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de Lima JM, de Souza LG, da Silva IDCG, Forones NM. E-Cadherin and Metalloproteinase-1 and -7 Polymorphisms in Colorectal Cancer. Int J Biol Markers 2018; 24:99-106. [DOI: 10.1177/172460080902400206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose E-cadherin (CDH1) and metalloproteinase (MMP) polymorphisms could play a crucial role in cancer invasion. Our aim was to investigate the influence of the -160C/A CDH1, -1607ins/delG MMP-1 and -181A/G MMP-7 polymorphisms on the frequency and progression of colorectal cancer (CRC). Experimental design A total of 130 patients with CRC and 130 noncancer controls were studied. The -160C/A CDH1, -1607ins/delG MMP-1 and -181A/G MMP-7 genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. Results Patients with the 1G allele and a family history of CRC showed a six times higher risk of developing CRC (OR: 6.45, 95%CI: 2.02–20.6, p=0.001). The A/A CDH1 genotype was associated with a higher risk of metastatic disease (OR: 3.43, 95%CI: 1.27–9.27, p=0.023). A higher marginal risk of metastatic disease was observed for MMP-1 genotypes 1G/1G and 1G/2G (OR: 2.97, 95%CI: 0.93–9.47, p=0.098). Conclusions The -160C/A CDH1, -1607ins/delG MMP-1 and -181A/G MMP-7 single nucleotide polymorphisms did not modify the risk of CRC development. Patients with the 1G/1G or 1G/2G genotype and a family history of CRC presented a higher risk of CRC. The AA CDH1 and 1G/1G and 1G/2G MMP-1 genotypes might be associated with advanced metastatic disease, but are not markers of lymphatic metastasis.
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Affiliation(s)
- Jacqueline Miranda de Lima
- Oncology Group, Gastroenterology Division, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo - Brazil
| | - Lessileia Gomes de Souza
- Oncology Group, Gastroenterology Division, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo - Brazil
| | | | - Nora Manoukian Forones
- Oncology Group, Gastroenterology Division, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo - Brazil
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Williams R, White P, Nieto J, Vieira D, Francois F, Hamilton F. Colorectal Cancer in African Americans: An Update. Clin Transl Gastroenterol 2016; 7:e185. [PMID: 27467183 PMCID: PMC4977418 DOI: 10.1038/ctg.2016.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.
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Affiliation(s)
- Renee Williams
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Pascale White
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Dorice Vieira
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Fritz Francois
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
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Colquhoun P, Weiss EG, Efron J, Nogueras JJ, Vernava AM, Wexner SD. Colorectal Cancer Screening: Do We Practice What We Preach? Surg Innov 2016; 13:81-5. [PMID: 17012147 DOI: 10.1177/1553350606290163] [Citation(s) in RCA: 5] [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
Objective: Compliance rates for colorectal cancer screening have been reported as low, and ignorance is the most common factor sighted to explain this. The aim of this study was to determine screening compliance among colorectal surgeons assumed to be educated of the risks of colorectal cancer. Methods: A postal survey was distributed to the members of the American Society of Colon and Rectal Surgeons. Results: A total of 1195 members were surveyed. All respondents indicated that they advocate screening. Colonoscopy every 10 years and annual fecal occult blood testing were the most common strategies advocated to individuals with baseline risk. Colonoscopy every 5 years and annual fecal occult blood testing were the most common strategies advocated to patients with a first-degree relative with polyps or cancer. Most of these colorectal surgeons initiated their screening before 50 years of age. Conclusion: Colorectal cancer screening compliance is high among members of the American Society of Colon and Rectal Surgeons. These rates may be the result of awareness of the risks of colorectal cancer.
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Affiliation(s)
- Patrick Colquhoun
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston and Naples, Florida 3331, USA
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Atreja A, Patel SS, Boules M, Putka B, Rizk M. Automated recall system for colonoscopy: a generalizable informatics solution for procedures requiring timely follow-up. Gastrointest Endosc 2014; 80:684-688. [PMID: 24818546 DOI: 10.1016/j.gie.2014.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/14/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Ashish Atreja
- Division of Gastroenterology, Department of Medicine, Mount Sinai Medical Center, New York, New York, USA
| | - Samarth S Patel
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York, USA
| | - Mena Boules
- Department of Gastroenterology & Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Putka
- Department of Gastroenterology & Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maged Rizk
- Department of Gastroenterology & Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD. SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 2012; 27:1-10. [PMID: 23239291 DOI: 10.1007/s00464-012-2592-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Marc Zerey
- Department of Surgery, Sansum Clinic, Santa Barbara, CA, USA.
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Lai HC, Lin HC. Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study. Liver Int 2010; 30:1387-93. [PMID: 20731775 DOI: 10.1111/j.1478-3231.2010.02327.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS No large-scale population-based study has ever been conducted to examine the relationship between cryptogenic pyogenic liver abscesses (PLA) and the subsequent risk of colorectal cancer. This study aimed to estimate the risk for colorectal cancer following a diagnosis of cryptogenic PLA over a 5-year period. METHODS The study group comprised 274 patients who visited an outpatient care centre or were hospitalized with a diagnosis of cryptogenic PLA between 2001 and 2003. The comparison group included 1370 randomly selected subjects. Cox proportional hazard regressions were performed to compare the 5-year colorectal cancer-free survival rates for these two groups. RESULTS Of the total sample, 40 patients from the study group (2.43%) had colorectal cancer during the 5-year follow-up period: 15 (5.45% of those with cryptogenic PLA) and 25 from the comparison group (1.82% of the comparison group). After adjusting for patients' age, sex, monthly income, level of urbanization and geographical location, the hazard of colorectal cancer during the 5-year period was 3.36 times greater for patients with cryptogenic PLA than for the comparison group [95% confidence interval (CI)=1.72-6.56, P<0.001]. The adjusted hazard of colorectal cancer during the 5-year follow-up period was 5.54 times higher for cryptogetic PLA patients with diabetes (95% CI=2.11-14.56, P<0.001) than the comparison group and 2.64 times higher among PLA patients without diabetes (95% CI=1.19-5.85, P<0.05). CONCLUSIONS We conclude that cryptogenic PLA is an alarm that may signal colorectal cancer, especially among female patients with diabetes.
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Affiliation(s)
- Hsueh-Chou Lai
- Department of Internal Medicine, Division of Gastroenterology, China Medical University Hospital, Taichung, Taiwan
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Salz T, Weinberger M, Ayanian JZ, Brewer NT, Earle CC, Elston Lafata J, Fisher DA, Weiner BJ, Sandler RS. Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States. BMC Health Serv Res 2010; 10:256. [PMID: 20809966 PMCID: PMC2941495 DOI: 10.1186/1472-6963-10-256] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 09/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics. METHODS We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use. RESULTS Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively). CONCLUSIONS Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.
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Affiliation(s)
- Talya Salz
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E. 63rd St., New York, NY 10065, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101d McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411, USA
| | - John Z Ayanian
- Division of General Medicine, Brigham and Women's Hospital; Department of Health Care Policy, Harvard Medical School, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA
| | - Noel T Brewer
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina, 364 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA
| | - Craig C Earle
- Health Services Research Program, Cancer Care Ontario and the Ontario Institute for Cancer Research, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room G-106 Toronto ON, M4N 3M5, Canada
| | - Jennifer Elston Lafata
- Center for Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI 48202, USA
| | - Deborah A Fisher
- Durham VAMC, HSR&D Center of Excellence, Duke University Medical Center, Department of Medicine, 508 Fulton Street, Building #6, Durham NC 27705, USA
| | - Bryan J Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101d McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411, USA
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, CB# 7555, 4157 Bioinformatics Building, University of North Carolina, Chapel Hill, NC 27599-7555, USA
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Salz T, Brewer NT, Sandler RS, Weiner BJ, Martin CF, Weinberger M. Association of health beliefs and colonoscopy use among survivors of colorectal cancer. J Cancer Surviv 2009; 3:193-201. [PMID: 19760152 PMCID: PMC2809816 DOI: 10.1007/s11764-009-0095-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Clinical practice guidelines recommend ongoing testing (surveillance) for colorectal cancer survivors because they remain at risk for both local recurrences and second primary tumors. However, survivors often do not receive colorectal cancer surveillance. We used the Health Belief Model (HBM) to identify health beliefs that predict intentions to obtain routine colonoscopies among colorectal cancer survivors. METHODS We completed telephone interviews with 277 colorectal cancer survivors who were diagnosed 4 years earlier, between 2003 and 2005, in North Carolina. The interview measured health beliefs, past preventive behaviors, and intentions to have a routine colonoscopy in the next 5 years. RESULTS In bivariate analyses, most HBM constructs were associated with intentions. In multivariable analyses, greater perceived likelihood of colorectal cancer (OR = 2.00, 95% CI = 1.16-3.44) was associated with greater intention to have a colonoscopy. Survivors who already had a colonoscopy since diagnosis also had greater intentions of having a colonoscopy in the future (OR = 9.47, 95% CI = 2.08-43.16). CONCLUSIONS Perceived likelihood of colorectal cancer is an important target for further study and intervention to increase colorectal cancer surveillance among survivors. Other health beliefs were unrelated to intentions, suggesting that the health beliefs of colorectal cancer survivors and asymptomatic adults may differ due to the experience of cancer.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY, 10021, USA.
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Mack LA, Cook LS, Temple WJ, Carlson LE, Hilsden RJ, Paolucci EO. Colorectal cancer screening among first-degree relatives of colorectal cancer patients: benefits and barriers. Ann Surg Oncol 2009; 16:2092-100. [PMID: 19479307 DOI: 10.1245/s10434-009-0528-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/30/2009] [Accepted: 04/30/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals with a first-degree family history of colorectal cancer (CRC) are at increased risk of CRC. Study objectives were: (1) to estimate the proportion of first-degree relatives (FDR) of CRC patients being screened for CRC and (2) to identify predictors of screened behavior. METHODS A questionnaire was mailed to 640 stage I-III CRC patients from a population-based registry to identify FDR. A survey was sent to 747 FDR, aged 40 or older, to assess CRC screening, knowledge, demographics, access, benefits, and barriers of CRC screening. Factor analysis was used to detect underlying constructs. Predictors of screening were explored by multivariate analysis (MVA). RESULTS There was a 54% and 51% response for patients and FDR, respectively. Among FDR, 86% were born in Canada, 94% spoke English, 93.5% had a high school education, 73% were married, and 55% were employed. The age distribution was: 40-44 years (19.7%), 45-49 (19.1%), 50-54 (16%), 55-59 (15.2%), 60-64 (9.8%), and >65 (18%). Seventy percent had undergone CRC screening with 60% adherent to current guidelines. Of those screened, 33.7% had fecal occult blood testing, 19.4% had barium enema, 10.7% had sigmoidoscopy, and 58.7% had colonoscopy. Five constructs influencing CRC screening include: salience and coherence, perceived susceptibility, response efficacy, social influence, and cancer worries. MVA determined age >50 years as the most important predictor of screening. CONCLUSION In this survey, 70% of FDR of CRC patients had undergone screening; age was the most important predictor. Understanding underlying constructs influencing screening behavior may improve uptake of CRC screening in this population.
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Affiliation(s)
- Lloyd A Mack
- Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada.
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Courtier R, Casamitjana M, Macià F, Panadés A, Castells X, Gil MJ, Parés D, Sánchez-Ortega JM, Grande L. [Results of a study on populational colorectal cancer screening]. Cir Esp 2009; 85:152-7. [PMID: 19309603 DOI: 10.1016/j.ciresp.2008.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 10/06/2008] [Indexed: 01/22/2023]
Abstract
INTRODUCTION As colorectal cancer (CRC) screening based on occult blood detection has been shown to be effective in reducing mortality due to this disease, it is now important to decide on the best methods to obtain the maximum numbers of participants. The aim of the study was to analyse the results from a pilot CRC screening programme in a general population sample in Barcelona. A follow-up of false positive cases was made after five years. PATIENTS AND METHOD A cross section of the population aged 50-74 years in one primary health care centre was studied. The screening test consisted of an immunological method for the detection of faecal occult blood which was sent to the homes of the target population. RESULTS Participation was 46.6%, 11.7% of the tests were positive, and 79.3% agreed to have a colonoscopy. Eight adenocarcinomas and 32 patients with adenomas >0.4 cm were diagnosed. CONCLUSIONS The results obtained on the initial participation and the follow-up at five years suggest the viability of a CCR screening programme in our country.
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Affiliation(s)
- Ricardo Courtier
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Mar, Barcelona, Spain.
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Ng KH, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW. Charity Colonoscopy Event to Commemorate the 185th Anniversary of Singapore General Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v37n3p180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Colorectal cancer is now the cancer with the highest incidence in Singapore. However, the overall mortality rate is still about 50% because the majority of the patients present at a late stage of disease. A charity event of screening colonoscopy was offered to the public in conjunction with the 185th anniversary of Singapore General Hospital. The aim of this event was to raise awareness about early detection of colorectal cancer and the safety of colonoscopy.
Materials and Methods: We conducted a one-off free screening event for colorectal cancer using colonoscopy. Four hundred and ninety individuals responded to a multimedia advertisement for the event. Of these, 220 individuals were selected for the screening based on National Guidelines for colorectal cancer screening and financial status.
Results: One hundred and fifty-two individuals turned up for the colonoscopy. The median age was 55 years (range, 22 to 82), with 84 males. Significant pathology was found in 33% of the individuals (n = 51). Colorectal polyps were detected in 34 individuals (22%). A total of 45 polyps were removed, with 20 hyperplastic polyps and 25 adenomas. Eight out of 25 adenomas were located proximal to the splenic flexure. Rectal cancer was diagnosed in 1 individual (0.6%). One individual had a large dysplastic rectosigmoid ulcer and refused further intervention. There were no significant complications from any of the colonoscopies.
Conclusions: Colonoscopy is an invaluable screening modality as it has a high pick-up rate for colorectal polyp and cancer in an asymptomatic population. It is also proven to be safe in our study. It has the added advantage over flexible sigmoidoscopy of detecting a significant number of proximal lesions. Also, therapeutic polypectomy can be performed in the same setting.
Colorectal cancer is now the cancer with the highest incidence in Singapore. Similar to many developed countries, individuals here have a moderate to high risk of developing colorectal cancer in their lifetime.
Key words: Cancer screening, Colonoscopy, Colorectal cancer, Colorectal polyps, Polypectomy
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Young-Fadok TM, Fanelli RD, Price RR, Earle DB. Laparoscopic resection of curable colon and rectal cancer: an evidence-based review. Surg Endosc 2007; 21:1063-8. [PMID: 17484010 DOI: 10.1007/s00464-006-9172-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 10/16/2006] [Indexed: 01/20/2023]
Abstract
The initial enthusiastic application of laparoscopic techniques to colorectal surgical procedures was tempered in the early 1990s by reports of tumor implants in the laparoscopic incisions. Substantial evidence has accumulated, including evidence from randomized controlled trials, to support that laparoscopic resection results in oncologic outcomes similar to open resection, when performed by well-trained, experienced surgeons. This review was developed in conjunction with guidelines published by the Society of American Gastrointestinal and Endoscopic Surgeons. Data from the surgical literature concerning laparoscopic resection of curable colorectal cancer was evaluated regarding diagnostic evaluation, preoperative preparation, operative techniques, prevention of tumor implants, and training and experience. Recommendations are accompanied by an assessment of the level of supporting evidence available at the time of the development of the guidelines.
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Affiliation(s)
- T M Young-Fadok
- Division of Colon and Rectal Surgery, Mayo Clinic, Scottsdale, Arizona, United States.
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Siddiqui AA, Patel A, Huerta S. Determinants of compliance with colonoscopy in patients with adenomatous colon polyps in a veteran population. Aliment Pharmacol Ther 2006; 24:1623-30. [PMID: 17206950 DOI: 10.1111/j.1365-2036.2006.03176.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To determine factors affecting compliance of a follow-up colonoscopy in patients with previously diagnosed adenomatous colon polyps. METHODS A retrospective review was performed on patients with adenomatous polyps excised between January and December 1998. Twenty-nine clinical factors were assessed in patients grouped into whether they were compliant (n = 81) or noncompliant (n = 38) with follow-up colonoscopy. Significant variables by univariate analysis were included in multivariate regression. RESULTS One hundred and nineteen patients with adenomatous colon polyps were identified. Of 119 patients, 114 had a documented recommendation for follow-up of 5 years or less, with 69% having been compliant. In a univariate analysis, greater number of polyps (P = 0.04), NSAID use (P = 0.02), statin use (P = 0.005), first-degree relatives with colon cancer (P = 0.05) and compliance with out-patient clinic follow-up (P < 0.001) were significantly associated with patient compliance. Multivariate analysis revealed statin use (P = 0.05), first-degree relatives with colon cancer (P = 0.06) and compliance with out-patient clinic follow-up (P < 0.001) were independent predictors of compliance. CONCLUSIONS History of statin use and family history of colon cancer are good predictors of compliance. The strongest predictor can be anticipated with compliance assessed with encounters for other visits. Strong efforts should be directed at improving patient education about colon cancer by the physician and facilitating patient compliance.
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Affiliation(s)
- A A Siddiqui
- Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, TX 75216, USA.
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Lafata JE, Divine G, Moon C, Williams LK. Patient-physician colorectal cancer screening discussions and screening use. Am J Prev Med 2006; 31:202-9. [PMID: 16905030 PMCID: PMC4682196 DOI: 10.1016/j.amepre.2006.04.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/05/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about patient-physician colorectal cancer (CRC) screening discussions or how discussion content affects screening use. Analyses conducted in 2004-2005 of patient-physician CRC screening discussion content and its association with screening use are described. METHODS A mailed survey and retrospective claims data were used to compile information on insured, primary care patients aged 50 to 70 years (n = 4966). The survey collected information on patient-physician CRC screening discussion content (including the 5A's: assess, advise, agree, assist, and arrange). Survey responses were linked with 5-year retrospective claims data (ending December 31, 2003) on CRC screening use. Among patients reporting screening discussions, generalized estimating equation approaches were used to estimate the association of discussion content with screening use. RESULTS Among those reporting discussion information (n = 2463), 80% reported discussing CRC screening with their physician. The content of these discussions varied, and only 54% used CRC screening. Multivariable model results indicated that the likelihood of screening was greater among patients reporting help scheduling an appointment (assist) (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.95-3.72) and those reporting a discussion of results or follow-up (arrange) (OR = 1.63, 95% CI = 1.18-2.24), and lower among patients offered a choice among screening modalities (agree) (OR = 0.57, 95% CI = 0.37-0.86) as well as among those who wanted more screening information (OR = 0.65, 95% CI = 0.43-0.97). CONCLUSIONS Not all patient-physician CRC screening discussions result in CRC screening use. It is important to understand which aspects of shared decision making and discussion content are likely to increase informed and value-concordant decisions to participate in recommended evidence-based CRC screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Center for Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA.
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Ko C, Hyman NH. Practice parameter for the detection of colorectal neoplasms: an interim report (revised). Dis Colon Rectum 2006; 49:299-301. [PMID: 16421663 DOI: 10.1007/s10350-005-0289-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Clifford Ko
- Department of Surgery, Medical Center Hospital of Vermont, Fletcher 301, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, Vermont, 05401, USA
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Lafata JE, Williams LK, Ben-Menachem T, Moon C, Divine G. Colorectal carcinoma screening procedure use among primary care patients. Cancer 2005; 104:1356-61. [PMID: 16092119 DOI: 10.1002/cncr.21333] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite evidence-based recommendations for colorectal carcinoma screening, population-based surveys report low screening rates. To the authors' knowledge, the extent to which screening procedures are used by patients seen in primary care is not as clear. The authors estimated the annual and 5-year colorectal carcinoma screening procedure use among a cohort of primary care patients and evaluated the correlation between patient characteristics and the use of screening procedures. METHODS The authors identified a cohort of patients (n = 21,833 patients) ages 55-70 years who had a primary care visit in 2003 and who were enrolled in a health plan for the 5-year period ending December 31, 2003. Using automated data for the 5-year period ending December 31, 2003, information on patient sociodemographic characteristics, primary care and health maintenance examination (HME) visits, comorbid diagnoses, income, and screening receipt was compiled. The latter included barium enema, colonoscopy, fecal occult blood testing (FOBT), and flexible sigmoidoscopy use. RESULTS Approximately one-half of insured, primary care patients (54%) received recommended colorectal carcinoma screening procedures over the 5-year observation period. Among individuals who received screening, colonoscopy was used most frequently (39.9%), followed by flexible sigmoidoscopy testing alone (28.3%) or in combination with FOBT (4.3%). Annual screening rates increased by 3.1% between 1999 and 2003. Among individuals who did not receive recommended colorectal carcinoma screening, 64% had at least 3 HME visits, and 41% received at least 1 FOBT. Increasing HME visits and other primary care visit frequency, along with increasing age, income, male gender, and African-American race, were associated with screening receipt. CONCLUSIONS Significant opportunities exist to increase colorectal carcinoma screening among primary care patients.
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Affiliation(s)
- Jennifer Elston Lafata
- Center for Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA.
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19
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Keating NL, Landrum MB, Meara E, Ganz PA, Guadagnoli E. Do Increases in the Market Share of Managed Care Influence Quality of Cancer Care in the Fee-For-Service Sector? J Natl Cancer Inst 2005; 97:257-64. [PMID: 15713960 DOI: 10.1093/jnci/dji044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increases in the market share of managed care in an area are associated with decreases in expenditures in the fee-for-service sector (i.e., a spillover effect). Given concerns that these decreases in expenditures result from reductions in necessary care, we examined associations between increases in managed care market share and changes in the quality of care delivered to cancer patients in the fee-for-service sector. METHODS We studied a population-based sample of fee-for-service Medicare beneficiaries aged 66 years or older who were diagnosed with breast (N = 41,394) or colorectal (N = 48,027) cancer during 1993-1999. We used fixed effects regression analysis of SEER cancer registry and Medicare claims data to assess whether county-level increases in the market share of managed care over time were associated with the quality of cancer care. All statistical tests were two-sided. RESULTS Increases in the market share of managed care were not associated with most quality indicators, including receipt of surveillance mammography after diagnosis for patients with breast cancer (P = .83), receipt of radiation after breast-conserving surgery among women who underwent breast-conserving surgery (P = .16), receipt of adjuvant chemotherapy for patients with stage III colorectal cancer (P = .94), or surveillance colonoscopy after treatment for colorectal cancer (P = .39). Increases in the market share of managed care were associated with increased rates of surveillance carcinoembryonic antigen testing for colorectal cancer patients (P = .001). CONCLUSIONS Increases in managed care market share had limited or no effect on the quality of care for cancer patients. Concerns that increases in managed care would have large negative spillover effects on the quality of cancer care appear to be unfounded; however, the potential for managed care to stimulate improved quality throughout the medical care system have not yet been realized.
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Affiliation(s)
- Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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20
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Battat AC, Rouse RV, Dempsey L, Safadi BY, Wren SM. Institutional Commitment to Rectal Cancer Screening Results in Earlier-Stage Cancers on Diagnosis. Ann Surg Oncol 2004; 11:970-6. [PMID: 15525825 DOI: 10.1245/aso.2004.03.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Veterans Administration hospitals underwent an institutional directive in 1998 to meet a colorectal cancer screening (CRCS) standard. This intervention should result in an increase in the hospital's screening rate and percentage of early-stage rectal cancers diagnosed. METHODS A retrospective review, from 1991 to 2002, of our institution's pathology and cancer registry databases for rectal cancers. CRCS data were obtained from the Veterans Administration Prevention Disease Index. Cancer stage at diagnosis was compared before and after the directive and was compared with the National Cancer Data Base and the Surveillance, Epidemiology, and End Results data. RESULTS The rate of CRCS was 55% in 1998 and increased to 75% in 2003. During the 11 years studied, a total of 147 rectal cancers were diagnosed. After the Veterans Administration directive, there was a significant increase in stage 0 cancers (P < .02) and an overall migration to earlier-stage cancers. Our Veterans Administration hospital had a significantly greater percentage of stage 0 cancers both before (P < .007) and after the directive (P < .00) and had fewer stage 3 cancers after the directive (P < .03) compared with National Cancer Data Base data. Compared with Surveillance, Epidemiology, and End Results data, the Palo Alto Veterans Affairs Health Care System had more local disease (P < .03) and less regional disease (P < .006). CONCLUSIONS These data suggest that a monitored institutional directive may significantly increase early detection of rectal cancers. This should result in a greater survival rate and lower local recurrence rate, because survival is predicated on stage at presentation. This may serve as a model for other health-care systems.
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Affiliation(s)
- Anna C Battat
- Department of Surgery, Stanford University, G112 PAVAHCS, 3801 Miranda Avenue, Palo Alto, CA 94304, USA
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21
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Colquhoun P, Chen HC, Kim JI, Efron J, Weiss EG, Nogueras JJ, Vernava AM, Wexner SD. High compliance rates observed for follow up colonoscopy post polypectomy are achievable outside of clinical trials: efficacy of polypectomy is not reduced by low compliance for follow up. Colorectal Dis 2004; 6:158-61. [PMID: 15109378 DOI: 10.1111/j.1463-1318.2004.00585.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The National Polyp Study demonstrated that removal of adenomas with at least a three-year follow up reduced the incidence of colorectal cancer. However, compliance with follow up colonoscopy may affect the estimates of reduction in colorectal cancer incidence demonstrated by the National Polyp Study. While an 80% compliance rate for follow up colonoscopy was achieved during the National Polyp Study, the compliance rate for follow up colonoscopy is unknown in the general population. The aim of this study was to determine the compliance rate for follow up colonoscopy and factors which affect follow up. METHODS A retrospective medical record review to identify patients who had adenomatous polyps excised in 1997 was undertaken. Patients who had inflammatory bowel disease, a prior history of colorectal cancer, familial adenomatous polyposis syndrome, colonic surgery; incomplete polypectomy or incomplete colonoscopy, and those patients who died before planned follow up, were excluded from analysis. Follow up was performed by telephone survey. RESULTS Three hundred and thirty-three patients were identified (196 males; 147 females) with a mean age of 70 years. Three hundred and thirty-one (99%) of 333 had a documented recommendation for follow up of three years or less. Thirty-four percent (113 of 333) had previously undergone colonoscopy; 29% (98 of 333) had previously undergone polypectomy and 54% (180 of 333) were symptomatic at the time of the colonoscopy. Twenty-eight percent (40 of 141) had a family history of colorectal cancer. Pathology at polypectomy included a single polyp and polyps less than 10 mm in 68% and 88% of cases, respectively. Follow up was available in 211 of these cases, 179 (85%) of which had been compliant with follow up colonoscopy. In a univariate analysis, previous colonoscopy (P = 0.035), previous polyps (P = 0.043), asymptomatic status at time of colonoscopy (P = 0.021), polyp size (P = 0.008) and number of polyps (P = 0.010) were significantly associated with patients who were compliant with follow up colonoscopy. A multivariate logistics regression analysis revealed number of polyps (P = 0.036) and polyp size (P = 0.045) to be statistically significantly associated with compliance. CONCLUSION Compliance with follow up colonoscopy after polypectomy is greater than 80%, regardless of age, education, family history, prior colonoscopy, or prior polypectomy. Risk reduction published in the National Polyp Study may likely reflect what can be achieved through the general use of colonoscopy for surveillance.
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Affiliation(s)
- P Colquhoun
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston and Naples, Florida 33331, USA
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22
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Annie Yu HJ, Lin KM, Ota DM, Lynch HT. Hereditary nonpolyposis colorectal cancer: preventive management. Cancer Treat Rev 2003; 29:461-70. [PMID: 14585257 DOI: 10.1016/s0305-7372(03)00084-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common form of hereditary colorectal cancer. Inherited mutations in the mismatch repair genes associated with this syndrome have an approximate 80% lifetime risk of colorectal cancer. Since there are no premonitory signs of susceptibility to HNPCC, family history is the initial method for identifying those at increased risk. At risk individuals should undergo genetic counseling and testing. Although an algorithmic indication for genetic testing in at risk HNPCC patients is yet to be determined, many advocate initial screening for microsatellite instability (MSI) of the cancer specimen in individuals suspected of carrying HNPCC mutations. Those who test positive for MSI can then undergo further testing for mutations in the associated germline mismatch repair genes. Techniques for detecting these mutations currently include in vitro synthesized-protein assay, single-strand conformational polymorphism, and DNA sequencing. Given the aggressive nature of HNPCC adenomas, individuals who test positive for HNPCC mutations are recommended to undergo yearly colonoscopic surveillance starting at the age of 25. A reasonable alternative to lifetime colonoscopic surveillance for the prevention of colorectal cancer in these individuals is prophylactic colectomy. The prevention of colorectal cancer through pharmacological means is under investigation as another option in the management of HNPCC patients. Specifically, chemoprevention trials are currently ongoing to evaluate the efficacy of COX-2 inhibitors in the prevention of colorectal cancer in HNPCC and familial adenomatous polyposis patients.
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Affiliation(s)
- Hwei-Ju Annie Yu
- Department of Internal Medicine, Southern California Permanente Medical Center, Los Angeles, CA 90027, USA.
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23
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Colquhoun P, Newstead G, Weiss EG, Efron J, Nogueras JJ, Vernava AM, Wexner SD. Colorectal cancer screening: do they practice what they preach? ANZ J Surg 2003; 73:1028-31. [PMID: 14632898 DOI: 10.1046/j.1445-2197.2003.t01-12-.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Compliance for voluntary colorectal cancer (CRC) screening reported by the American Society of Colon and Rectal Surgeons (ASCRS) is>85%. This high rate is assumed to be the result of heightened awareness of CRC. The purpose of the present paper was to determine if observed participation rates in the USA are the result of increased awareness of CRC alone. METHODS Postal survey of Colorectal Surgical Society of Australia (CSSA). RESULTS A response rate of 65% (52\80) was observed. As in the ASCRS, the majority of members support screening (94%); but 4% (2\52) reported that they do not advocate CRC screening, which was lower than that observed in the ASCRS survey (P = 0.03). A total of 94% support screening of baseline risk (BLR) patients at age 50 or less. Support was similar for annual fecal occult blood testing (FOBT; CSSA 54% vs ASCRS 56%, P = NS) for patients with BLR, but much less support for colonoscopy every 10 years (CSq10) was observed (CSSA 31% vs ASCRS 68%, P < 0.01). Similar to the ASCRS, CS every 5 years (CSq5) was the most common strategy advocated to patients with a family history of polyps (CSSA 75% vs ASCRS 78%, P = NS) and cancer (CSSA 94% vs ASCRS 94%, P = NS), respectively. A total of 25% (13\52) of CSSA members report participating in CRC screening, compared to the 55% reported by the ASCRS (P < 0.01). As in the ASCRS, CSq5 (69%) was the most common form of screening undergone. None of the CSSA members were being screened with more than one test, compared to the 46% reported by the ASCRS (P < 0.01). Of those who had not been screened, 82%(31\38) reported that they do plan to undergo CRC screening compared to 99% reported by the ASCRS (P < 0.05). CONCLUSION Screening compliance is significantly higher in the ASCRS than in the CSSA. Awareness of CRC is not the only obstacle to improving screening compliance.
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Affiliation(s)
- Patrick Colquhoun
- Department of Colorectal Surgery, Cleveland Clinic Florida, Naples and Weston, Florida 33331, USA
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24
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Madlensky L, Esplen MJ, Gallinger S, McLaughlin JR, Goel V. Relatives of colorectal cancer patients: factors associated with screening behavior. Am J Prev Med 2003; 25:187-94. [PMID: 14507524 DOI: 10.1016/s0749-3797(03)00202-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The purpose of this study was to identify whether decisions regarding colorectal cancer (CRC) screening by relatives of CRC patients are influenced by social interactions with family members, friends, and physicians or by public awareness campaigns. METHODS Screened (n=236) and nonscreened (n=132) relatives of CRC patients were interviewed in 2001. A socioecologic model was used as the framework for the interview variables, which included interactions with relatives, medical professionals, and social groups, as well as perceived benefits and barriers to screening and perceived susceptibility. RESULTS Physician encouragement, fewer barriers to screening, strong CRC family history, encouragement from relatives, advice from a surgeon, and discussion of CRC screening with social groups were all associated with ever having been screened. Having been encouraged by a physician was the strongest correlate of screening behavior. Perceived susceptibility to CRC, advice from family members, and exposure to public awareness information were not associated with screening. CONCLUSIONS The socioecologic framework is a good explanatory model of CRC screening in increased-risk relatives, as variables from each level were associated with screening. These findings can guide interventions aimed at increasing screening uptake, particularly those involving physicians.
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Affiliation(s)
- Lisa Madlensky
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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25
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Drake AC, Campbell H, Porteous MEM, Dunlop MG. The contribution of DNA mismatch repair gene defects to the burden of gynecological cancer. Int J Gynecol Cancer 2003; 13:262-77. [PMID: 12801255 DOI: 10.1046/j.1525-1438.2003.13194.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A C Drake
- University of Edinburgh, Edinburgh, United Kingdom.
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26
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Nash JW, Niemann T, Marsh WL, Frankel WL. To step or not to step: an approach to clinically diagnosed polyps with no initial pathologic finding. Am J Clin Pathol 2002; 117:419-23. [PMID: 11888080 DOI: 10.1309/27nq-a1r2-dq41-20y7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We determined whether there were additional diagnostic findings in additional level sections performed on polyps with no pathologic diagnosis (NPD) or those in which only lymphoid aggregates (LAs) were seen initially and determined the level at which findings were identified. All colorectal biopsy specimens submitted with a clinical diagnosis of polyp during a 6-month period were included (N = 733). Initially, 3 level sections were cut for each polyp, and if a cause for the polyp was found, no additional levels were evaluated. If LAs or no cause for the polyp was found, 5 additional levels through each block were examined. Any diagnostic findings and the level at which they were identified were recorded. A discrete cause for the polyp was identified in routine levels in 574 cases (78.3%). Deeper levels were performed in 159: 23 for clarification of a suspected diagnosis, 38 for LAs, and 98 for NPD. Findings were identified in 31 (22.8%) of 136 stepped for LA or NPD with neoplastic findings in 13 (9.6%). Most diagnoses were identified in levels 4 or 5, but tubular adenomas were found in levels 7 and 8. These results support level sectioning specimens submitted as polyps with NPD or LAs on initial sections.
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Affiliation(s)
- Jason W Nash
- Department of Pathology, Ohio State University Hospitals, Columbus, USA
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27
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Colorectal Cancer Screening and Surveillance. COLORECTAL CANCER 2002. [DOI: 10.1007/978-3-642-56008-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Common Anorectal Conditions. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200112000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Lowry A. Commentary on ‘familial Adenomatous Polyposis, Hereditary Nonpolyposis Colon Cancer, and Familial Risk’ by Thorson and Faria. Surg Oncol Clin N Am 2000. [DOI: 10.1016/s1055-3207(18)30105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moore EM, Magrino TJ, Johnstone PA. Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Radiology 2000; 217:215-8. [PMID: 11012447 DOI: 10.1148/radiology.217.1.r00oc24215] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To analyze the frequency and clinical importance of proctitis and hematochezia after radiation therapy for prostate cancer. MATERIALS AND METHODS Of 63 patients with prostate cancer treated with curative intent by a single radiation oncologist between July 1, 1993, and December 31, 1997, 30 were asymptomatic, but 33 had heme-positive digital rectal examination (DRE) results or hematochezia at routine follow-up. Twenty-six of these patients underwent endoscopy of the sigmoid colon or colon for evaluation of these symptoms. Median doses of 60.0 Gy at postoperative radiation therapy and 68.4 Gy at definitive radiation therapy were delivered to four fields daily by using blocking customized on the basis of computed tomographically documented evidence of disease. The Fisher exact test and the Kaplan-Meier method were used to analyze the results. RESULTS The frequency of rectal bleeding approached 80% at 3 years after radiation therapy in definitively treated patients. Only 14 patients had proctitis: eight as the only sign, and six in association with other disease. Six patients had other disease without proctitis, and four patients had normal examination findings. The frequency of rectal bleeding in the presence of proctitis was similar to that in the presence of other disease (Fisher exact test, P =.68). CONCLUSION Hematochezia or positive DRE findings are frequent sequelae of definitive radiation therapy for prostate cancer; however, causes other than proctitis are often documented at endoscopy. Symptomatic individuals warrant rigorous evaluation to rule out serious coexistent disease.
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Affiliation(s)
- E M Moore
- General Surgery Department and the Clinical Investigation Department, Naval Medical Center San Diego, Suite 5, 34800 Bob Wilson Dr, San Diego CA 92134-1014, USA
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31
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Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colon Cancer, and Familial Risk. Surg Oncol Clin N Am 2000. [DOI: 10.1016/s1055-3207(18)30104-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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