancerous lesions. METHODS Bioinformatics and machine learning methods were used to evaluate CRC-related genes within the TCGA database. By identifying the overlapped genes, potential biomarkers were selected for further validation. Methylation-specific PCR (MSP) was utilized to identify the associated genes as biomarkers. Subsequently, a real-time PCR assay for detecting the presence of neoplasia or cancer of the colon or rectum was established. This screening approach involved the recruitment of 978 participants from five cohorts. RESULTS The genes with the highest specificity and sensitivity were Septin9, AXL4, and SDC2. A total of 940 participants were involved in the establishment of the final PCR system and the subsequent performance evaluation test. A multiplex TaqMan real-time PCR system has been illustrated to greatly enhance the ability to detect precancerous lesions and achieved an accuracy of 87.8% (95% CI 82.9-91.5), a sensitivity of 82.7% (95% CI 71.8-90.1), and a specificity of 90.1% (95% CI 84.3-93.9). Moreover, the detection rate of precancerous lesions of this assay reached 55.0% (95% CI 38.7-70.4). CONCLUSION The combined detection of the methylation status of SEPT9, SDC2, and ALX4 in plasma holds the potential to further enhance the sensitivity of CRC detection.
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Affiliation(s)
- Yuan Li
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Bin Li
- Beijing BGI‐GBI Biotech Co., LtdBeijingChina
| | - Rou Jiang
- Department of Cancer Prevention CenterSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Leen Liao
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | | | - Jie Yuan
- Department of General SurgeryThe Fifth Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | | | - Kunling Hu
- Beijing BGI‐GBI Biotech Co., LtdBeijingChina
| | | | - Weijian Mei
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Zhigang Hong
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Binyi Xiao
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Lingheng Kong
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Kai Han
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Jinghua Tang
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Wu Jiang
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Zhizhong Pan
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | | | - Peirong Ding
- Department of Colorectal SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
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Bretthauer M, Wieszczy P, Løberg M, Kaminski MF, Werner TF, Helsingen LM, Mori Y, Holme Ø, Adami HO, Kalager M. Estimated Lifetime Gained With Cancer Screening Tests: A Meta-Analysis of Randomized Clinical Trials. JAMA Intern Med 2023; 183:1196-1203. [PMID: 37639247 PMCID: PMC10463170 DOI: 10.1001/jamainternmed.2023.3798] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/14/2023] [Indexed: 08/29/2023]
Abstract
Importance Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests. Objective To estimate lifetime gained with cancer screening. Data Sources A systematic review and meta-analysis was conducted of randomized clinical trials with more than 9 years of follow-up reporting all-cause mortality and estimated lifetime gained for 6 commonly used cancer screening tests, comparing screening with no screening. The analysis included the general population. MEDLINE and the Cochrane library databases were searched, and the last search was performed October 12, 2022. Study Selection Mammography screening for breast cancer; colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) for colorectal cancer; computed tomography screening for lung cancer in smokers and former smokers; or prostate-specific antigen testing for prostate cancer. Data Extraction and Synthesis Searches and selection criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were independently extracted by a single observer, and pooled analysis of clinical trials was used for analyses. Main Outcomes and Measures Life-years gained by screening was calculated as the difference in observed lifetime in the screening vs the no screening groups and computed absolute lifetime gained in days with 95% CIs for each screening test from meta-analyses or single randomized clinical trials. Results In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, -190 to 237 days), prostate cancer screening (37 days; 95% CI, -37 to 73 days), colonoscopy (37 days; 95% CI, -146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, -70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, -286 days to 430 days). Conclusions and Relevance The findings of this meta-analysis suggest that current evidence does not substantiate the claim that common cancer screening tests save lives by extending lifetime, except possibly for colorectal cancer screening with sigmoidoscopy.
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Affiliation(s)
- Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Paulina Wieszczy
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magnus Løberg
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Michal F. Kaminski
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cancer Prevention and Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Lise M. Helsingen
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Øyvind Holme
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mette Kalager
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Department for Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Pennington E, Bell S, Hill JE. Should video laryngoscopy or direct laryngoscopy be used for adults undergoing endotracheal intubation in the pre-hospital setting? A critical appraisal of a systematic review. JOURNAL OF PARAMEDIC PRACTICE : THE CLINICAL MONTHLY FOR EMERGENCY CARE PROFESSIONALS 2023; 15:255-259. [PMID: 38812899 PMCID: PMC7616025 DOI: 10.1002/14651858] [Citation(s) in RCA: 2724] [Impact Index Per Article: 1362.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The safety and utility of endotracheal intubation by paramedics in the United Kingdom is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice.
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Affiliation(s)
| | - Steve Bell
- Consultant Paramedic, North West Ambulance Service NHS Trust
| | - James E Hill
- University of Central Lancashire, Colne, Lancashire
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9
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Castanon A, Parmar D, Massat NJ, Sasieni P, Duffy SW. Benefit of Biennial Fecal Occult Blood Screening on Colorectal Cancer in England: A Population-Based Case-Control Study. J Natl Cancer Inst 2022; 114:1262-1269. [PMID: 35575409 PMCID: PMC9468279 DOI: 10.1093/jnci/djac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The English national bowel cancer screening program offering a guaiac fecal occult blood test began in July 2006. In randomized controlled trials of guaiac fecal occult blood test screening, reductions in mortality were accompanied by reductions in advanced stage colorectal cancer (CRC). We aimed to evaluate the effect of participation in the national bowel cancer screening program on stage-specific CRC incidence as a likely precursor of a mortality effect. METHODS In this population-based case-control study, cases were individuals diagnosed with CRC aged 60-79 years between January 1, 2012, and December 31, 2013. Two controls per case were matched on geographic region, gender, date of birth, and year of first screening invitation. Screening histories were extracted from the screening database. Conditional logistic regression with correction for self-selection bias was used to estimate odds ratios (odds ratios corrected for self-selection bias [cOR]) and 95% confidence intervals (CIs) by Duke stage, sex, and age. RESULTS 14 636 individuals with CRC and 29 036 without were eligible for analysis. The odds of CRC (any stage) were increased within 30 days of a screening test and decreased thereafter. No reduction in CRC (any stage) among screened individuals compared with those not screened was observed (cOR = 1.00, 95% CI = 0.89 to 1.15). However, screened individuals had lower odds of Duke stage D CRC (cOR = 0.68, 95% CI = 0.50 to 0.93). We estimate 435 fewer Duke D CRC by age 80 years in 100 000 people screened biennially between ages 60 and 74 years compared with an unscreened cohort. CONCLUSION The impact of colorectal screening on advanced CRC incidence suggests that the program will meet its aim of reducing mortality.
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Affiliation(s)
- Alejandra Castanon
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Dharmishta Parmar
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nathalie J Massat
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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10
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Akwiwu EU, Klausch T, Jodal HC, Carvalho B, Løberg M, Kalager M, Berkhof J, H. Coupé VM. A progressive three-state model to estimate time to cancer: a likelihood-based approach. BMC Med Res Methodol 2022; 22:179. [PMID: 35761181 PMCID: PMC9235269 DOI: 10.1186/s12874-022-01645-2] [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] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To optimize colorectal cancer (CRC) screening and surveillance, information regarding the time-dependent risk of advanced adenomas (AA) to develop into CRC is crucial. However, since AA are removed after diagnosis, the time from AA to CRC cannot be observed in an ethically acceptable manner. We propose a statistical method to indirectly infer this time in a progressive three-state disease model using surveillance data. METHODS Sixteen models were specified, with and without covariates. Parameters of the parametric time-to-event distributions from the adenoma-free state (AF) to AA and from AA to CRC were estimated simultaneously, by maximizing the likelihood function. Model performance was assessed via simulation. The methodology was applied to a random sample of 878 individuals from a Norwegian adenoma cohort. RESULTS Estimates of the parameters of the time distributions are consistent and the 95% confidence intervals (CIs) have good coverage. For the Norwegian sample (AF: 78%, AA: 20%, CRC: 2%), a Weibull model for both transition times was selected as the final model based on information criteria. The mean time among those who have made the transition to CRC since AA onset within 50 years was estimated to be 4.80 years (95% CI: 0; 7.61). The 5-year and 10-year cumulative incidence of CRC from AA was 13.8% (95% CI: 7.8%;23.8%) and 15.4% (95% CI: 8.2%;34.0%), respectively. CONCLUSIONS The time-dependent risk from AA to CRC is crucial to explain differences in the outcomes of microsimulation models used for the optimization of CRC prevention. Our method allows for improving models by the inclusion of data-driven time distributions.
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Affiliation(s)
- Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Thomas Klausch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Henriette C. Jodal
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
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Van Poel E, Vanden Bussche P, Klemenc-Ketis Z, Willems S. How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC PRIMARY CARE 2022; 23:11. [PMID: 35172744 PMCID: PMC8760114 DOI: 10.1186/s12875-021-01587-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND General practitioners (GPs) play a crucial role in the fight against the COVID-19 pandemic as the first point of contact for possibly infected patients and are responsible for short and long-term follow-up care of the majority of COVID-19 patients. Nonetheless, they experience many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in 38 countries are organized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks and the wellbeing of staff members is researched. Finally, PRICOV-19 aims to study the association with practice- and health care system characteristics. It is expected that both characteristics of the GP practice and health care system features are associated with how GP practices can cope with these challenges. This paper describes the protocol of the study. METHODS Using a cross-sectional design, data are collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The questionnaire is developed in multiple phases, including a pilot study in Belgium. The final version includes 53 items divided into six sections: patient flow (including appointments, triage, and management for routine care); infection prevention; information processing; communication; collaboration and self-care; and practice and participant characteristics. In the countries where data collection is already finished, between 13 and 636 GP practices per country participated in the study. Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level. DISCUSSION To the best of our knowledge, the PRICOV-19 study is the largest and most comprehensive study that examines how GP practices function during the COVID-19 pandemic. Its results can significantly contribute to better preparedness of primary health care systems across Europe for future major outbreaks of infectious diseases.
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Affiliation(s)
- E Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - P Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Z Klemenc-Ketis
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - S Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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12
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Murphy CC, Halm EA, Zaki T, Johnson C, Yekkaluri S, Quirk L, Singal AG. Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System. Dig Dis Sci 2022; 67:4403-4409. [PMID: 34800219 PMCID: PMC8605769 DOI: 10.1007/s10620-021-07313-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Screening with fecal immunochemical testing (FIT) reduces colorectal cancer mortality; however, screening remains low in underserved populations. Mailed outreach, including an invitation letter, FIT, and test instructions, is an evidence-based strategy to improve screening. AIMS To examine screening completion and yield in a mailed outreach program in a safety-net healthcare system. METHODS We identified and mailed outreach invitations to patients due for screening in a large safety-net system between September 1, 2018, and August 31, 2019. We examined: (1) screening completion, the proportion of patients completing FIT or screening colonoscopy within 6 months of the mailed invitation; and (2) timely diagnostic colonoscopy, the proportion of patients completing colonoscopy within 6 months of positive FIT. RESULTS We mailed 14,879 invitations to 13,190 patients. Nearly half (n = 6098, 46.2%) of patients completed screening: 4,896 (80.3%) completed FIT through mailed outreach; 1,114 (18.3%) FIT through usual care; and 88 (1.4%) screening colonoscopy through usual care. Of patients with a positive FIT (n = 289), 50.5% completed diagnostic colonoscopy within 6 months, 10.7% within 6-12 months, and 4.8% after 12 months. A total of 8 cancers and 83 advanced adenomas were detected in the 191 patients completing diagnostic colonoscopy. CONCLUSION After implementing and scaling up mailed outreach in a safety-net system, about half of patients completed screening, and the majority did so through mailed outreach. However, many patients failed to complete diagnostic colonoscopy after positive FIT. Results highlight the importance of adapting mailed outreach programs to local contexts and constraints of healthcare systems, in order to support efforts to improve CRC screening in underserved populations.
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Affiliation(s)
- Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin St., Ste. 2618, Houston, TX 77030 USA
| | - Ethan A. Halm
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Timothy Zaki
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Carmen Johnson
- Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Sruthi Yekkaluri
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Lisa Quirk
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Amit G. Singal
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
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13
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Tran BT, Choi KS, Sohn DK, Kim SY, Suh JK, Tran TH, Nguyen TTB, Oh JK. Estimating cost-effectiveness of screening for colorectal cancer in Vietnam. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1-10. [PMID: 34129408 DOI: 10.1080/14737167.2021.1940963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 01/22/2023]
Abstract
Background:Presently, there are no national screening programs for cancer in Vietnam. This study aimed to analyze the cost-effectiveness of an annual colorectal cancer (CRC) screening program from the healthcare service provider's perspective for the Vietnamese population.Methods:The economic model consisted of adecision tree and aMarkov model. Adecision tree was constructed for comparing two strategies, including ascreening group with aguaiac-based fecal occult blood test (gFOBT) and ano-screening group in general populations, aged 50 years and above. The Markov model projected outcomes over a25-year horizon. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per quality-adjusted life-years (QALYs).Results:When compared with no screening, ICER was $1,388per QALY with an increased cost of $ 43.98 and again of 0.032 QALY (Willingness to pay $2,590). The uptake rate of gFOBT, cost of colonoscopy, and the total cost of screening contributed to the largest impact on the ICER. PSA showed that results were robust to variation in parameter estimates, with annual screening remaining cost-effective compared with no screening.Conclusion:Our screening strategy could be considered cost-effective compared to ano screening strategy. Our findings could be potentially used to develop aCRC national screening program.
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Affiliation(s)
- Binh Thang Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- National Cancer Control Institute; National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jae Kyung Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Thanh Huong Tran
- National Cancer Institute, National Oncology Hospital, Hanoi, Vietnam
| | - Thi Thanh Binh Nguyen
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Division of Cancer Prevention & Early Detection, National Cancer Center, Goyang, Republic of Korea
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14
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Green BB, Baldwin LM, West II, Schwartz M, Coronado GD. Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program. J Prim Care Community Health 2021; 11:2150132720958525. [PMID: 32912056 PMCID: PMC7488888 DOI: 10.1177/2150132720958525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Follow-up colonoscopy after a positive fecal immunochemical test (FIT) is necessary for colorectal cancer (CRC) screening to be effective. We report colonoscopy follow-up rates after a positive FIT overall and by population characteristics in the BeneFIT demonstration pilot, a Medicaid health insurance plan-delivered mailed FIT outreach program. METHODS In 2016, 2 health insurance plans in Oregon and in Washington state mailed FIT kits to Medicaid patients who, based on claims data, were overdue for CRC screening. We report follow-up colonoscopy completion rates after positive FIT, and differences in completion rates by age, sex, race, ethnicity, preferred language, and number of primary care visits in the prior year. This research was human subjects approved with a waiver of consent for data collection. RESULTS The FIT positivity rates in Health Plan Oregon and Health Plan Washington were 7.9% (39/488) and 14.6% (125/857), respectively. Colonoscopy completion rates within 12 months of the positive test were 35.9% (14/41) in Health Plan Oregon and 32.8% (41/125) in Health Plan Washington. Colonoscopy completion rates were higher among individuals who preferred a language other than English (Non-English speakers 70.0%, English speakers 31.3%, P = .04). CONCLUSION In a health plan-delivered mailed FIT outreach program, follow-up colonoscopy rates after a positive test were low. Additional interventions are needed to assure colonoscopy after a positive FIT test and to reap the benefits of screening.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | - Gloria D Coronado
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
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15
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Nakazawa K, Nouda S, Kakimoto K, Kinoshita N, Tanaka Y, Tawa H, Koshiba R, Naka Y, Hirata Y, Ota K, Kawakami K, Takeuchi T, Inoue T, Miyazaki T, Sanomura M, Nakamura S, Saito Y, Higuchi K. The Differential Diagnosis of Colorectal Polyps Using Colon Capsule Endoscopy. Intern Med 2021; 60:1805-1812. [PMID: 33456043 PMCID: PMC8263190 DOI: 10.2169/internalmedicine.6446-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Although colorectal polyps (CPs) can be observed with colon capsule endoscopy (CCE), it is difficult to determine the type of polyp using CCE. The objective of this study was to differentiate adenomatous polyps (APs) from hyperplastic polyps (HPs) with CCE. Methods In this single-center retrospective study, an analysis was conducted on the same CPs with both CCE and colonoscopy (CS) and histopathologically diagnosed as AP or HP. The color difference (ΔE) between the polyp surface and the surrounding mucosa was calculated using the CIE1976 L*a*b* color space method on white light (WL), flexible spectral imaging color enhancement (FICE), and blue mode (BM) CP images. We investigated the ability of the ratio of the color differences (ΔE') to differentiate between APs and HPs. Results The size of all 51 polyps (34 APs, 17 HPs) was 7.5±4.6 mm with CCE and 7.3±4.2 mm with CS, and this difference was not significant (p=0.28). The FICEΔE' of APs was 3.3±1.8, which was significantly higher than the FICEΔE' of HPs (1.3±0.6; p<0.001). A receiver operating characteristic analysis showed that FICEΔE' was useful for differentiating between APs and HPs, with an area under the curve of 0.928 (95% confidence interval, 0.843-1). The sensitivity was 91.2%, and the specificity was 88.2% with a cut-off value of 1.758. Conclusion Using FICE on CCE images of CPs and applying the CIELAB color space method, we were able to differentiate between APs and HPs with high accuracy. This method has the potential to reduce unnecessary CS procedures.
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Affiliation(s)
- Kei Nakazawa
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
- Endoscopy Division, National Cancer Center Hospital, Japan
| | - Sadaharu Nouda
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Kazuki Kakimoto
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | | | - Yasuyoshi Tanaka
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Hideki Tawa
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Ryoji Koshiba
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Yutaka Naka
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Yuki Hirata
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Kazuhiro Ota
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Ken Kawakami
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | | | - Takuya Inoue
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Takako Miyazaki
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Makoto Sanomura
- Department of Gastroenterology, Hokusetsu General Hospital, Japan
| | - Shiro Nakamura
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Japan
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16
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Sandoval JL, Relecom A, Ducros C, Bulliard JL, Arzel B, Guessous I. Screening Status as a Determinant of Choice of Colorectal Cancer Screening Method: A Population-Based Informed Survey. Gastrointest Tumors 2021; 8:63-70. [PMID: 33981684 DOI: 10.1159/000512954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives Fecal blood testing is a noninvasive alternative to colonoscopy for colorectal cancer (CRC) screening and is preferred by a substantial proportion of individuals. However, participant-related determinants of the choice of screening method, particularly up-to-date screening status, remain less studied. We aimed to determine if up-to-date screening status was related to choosing a fecal blood test over colonoscopy. Setting Participants in the population-based cross-sectional survey study Bus Santé in Geneva, Switzerland - aged 50-69 years. Design Cross-sectional survey study using mailed questionnaires inquiring about CRC screening method of choice after providing information on advantages and disadvantages of both screening methods. We used multivariable logistic regression models to determine the association between up-to-date CRC screening status and choosing fecal blood testing. Key results We included 1,227 participants. Thirty-eight percent of participants did not have up-to-date CRC screening. Overall, colonoscopy (54.9%) was preferred to fecal blood testing (45.1%) (p < 0.001) as screening method of choice. However, screening method choices differed between those with (65.6% colonoscopy and 34.4% fecal blood testing) and without up-to-date CRC screening (36.5% colonoscopy and 63.5% fecal blood testing). Not having up-to-date CRC screening was associated with a higher probability of choosing fecal blood testing as screening method (odds ratio = 2.6 [1.9; 3.7], p < 0.001) after adjustment for the aforementioned confounders. Conclusions Not having up-to-date screening was independently associated with fecal blood testing as the preferred method for CRC screening. Proposing this method to this subpopulation, in a context of shared decision, could potentially increase screening uptake in settings where it is already high.
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Affiliation(s)
- José Luis Sandoval
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Allan Relecom
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Cyril Ducros
- Vaud Cancer Screening Foundation, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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17
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Manne SL, Islam N, Frederick S, Khan U, Gaur S, Khan A. Culturally-adapted behavioral intervention to improve colorectal cancer screening uptake among foreign-born South Asians in New Jersey: the Desi Sehat trial. ETHNICITY & HEALTH 2021; 26:554-570. [PMID: 30394106 PMCID: PMC6500482 DOI: 10.1080/13557858.2018.1539219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Colorectal cancer (CRC) is the third most common cancer among Americans of South Asian (SA) descent and is a significant public health concern in SA communities. Rates of screening compliance among foreign-born SAs are very low. The goal of this study was to report on the development, acceptability, and preliminary impact of a culturally-targeted 1:1 intervention delivered in English, Hindi, and Urdu, called Desi-Sehat.Design: Ninety-three foreign-born SAs between the ages of 50 and 75 were recruited using community-based organization methods. Participants completed a baseline survey, participated in a 1:1 session with a community health educator, and a follow-up survey was administered four months after the baseline.Results: The acceptance rate was moderate (52.8%). Attendance at the intervention session was high. More than half of the population did not complete the follow-up survey (58.7%). Participant evaluations of the intervention were high. Intent-to-treat analyses indicate a 30% four month follow-up CRC screening uptake. There were significant increases in knowledge and significant reductions in perceived barriers to screening, worry about CRC screening tests, and worry about CRC. Effect sizes for significant changes were in the medium to large range.Conclusions: Desi Sehat was a well-evaluated and participation in the session was high, participant knowledge significantly increased, and screening barriers, worry about CRC, and worry about CRC screening tests declined significantly. Future studies should focus on enhancing recruitment and retention and include a randomized control design.
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Affiliation(s)
| | - Nadia Islam
- New York University School of Medicine, New York, NY,
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Usman Khan
- Rutgers Robert Wood Johnson Medical School,
| | | | - Anam Khan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
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18
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Effects of Screening Compliance on Long-term Reductions in All-Cause and Colorectal Cancer Mortality. Clin Gastroenterol Hepatol 2021; 19:967-975.e2. [PMID: 32634624 DOI: 10.1016/j.cgh.2020.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Randomized trials have shown that biennial fecal occult blood test (FOBT) screening reduces mortality from colorectal cancer (CRC), but not overall mortality. Differences in benefit for men vs women, and by age, are unknown. We sought to evaluate long-term reduction in all-cause and CRC-specific mortality in men and women who comply with offered screening, and in different age groups, using individual participant data from 2 large randomized trials of biennial FOBT screening, compared with an intention to treat analysis. METHODS We updated the CRC and all-cause mortality from the Danish CRC screening trial (n = 61,933) through 30 years of follow up and pooled individual participant data with individual 30-year follow-up data from the Minnesota Colon Cancer Control trial (n = 46,551). We compared the biennial screening groups to usual care (controls) in individuals 50-80 years old using Kaplan Meier estimates of relative risks and risk differences, adjusted for study differences in age, sex, and compliance. RESULTS Through 30 years of follow up, there were 33,478 (71.9%) and 33,479 (72.2%) total deaths and 1023 (2.2%) and 1146 (2.5%) CRC deaths in the biennial screening (n = 46,553) and control groups (n = 46,358), respectively. Among compliers, biennial FOBT screening significantly reduced CRC mortality by 16% (relative risk [RR], 0.84; 95% CI, 0.74-0.96) and all-cause mortality by 2% (RR, 0.98; 95% CI, 0.97-0.99). Among compliers, the reduction in CRC mortality was larger for men (RR, 0.75; 95% CI, 0.62-0.90) than women (RR, 0.91; 95% CI, 0.75-1.09). The largest reduction in CRC mortality was in compliant men 60-69 years old (RR, 0.59; 95% CI, 0.42-0.81) and women 70 years and older (RR, 0.53; 95% CI, 0.30-0.94). CONCLUSIONS Long-term CRC mortality outcomes of screening among compliers using biennial FOBT are sustained, with a statistically significant reduction in all-cause mortality. The reduction in CRC mortality is greater in men than women-the benefit in women lags that of men by about 10 years.
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19
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Robbins EC, Cross AJ. Guaiac Fecal Occult Blood Tests and Mortality: A 30-Year Follow-up of Two Pooled Trials. Clin Gastroenterol Hepatol 2021; 19:892-894. [PMID: 32798704 DOI: 10.1016/j.cgh.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Emma C Robbins
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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20
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Liang JQ, Wong SH, Szeto CH, Chu ESH, Lau HC, Chen Y, Fang J, Yu J, Sung JJY. Fecal microbial DNA markers serve for screening colorectal neoplasm in asymptomatic subjects. J Gastroenterol Hepatol 2021; 36:1035-1043. [PMID: 32633422 PMCID: PMC8247299 DOI: 10.1111/jgh.15171] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/04/2020] [Accepted: 07/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM We have previously shown that fecal microbial markers might be useful for non-invasive diagnosis of colorectal cancer (CRC) and adenoma. Here, we assessed the application of microbial DNA markers, as compared with and in combination with fecal immunochemical test (FIT), in detecting CRC and adenoma in symptomatic patients and asymptomatic subjects. METHODS We recruited 676 subjects [210 CRC, 115 advanced adenoma (AA), 86 non-advanced adenoma, and 265 non-neoplastic controls], including 241 symptomatic and 435 asymptomatic subjects. Fecal abundances of Fusobacterium nucleatum, a Lachnoclostridium sp. m3, Bacteroides clarus, and Clostridium hathewayi were quantified by quantitative PCR. Combining score of the four microbial markers (4Bac) and diagnostic prediction were determined using our previously established scoring model and cutoff values and FIT with a cutoff of 100 ng Hb/mL. RESULTS 4Bac detected similar percentages of CRC [85.3% (95%CI: 79.2-90.2%) vs 84.9% (68.1-94.9%)] and AA [35.7% (12.8-64.9%) vs 38.6% (29.1-48.8%)], while FIT detected more CRC [72.1% (63.7-79.4%) vs 66.7% (48.2-82.0%)] and AA [28.6% (8.4-58.1%) vs 16.8% (10.1-25.6%)], in symptomatic vs asymptomatic subjects, respectively. Focusing on the asymptomatic cohort, 4Bac was more sensitive for diagnosing CRC and AA than FIT (P < 0.001), with lower specificity [83.3% (77.6-88.0%) vs 98.6% (96.0-99.7%)]. FIT failed to detect any non-advanced adenoma [0% (0.0-4.2%)] compared with 4Bac [41.9% (31.3-53.0%), P < 0.0001]. Combining 4Bac with FIT improved sensitivities for CRC [90.9% (75.7-98.1%)] and AA [48.5% (38.4-58.7%)] detection. CONCLUSION Quantitation of fecal microbial DNA markers may serve as a new test, stand alone, or in combination with FIT for screening colorectal neoplasm in asymptomatic subjects.
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Affiliation(s)
- Jessie Qiaoyi Liang
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China,Department of Microbiology, Faculty of MedicineThe Chinese University of Hong KongHong Kong, China
| | - Sunny H Wong
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
| | - Chun Ho Szeto
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
| | - Eagle SH Chu
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
| | - Harry C Lau
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
| | - Yingxuan Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, School of MedicineShanghai Jiaotong UniversityShanghaiChina
| | - Jingyuan Fang
- Division of Gastroenterology and Hepatology, Renji Hospital, School of MedicineShanghai Jiaotong UniversityShanghaiChina
| | - Jun Yu
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
| | - Joseph JY Sung
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research InstituteThe Chinese University of Hong KongHong Kong, China
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21
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Hultcrantz R. Aspects of colorectal cancer screening, methods, age and gender. J Intern Med 2021; 289:493-507. [PMID: 32929813 PMCID: PMC8048936 DOI: 10.1111/joim.13171] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is, besides breast, prostate, lung and skin cancers, the most common cancer worldwide and is suitable for screening. The incidence of CRC varies considerably in different parts of the world: in well-developed countries, the incidence is between 30 and 70 per 100 000 inhabitants, whereas in less-developed countries such as sub-Saharan Africa, it is 10-20/100 000 inhabitants. Women have a lower incidence of CRC, which is usually one-third of total incidence. Several studies have shown that it is possible to decrease mortality from CRC with about 20%, which is evidenced through the data from countries with screening programmes. Though the method of choice to identify blood samples in faecal matter is under debate, the most feasible way is to perform colonoscopy. Other methods include more advanced faecal analyses, testing for mutations from CRC, sigmoidoscopy, CT colonoscopy or optical colonoscopy. Colonoscopy is in most countries not available in sufficient amount and has to be carried out with great accuracy; otherwise, lesions will be missed to identify, thus leading to complications. Gender is an issue in CRC screening, as women have about 20% fewer colorectal adenomas and CRCs, but they also have more right-sided lesions, which are more difficult to detect with tests for faecal blood since they create less blood in faeces. Thus, other strategies may have to be developed for women in order for screening to have the same effect. It is essential to introduce colorectal cancer screening in all countries together with other clinical pieces of advice such as information on smoking, obesity and exercise in order to reduce one of the most dangerous cancers.
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Affiliation(s)
- R Hultcrantz
- From the, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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22
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Musselwhite LW, May FP, Salem ME, Mitchell EP. Colorectal Cancer: In the Pursuit of Health Equity. Am Soc Clin Oncol Educ Book 2021; 41:108-117. [PMID: 34010044 DOI: 10.1200/edbk_321071] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients-all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.
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Affiliation(s)
- Laura W Musselwhite
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA-Kaiser Permanente Center for Health Equity, and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, CA
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Mohamed E Salem
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Edith P Mitchell
- Center to Eliminate Cancer Disparities, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA
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23
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Fisher DA, Karlitz JJ, Jeyakumar S, Smith N, Limburg P, Lieberman D, Fendrick AM. Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population. J Med Econ 2021; 24:654-664. [PMID: 33902366 DOI: 10.1080/13696998.2021.1922240] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM Multiple screening strategies are guideline-endorsed for average-risk colorectal cancer (CRC). The impact of real-world adherence rates on the cost-effectiveness of non-invasive stool-based CRC screening strategies remains undefined. METHODS This cost-effectiveness analysis from the perspective of Medicare as a primary payer used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) to estimate cost and clinical outcomes for triennial multi-target stool DNA (mt-sDNA), annual fecal immunochemical test (FIT) and annual fecal occult blood test (FOBT) screening strategies in a simulated cohort of US adults aged 65 years, who were assumed to either be previously unscreened or initiating screening upon entry to Medicare. Reported real-world adherence rates for initial stool-based screening and colonoscopy follow up (after a positive stool test result) were defined as 71.1% and 73.0% for mt-sDNA, 42.6% and 47.0% for FIT, and 33.4% and 47.0% for FOBT, respectively. The incremental cost-effectiveness ratio using quality-adjusted life years (QALY) was defined as the primary outcome of interest; other cost and clinical outcomes were also reported in secondary analyses. Multiple sensitivity and scenario analyses were conducted. RESULTS When reported real-world adherence rates were included only for initial stool-based screening, mt-sDNA was cost-effective versus FIT ($62,814/QALY) and FOBT ($39,171/QALY); mt-sDNA also yielded improved clinical outcomes. When reported real-world adherence rates were included for both initial stool-based screening and follow-up colonoscopy (when indicated), mt-sDNA was increasingly cost-effective compared to FIT and FOBT ($31,725/QALY and $28,465/QALY, respectively), with further improved clinical outcomes. LIMITATIONS Results are based on real-world cross-sectional adherence rates and may vary in the context of other types of settings. Only guideline-recommended stool-based strategies were considered in this analysis. CONCLUSION Comparisons of the effectiveness and benefits of specific CRC screening strategies should include both test-specific performance characteristics and real-world adherence to screening tests and, when indicated, follow-up colonoscopy.
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Affiliation(s)
- Deborah A Fisher
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC, USA
| | - Jordan J Karlitz
- Division of Gastroenterology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Paul Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA
| | - A Mark Fendrick
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
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24
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Viramontes O, Bastani R, Yang L, Glenn BA, Herrmann AK, May FP. Colorectal cancer screening among Hispanics in the United States: Disparities, modalities, predictors, and regional variation. Prev Med 2020; 138:106146. [PMID: 32473957 DOI: 10.1016/j.ypmed.2020.106146] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023]
Abstract
Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from colorectal cancer (CRC) than non-Hispanic Whites (NHW). We aimed to examine screening modalities, predictors, and regional disparities among Hispanics and NHW in the U.S. by conducting a cross-sectional analysis of Hispanic participants age 50 to 75 from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. The primary outcome was self-reported CRC screening status. We used the Rao-Scott Chi-square test to compare screening rates and modalities in NHWs and Hispanics. We also used univariable and multivariable logistic regression to determine predictors of screening among Hispanics and calculated Hispanic-NHW screening rate differences for each U.S. state/territory as a measure of regional screening disparities. The screening rate was 53.4% for Hispanics (N = 12,395), compared to 70.4% for NHWs (N = 186,331) (p < 0.001). Among Hispanics, colonoscopy was most common (75.9%). Uninsured status (aOR = 0.51; 95% CI = 0.38-0.70) and limited access to medical care (aOR = 0.38; 95% CI = 0.29-0.49) predicted lack of screening. States/territories with the largest screening disparities were North Carolina (33.9%), Texas (28.3%), California (25.1%), and Nebraska (25.6%). Disparities were smallest in New York (2.6%), Indiana (3.1%), and Delaware (4.0%). In Ohio and Guam, Hispanics had higher screening rates than NHWs. In conclusion, Hispanics have lower CRC screening rates than NHWs across most U.S. states/territories; however, the disparity varies by region. Future efforts must address multi-level barriers to screening among Hispanics and target regions with low rates to improve CRC outcomes in this growing population.
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Affiliation(s)
- Omar Viramontes
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, UCSF, San Francisco, CA, United States of America
| | - Roshan Bastani
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Liu Yang
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Beth A Glenn
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Alison K Herrmann
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Folasade P May
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, United States of America; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Medicine, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
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25
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Fujita M, Fujisawa T, Hata A. Additional outreach effort of providing an opportunity to obtain a kit for fecal immunochemical test during the general health check-up to improve colorectal cancer screening rate in Japan: A longitudinal study. PLoS One 2020; 15:e0238474. [PMID: 32866208 PMCID: PMC7458287 DOI: 10.1371/journal.pone.0238474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives A sufficient screening rate is indispensable to optimize the positive impact of colorectal cancer (CRC) screening. This study aimed to evaluate the effect of an additional outreach of providing an opportunity to obtain a kit for fecal immunochemical test (FIT) during the general health check-up to increase CRC screening rate. Methods This was a longitudinal study using pre-existing data in Kujukuri Town, Japan. The town provided CRC screening in the fiscal year (FY) 2017 using an existing procedure for all beneficiaries of the National Health Insurance, whereas in FY 2018, an additional outreach effort was made to only those with an even number of age (exposed group), who were offered an opportunity to obtain a kit for FIT at the time of general health check-ups but not to those with an odd number of age (control group). To estimate the effectiveness, generalized estimating equation (GEE) with individuals as clusters was performed. Results In total, 3,530 individuals were included (1,708 in the control group and 1,822 in the exposed group). GEE showed significant interaction between the groups (control and exposed) and FYs (2017 and 2018) (p<0.001), indicating that the change in CRC screening rate from 2017 to 2018 was significantly different between the two groups. Although an achieved actual rate of 17.1% in the exposed group in FY 2018 was low, the additional outreach increased the rate by 5.8 percentage point (95% confidence interval, 3.5–8.1) compared with an existing rate. Conclusions Additional outreach of providing an opportunity to obtain a kit for FIT at the time of the general health check-up improved the CRC screening rate. However, screening rate achieved by this strategy remained low, indicating further efforts is required.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Heath Promotion and Disease Prevention, Chiba City, Chiba, Japan
- * E-mail:
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Heath Promotion and Disease Prevention, Chiba City, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Heath Promotion and Disease Prevention, Chiba City, Chiba, Japan
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26
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Lew JB, Greuter MJE, Caruana M, He E, Worthington J, St John DJ, Macrae FA, Feletto E, Coupé VMH, Canfell K. Validation of Microsimulation Models against Alternative Model Predictions and Long-Term Colorectal Cancer Incidence and Mortality Outcomes of Randomized Controlled Trials. Med Decis Making 2020; 40:815-829. [PMID: 32845232 DOI: 10.1177/0272989x20944869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. This study aimed to assess the validity of 2 microsimulation models of colorectal cancer (CRC), Policy1-Bowel and ASCCA. Methods. The model-estimated CRC risk in population subgroups with different health statuses, "dwell time" (time from incident precancerous polyp to symptomatically detected CRC), and reduction in symptomatically detected CRC incidence after a one-time complete removal of polyps and/or undetected CRC were compared with published findings from 3 well-established models (MISCAN, CRC-SPIN, and SimCRC). Furthermore, 6 randomized controlled trials (RCTs) that provided screening using a guaiac fecal occult blood test (Funen trial, Burgundy trial, and Minnesota Colon Cancer Control Study [MCCCS]) or flexible sigmoidoscopy (NORCCAP, SCORE, and UKFSST) with long-term follow-up were simulated. Model-estimated long-term relative reductions of CRC incidence (RRinc) and mortality (RRmort) were compared with the RCTs' findings. Results. The Policy1-Bowel and ASCCA estimates showed more similarities to CRC-SPIN and SimCRC. For example, overall dwell times estimated by Policy1-Bowel (24.0 years) and ASCCA (25.3) were comparable to CRC-SPIN (25.8) and SimCRC (25.2) but higher than MISCAN (10.6). In addition, ∼86% of Policy1-Bowel's and ∼74% of ASCCA's estimated RRinc and RRmort were consistent with the RCTs' long-term follow-up findings. For example, at 17 to 18 years of follow-up, the MCCCS reported RRmort of 0.67 (95% confidence interval [CI], 0.51-0.83) and 0.79 (95% CI, 0.62-0.97) for the annual and biennial screening arm, respectively, and the UKFSST reported RRmort of 0.70 (95% CI, 0.62-0.79) for CRC at all sites and 0.54 (95% CI, 0.46-0.65) for distal CRC. The corresponding model estimates were 0.65, 0.74, 0.81, and 0.61, respectively, for Policy1-Bowel and 0.65, 0.70, 0.75, and 0.58, respectively, for ASCCA. Conclusion. Policy1-Bowel and ASCCA's estimates are largely consistent with the data included for comparisons, which indicates good model validity.
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Affiliation(s)
- Jie-Bin Lew
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Marjolein J E Greuter
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michael Caruana
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Emily He
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | | | - D James St John
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.,Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Finlay A Macrae
- Department of Colorectal Medicine and Genetics, and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Karen Canfell
- School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
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27
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O'Reilly SM, Hughes KN, Mooney T, Fitzpatrick P, O'Donoghue D, McNally S, Codd M, Ryan E, Doherty G, Mason O, Mulcahy HE, Cullen G. Characteristics and attitudes of first round invitees in the Irish National Colorectal Cancer Screening Programme. Frontline Gastroenterol 2020; 12:374-379. [PMID: 35401954 PMCID: PMC8989011 DOI: 10.1136/flgastro-2020-101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/OBJECTIVE Colorectal cancer (CRC) screening is proven to reduce CRC-related mortality. Faecal immunochemical testing (FIT)-positive clients in the Irish National CRC Screening Programme underwent colonoscopy. Round 1 uptake was 40.2%. We sought to identify barriers to participation by assessing knowledge of CRC screening and examining attitudes towards FIT test and colonoscopy. METHODS Questionnaires based on a modified Champion's Health Belief Model were mailed to 3500 invitees: 1000 FIT-positive, 1000 FIT-negative and 1500 non-participants. 44% responded: 550 (46%) FIT-positive, 577 (48%) FIT-negative and 69 (6%) non-responders (NR). RESULTS 25% of respondents (n=286) did not perceive a personal risk of cancer, did not perceive CRC to be a serious disease and did not perceive benefits to screening. These opinions were more likely to be expressed by men (p=0.035). One-fifth (n=251) found screening stressful. Fear of cancer diagnosis and test results were associated with stress. FIT-positive clients, women and those with social medical insurance were more likely to experience stress. CONCLUSIONS The CRC screening process causes stress to one-fifth of participants. Greater use of media and involvement of healthcare professionals in disseminating information on the benefits of screening may lead to higher uptake in round 2.
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Affiliation(s)
- Susanne M O'Reilly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Katie N Hughes
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Therese Mooney
- BowelScreen, National Screening Service, Dublin, Ireland
| | | | - Diarmuid O'Donoghue
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland,BowelScreen, National Colorectal Cancer Screening Programme, Dublin, Ireland
| | - Sara McNally
- BowelScreen, National Screening Service, Dublin, Ireland
| | - Mary Codd
- School of Public Health, University College Dublin, Dublin, Ireland
| | - Elizabeth Ryan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Glen Doherty
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Olivia Mason
- School of Public Health, University College Dublin, Dublin, Ireland
| | - Hugh E Mulcahy
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Garret Cullen
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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28
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Kim J, Dobson B, Ng Liet Hing C, Cooper M, Lu CT, Nolan G, Von Papen M. Increasing rate of colorectal cancer in younger patients: a review of colonoscopy findings in patients under 50 at a tertiary institution. ANZ J Surg 2020; 90:2484-2489. [DOI: 10.1111/ans.16060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Jason Kim
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Benjamin Dobson
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Cedric Ng Liet Hing
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Michelle Cooper
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
- Griffith University Brisbane Queensland Australia
| | - Cu Tai Lu
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Gregory Nolan
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Michael Von Papen
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
- Griffith University Brisbane Queensland Australia
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29
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Hasegawa R, Yashima K, Ikebuchi Y, Sasaki S, Yoshida A, Kawaguchi K, Isomoto H. Characteristics of Advanced Colorectal Cancer Detected by Fecal Immunochemical Test Screening in Participants with a Negative Result the Previous Year. Yonago Acta Med 2020; 63:63-69. [PMID: 32158335 PMCID: PMC7028528 DOI: 10.33160/yam.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is sufficient evidence to show the mortality reduction effect of colorectal cancer (CRC) screening programs using the fecal occult blood test (FOBT). However, we see cases that are found to be advanced CRC despite yearly FOBT screening. METHODS The aim of this study was to investigate the characteristics of advanced CRC detected by a fecal immunochemical test (FIT) screening program in participants with a negative screening result the previous year, which we call "Negative advanced CRC". A total of 109,639 participants (10.0% required colonoscopy, of whom 76.9% received one) underwent a CRC screening program using a FIT from fiscal 2009 to 2017. Negative advanced CRC was compared with advanced CRC (First advanced CRC) found at the first visit in a person who had not had a FIT screening history for more than 3 years. In addition, we compared the characteristics of Negative advanced CRC with those of interval cancer: cancer cases detected after a negative screening result and before the date of the next recommended screening. RESULTS A total of 339 cases of CRC (175 male: 164 female, 173 early stage: 166 advanced stage) were detected in the nine-year CRC screening period. The rate of right-sided CRCs was significantly higher in female (P < 0.01), advanced stage (P < 0.01), negative result previous year (P < 0.01), and symptom-negative (P < 0.01) participants than in each counterpart, respectively. The ratio of female (22/35; 62.9%) patients in Negative advanced CRCs tended to be high compared with that (40/83; 48.2%) in First advanced CRCs (P = 0.145). Overall, 22 (62.9%) of 35 Negative advanced CRCs and 28 (33.7%) of 83 First advanced CRCs were located in the right-sided colon, and the rate was significantly higher in Negative advanced CRCs (P < 0.01). In addition, the frequency of female patients was significantly higher in right-sided Negative advanced CRCs than in right-sided First advanced CRCs (P = 0.03). CONCLUSION The characteristics of Negative advanced CRC cases (female and right-sided colon) were similar to those of interval cancer reported so far. In the future, it will be necessary to introduce a screening program that is highly sensitive to right-sided CRC.
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Affiliation(s)
- Ryosuke Hasegawa
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Kazuo Yashima
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Yuichiro Ikebuchi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Shuji Sasaki
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Akira Yoshida
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Koichiro Kawaguchi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan
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30
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Mu J, Huang Y, Cai S, Li Q, Song Y, Yuan Y, Zhang S, Zheng S. Plausibility of an extensive use of stool DNA test for screening advanced colorectal neoplasia. Clin Chim Acta 2019; 501:42-47. [PMID: 31816287 DOI: 10.1016/j.cca.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE FIT-DNA test is supposed to be highly sensitive for advanced colorectal neoplasms and is advocated in some developed countries, but lack extensive use in developing countries. METHODS A case control study on stool DNA test for colorectal neoplasms patients was conducted from March 2016 to October 2017 in China. We recruited CRC, colorectal neoplasms and normal controls from ambulatory patients and screening attendees in communities. The stool DNA was tested by a molecular panel similar as ColoGuard in addition to fecal immunochemical test(FIT) in a blinded manner. A risk scoring system was used to determine the positiveness of tests with histological diagnosis as its reference standard. RESULTS Eligible subjects included 203 colorectal cancer (CRC), 49 advanced adenoma (AA), 156 non-advanced adenoma(NAA) and 431 normal controls(NC). The FIT-DNA kit detected 97.5% CRC (n = 198, 95% CI = 95.4-99.7) and 53.1% AA (n = 26, 95% CI = 39.1-67.0), with specificity of 89.1% (95% CI = 86.2-92.0) in NC and 88.1% (95% CI = 85.5-90.7) in non-advanced controls. The FIT embedded in the kit alone identified 94.6% (n = 192, 95% CI = 91.5-97.7) CRC and 36.7% AA (n = 18, 95% CI = 23.2-50.2). Consistency of KRAS mutation, BMP3 methylation, NDRG4 methylation in 26 paires stool DNA and CRC tumor DNA were 80.9%, 71.4% and 81.8%, respectively. CONCLUSION At the sacrifice of significantly decreased specificity, a FIT-DNA kit may has better sensitivity than FIT for predicting advanced colorectal adenoma, but not for predicting colorectal cancer. More evidences are needed for the extensive use of FIT-DNA testing.
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Affiliation(s)
- Jiayi Mu
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Yanqin Huang
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China.
| | - Shanrong Cai
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Qilong Li
- Jiashan Institute of Cancer Prevention and Treatment, Jiaxing, Zhejiang, China
| | - Yongmao Song
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Ying Yuan
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Suzhan Zhang
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Shu Zheng
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, China.
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31
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Chido-Amajuoyi OG, Sharma A, Talluri R, Tami-Maury I, Shete S. Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults. Cancer Med 2019; 8:7408-7418. [PMID: 31637870 PMCID: PMC6885889 DOI: 10.1002/cam4.2604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background Guidelines of the American Cancer Society and US Preventive Services Task Force specify that colorectal cancer (CRC) screening using guaiac‐based fecal occult blood test (FOBT)/fecal immunochemical test (FIT) should be done at home. We therefore examined the prevalence and correlates of CRC screening using FOBT/FIT in physicians' office vs at home. Methods Analysis of 9493 respondents 50‐75 years old from the Cancer Control Supplement of the 2015 National Health Interview Survey was conducted. Weighted multivariable logistic regression was used to identify the determinants of in‐office vs home use of FOBT/FIT for CRC screening. Results Of the overall sample of screening‐eligible adults (n = 9403), only 937 (10.4%) respondents underwent CRC screening using FOBT/FIT within the past year; among this screening population, 279 (28.3%) respondents were screened in‐office. We found that sociodemographic factors alone, not CRC risk factors, determined whether FOBT/FIT would be used in‐office or at home. Hispanics had greater odds of being screened in‐office using FOBT/FIT (aOR: 2.04; 95% CI: 1.05‐3.99). Compared with those 50‐59 years old, respondents 70‐75 years old were less likely to be screened in‐office using FOBT/FIT (aOR: 0.44, 95% CI: 0.25‐0.79). Similarly, individuals residing in the Western region of the country had lower odds of in‐office FOBT/FIT (aOR: 0.26; 95% CI: 0.11‐0.58). Conclusion Amid low overall uptake rates of FOBT/FIT in the United States, in‐physician office testing is high, indicative of a missed opportunity for effective screening and poor adherence of physicians to national guidelines. Sociodemographic factors are determinants of uptake of FOBT/FIT at home or in‐office and should be considered in designing interventions aimed at providers and the general population. Amid low overall uptake rates of FOBT/FIT in the United States, in‐physician office testing is high, indicative of a missed opportunity for effective screening and poor adherence of physicians to national guidelines.
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Affiliation(s)
| | - Anushree Sharma
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesh Talluri
- Department of Data Science, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Irene Tami-Maury
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Jodal HC, Helsingen LM, Anderson JC, Lytvyn L, Vandvik PO, Emilsson L. Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis. BMJ Open 2019; 9:e032773. [PMID: 31578199 PMCID: PMC6797379 DOI: 10.1136/bmjopen-2019-032773] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Evaluate effectiveness, harms and burdens of faecal blood testing, sigmoidoscopy and colonoscopy screening for colorectal cancer over 15 years. DESIGN We performed an update of a Cochrane systematic review, and performed network meta-analysis comparing randomised trials evaluating colorectal cancer screening with guaiac faecal occult blood test (gFOBT) (annual, biennial), faecal immunochemical test (FIT) (annual, biennial), sigmoidoscopy (once-only) or colonoscopy (once-only) in a healthy population, aged 50-79 years. We conducted subgroup analysis on sex. Follow-up >5 years was required for analysis of colorectal cancer incidence and mortality. RESULTS 12 randomised trials proved eligible. Compared with no-screening, we found high certainty evidence for sigmoidoscopy screening slightly reducing colorectal cancer incidence (relative risk (RR) 0.76; 95% confidence interval (CI 0.70 to 0.83) and mortality (RR 0.74; 95% CI 0.69 to 0.80), while gFOBT screening had little or no difference on colorectal cancer incidence, but slightly reduced colorectal cancer mortality (annual: RR 0.69; 95% CI 0.56 to 0.86, biennial: RR 0.88; 95% CI 0.82 to 0.93). No screening test reduced mortality nor incidence by more than six per 1000 screened over 15 years. Sigmoidoscopy had a greater effect in men, for both colorectal cancer incidence (women: RR 0.86; 95% CI 0.81 to 0.92, men: RR 0.75, 95% CI 0.71 to 0.79), and mortality (women: RR 0.85; 95% CI 0.71 to 0.96, men: RR 0.67; 95% CI 0.61 to 0.75) (moderate certainty). CONCLUSIONS In a 15-year perspective, sigmoidoscopy reduces colorectal cancer incidence, while sigmoidoscopy, annual and biennial gFOBT all reduce colorectal cancer mortality. Sigmoidoscopy may reduce colorectal cancer incidence and mortality more in men than in women. PROSPERO REGISTRATION NUMBER CRD42018093401.
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Affiliation(s)
- Henriette C Jodal
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Lise M Helsingen
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Frontier Science Foundation, Boston, Massachusetts, USA
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont, USA
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Louise Emilsson
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Vårdcentralen Värmlands Nysäter & Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
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Buskermolen M, Cenin DR, Helsingen LM, Guyatt G, Vandvik PO, Haug U, Bretthauer M, Lansdorp-Vogelaar I. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. BMJ 2019; 367:l5383. [PMID: 31578177 PMCID: PMC6774435 DOI: 10.1136/bmj.l5383] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. DESIGN Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). SETTING A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. POPULATION Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). COMPARISONS Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. MAIN OUTCOME MEASURES Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. RESULTS Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. CONCLUSIONS Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.
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Affiliation(s)
- Maaike Buskermolen
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Dayna R Cenin
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Lise M Helsingen
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effecitveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, MA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Per Olav Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Clinical Effecitveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Frontier Science Foundation, Boston, MA, USA
| | - Iris Lansdorp-Vogelaar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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Naber SK, Knudsen AB, Zauber AG, Rutter CM, Fischer SE, Pabiniak CJ, Soto B, Kuntz KM, Lansdorp-Vogelaar I. Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries. PLoS One 2019; 14:e0220234. [PMID: 31483796 PMCID: PMC6726189 DOI: 10.1371/journal.pone.0220234] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/11/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2014, the Centers for Medicare and Medicaid Services (CMS) began covering a multitarget stool DNA (mtSDNA) test for colorectal cancer (CRC) screening of Medicare beneficiaries. In this study, we evaluated whether mtSDNA testing is a cost-effective alternative to other CRC screening strategies reimbursed by CMS, and if not, under what conditions it could be. METHODS We use three independently-developed microsimulation models to simulate a cohort of previously unscreened US 65-year-olds who are screened with triennial mtSDNA testing, or one of six other reimbursed screening strategies. Main outcome measures are discounted life-years gained (LYG) and lifetime costs (CMS perspective), threshold reimbursement rates, and threshold adherence rates. Outcomes are expressed as the median and range across models. RESULTS Compared to no screening, triennial mtSDNA screening resulted in 82 (range: 79-88) LYG per 1,000 simulated individuals. This was more than for five-yearly sigmoidoscopy (80 (range: 71-89) LYG), but fewer than for every other simulated strategy. At its 2017 reimbursement rate of $512, mtSDNA was the most costly strategy, and even if adherence were 30% higher than with other strategies, it would not be a cost-effective alternative. At a substantially reduced reimbursement rate ($6-18), two models found that triennial mtSDNA testing was an efficient and potentially cost-effective screening option. CONCLUSIONS Compared to no screening, triennial mtSDNA screening reduces CRC incidence and mortality at acceptable costs. However, compared to nearly all other CRC screening strategies reimbursed by CMS it is less effective and considerably more costly, making it an inefficient screening option.
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Affiliation(s)
- Steffie K. Naber
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
| | - Amy B. Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Carolyn M. Rutter
- RAND Corporation, Santa Monica, California, United States of America
| | - Sara E. Fischer
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Chester J. Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America
| | - Brittany Soto
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Karen M. Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Iris Lansdorp-Vogelaar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
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35
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Haug U. [Current evidence and development of colorectal cancer screening in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1513-1516. [PMID: 30327833 DOI: 10.1007/s00103-018-2832-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colon cancer is currently the third leading cause of cancer death in men and women in Germany, with a total of about 25,000 deaths per year. Established methods for early detection of colorectal cancer include lower gastrointestinal endoscopy and fecal occult blood testing. For both procedures, there is evidence of a reduction in colorectal cancer-specific mortality and for endoscopy a reduction of colorectal cancer incidence has been shown.In Germany, the guaiac test for fecal occult blood has been offered since 1977. Additionally, screening colonoscopy has been offered since 2002 and in 2016, the guaiac test was replaced by the immunological fecal occult blood test, which has an improved diagnostic performance. Overall, participation rates have been low over the past decades and differed between men, women, and age groups.Personal invitations are expected to be sent out starting in 2019 as part of the introduction of an organized colorectal cancer screening program in Germany. The program also provides for measures to systematically monitor and improve the quality of colorectal cancer screening. It remains to be seen which effects these changes will have and whether the trend towards declining colon cancer incidence and mortality that has been observed in Germany will continue in the coming years.
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Affiliation(s)
- Ulrike Haug
- Abteilung Klinische Epidemiologie, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland. .,Fachbereich Human- und Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland.
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36
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Hong JT, Kim ER. Current state and future direction of screening tool for colorectal cancer. World J Meta-Anal 2019; 7:184-208. [DOI: 10.13105/wjma.v7.i5.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
As the second-most-common cause of cancer death, colorectal cancer (CRC) has been recognized as one of the biggest health concerns in advanced countries. The 5-year survival rate for patients with early-stage CRC is significantly better than that for patients with CRC detected at a late stage. The primary target for CRC screening and prevention is advanced neoplasia, which includes both CRC itself, as well as benign but histologically advanced adenomas that are at increased risk for progression to malignancy. Prevention of CRC through detection of advanced adenomas is important. It is, therefore, necessary to develop more efficient detection methods to enable earlier detection and therefore better prognosis. Although a number of CRC diagnostic methods are currently used for early detection, including stool-based tests, traditional colonoscopy, etc., they have not shown optimal results due to several limitations. Hence, development of more reliable screening methods is required in order to detect the disease at an early stage. New screening tools also need to be able to accurately diagnose CRC and advanced adenoma, help guide treatment, and predict the prognosis along with being relatively simple and non-invasive. As part of such efforts, many proposals for the early detection of colorectal neoplasms have been introduced. For example, metabolomics, referring to the scientific study of the metabolism of living organisms, has been shown to be a possible approach for discovering CRC-related biomarkers. In addition, a growing number of high-performance screening methodologies could facilitate biomarker identification. In the present, evidence-based review, the authors summarize the current state as recognized by the recent guideline recommendation from the American Cancer Society, US Preventive Services Task Force and the United States Multi-Society Task Force and discuss future direction of screening tools for colorectal cancer. Further, we highlight the most interesting publications on new screening tools, like molecular biomarkers and metabolomics, and discuss these in detail.
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Affiliation(s)
- Ji Taek Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, South Korea
| | - Eun Ran Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
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Low participation in organized colorectal cancer screening in France: underlying ethical issues. Eur J Cancer Prev 2019; 28:27-32. [PMID: 29176350 DOI: 10.1097/cej.0000000000000417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50-74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.
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Sultanian R, Du L, Moysey B, Morse A, Veldhuyzen van Zanten S, Montano-Loza AJ. The Impact of Transitioning From Guaiac-Fecal Occult Blood Testing to Fecal Immunochemical Testing in a Canadian Colon Cancer Screening Program. J Can Assoc Gastroenterol 2019; 3:177-184. [PMID: 32671327 PMCID: PMC7338847 DOI: 10.1093/jcag/gwz009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/24/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives To determine the impact of transitioning from guaiac-based fecal occult blood testing (gFOBT) to fecal immunochemical testing (FIT) on the detection rate of adenomas, advanced adenomas (AA) and colorectal cancer (CRC). Background Recently, the health region in Edmonton, Alberta switched from gFOBT to FIT for CRC screening. Study A retrospective analysis of all patients, aged 50 to 74 years, referred for colonoscopy from January 1, 2013 to December 31, 2014 due to a positive gFOBT (at least one of three samples positively using the guaiac-based Hemoccult II SENSA in 2013) or FIT (≥75 µg/g of stool, using the Polymedco OC FIT-CHEK in 2014). The primary outcomes were the number of colon cancers, AA and adenomas detected in 2013 and 2014. A comparison between the two tests was also made for the composite outcome of detection of either AA or CRC. Results Six hundred and forty-nine patients underwent colonoscopy due to a positive gFOBT in 2013, and 2167 patients for a positive FIT in 2014. FIT compared with gFOBT detected more CRC (67 compared with 34), AA (770 compared with 147) and adenomas (1575 versus 320). By multivariable regression analysis adjusted for different demographics and endoscopic metrics, positive FIT was independently associated with higher adenoma detection rate (odds ratio [OR] 2.62; 95% confidence interval [CI] 2.13 to 3.21, P < 0.001), AA detection rate (OR 1.83, 95% CI 1.43 to 2.33, P < 0.001), and the composite outcome of AA and CRC (OR 2.04, 95% CI 1.60 to 2.59, P < 0.001). Conclusions Adoption of FIT compared with gFOBT led to higher detection of colon cancer, AA and adenomas.
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Affiliation(s)
- Richard Sultanian
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Lillian Du
- Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Moysey
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Amy Morse
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Aldo J Montano-Loza
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
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Swartz AW, Eberth JM, Strayer SM. Preventing colorectal cancer or early diagnosis: Which is best? A re-analysis of the U.S. Preventive Services Task Force Evidence Report. Prev Med 2019; 118:104-112. [PMID: 30367971 DOI: 10.1016/j.ypmed.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022]
Abstract
Flexible sigmoidoscopy (FS) is the only cancer screening test to lower the risk of death compared to usual care in randomized controlled trials (RCTs). We hypothesize that this unique death reduction is more attributable to prevention of colorectal cancer (CRC) than to early diagnosis. The systematic review of the 2016 US Preventive Services Task Force Evidence Report for CRC Screening was used for selection of RCT studies. A random-effects meta-analysis of five FS trials (N = 458,002) and four fecal occult blood test (FOBT) trials (N = 328,767) was performed using intention-to-screen outcomes for death, CRC incidence, and death attributed to CRC; correlation and linear regression analyses explored the relationships between these outcomes. At 10.5-11.9 years of follow-up FS reduces death (relative risk [RR], 0.975; 95% CI, 0.958-0.992 and reduces CRC incidence (RR, 0.79; 95% CI, 0.74-0.84). Within the FS trials death reduction shows a strong linear correlation with CRC incidence reduction (r, 0.95; 95% CI 0.42-0.99). At 15.6-30.0 years of follow-up FOBT does not reduce death (RR, 1.001; 95% CI, 0.992-1.010) or CRC incidence (RR, 0.96; 95% CI, 0.89-1.02) but does reduce deaths attributed to CRC (RR, 0.84; 95% CI, 0.78-0.91). Clinical trials of screening FS display a dose-response relationship between the magnitude of CRC prevention and the magnitude of death reduction. Prevention of CRC appears to be the major (or sole) mechanism of action for death reduction by FS in clinical trials. Conversely, early diagnosis of CRC does not appear to reduce death.
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Affiliation(s)
- Andrew W Swartz
- Departments of Emergency Medicine, Family Medicine, and Surgery, Yukon-Kuskokwim Delta Regional Hospital, 700 Chief Eddie Hoffman Highway, Bethel, AK 99559, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Scott M Strayer
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203, USA.
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Levin TR, Corley DA, Jensen CD, Schottinger JE, Quinn VP, Zauber AG, Lee JK, Zhao WK, Udaltsova N, Ghai NR, Lee AT, Quesenberry CP, Fireman BH, Doubeni CA. Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large Community-Based Population. Gastroenterology 2018; 155:1383-1391.e5. [PMID: 30031768 PMCID: PMC6240353 DOI: 10.1053/j.gastro.2018.07.017] [Citation(s) in RCA: 366] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. METHODS We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after (through 2015) implementation of organized screening outreach, from 2007 through 2008 (primarily annual fecal immunochemical testing and colonoscopy), in a large community-based population. Among screening-eligible individuals 51-75 years old, we calculated annual up-to-date status for cancer screening (by fecal test, sigmoidoscopy, or colonoscopy), CRC incidence, cancer stage distributions, and incidence-based mortality. RESULTS Initiation of organized CRC screening significantly increased the up-to-date status of screening, from 38.9% in 2000 to 82.7% in 2015 (P < .01). Higher rates of screening were associated with a 25.5% reduction in annual CRC incidence between 2000 and 2015, from 95.8 to 71.4 cases/100,000 (P < .01), and a 52.4% reduction in cancer mortality, from 30.9 to 14.7 deaths/100,000 (P < .01). Increased screening was initially associated with increased CRC incidence, due largely to greater detection of early-stage cancers, followed by decreases in cancer incidence. Advanced-stage CRC incidence rates decreased 36.2%, from 45.9 to 29.3 cases/100,000 (P < .01), and early-stage CRC incidence rates decreased 14.5%, from 48.2 to 41.2 cases/100,000 (P < .04). CONCLUSIONS Implementing an organized CRC screening program in a large community-based population rapidly increased screening participation to the ≥80% target set by national organizations. Screening rates were sustainable and associated with substantial decreases in CRC incidence and mortality within short time intervals, consistent with early detection and cancer prevention.
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Affiliation(s)
- Theodore R. Levin
- Kaiser Permanente Medical Center, Walnut Creek, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Joanne E. Schottinger
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Virginia P. Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Nirupa R. Ghai
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alexander T. Lee
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Bruce H. Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chyke A. Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Buskermolen M, Gini A, Naber SK, Toes-Zoutendijk E, de Koning HJ, Lansdorp-Vogelaar I. Modeling in Colorectal Cancer Screening: Assessing External and Predictive Validity of MISCAN-Colon Microsimulation Model Using NORCCAP Trial Results. Med Decis Making 2018; 38:917-929. [PMID: 30343626 DOI: 10.1177/0272989x18806497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Microsimulation models are increasingly being used to inform colorectal cancer (CRC) screening recommendations. MISCAN-Colon is an example of such a model, used to inform the Dutch CRC screening program and US Preventive Services Task Force guidelines. Assessing the validity of these models is essential to provide transparency regarding their performance. In this study, we tested the external and predictive validity of MISCAN-Colon. METHODS We validated MISCAN-Colon using the Norwegian Colorectal Cancer Prevention (NORCCAP) trial, a randomized controlled trial that examined the effectiveness of once-only flexible sigmoidoscopy (FS) screening. We simulated the study population and design of the NORCCAP trial in MISCAN-Colon and compared 10- to 12-year model-predicted hazard ratios (HRs) for overall and distal CRC incidence and mortality to those observed. In addition, we compared the numbers of screen-detected neoplasia. Finally, we predicted the trial's future results to allow for the assessment of predictive validity. RESULTS MISCAN-Colon predicted an HR for overall CRC incidence (0.85), distal CRC incidence (0.82), overall CRC mortality (0.68), and distal CRC mortality (0.62). These were within the limits of the 95% confidence intervals of the NORCCAP trial results. Similar results were observed for the number of screen-detected cancers. The model significantly underestimated the number of screen-detected adenomas. Model-predicted HRs for CRC incidence and mortality up to 15- to 17-year follow-up were 0.84 and 0.72, respectively. CONCLUSION Although the underestimation of screen-detected adenomas requires further investigation, MISCAN-Colon is able to make a valid replication of the CRC incidence and mortality reduction of an FS screening trial, which suggests that it can be considered a useful tool to support decision making on CRC screening.
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Affiliation(s)
- Maaike Buskermolen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
| | - Andrea Gini
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
| | - Steffie K Naber
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (MB, AG, AKN, ETZ, HJdK, ILV)
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42
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Blom J, Löwbeer C, Elfström KM, Sventelius M, Öhman D, Saraste D, Törnberg S. Gender-specific cut-offs in colorectal cancer screening with FIT: Increased compliance and equal positivity rate. J Med Screen 2018; 26:92-97. [PMID: 30336730 DOI: 10.1177/0969141318804843] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Using quantitative Faecal Immunochemical Test (FIT) in colorectal cancer screening enables adjustment of the cut-off for a positive test. As men have higher stool blood levels and higher prevalence of colorectal neoplasia, different cut-off levels can be chosen for men and women. We evaluated participation and positivity rates switching from guaiac-based faecal occult blood test (gFOBT) (Hemoccult®) to FIT (OC-Sensor), using gender-specific cut-offs. METHODS The colorectal cancer screening programme of Stockholm-Gotland, Sweden, started in 2008 and invited individuals aged 60-69 to biennial testing using gFOBT. From 1 October 2015 the test was switched to FIT, with positivity cut-offs of 40 (200) and 80 (400) µg Hb/g (ng/mL) faeces for women and men, respectively. The first year was evaluated for compliance and positivity, number of reminders and incorrect/inadequate tests, compared with gFOBT in the preceding 12-month period. RESULTS There were 127,030 and 87,269 individuals invited to screening with gFOBT and FIT, respectively. The change of test increased overall participation by 11.9% (95% confidence interval 11.5%-12.3%) from 56.5% to 68.4% ( p < 0.001). The increase was larger in men (14.3%) than women (9.7%), and in those aged 60-64 (14.2%) than those aged 65-69 (8.7%). The positivity rate was 2.6% in women and 2.5% in men. There was a lower rate of reminders and incorrect/inadequate tests with FIT. CONCLUSIONS Within a well-organised colorectal cancer screening programme, changing the test from gFOBT to FIT markedly increased participation, especially among men, and in the younger age group. With a lower cut-off in women than men, the positivity rate was similar.
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Affiliation(s)
- Johannes Blom
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,2 Regional Cancer Centre, Stockholm-Gotland, Sweden
| | - Christian Löwbeer
- 3 Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,4 Department of Clinical Chemistry, Aleris Medilab, Täby, Sweden
| | - K Miriam Elfström
- 2 Regional Cancer Centre, Stockholm-Gotland, Sweden.,5 Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Daniel Öhman
- 2 Regional Cancer Centre, Stockholm-Gotland, Sweden
| | - Deborah Saraste
- 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sven Törnberg
- 2 Regional Cancer Centre, Stockholm-Gotland, Sweden.,6 Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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43
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Borges LV, Mattar R, Silva JMKD, Silva ALWD, Carrilho FJ, Hashimoto CL. FECAL OCCULT BLOOD: A COMPARISON OF CHEMICAL AND IMMUNOCHEMICAL TESTS. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:128-132. [PMID: 30043860 DOI: 10.1590/s0004-2803.201800000-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Colorectal bleeding is a warning sign that may be identified by fecal occult blood testing. A positive fecal occult blood test result requires a subsequent colonoscopy, a costly and invasive examination. Therefore, the use of diagnostic tests with optimal sensitivity and specificity is warranted. In this study, we evaluated four different fecal occult blood tests in 176 patients undergoing colonoscopy and compared their results. OBJECTIVE To assess the sensitivity, specificity and predictive values of chemical and immunochemical fecal occult blood tests in patients undergoing colonoscopy and to evaluate the degree of concordance between the tests and colonoscopy. METHODS Patients with indications for colonoscopy also underwent fecal occult blood testing by chemical (toluidine test) and immunochemical methods, employing three commercially available kits. Based on the endoscopic findings, the colonoscopy was rated as positive or negative for colorectal bleeding. The degree of concordance between the fecal occult blood tests and the colonoscopy was evaluated by the kappa index. RESULTS Forty-four (25%) colonoscopies were categorized as positive for colorectal bleeding. The toluidine test presented lower concordance than the immunochemical tests, which showed moderate concordance with the colonoscopy. The toluidine test had the least sensitivity, specificity, and positive and negative predictive values. CONCLUSION The immunochemical fecal occult blood tests showed greater sensitivity, specificity and predictive values in detecting colorectal bleeding. The immunochemical tests had superior indexes of agreement with colonoscopy compared to the toluidine test.
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Affiliation(s)
- Luana Vilarinho Borges
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, SP, Brasil
| | - Rejane Mattar
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, SP, Brasil
| | | | - Ana Luiza Werneck da Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, SP, Brasil
| | - Flair José Carrilho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, SP, Brasil
| | - Cláudio Lyoiti Hashimoto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, SP, Brasil
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44
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Histopathologic study from a colorectal cancer screening in Chile: results from the first 2 years of an international collaboration between Chile and Japan. Eur J Cancer Prev 2018; 28:245-253. [PMID: 29958195 DOI: 10.1097/cej.0000000000000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A national colorectal cancer (CRC) screening program began in Chile in 2012, which is an international collaboration between Japan and Chile and is based on a standardized protocol supported by Tokyo Medical and Dental University. We describe the results from the first 2 years of screening at one public hospital in Punta Arenas, Chile. Of 4124 asymptomatic individuals aged between 50 and 75 years, 485 participants with immunological fecal occult blood test values of at least 100 ng/ml and/or those with family histories of CRC underwent colonoscopies. Lesions were found in 291 participants, and 642 histologic samples were obtained. Chilean pathologists made the initial histologic diagnoses, and a Japanese pathologist reviewed the histologic slides and analyzed the results. Of the 291 participants with lesions, 60 (20.6%) were diagnosed with adenocarcinomas, of which 50 (83.3%) were early-phase adenocarcinomas (pTis or pT1), and 163 (56.0%) were diagnosed with conventional adenomas, of which 96 (58.9%) were high-risk adenomas. The cancer prevalence within the screened population was 1.5% (60 of 4124). The colonoscopy cancer detection rate was 12.4% (60 of 485). Notably, we detected one flat-depressed (0-IIc) lesion that measured 5 mm and had invaded the submucosa. The findings from this screening program are the first to show the histopathologic distributions of consecutive lesions and the high incidence of CRC in Chile. The high detection rates for high-risk adenomas and cancer support the feasibility of early CRC screening and its potential to reduce the mortality associated with CRC.
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Liu H, Li Y, Li J, Liu Y, Cui B. H3K4me3 and Wdr82 are associated with tumor progression and a favorable prognosis in human colorectal cancer. Oncol Lett 2018; 16:2125-2134. [PMID: 30008910 PMCID: PMC6036332 DOI: 10.3892/ol.2018.8902] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/15/2018] [Indexed: 12/25/2022] Open
Abstract
Histone methylation is closely associated with the occurrence of cancer. Histone H3 trimethylation at lysine 4 (H3K4me3) has been reported to modulate the expression of tumor-associated expression and be altered during the progression of several human cancers. WD Repeat Domain 82 (Wdr82), a key epigenetics-associated factor, is a component of the H3K4me3 methyltransferase complex. An aim of the present study was to determine H3K4me3 and Wdr82 expression and their clinical significances in colorectal cancer (CRC). Immunohistochemistry results demonstrated that the expression level of the H3K4me3 and Wdr82 were significantly decreased in CRC tissues compared with paired noncancerous tissues from 123 patients with CRC. Furthermore, the negative expression of H3K4me3 and Wdr82 expression were significantly associated with lymph node (n=33, P=0.0001) and liver metastasis (n=30, P=0.0001). Additionally, multivariate Cox regression analysis indicated that the low expression level of H3K4me3 or Wdr82 was associated with reduced overall survival (OS, P<0.05), and patients with a low H3K4me3 and Wdr82 expression had a significantly poorer outcome compared with patients with a high expression of H3K4me3 and Wdr82 (P=0.0001), suggesting that H3K4me3 and Wdr82 expression were independent factors for OS in patients with CRC. In conclusion, the decreased expressions of H3K4me3 and Wdr82 were associated with a poor prognosis in CRC. The combined expression of H3K4me3 and Wdr82 may serve as a novel prognostic marker for CRC.
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Affiliation(s)
- He Liu
- Department of Colorectal Surgery, Harbin Medical University, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Yongmin Li
- Department of Colorectal Surgery, Harbin Medical University, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Jingwen Li
- Department of Colorectal Surgery, Harbin Medical University, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
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Nakabayashi N, Hirose M, Suzuki R, Suzumiya J, Igawa M. How asymptomatic are early cancer patients of five organs based on registry data in Japan. Int J Clin Oncol 2018; 23:999-1006. [PMID: 29785620 DOI: 10.1007/s10147-018-1287-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND One reason for the low cancer screening rate in Japan is that people are not concerned about cancer if they do not have symptoms. METHODS The authors retrospectively analyzed 18,405 cancer patients using hospital-based cancer registry data collected between 2007 and 2013 at the 13 hospitals of Shimane Prefecture, Japan. The symptomatic rates of five cancers (stomach, colorectal, lung, breast, and cervix) at each stage and the time of early diagnosis were investigated. The early detection rates of symptomatic and asymptomatic individuals were investigated. RESULTS The percentages of symptomatic cases tended to increase with progressive stages. The odds ratio (OR) of stage IV compared with that of stage I was 12.23 for stomach, 7.21 for colorectal, 16.91 for lung, 10.30 for breast, and 51.62 for cervical cancer. The proportions of early symptomatic cases at the time of diagnosis were low. Compared with the percentage of early symptomatic cases of stomach cancer of 25.5%, the percentage of lung cancer was the lowest, at 8.2% (OR 0.26), and the percentage of breast cancer was the highest, at 30.2% (OR 1.26). The percentages of early symptomatic cases of colorectal and cervical cancer were 18.9% (OR 0.68) and 19.9% (OR 0.73), respectively. The early detection rates of the asymptomatic and symptomatic groups were 77.6 and 36.1%, respectively. CONCLUSION Cancer registry data indicate that early cancers are asymptomatic, and once symptoms appear, treatment may not be effective. Policy makers should inform people of the necessity of cancer screening before they have symptoms.
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Affiliation(s)
- Narue Nakabayashi
- Medical Services Division, Faculty of Medicine, Shimane University, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan.,Department of Community-Based Health Policy and Quality Management, Faculty of Medicine, Shimane University, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan
| | - Masahiro Hirose
- Department of Community-Based Health Policy and Quality Management, Faculty of Medicine, Shimane University, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan.
| | - Ritsuro Suzuki
- Center of Clinical Research, Shimane University Hospital, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan
| | - Junji Suzumiya
- Center for Innovative Cancer Therapy, Shimane University Hospital, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan
| | - Mikio Igawa
- Shimane University Hospital, 89-1 Enya-Chou, Izumo, Shimane, 693-8501, Japan
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Evaluation of Cancer-Associated DNA Copy Number Events in Colorectal (Advanced) Adenomas. Cancer Prev Res (Phila) 2018; 11:403-412. [PMID: 29685877 DOI: 10.1158/1940-6207.capr-17-0317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/04/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
Abstract
About 5% of colorectal adenomas are estimated to progress to colorectal cancer. However, it is important to identify which adenomas actually carry a high risk of progression, because these serve as intermediate endpoints, for example, in screening programs. In clinical practice, adenomas with a size of ≥10 mm, villous component and/or high-grade dysplasia, called advanced adenomas, are considered high risk, although solid evidence for this classification is lacking. Specific DNA copy number changes are associated with adenoma-to-carcinoma progression. We set out to determine the prevalence of cancer-associated events (CAE) in advanced and nonadvanced adenomas. DNA copy number analysis was performed on archival tissues from three independent series of, in total, 297 adenomas (120 nonadvanced and 177 advanced) using multiplex ligation-dependent probe amplification or low-coverage whole-genome DNA sequencing. Alterations in two or more CAEs were considered to mark adenomas as high risk. Two or more CAEs were overall present in 25% (95% CI, 19.0-31.8) of advanced adenomas; 23% (11/48), 36% (12/33), and 23% (22/96) of the advanced adenomas in series 1, 2, and 3, respectively, and 1.7% (1/58) and 4.8% (3/62) of the nonadvanced adenomas, in series 1 and 2, respectively. The majority of advanced adenomas do not show CAEs, indicating that only a subset of these lesions is to be considered high risk. Nonadvanced adenomas have very low prevalence of CAEs, although those with CAEs should be considered high risk as well. Specific DNA copy number alterations may better reflect the true progression risk than the advanced adenoma phenotype. Cancer Prev Res; 11(7); 403-12. ©2018 AACR.
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Ciatto S, Castiglione G. Role of Double-contrast Barium Enema in Colorectal Cancer Screening Based on Fecal Occult Blood. TUMORI JOURNAL 2018; 88:95-8. [PMID: 12088265 DOI: 10.1177/030089160208800203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Screening for colorectal cancer by fecal occult-blood testing has been shown to be effective in reducing colorectal cancer mortality. Total colonoscopy is the test of choice for the assessment of fecal occult blood-positive subjects. Double-contrast barium enema is commonly employed to study the rest of the colon when colonoscopy is incomplete. The present study evaluated the contribution of double-contrast barium enema in detecting neoplastic lesions of the colon in fecal occult-blood-positive subjects with incomplete colonoscopy. Methods In the frame of a screening program for colorectal cancer in the Florence District, a new immunochemical fecal occult-blood test replaced the classic guaiac fecal occult-blood test in 1993. Subjects with a positive fecal occult-blood test were invited to undergo total colonoscopy. Incomplete colonoscopy prompted double-contrast barium enema. Type and rate of neoplastic lesions detected by endoscopy or double-contrast barium enema as single methods or combined were evaluated. Results A total of 38,829 subjects underwent fecal occult-blood testing in the period 1993-2000. Overall, 1,542 were positive. Assessment was refused by 235 subjects. Out of 1,307 subjects accepting assessment, total colonoscopy was attempted in 1,294: of these, it was not possible in 343 cases, and double-contrast barium enema was advised and performed in 261 subjects. Colorectal cancer was detected in 115 subjects, single or multiple adenomas in 323, hyperplastic polyps in 58, inflammatory, hamartomatous or not histologically confirmed polyps in 38, and other benign non-polypoid findings or no abnormality in 773. There were significant differences between the rates of detected colorectal cancers or adenomas of total and incomplete colonoscopy. There were also significant differences between incomplete colonoscopy and the combination of incomplete colonoscopy and double-contrast barium enema as regards rates of detected colorectal cancer, and between total colonoscopy and the combination of incomplete colonoscopy with double-contrast barium enema as regards rates of detected adenomas. Double-contrast barium enema associated to incomplete colonoscopy was responsible for an increase in detection rates of cancer or adenoma of 2.3‰ or 3.8‰, respectively. Conclusions Double-contrast barium enema was useful in detecting colorectal cancer beyond the range reached by incomplete colonoscopy, whereas our data confirmed a lower sensitivity of double-contrast barium enema for polyps. The diagnostic contribution observed in the present survey confirms the opportunity of performing double-contrast barium enema as a routine adjunct to incomplete colonoscopy. Nevertheless, in order to maximize the detection rate of adenomas, the rate of total colonoscopy should be kept as high as possible.
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Affiliation(s)
- Stefano Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Scientific Institute of Tuscany Region, Florence, Italy.
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49
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Grazzini G, Castiglione G, Isu A, Mantellini P, Rubeca T, Sani C, Turco P, Zappa M. Colorectal Cancer Screening by Fecal Occult Blood Testing: Results of a Population-Based Experience. TUMORI JOURNAL 2018; 86:384-8. [PMID: 11130566 DOI: 10.1177/030089160008600503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The study evaluated the results of an experimental screening protocol for colorectal cancer by fecal occult blood testing in a municipality of the Province of Florence. Methods A total of 15,235 subjects aged 50–70 years were invited to perform a 1-day immunochemical fecal occult blood testing without any dietary restrictions. All eligible subjects were sent a personal invitation letter, followed by a postal reminder to non-responders. Subjects with a negative stool test were advised to repeat screening after 2 years. Subjects with a positive screening test were invited to undergo full colonoscopy or a combination of left colonoscopy and a double contrast barium enema. Results A total of 6,418 subjects performed the screening test, with an overall compliance of 42.1%. A total of 268 compilers had positive test results. The positivity rate was 4.2%. Detection rate for cancer and for adenomas was 5.1‰ and 11.6‰, respectively. The positive predictive value was 14.3% for cancer and 32.5% for adenoma. A higher compliance was recorded in subjects born in the province of Florence or living in the centre of the town, in married subjects, and in women. The best results in compliance were associated with the direct distribution of fecal occult blood testing kits by general practitioners to their outpatients. Conclusions The study provides useful information about the efficiency and feasibility of a screening program for colorectal cancer using fecal occult blood testing. Compliance results confirm the importance of GP involvement in oncological screening.
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Affiliation(s)
- G Grazzini
- CSPO Presidio per la Prevenzione Oncologica, Azienda Ospedaliera Careggi, Florence, Italy.
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Kobayashi LC, von Wagner C, Wardle J. Perceived Life Expectancy Is Associated with Colorectal Cancer Screening in England. Ann Behav Med 2018; 51:327-336. [PMID: 27822612 PMCID: PMC5440484 DOI: 10.1007/s12160-016-9855-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Cancer screening is a behavior that represents investment in future health. Such investment may depend on how much ‘future’ a person expects. Purpose The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program. Methods Data were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual’s estimate of their chance of living another 10–15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors. Results Overall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10–15-year life expectancy as 75–100%, compared with 52% (126/243) among those who estimated theirs as 0–25% (adjusted OR 1.74, 95% CI 1.29–2.34). Conclusions A longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.
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Affiliation(s)
- Lindsay C Kobayashi
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, 9 Bow St, Cambridge, MA, 02138, USA.
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
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