Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Determinants of polyp size in patients undergoing screening colonoscopy

BACKGROUND

Pre-existing polyps, especially large polyps, are known to be the major source for colorectal cancer, but there is limited available information about factors that are associated with polyp size and polyp growth. We aim to determine factors associated with polyp size in different age groups.

METHODS

Colonoscopy data were prospectively collected from 67 adult gastrointestinal practice sites in the United States between 2002 and 2007 using a computer-generated endoscopic report form. Data were transmitted to and stored in a central data repository, where all asymptomatic white (n = 78352) and black (n = 4289) patients who had a polyp finding on screening colonoscopy were identified. Univariate and multivariate analysis of age, gender, performance site, race, polyp location, number of polyps, and family history as risk factors associated with the size of the largest polyp detected at colonoscopy.

RESULTS

In both genders, size of the largest polyp increased progressively with age in all age groups (P < .0001). In subjects ≥ 80 years the relative risk was 1.55 (95% CI, 1.35-1.79) compared to subjects in the youngest age group. With the exception of family history, all study variables were significantly associated with polyp size (P < .0001), with multiple polyps (≥ 2 versus 1) having the strongest risk: 3.41 (95% CI, 3.29-3.54).

CONCLUSIONS

In both genders there is a significant increase in polyp size detected during screening colonoscopy with increasing age. Important additional risk factors associated with increasing polyp size are gender, race, polyp location, and number of polyps, with polyp multiplicity being the strongest risk factor. Previous family history of bowel cancer was not a risk factor.

Validity of the process of change for colorectal cancer screening among African Americans

BACKGROUND

Process of change (POC) is a construct of the transtheoretical model that proposes to promote healthy behaviors.

PURPOSE

African Americans participate in colorectal cancer (CRC) screening less often than whites, while disease onset is younger, and incidence and mortality from CRC are higher.

METHODS

POC items for CRC screening were administered to 158 African Americans, the majority of whom were female (75.9%) and were not employed (85.4%). Confirmatory factor analysis was used to validate four factors reflecting the POC sub-domains.

RESULTS

Support of the factor validity of the POC with internal consistency of standardized alpha for the four factors was found. A logistic regression showed predictive validity in predicting current screening stage for two of the four sub-domains.

CONCLUSION

These data support the application of the POC to prediction of CRC screening intention among African Americans.

A randomized controlled trial of a tailored interactive computer-delivered intervention to promote colorectal cancer screening: sometimes more is just the same

BACKGROUND

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening.

PURPOSE

We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening.

METHODS

Patients 50-70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months.

RESULTS

There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects.

CONCLUSIONS

A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.

Cost effectiveness of interventions to promote screening for colorectal cancer: a randomized trial

Objectives

Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention.

Methods

A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping.

Results

The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy.

Conclusions

The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.

The value of age and medical history for predicting colorectal cancer and adenomas in people referred for colonoscopy

BACKGROUND

Colonoscopy is an invasive and costly procedure with a risk of serious complications. It would therefore be useful to prioritise colonoscopies by identifying people at higher risk of either cancer or premalignant adenomas. The aim of this study is to assess a model that identifies people with colorectal cancer, advanced, large and small adenomas.

METHODS

Patients seen by gastroenterologists and colorectal surgeons between April 2004 and December 2006 completed a validated, structured self-administered questionnaire prior to colonoscopy. Information was collected on symptoms, demographics and medical history. Multinomial logistic regression was used to simultaneously assess factors associated with findings on colonoscopy of cancer, advanced adenomas and adenomas sized 6 -9 mm, and ≤ 5 mm. The area under the curve of ROC curve was used to assess the incremental gain of adding demographic variables, medical history and symptoms (in that order) to a base model that included only age.

RESULTS

Sociodemographic variables, medical history and symptoms (from 8,204 patients) jointly provide good discrimination between colorectal cancer and no abnormality (AUC 0.83), but discriminate less well between adenomas and no abnormality (AUC advanced adenoma 0.70; other adenomas 0.67). Age is the dominant risk factor for cancer and adenomas of all sizes. Having a colonoscopy within the last 10 years confers protection for cancers and advanced adenomas.

CONCLUSIONS

Our models provide guidance about which factors can assist in identifying people at higher risk of disease using easily elicited information. This would allow colonoscopy to be prioritised for those for whom it would be of most benefit.

Metabolic syndrome is associated with increased risk of recurrent colorectal adenomas in Korean men

OBJECTIVE

Because of the high incidence of recurrent colorectal adenomas, regular surveillance by colonoscopy is recommended. However, there is still a shortage of information on the factors that influence the incidence of recurrent colorectal adenomas in patients with a history of these lesions. The aim of this study was to determine the association between the development of recurrent colorectal adenomas, metabolic syndrome and obesity.

SUBJECTS AND METHODS

The hospital-based cohort was composed of 193 patients who had recurrent colorectal adenomas removed between January 2002 and December 2003. The Cox proportional hazard model was used to determine hazard ratio (HR) and 95% confidence interval (CI) between obesity, metabolic syndrome and other factors, and the incidence of recurrent adenomatous polyps.

RESULTS

The mean follow-up period was 4.8 person-years. In all, 78 of the patients (40.4%) had recurrent colorectal adenomas. In the overall recurrent adenoma group, significant associations between metabolic syndrome (HR, 1.33; 95% CI, 1.02-1.73), waist circumference (WC) ≥ 90 cm (HR, 1.42; 95% CI, 1.06-1.90) and waist-hip ratio (WHR) ≥ 0.9 (HR, 2.03; 95% CI, 1.55-2.68) were found. Moreover, advanced adenomas were significantly associated with metabolic syndrome (HR, 2.81; 95% CI, 1.86-4.25), body mass index ≥ 25 kg m(-2) (HR, 2.69; 95% CI, 1.64-4.42), WC (HR, 2.16; 95% CI, 1.31-3.54) and WHR (HR, 1.99; 95% CI, 1.28-3.11). In addition, current smoking (HR, 2.60; 95% CI, 1.09-6.25) and alcohol consumption (HR, 2.20; 95% CI, 1.10-4.39) were also significantly associated with recurrent advanced adenoma.

CONCLUSION

Metabolic syndrome and obesity were significantly associated with the development of recurrent colorectal adenomas in Korean adult males. Furthermore, these associations were more strongly associated with advanced adenomas.

Korean type 2 diabetes patients have multiple adenomatous polyps compared to non-diabetic controls

We tested the correlation between diabetes and aggressiveness of colorectal polyps in diabetic patients and matched non-diabetic controls. We retrospectively studied 3,505 type 2 diabetes (T2DM) patients without gastrointestinal symptoms who underwent colonoscopy for colorectal cancer at Samsung Medical Center, Seoul, Korea from August 1995 to August 2009. We matched 495 non-diabetic subjects with colon polyps to the diabetic patients in whom polyps were detected by year of colonoscopy, age, sex and body mass index (BMI). Among the 3,505 T2DM patients screened, 509 were found to have 1,136 colon polyps. Those with diabetes had a greater proportion of adenomatous polyps (62.8% vs 53.6%) compared to the control. Multivariate logistic regression analysis identified DM, male gender, age and BMI as independent risk factors for multiple polyps (more than three polyps). Polyp multiplicity in diabetic patients was significantly associated with male gender (OR 2.360, P = 0.005), age (OR 1.033, P = 0.005) and BMI (OR 1.077, P = 0.028). Neither aspirin nor metformin use affected either size or number of polyps in diabetic patients. Male patients older than 65 yr with T2DM and BMI greater than 25 have increased risk for multiple adenomatous polyps and should be screened with colonoscopy to prevent colorectal cancer.

Recommendations for post-polypectomy surveillance in community practice

BACKGROUND

After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number.

AIMS

To learn physicians' recommendations for post-polypectomy surveillance from physicians' office charts.

METHODS

Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted.

RESULTS

Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4-6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1-3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than "excellent." Prep quality was not reported for 32% of examinations.

CONCLUSIONS

Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.

Sources of false positives in computer-assisted CT colonography

The application of computer-aided detection (CAD) is expected to improve reader sensitivity and to reduce inter-observer variance in computed tomographic (CT) colonography. However, current CAD systems display a large number of false-positive (FP) detections. The reviewing of a large number of FP CAD detections increases interpretation time, and it may also reduce the specificity and/or sensitivity of a computer-assisted reader. Therefore, it is important to be aware of the patterns and pitfalls of FP CAD detections. This pictorial essay reviews common sources of FP CAD detections that have been observed in the literature and in our experiments in computer-assisted CT colonography. Also the recommended computer-assisted reading technique is described.

Barriers to and motivations for physician referral of patients to cancer genetics clinics

Although it is well known that under-referral of colon cancer patients to cancer genetics clinics is a chronic problem, no study has yet examined why physicians may be ordering testing independently rather than referring patients to cancer genetics clinics. The current study explored variables which may impact a physician's preference for ordering testing independently or referring patients to outside cancer genetics experts. An online questionnaire, distributed to the membership of the American College of Gastroenterology and the American Society of Colorectal Surgeons, yielded responses from 298 physicians. Motivations to refer to cancer genetics clinics rather than order testing independently included fear of genetic discrimination and a belief that patients benefit from genetic counseling about the risks, benefits and consequences of testing. These results suggest that in order to increase referrals, genetic counselors must educate physicians about the unique benefits patients receive from participating in genetic counseling.

Multidetector computed tomography in large bowel lesions-a study of 100 cases

This study aims to evaluate the role of multidetector computed tomography (MDCT) in detecting and classifying the large bowel lesions. A prospective study of 100 adult patients was conducted from June 2007 to October 2009. Rectal and IV contrast were used for three dimensional reconstruction. Angiography was performed in cases of suspected ischemic pathology. CT colongraphy was done to evaluate adenomas. CT findings were correlated and confirmed by either colonoscopy, biopsy, postoperative findings or follow-up CT. The pathologies were common in 50-70 yrs (44%). M: F ratio was 2:1. Malignant lesions were seen in (55%) followed by inflammatory lesions in 26%, diverticulitis and ischemic colitis in 6% each. Miscellaneous conditions like polyps, volvulus and intussusceptions were seen in 7%. Adenocarcinoma was the common malignancy (81.2%). Present study showed that adenocarcinomas were associated with marked thickening of bowel wall (>1.5 cm) in 85.4% of patients, asymmetrical wall thickening (96.4%), focal involvement (length <10 cm) in 85.5% with heterogeneous post contrast enhancement (96.3%). Inflammatory lesions showed mild thickening (69%),segmental or diffuse involvement (77%), symmetrical wall thickening (89%) and homogenous post contrast enhancement (81%). Ischemic lesions showed marked thickening (83.4%), symmetrical thickening (100%) and homogenous enhancement (100%). Diverticulitis showed marked thickening (100%), asymmetrical wall thickening (66.7%) with heterogeneous post contrast enhancement (100%), with pericolic fluid. Arterial/venous thrombosis was diagnosed in 66.66%. Three per cent had benign adenomatous polyps on CT colonographic studies. MDCT was accurate in 98.2% cases for differentiating between benign and malignant etiology and is the modality of choice.

Comparative economic evaluation of data from the ACRIN National CT Colonography Trial with three cancer intervention and surveillance modeling network microsimulations

PURPOSE

To estimate the cost-effectiveness of computed tomographic (CT) colonography for colorectal cancer (CRC) screening in average-risk asymptomatic subjects in the United States aged 50 years.

MATERIALS AND METHODS

Enrollees in the American College of Radiology Imaging Network National CT Colonography Trial provided informed consent, and approval was obtained from the institutional review board at each site. CT colonography performance estimates from the trial were incorporated into three Cancer Intervention and Surveillance Modeling Network CRC microsimulations. Simulated survival and lifetime costs for screening 50-year-old subjects in the United States with CT colonography every 5 or 10 years were compared with those for guideline-concordant screening with colonoscopy, flexible sigmoidoscopy plus either sensitive unrehydrated fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT), and no screening. Perfect and reduced screening adherence scenarios were considered. Incremental cost-effectiveness and net health benefits were estimated from the U.S. health care sector perspective, assuming a 3% discount rate.

RESULTS

CT colonography at 5- and 10-year screening intervals was more costly and less effective than FOBT plus flexible sigmoidoscopy in all three models in both 100% and 50% adherence scenarios. Colonoscopy also was more costly and less effective than FOBT plus flexible sigmoidoscopy, except in the CRC-SPIN model assuming 100% adherence (incremental cost-effectiveness ratio: $26,300 per life-year gained). CT colonography at 5- and 10-year screening intervals and colonoscopy were net beneficial compared with no screening in all model scenarios. The 5-year screening interval was net beneficial over the 10-year interval except in the MISCAN model when assuming 100% adherence and willingness to pay $50,000 per life-year gained.

CONCLUSION

All three models predict CT colonography to be more costly and less effective than non-CT colonographic screening but net beneficial compared with no screening given model assumptions.

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

BACKGROUND

Previous studies have suggested that the immunochemical fecal occult blood test has superior specificity for detecting bleeding in the lower gastrointestinal tract even if bleeding occurs in the upper tract. We conducted a large population-based study involving asymptomatic adults in Taiwan, a population with prevalent upper gastrointestinal lesions, to confirm this claim.

METHODS

We conducted a prospective cohort study involving asymptomatic people aged 18 years or more in Taiwan recruited to undergo an immunochemical fecal occult blood test, colonoscopy and esophagogastroduodenoscopy between August 2007 and July 2009. We compared the prevalence of lesions in the lower and upper gastrointestinal tracts between patients with positive and negative fecal test results. We also identified risk factors associated with a false-positive fecal test result.

RESULTS

Of the 2796 participants, 397 (14.2%) had a positive fecal test result. The sensitivity of the test for predicting lesions in the lower gastrointestinal tract was 24.3%, the specificity 89.0%, the positive predictive value 41.3%, the negative predictive value 78.7%, the positive likelihood ratio 2.22, the negative likelihood ratio 0.85 and the accuracy 73.4%. The prevalence of lesions in the lower gastrointestinal tract was higher among those with a positive fecal test result than among those with a negative result (41.3% v. 21.3%, p < 0.001). The prevalence of lesions in the upper gastrointestinal tract did not differ significantly between the two groups (20.7% v. 17.5%, p = 0.12). Almost all of the participants found to have colon cancer (27/28, 96.4%) had a positive fecal test result; in contrast, none of the three found to have esophageal or gastric cancer had a positive fecal test result (p < 0.001). Among those with a negative finding on colonoscopy, the risk factors associated with a false-positive fecal test result were use of antiplatelet drugs (adjusted odds ratio [OR] 2.46, 95% confidence interval [CI] 1.21-4.98) and a low hemoglobin concentration (adjusted OR 2.65, 95% CI 1.62-4.33).

INTERPRETATION

The immunochemical fecal occult blood test was specific for predicting lesions in the lower gastrointestinal tract. However, the test did not adequately predict lesions in the upper gastrointestinal tract.

State of the Art Review: Colorectal Cancer Screening

Although colorectal cancer is the third leading cause of cancer-related deaths in the U.S., the burden of this disease could be dramatically reduced by increased utilization of screening. Evidence-based recommendations and guidelines from national societies recommend screening all average risk adults starting at age fifty. However, the myriad of screening options and slight differences in screening recommendations between guidelines may lead to confusion among patients and their primary care providers. This goal of this review is to briefly summarize the colorectal cancer screening guidelines issued by three major organizations, compare their recommendations, and address emerging issues in colorectal cancer screening.

Matching colonoscopy and pathology data in population-based registries: development of a novel algorithm and the initial experience of the New Hampshire Colonoscopy Registry

BACKGROUND

The quality of polyp-level data in a population-based registry depends on the ability to match each polypectomy recorded by the endoscopist to a specific diagnosis on the pathology report.

OBJECTIVE

To review impediments encountered in matching colonoscopy and pathology data in a population-based registry.

DESIGN

New Hampshire Colonoscopy Registry data from August 2006 to November 2008 were analyzed for prevalence of missing reports, discrepancies between colonoscopy and pathology reports, and the proportion of polyps that could not be matched because of multiple polyps submitted in the same container.

SETTING

New Hampshire Colonoscopy Registry.

PATIENTS

This study involved all consenting patients during the study period.

INTERVENTION

Develop an algorithm for capturing number, size, location, and histology of polyps and for defining and flagging discrepancies to ensure data quality.

MAIN OUTCOME MEASUREMENTS

The proportion of polyps with no assumption or discrepancy, the proportion of patient records eligible for determining the adenoma detection rate (ADR), and the number of patients with ≥3 adenomas.

RESULTS

Only 50% of polyps removed during this period were perfectly matched, with no assumption or discrepancy. Records from only 69.9% and 29.7% of eligible patients could be used to determine the ADR and the number of patients with ≥3 adenomas, respectively.

LIMITATIONS

Rates of missing reports may have been higher in the early phase of establishment of the registry.

CONCLUSION

This study highlights the impediments in collecting polyp-level data in a population-based registry and provides useful parameters for evaluating the quality and accuracy of data obtained from such registries.

Toward standardized high-throughput serum diagnostics: multiplex-protein array identifies IL-8 and VEGF as serum markers for colon cancer

Development and progression of colon cancer may be related to cytokines. Cytokines with diagnostic value have been identified individually but have not been implemented into clinical praxis. Using a multiplex protein array, the authors explore a panel of cytokines simultaneously and compared its performance to carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). Serum concentrations of 12 cytokines were simultaneously determined by multiplex biochip technology in 50 colon cancer patients and 50 healthy controls. Serum levels of interleukin-8 (IL-8) and CEA were significantly higher in cancer patients than in healthy controls. Areas under the receiver operating characteristic curves (AUCs) were largest for IL-8, followed by CEA, vascular endothelial growth factor (VEGF), and CA 19-9. Analyses regarding marker combinations showed an advantage over single marker performance for CEA, VEGF, and CA 19-9 but not for IL-8. Multiplex biochip array technology represents a practical tool in cytokine and cancer research when simultaneous determination of different biomarkers is of interest. The results suggest that the assessment of IL-8, CEA, VEGF, and possibly CA 19-9 serum levels could be useful for colon cancer screening with the potential of also detecting early stage tumors. Further validation studies using these and additional markers on a multiplex array format are encouraged.

Risk of proximal colonic neoplasms in asymptomatic adults older than 50 years found to have distal hyperplastic polyps on routine colorectal cancer screening

PURPOSE

A retrospective case-control study was conducted to evaluate whether hyperplastic polyps (HPs) found in the lower 50 cm of colon could be used as indicators for synchronous proximal neoplasms (SPNs) in the large intestine. Additionally, other characteristics considered included age; sex; ethnicity; history of cancer, cholecystectomy, or appendectomy; current use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs); current use of estrogen or hormone replacement therapy (HRT) in women; current smoking status; and the size, number, and location of the distal HP if present.

METHODS

Convenience sampling of medical charts and colonoscopy reports compiled during a ten-year period was used to glean the sample of 1792 participants.

RESULTS

Distal HPs in the lower 50 cm of colon were not significantly associated with SPN when patients with HPs were compared with those without any distal polyps at all (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.73-1.22). However, significant relationships with proximal neoplasms (adenomas, advanced adenomas, and colon cancer) were noted in patients with a prior diagnosis of cancer (OR = 1.62; 95% CI =1.25-2.11), advancing age (OR = 1.02; 95% CI = 1.01-1.03), non-Caucasian (men only) ethnicity (OR = 0.72; 95% CI = 0.55-0.96), a history (men only) of taking aspirin or NSAIDs (OR = 0.73; 95% CI = 0.56-0.95), and a history (women only) of taking estrogen or receiving HRT (OR = 1.51; 95% CI = 1.04-2.20).

CONCLUSION

Routinely recommending a colonoscopy for every patient with distal HPs found only by screening flexible sigmoidoscopy is neither justified nor necessary. Nevertheless, further investigation (ie, colonoscopy) may be warranted in the aforementioned subgroups.

Colorectal cancer screening behavior and willingness: an outpatient survey in China

AIM

To identity the factors influencing colorectal cancer (CRC) screening behavior and willingness among Chinese outpatients.

METHODS

An outpatient-based face-to-face survey was conducted from August 18 to September 7, 2010 in Changhai Hospital. A total of 1200 consecutive patients aged ≥ 18 years were recruited for interview. The patient's knowledge about CRC and screening was pre-measured as a predictor variable, and other predictors included age, gender, educational level, monthly household income and health insurance status. The relationship between these predictors and screening behavior, screening willingness and screening approach were examined using Pearson's χ(2) test and logistic regression analyses.

RESULTS

Of these outpatients, 22.5% had undergone CRC screening prior to this study. Patients who had participated in the screening were more likely to have good knowledge about CRC and screening (OR: 5.299, 95% CI: 3.415-8.223), have health insurance (OR: 1.996, 95% CI: 1.426-2.794) and older in age. Higher income, however, was found to be a barrier to the screening (OR: 0.633, 95% CI: 0.467-0.858). An analysis of screening willingness showed that 37.5% of the patients would voluntarily participated in a screen at the recommended age, but 41.3% would do so under doctor's advice. Screening willingness was positively correlated with the patient's knowledge status. Patients with higher knowledge levels would like to participate in the screening (OR: 4.352, 95% CI: 3.008-6.298), and they would select colonoscopy as a screening approach (OR: 3.513, 95% CI: 2.290-5.389). However, higher income level was, again, a barrier to colonoscopic screening (OR: 0.667, 95% CI: 0.505-0.908).

CONCLUSION

Patient's level of knowledge and income should be taken into consideration when conducting a feasible CRC screening.

Genetic testing for lynch syndrome in individuals newly diagnosed with colorectal cancer to reduce morbidity and mortality from colorectal cancer in their relatives

Individuals with Lynch syndrome, sometimes referred to as hereditary non-polyposis colorectal cancer (HNPCC), have an increased risk of developing colorectal cancer (CRC) as well as other cancers. The increased risk is due to inherited mutations in mismatch repair (MMR) genes, which reduce the ability of cells to repair DNA damage. Screening for Lynch syndrome in individuals newly diagnosed with colorectal cancer has been proposed as part of a strategy that combines tests and interventions to reduce the risk of colorectal cancer in the relatives of the colorectal cancer patients with Lynch Syndrome.

Prevalence of any size adenomas and advanced adenomas in 40- to 49-year-old individuals undergoing screening colonoscopy because of a family history of colorectal carcinoma in a first-degree relative

BACKGROUND

Per current guidelines, patients with a first-degree relative (FDR) with colorectal cancer (CRC) should get screened at least at age 40. Data about the prevalence of adenomas and advanced adenomas (AAs) in these patients are lacking.

OBJECTIVE

To examine the prevalence of adenomas and AAs in 40- to 49-year-old individuals undergoing screening colonoscopy for family history of CRC.

DESIGN

Retrospective chart review.

PATIENTS

Asymptomatic patients 40 to 49 years of age undergoing their first screening colonoscopy at the University of Michigan during the period 1999 to 2009 because of an FDR with CRC.

MAIN OUTCOME MEASUREMENTS

Prevalence of adenomas (any size), AAs, and risk factors associated with adenomas.

RESULTS

Among 640 study patients, the prevalence of adenomas (any size) was 15.4% and 3.3% for AAs. Adenoma prevalence was lower if the FDR with CRC was younger than 60 years of age versus an FDR with CRC older than 60 years of age (12.4% vs 19%, P = .034). Male sex (odds ratio 2.6; 95% CI, 1.06-4.4) and advancing age (odds ratio 1.16; 95% CI, 1.03-1.31) were associated with adenomas.

LIMITATIONS

Limited data on risk factor exposure and insufficient sample size to assess risk factors for AAs.

CONCLUSIONS

Among 40- to 49-year-old patients undergoing screening colonoscopy because of an FDR with CRC, the prevalence of adenomas and AAs is low. Further research should determine whether these individuals have a higher prevalence of adenomas compared with average-risk individuals.

Routine colonoscopy following acute uncomplicated diverticulitis

BACKGROUND

The evidence supporting current recommendations that the colon should be evaluated following an initial episode of acute diverticulitis is poor. The aim of this study was to clarify whether acute uncomplicated diverticulitis is a valid indication for subsequent colonoscopy/computed tomography (CT) colonography.

METHODS

This was a retrospective longitudinal study of patients with an initial presentation of acute uncomplicated diverticulitis on the basis of CT criteria, at a single institution between January 2004 and December 2008.

RESULTS

A radiological diagnosis of acute uncomplicated diverticulitis was made in 292 patients. Some 205 patients underwent subsequent colonic evaluation or had undergone colonoscopy/CT colonography within the preceding 2 years. Colorectal polyps were present in 50 patients (24·4 per cent). Twenty patients (9·8 per cent) had hyperplastic polyps and 19 (9·3 per cent) had adenomas. Eleven patients (5·4 per cent) had advanced colonic neoplasia, including one (0·5 per cent) with a colorectal cancer. One patient had inflammatory bowel disease (IBD). The patients with colorectal cancer and IBD had clinical indicators that independently warranted colonoscopy. None of the 87 patients who did not undergo colonic evaluation had a diagnosis of colorectal cancer registered with the New Zealand Cancer Registry.

CONCLUSION

The yield of advanced colonic neoplasia in this cohort was equivalent to, or less than that detected on screening asymptomatic average-risk individuals. In the absence of other indications, subsequent evaluation of the colon may not be required to confirm the diagnosis of diverticulitis.

Detection of OSMR and TFPI2 gene methylation in stool DNA for diagnosis of colorectal cancer

AIM: To study the feasibility and clinical significance of detection of oncostatin M receptor (OMSR) and tissue factor pathway inhibitor 2 (TFPI2) gene methylation in stool DNA in patients with colorectal cancer.

METHODS: Stool samples were collected from 60 patients with colorectal cancer, 17 patients with colorectal polyps, and 30 normal controls. The methylation of OMSR and TFPI2 in stool DNA was detected by methylation-specific PCR (MSP).

RESULTS: The detection rates of OSMR and TFPI2 methylation in stool DNA were significantly higher in patients with colorectal cancer than in those with colorectal polyps and normal controls [OSMR: 35% (21/60) vs 12% (2/17), 7% (2/30); TFPI2: 70% (42/60) vs 18% (3/17), 3% (1/30); all P < 0.01]. The sensitivity and specificity of combined detection of OSMR and TFPI2 methylation in stool DNA in the diagnosis of colorectal cancer were 81.7% and 90%, respectively.

CONCLUSION: Detection of OSMR and TFPI2 methylation in stool DNA is a promising approach to the diagnosis of colorectal cancer.

Organized colorectal cancer screening in integrated health care systems

Colorectal cancer (CRC) is an ideal target for early detection and prevention through screening. Noninvasive screening options are the guaiac fecal occult blood test and the fecal immunochemical test. Organized screening offers the promise of uniformly delivering screening to all members of a population who are eligible and due. Organized screening is defined as an explicit policy with defined age categories, method, and interval for screening in a defined target population with a defined implementation and quality assurance structure, and tracking of cancer in the population. The UK National Health Service; the Ontario, Canada Ministry of Health and Long-Term Care; and the US Veteran's Health Administration have used varied organized approaches to deliver guaiac fecal occult blood test screening to their populations. Kaiser Permanente Northern California began CRC screening in the 1960s, initially using flexible sigmoidoscopy. Implementation of organized fecal immunochemical test outreach was associated with improved Healthcare Effectiveness Data and Information Set CRC screening rates between 2005 and 2010 from 37% to 69% and from 41% to 78% in the commercial and Medicare populations, respectively. Organized fecal immunochemical test screening has been associated with an increase in annually detected CRCs, almost entirely because of increased detection of localized-stage cancers.

[CT colonography: what radiologists need to know]

In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.

A systematic comparison of microsimulation models of colorectal cancer: the role of assumptions about adenoma progression

BACKGROUND

As the complexity of microsimulation models increases, concerns about model transparency are heightened.

METHODS

The authors conducted model "experiments" to explore the impact of variations in "deep" model parameters using 3 colorectal cancer (CRC) models. All natural history models were calibrated to match observed data on adenoma prevalence and cancer incidence but varied in their underlying specification of the adenocarcinoma process. The authors projected CRC incidence among individuals with an underlying adenoma or preclinical cancer v. those without any underlying condition and examined the impact of removing adenomas. They calculated the percentage of simulated CRC cases arising from adenomas that developed within 10 or 20 years prior to cancer diagnosis and estimated dwell time-defined as the time from the development of an adenoma to symptom-detected cancer in the absence of screening among individuals with a CRC diagnosis.

RESULTS

The 20-year CRC incidence among 55-year-old individuals with an adenoma or preclinical cancer was 7 to 75 times greater than in the condition-free group. The removal of all adenomas among the subgroup with an underlying adenoma or cancer resulted in a reduction of 30% to 89% in cumulative incidence. Among CRCs diagnosed at age 65 years, the proportion arising from adenomas formed within 10 years ranged between 4% and 67%. The mean dwell time varied from 10.6 to 25.8 years.

CONCLUSIONS

Models that all match observed data on adenoma prevalence and cancer incidence can produce quite different dwell times and very different answers with respect to the effectiveness of interventions. When conducting applied analyses to inform policy, using multiple models provides a sensitivity analysis on key (unobserved) "deep" model parameters and can provide guidance about specific areas in need of additional research and validation.

Surgical management of lower gastrointestinal bleeding

PURPOSE

Lower gastrointestinal bleeding (LGIB) is any form of bleeding distal to the Ligament of Treitz. In most cases, acute LGIB is self-limited and resolves spontaneously with conservative management.

METHODS

Only a minority of approximately 10% is admitted to hospital with signs of massive bleeding and shock requiring resuscitation, urgent evaluation and treatment.

RESULTS

Over the past decade, there has been a progressive decrease in upper GI events and a significant increase in lower GI events. Overall, mortality has also decreased, but in-hospital fatality due to upper or lower GI complications have remained constant. The problem is that LGIB can arise from a number of sources and may be a significant cause of hospitalisation and mortality in elderly patients.

CONCLUSIONS

After initial resuscitation, the diagnosis and treatment of LGIB remains a challenge for acute care surgeons, whereby the identification of the source of bleeding is of utmost importance.

Development and Psychometric Testing of the Colonoscopy Embarrassment Scale

Colorectal cancer, the third leading cause of cancer-related death in the United States, could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment is one important barrier to colonoscopy, but little is known about embarrassment in this context, and there were no reliable and valid measures of this construct. The purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. Transtheoretical Model of Behavior Change and Health Belief Model provided the theoretical basis for this study. Participants were health maintenance organization members aged 50 to 65 years ( N = 234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. Internal consistency (Cronbach’s α = .96) and construct validity of the 13-item instrument were demonstrated. This unidimensional scale shows promise as a valid and reliable instrument to measure colonoscopy-related embarrassment and to inform development of interventions to reduce embarrassment, leading to higher colonoscopy completion rates and lower mortality.

Clinical relevance of incidental finding of focal uptakes in the colon during 18F-FDG PET/CT studies in oncology patients without known colorectal carcinoma and evaluation of the impact on management

AIMS

To assess the significance and the impact of focal FDG uptake in the colon in oncology patients without known colorectal carcinoma.

MATERIALS AND METHODS

A retrospective study was undertaken on 2,220 (18)F-FDG PET/CT studies carried out consecutively in the Nuclear Medicine Department in our hospital from 2 December 2008 to 31 May 2010. Inclusion criteria were patients with abnormal (18)F-FDG uptake in colorectal area that could not be explained (or not previously known) by their clinical histories. Patients previously diagnosed with colorectal carcinoma were excluded. A total of 86 patients (57 male, average age 63.4, range 46-85) were finally included. Colonoscopy with biopsy was established as a reference test. The impact of these findings on the diagnostic-therapeutic management in these patients was evaluated.

RESULTS

A colonoscopy was performed in 54 of the 86 patients, this examination not having been done up-to-date in the remaining 32 patients. Biopsy was obtained in 43 lesions of the 54 patient in whom a colonoscopy was performed. Colon disease was detected in 49 of these 54 patients, obtaining 54 FDG incidental foci which corresponded to 10 previously unsuspected primary colorectal carcinoma, 3 metastases, 27 adenomatous polyps with different degrees of dysplasia and 14 inflammatory processes. In the remaining 5 patients, the colonoscopy was normal. PET/CT modified the diagnostic and treatment management in most of the patients (49/54, that is 91%).

CONCLUSIONS

These results confirm the need to determine the cause of abnormal (18)F-FDG colorectal uptakes in the PET/CT studies by using colonoscopy and biopsy. This approach allows for the detection and early treatment of malignant and premalignant lesions.

Correlates of colorectal cancer screening adherence among men who have been screened for prostate cancer

Prostate cancer screening rates are higher than colorectal cancer (CRC) screening rates, despite the established benefit of screening in reducing CRC incidence and mortality. We used data from the 2006 Behavioral Risk Factor Surveillance System to identify correlates of CRC screening among men who have undergone prostate cancer screening. Our sample included 41,781 men aged 50 years and older who reported undergoing prostate cancer screening in the last year. More than two thirds (69.2%) of the men were up-to-date with CRC screening. On multivariable analysis, men who were younger, Hispanic, less educated, not married or partnered, employed, not a veteran, did not have a personal doctor, lacked a recent medical checkup, smoked, or were sedentary were less likely to be adherent to CRC screening. Tailored interventions targeted toward men who have already undergone prostate cancer screening may improve rates of CRC screening in a group that may be already aware of and interested in the benefits of cancer risk prevention. The prostate cancer screening encounter may represent a "teachable moment" to increase CRC screening rates.

The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy

BACKGROUND

There are no guidelines for the recommended interval to the next examination after colonoscopy with suboptimal bowel preparation.

OBJECTIVE

To identify factors associated with early repeat colonoscopy after initial examinations with suboptimal preparations and to measure adenoma miss rates in this context.

DESIGN

Retrospective study.

SETTING

Hospital-based endoscopy unit.

PATIENTS

Bowel preparation quality was recorded in 12,787 patients.

RESULTS

Of 12,787 colonoscopies, preparation quality was suboptimal (poor or fair) in 3047 patients (24%). Among these 3047 patients, repeat examination was performed in <3 years in 505 (17%). Factors associated with early repeat colonoscopy included lack of cecal intubation (odds ratio [OR] 3.62, 95% confidence interval [CI], 2.50-5.24) and finding a polyp (OR 1.55, 95% CI, 1.17-2.07). Among 216 repeat colonoscopies with optimal preparation, 198 adenomas were identified, of which 83 were seen only on the second examination, an adenoma miss rate of 42% (95% CI, 35-49). The advanced adenoma miss rate was 27% (95% CI, 17-41). For colonoscopies repeated in <1 year, the adenoma and advanced adenoma miss rates were 35% and 36%, respectively.

LIMITATIONS

Single-center, retrospective study.

CONCLUSION

Although a minority of patients undergo early repeat examination after colonoscopies done with suboptimal bowel preparation, the miss rates for colonoscopies done with suboptimal bowel preparation were high, suggesting that suboptimal bowel preparation substantially decreases colonoscopy effectiveness and may mandate an early follow-up examination.

Training experiences of lay and professional patient navigators for colorectal cancer screening

Patient navigation (PN) is increasingly used in cancer care, but little is known about the identification and training of patient navigators. PN may be implemented by professional health care providers, paraprofessionals, or lay health workers and, therefore, presents an opportunity to compare professional and lay interventionist experiences. The goal of the current report is to compare the training experiences of four professional (Pro) and five lay (LHW) patient navigators enlisted to increase colonoscopy adherence among African American primary care patients. The results of early assessments showed that LHWs' intervention-related knowledge was significantly lower than that of Pros. However, there were no significant differences in knowledge scores between LHWs and Pros for most subsets of knowledge items in later assessments. Furthermore, there were no significant differences in LHWs' and Pros' reported self-efficacy and satisfaction with training. Findings support the use of diverse strategies to train and prepare LHWs as patient navigators.

Performance of a risk index for advanced proximal colorectal neoplasia among a racially/ethnically diverse patient population (risk index for advanced proximal neoplasia)

OBJECTIVES

Tailoring the use of screening colonoscopy based on the risk of advanced proximal neoplasia (APN) has been advocated as a strategy for reducing demand and optimizing effectiveness. A 7-point index based on age, sex, and distal findings at sigmoidoscopy has been proposed that stratifies individuals into low, intermediate, and high-risk categories. The aim of this cross-sectional analysis was to determine the validity of this index, which was originally derived and validated among mostly whites, for black and Hispanic patients.

METHODS

Data, including age, sex, colonoscopic findings, and pathology, were collected retrospectively from 1,481 white, 1,329 black, and 689 Hispanic asymptomatic, average-risk patients undergoing screening colonoscopy between 2000 and 2005. Cumulative scores ranging from 0 to 7 were derived for each subject and categorized as low, intermediate, or high risk. Rates of APN were assessed for each risk category after stratification by race/ethnicity. Index performance was assessed using the C-statistic and compared across the three racial groups.

RESULTS

Rates of APN among patients categorized as low, intermediate, or high risk increased from 1.0 to 2.8 to 3.7% for whites, 1.0 to 2.2 to 4.2% for blacks, and 0.6 to 1.9 to 3.7% for Hispanics. The index performed similarly for all three groups, but showed limited ability to discriminate low from intermediate-risk patients, with C-statistic values of 0.62 for whites, 0.63 for blacks, and 0.68 for Hispanics.

CONCLUSIONS

A risk index based on age, sex, and distal endoscopic findings has limited ability to discriminate low from intermediate-risk white, black, and Hispanic patients for APN.

Quality assurance for endoscopists

Quality assurance for gastrointestinal endoscopy addresses numerous aspects of unit management and patient care. Quality measures pertinent to patient care delivered by the individual endoscopist include optimal practices in the pre-procedure, intra-procedure, and post-procedure timeframes. Measures commonly employed to monitor colonoscopy care are discussed in detail. Several quality assurance techniques are well defined and useful for application to identified gaps in care. Quality improvement projects and ongoing quality assurance benchmarking against local and national norms are greatly facilitated by use of electronic report generators and computerized databases.

Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population

BACKGROUND

Colorectal cancer (CRC) screening reduces mortality yet remains underutilized. Low health literacy may contribute to this underutilization by interfering with patients' ability to understand and receive preventive health services.

PURPOSE

To determine if a web-based multimedia CRC screening patient decision aid, developed for a mixed-literacy audience, could increase CRC screening.

DESIGN

RCT. Patients aged 50-74 years and overdue for CRC screening were randomized to the web-based decision aid or a control program seen immediately before a scheduled primary care appointment.

SETTING/PARTICIPANTS

A large community-based, university-affiliated internal medicine practice serving a socioeconomically disadvantaged population.

MAIN OUTCOME MEASURES

Patients completed surveys to determine their ability to state a screening test preference and their readiness to receive screening. Charts were abstracted by masked observers to determine if screening tests were ordered and completed.

RESULTS

Between November 2007 and September 2008, a total of 264 patients enrolled in the study. Data collection was completed in 2009, and data analysis was completed in 2010. A majority of participants (mean age=57.8 years) were female (67%), African-American (74%), had annual household incomes of <$20,000 (76%), and had limited health literacy (56%). When compared to control participants, more decision-aid participants had a CRC screening preference (84% vs 55%, p<0.0001) and an increase in readiness to receive screening (52% vs 20%, p=0.0001). More decision-aid participants had CRC screening tests ordered (30% vs 21%) and completed (19% vs 14%), but no statistically significant differences were seen (AOR=1.6, 95% CI=0.97, 2.8, and AOR=1.7, 95% CI=0.88, 3.2, respectively). Similar results were found across literacy levels.

CONCLUSIONS

The web-based decision aid increased patients' ability to form a test preference and their intent to receive screening, regardless of literacy level. Further study should examine ways the decision aid can be combined with additional system changes to increase CRC screening.

A telematic tool to predict the risk of colorectal cancer in white men and women: ColoRectal Cancer Alert (CRCA)

Colorectal cancer is an important disease because of its severity and also since it affects much of the population. Nothing helps patients and doctors to determine the risk of suffering from colorectal cancer during their lives, except for medical tests such as the colonoscopy. There have been several studies and research to try to estimate the relative risks of colorectal cancer based on various factors and the applications to calculate the risk of this cancer, but these are not within everyone's research. This project offers a multilingual Web tool, called ColoRectal Cancer Alert (CRCA), to calculate the risk of colorectal cancer for life in men and women of white race. With this application, doctors can carry out research in a few minutes to explore this risk when they are seeing a patient. The platform is designed in such a way that anyone can use it. It is easy to use and intuitive. We should keep in mind that this tool does not replace diagnostic tests such as the colonoscopy or the sigmoidoscopy. It is designed so that users with the assistance of their doctor know the risk and act accordingly (for example, having more checkups on the disease in case of high risk). To access the tool a computer with Internet connection will be required. Currently, 250 users of white race under the supervision of a specialist have completed the questionnaire.

Rapid detection of low-abundance K-ras mutation in stools of colorectal cancer patients using chip-based temperature gradient capillary electrophoresis

Mutant K-ras provides an independent negative predictive marker for epidermal growth factor receptor (EGFR)-targeted therapy in colorectal cancers (CRCs). Rapid, sensitive, and cost-effective screening for K-ras status will overarch rational personalized medicine. Stool-based DNA testing offers unique advantages for CRC screening such as noninvasiveness, high specificity, and patient compliance, whereas complicated procedures and the low sensitivity of the present approaches have hampered its application on a wide scale. In this study, a chip-based temperature gradient capillary electrophoresis (TGCE) technique was applied to detect low-abundance K-ras mutations under a pooled experiment and analyze K-ras mutations in 30 paired stool samples and cancer tissues of CRC patients and 15 stool samples of healthy volunteers. The chip-based TGCE results showed that the successful analysis of K-ras status could be achieved within 6 min with an extremely low sample consumption of 14 nl. Detection is sensitive enough to reliably report 0.2% mutant CRC cells in a wild-type background, and 0.5 ng of template DNA was sufficient for chip-based TGCE. Of the 30 stool samples of CRC patients analyzed, 17 (57%) harbored K-ras mutations, and the lowest percentage of the detectable mutant K-ras in stool samples was 2%. The coincidence rate for K-ras mutations between stools and tissues obtained by the chip-based method reached 97% (29/30). One of the 15 stool samples of normal controls carried K-ras mutations, producing a specificity of 93%. Clone sequencing data entirely confirmed the results obtained by chip-based TGCE. The study demonstrates that chip-based TGCE is capable of rapidly screening low-abundance K-ras mutations with high sensitivity, reproducibility, simplicity, and significant savings of time and sample. Application of this method to genotype the K-ras gene in stools would provide a potential means for predicting the effectiveness of EGFR-targeted therapy in CRC patients using noninvasive approaches.

Detection of colorectal neoplasia by colonoscopy in average-risk patients age 40-49 versus 50-59 years

BACKGROUND

The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40-49 was similar to that among those aged 50-59.

AIM

To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients.

METHODS

Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40-49, 747 ages 50-59). We included consecutive patients of ages 40-59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI.

RESULTS

The prevalence of colorectal neoplasia was 12.1% in patients aged 40-49 and 22.6% in those aged 50-59. Compared with individuals aged 40-49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50-59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33-0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00-1.06). The number that had to be screened to detect one advanced lesion in the 40-49 age group was 49 compared with 20 in those aged 50-59.

CONCLUSION

Individuals aged 40-49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50-59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.

Brief report: exploration of colorectal cancer risk perceptions among Latinos

To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition and the digestive tract, and risks related to sexual practices. Participants frequently referred to the role of diet in keeping the colon "clean," suggesting that retained feces increase colorectal cancer risk. Among both men and women, rectal sex was commonly associated with increased colorectal cancer risk. Some Latinos may hold misperceptions about colorectal cancer risks, including an association between rectal sex and colon cancer, that may impact their screening behaviors. Clinicians and public health officials should consider these potential risk misperceptions and explore for other risk misperceptions when counseling and educating patients about colorectal cancer screening.