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Parmigiani G. Benefits and Harms of Interception and Early Detection of Cancer. Hematol Oncol Clin North Am 2024; 38:731-741. [PMID: 38789374 DOI: 10.1016/j.hoc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Strategies for early detection and interception of cancer are based on 2 synergistic elements: proactive search for asymptomatic cancer, precancer, or cancer predisposition and proactive disruption of cancer evolution. Benefits and harms of both these elements will vary widely depending on the screened populations, the types of cancers targeted, the detection modalities, and the health care delivery approaches following diagnosis. This article attempts to identify common elements that can inform the evaluation of alternative strategies across many of these scenarios.
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Affiliation(s)
- Giovanni Parmigiani
- Department of Data Science, Dana Farber Cancer Institute; Department of Biostatistics, Harvard T.H. Chan School of Public Health.
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2
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Yebyo HG, van Wifferen F, Pluymen LPM, Leeflang MMG, Dekker E, Coupé VMH, Puhan MA, Greuter MJE, Stegeman I. Benefit-Harm Analysis for Informed Decision Making on Participating in Colorectal Cancer Screening: A Modeling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:397-404. [PMID: 38141815 DOI: 10.1016/j.jval.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To facilitate informed decision making on participating in colorectal cancer (CRC) screening, we assessed the benefit-harm balance of CRC screening for a wide range of subgroups over different time horizons. METHODS The study combined incidence proportions of benefits and harms of (not) participating in CRC screening estimated by the Adenoma and Serrated pathway to CAncer microsimulation model, a preference eliciting survey, and benefit-harm balance modeling combining all outcomes to determine the net health benefit of CRC screening over 10, 20, and 30 years. Probability of net health benefit was estimated for 210 different subgroups based on age, sex, previous participation in CRC screening, and lifestyle. RESULTS CRC screening was net beneficial in 183 of 210 subgroups over 30 years (median probability [MP] of 0.79, interquartile range [IQR] of 0.69-0.85) across subgroups. Net health benefit was greater for men (MP 0.82; IQR 0.69-0.89) than women (MP 0.76; IQR 0.67-0.83) and for those without history of participation in previous screenings (MP 0.84; IQR 0.80-0.89) compared with those with (MP 0.69; IQR 0.59-0.75). Net health benefit decreased with increasing age, from MP of 0.84 (IQR 0.80-0.86) at age 55 to 0.61 (IQR 0.56-0.71) at age 75. Shorter time horizons led to lower benefit, with MP of 0.70 (IQR 0.62-0.80) over 20 years and 0.54 (IQR 0.48-0.67) over 10 years. CONCLUSIONS Our benefit-harm analysis provides information about net health benefit of screening participation, based on important characteristics and preferences of individuals, which could assist screening invitees in making informed decisions on screening participation.
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Affiliation(s)
- Henock G Yebyo
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Zürich, Switzerland; Ldwig Maximilian University (LMU), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Public Health and Health Services Research, Munich, Germany
| | - Francine van Wifferen
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - Linda P M Pluymen
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Evelien Dekker
- Amsterdam UMC location University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Milo A Puhan
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Zürich, Switzerland
| | - Marjolein J E Greuter
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Inge Stegeman
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands; University Medical Centre Utrecht, Department of Otorhinolaryngology and Head & Neck Surgery, Utrecht, The Netherlands; University Medical Centre Utrecht, Brain Centre, Utrecht, The Netherlands
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Emara MH, Mazid U, Elshaer YA, Elkerdawy MA, Malik DF, Mahros AM. Trauma to the solid abdominal organs: The missed dark box of colonoscopy. World J Gastroenterol 2024; 30:624-630. [PMID: 38515946 PMCID: PMC10950622 DOI: 10.3748/wjg.v30.i7.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Usama Mazid
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Yasmine A Elshaer
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | | | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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4
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Lock JJ, Püschel K. Fatal outcomes of endoscopy: an analysis from the coroner's point of view. Endosc Int Open 2023; 11:E435-E439. [PMID: 37124712 PMCID: PMC10147508 DOI: 10.1055/a-2057-4174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 02/16/2023] [Indexed: 05/02/2023] Open
Abstract
Background and study aims This study was designed to provide a profound analysis of fatalities associated with endoscopic procedures. Methods Protocols of all autopsies performed within 20 years in a large Department of Forensic Medicine were retrospectively analyzed to identify all fatalities directly related to an endoscopic procedure. Data were further specified focusing on the type of endoscopy and the final cause of death. Results Of 22,615 autopsies performed between January 2000 and September 2019, 86 deaths were identified as complications of an endoscopic procedure. The average age of these 86 patients was 70.9 years (66.4 (range, 26-89) in males (n = 35) and 74.1 years (range, 22-94) in females (n = 51)). Endoscopic procedures included 29 endoscopic retrograde cholangeopancreatographies (ERCPs), 27 colonoscopies, 18 percutaneous endoscopic gastrostomy (PEG) tube placements, six gastroscopies, two upper endosopic ultrasonographies, and four transesophageal echocardiographies. ERCPs, colonoscopy and PEG procedures together accounted for 74 of 86 (86 %) endoscopy-related deaths. Focusing on the single procedures, post-ERCP pancreatitis (14/29, 48 %), colonoscopy-associated perforation (24/27, 89 %), and peritonitis after PEG placement (16/18, 88 %) were the most common causes of death. Conclusions Even in the thought-to-be-safe and screening endoscopic procedures fatalities do occur. This study gives an overview of endoscopy-related fatalities, stressing the role of ERCP, colonoscopy, and PEG.
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Affiliation(s)
- Julian J. Lock
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Department of Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany
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Burns RB, Mangione CM, Weinberg DS, Kanjee Z. How Would You Screen This Patient for Colorectal Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2022; 175:1452-1461. [PMID: 36215708 DOI: 10.7326/m22-1961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death for men and women in the United States, with an estimated 52 580 people expected to die in 2022. Most frequently, CRC is diagnosed among persons aged 65 to 74 years. However, among persons younger than 50 years, incidence rates have been increasing since the mid-1990s. In 2021, partially because of the rising incidence, the U.S. Preventive Services Task Force (USPSTF) recommended CRC screening for adults aged 45 to 49 years (Grade B recommendation). Options for CRC screening include stool-based and direct visualization tests. The USPSTF did not recommend a specific screening test; rather, its guidance was to select a test after a discussion with the patient. Here, a primary care physician and a gastroenterologist discuss the recommendation to begin CRC screening at age 45, review options for CRC screening, and discuss how to choose among the available options.
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Affiliation(s)
- Risa B Burns
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (R.B.B., Z.K.)
| | - Carol M Mangione
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California (C.M.M.)
| | | | - Zahir Kanjee
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (R.B.B., Z.K.)
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Kooyker AI, Lansdorp-Vogelaar I, Van Leerdam ME. Reply. Clin Gastroenterol Hepatol 2022; 20:1418-1419. [PMID: 34536582 DOI: 10.1016/j.cgh.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Arthur I Kooyker
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Monique E Van Leerdam
- Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
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Weiss JB, Cetel NS, Weiss DE. Attribution of Colonoscopy Risk Does Not FIT! Clin Gastroenterol Hepatol 2022; 20:1417-1418. [PMID: 34333151 DOI: 10.1016/j.cgh.2021.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph B Weiss
- Department of Medicine, University of California San Diego School of Medicine, San Diego, California
| | | | - Danielle E Weiss
- Department of Medicine, University of California San Diego School of Medicine, San Diego, California
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Lee HJ, Lee HH, Cheung DY, Kim JI, Park SH. [Factors Associated with the Clinical Outcomes of Iatrogenic Colonic Perforation]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:210-216. [PMID: 35610551 DOI: 10.4166/kjg.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
Background/Aims This study evaluated the incidence of iatrogenic colonic perforation (ICP) in a high-volume center and analyzed the clinical outcomes and associated factors. Methods As a retrospective study of the electronic medical records, the whole data of patients who underwent colonoscopy from June 2004 to May 2020 were reviewed. Results During 16 years, 69,458 procedures were performed, of which 60,288 were diagnostic and 9,170 were therapeutic. ICP occurred in 0.027% (16/60,288) for diagnostic colonoscopies and in 0.076% (7/9,170) for therapeutic purposes (p=0.015; hazard ratio 2.878; 95% CI, 1.184-6.997). Fifty-two percent (12 cases) were managed with endoscopic clip closure, and 43.5% (10 cases) required surgery. The reasons for the procedure and the procedure timing appeared to affect the treatment decision. Perforations during therapeutic colonoscopy were treated with surgery more often than those for diagnostic purposes (66.7% [4/6] vs. 37.5% [6/16], p=0.221). Regarding the timing of the procedure, ICP that occurred in the afternoon session was more likely treated surgically (56.3% [9/16] vs. 0/5, p=0.027). Mortality occurred in two patients (2/23, 8.7%). Both were aged (mean age 84.0±1.4 vs. 65.7±10.5, p<0.001) and lately recognized (mean elapsed time [hours], 43.8±52.5 vs. 1.5±3.0, p<0.001) than the surviving patients. Conclusions ICP occurs in less than 0.1% of cases. The events that occurred during the morning session were more likely managed endoscopically. Age over 80 years and a longer time before perforation recognition were associated with mortality.
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Affiliation(s)
- Hyun Jin Lee
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Han Hee Lee
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jin Il Kim
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Soo-Heon Park
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
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9
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Nass KJ, van der Schaar PJ, van der Vlugt M, Ledeboer M, van Esch AAJ, van der Beek S, Lacle MM, van Leerdam ME, Ouwendijk RJT, Spaander MCW, Wouters MWJM, Fockens P, Dekker E. Continuous monitoring of colonoscopy performance in the Netherlands: first results of a nationwide registry. Endoscopy 2022; 54:488-495. [PMID: 34293811 DOI: 10.1055/a-1556-5914] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for colonoscopy. This study aimed to assess the feasibility of linking two national registries (one for colonoscopy and one for adverse events of gastrointestinal endoscopies in the Netherlands), and to describe the results of colonoscopy quality per indication. METHODS This retrospective study was conducted with prospectively collected data of the Dutch Gastrointestinal Endoscopy Audit (DGEA) and the Dutch Registration of Complications in Endoscopy (DRCE). Data between 01-01-2016 and 01-01-2019 were analyzed. To calculate adverse event rates, data were linked at the level of endoscopy service. RESULTS During the 3-year study period, 266 981 colonoscopies were recorded in DGEA. Of all indications, cecal intubation rate was highest in fecal immunochemical test (FIT)-positive screening colonoscopies (97.1 %), followed by surveillance (93.2 %), diagnostic (90.7 %), and therapeutic colonoscopies (83.1 %). The highest rate of adequate bowel preparation was observed in FIT-positive screening colonoscopies (97.1 %). A total of 1540 colonoscopy-related adverse events occurred (0.58 % of all colonoscopies). Bleeding and perforation and rates were highest for therapeutic (1.56 % and 0.51 %, respectively) and FIT-positive screening (0.72 % and 0.06 %, respectively) colonoscopies. The colonoscopy-related mortality was 0.006 %. CONCLUSION This study describes the first results of the Dutch national colonoscopy registry, which was successfully linked to data from the national registry for adverse events of gastrointestinal endoscopies. In this large dataset, performance varied between indications. Our results emphasize the importance of defining benchmarks per indication in future guidelines.
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Affiliation(s)
- Karlijn J Nass
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Peter J van der Schaar
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michiel Ledeboer
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands
| | - Aura A J van Esch
- Department of Gastroenterology and Hepatology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Sander van der Beek
- Department of Internal Medicine, Rivierenland Hospital, Tiel, The Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob J T Ouwendijk
- Department of Gastroenterology and Hepatology, Admiraal de Ruyter Hospital, Goes/Vlissingen, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes. Am J Gastroenterol 2022; 117:381-393. [PMID: 35029161 DOI: 10.14309/ajg.0000000000001614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) and guaiac-based fecal occult blood (gFOBT) are associated with a substantial reduction in CRC incidence and mortality. We conducted a systematic review and comprehensive meta-analysis to evaluate colonoscopy-related adverse events in individuals with a positive FIT or gFOBT. METHODS A systematic and detailed search was run in January 2021, with the assistance of a medical librarian for studies reporting on colonoscopy-related adverse events as part of organized CRC screening programs. Meta-analysis was performed using the random-effects model, and the results were expressed for pooled proportions along with relevant 95% confidence intervals (CIs). RESULTS A total of 771,730 colonoscopies were performed in patients undergoing CRC screening using either gFOBT or FIT across 31 studies. The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42% (CI 0.20-0.64); I2 = 38.76%. In patients with abnormal gFOBT, the incidence was 0.2% (CI 0.1-0.3); I2 = 24.6%, and in patients with a positive FIT, it was 0.4% (CI 0.2-0.7); I2 = 48.89%. The overall pooled incidence of perforation, bleeding, and death was 0.13% (CI 0.09-0.21); I2 = 22.84%, 0.3% (CI 0.2-0.4); I2 = 35.58%, and 0.01% (CI 0.00-0.01); I2 = 33.21%, respectively. DISCUSSION Our analysis shows that in colonoscopies performed after abnormal stool-based testing, the overall risk of severe adverse events, perforation, bleeding, and death is minimal.
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Spychalski P, Błażyńska-Spychalska A, Kobiela J. Mortality Rates of Colorectal Cancer Screening Programs: Differing Methodologies, Complimentary Results. Clin Gastroenterol Hepatol 2021; 19:2454-2455. [PMID: 33220522 DOI: 10.1016/j.cgh.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Piotr Spychalski
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Jarek Kobiela
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
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12
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Ribbing Wilén H, Saraste D, Blom J. Gender-specific cut-off levels in colorectal cancer screening with fecal immunochemical test: A population-based study of colonoscopy findings and costs. J Med Screen 2021; 28:439-447. [PMID: 34106777 DOI: 10.1177/09691413211020035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In the population-based Swedish regional colorectal cancer (CRC) screening program of Stockholm-Gotland using the fecal immunochemical test (FIT), gender-specific cut-off levels of fecal hemoglobin are applied, since previous studies have indicated a lower sensitivity of FIT for CRC in women. The aim was to evaluate the diagnostic yield and the screening costs overall and per detected CRC of this strategy. METHODS All individuals aged 60-69 invited to screening in 2015-2017 were included. Cut-off level for positive FIT was 40 µg/g in women and 80 µg/g in men. Those with a positive FIT were referred to colonoscopy. The yield of CRC and screening cost for the study period were assessed and compared to cut-off levels of 80 µg/g in both genders. RESULTS Approximately 230,000 individuals were invited. Overall participation rates were 72% in women and 65% in men (p < 0.05). FIT was positive in 4256 individuals (2.7% in both genders). In 3758 colonoscopies, 258 (6.9%) CRCs were detected. The positive predictive value for CRC was significantly higher in men (8.3% vs. 5.8%). In 120 women with CRC, 28 (23%) had FIT < 80 µg/g. Negative colonoscopies were more common in women (24% vs. 17%, p < 0.05). Total costs for the study period were 52,000,000SEK (≈5,200,000€), i.e. 16% higher compared to using cut-off levels of 80 µg/g in both genders, and corresponding to a 3% increment in cost per detected CRC. CONCLUSION The high rate of CRC detected in women in the lowest FIT category outweighs the minor reduction in screening costs if the same cut-off level was used as for men.
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Affiliation(s)
- Hanna Ribbing Wilén
- Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm.,Trauma & Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Deborah Saraste
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Johannes Blom
- Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institutet, Stockholm
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