Screening for Colorectal Cancer

Effect of gastrointestinal endoscopy center care on the psychological state and pain level of colorectal cancer patients

BACKGROUND

Colorectal cancer (CRC) has become the third leading cancer with the third highest occurrence rate and the second highest death ratio globally. Its incidence and mortality rates have been increasing annually in recent years, posing a serious threat to global public health. Digestive endoscopy technology can not only be used for the diagnosis of CRC, but it can also be used in determining the depth of infiltration in early CRC. There are significant deficiencies in care measures in this area.

AIM

To investigate the effect of digestive endoscopy center nursing on the psychological state and pain level of CRC patients.

METHODS

A total of 120 CRC patients were randomly and equally divided into a control group and an observation group. The patients in the control group received basic routine nursing care, and the patients in the observation group received systematic digestive endoscopy center nursing care. The patients' compliance and nursing satisfaction were observed and recorded, as well as the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Visual Analogue Scale (VAS) scores.

RESULTS

After care, the SAS and SDS scale scores of patients in both groups significantly decreased compared to before care (P < 0.05). The VAS scale scores significantly increased for each group compared to before examination (P < 0.05). The SAS, SDS and VAS scale scores of the observation group were significantly lower than those of the control group after nursing care (P < 0.05), and compliance and satisfaction of nursing care were significantly higher than those of the control group (P < 0.05).

CONCLUSION

Digestive endoscopy center nursing can effectively intervene in and improve the psychological state and pain level of CRC patients, suggesting it is a valuable approach to adopt in the clinic.

The role of Adiponectin and Leptin in Colorectal Cancer and Adenoma: a systematic review and meta-analysis

BACKGROUND

Colorectal cancer ranks as the third most frequently diagnosed cancer globally. Adipokines, including adiponectin and leptin, are believed to play a vital role in the development and progression of tumors. This study aimed to clarify the association between circulating adiponectin and leptin concentrations and the risk of colorectal cancer and adenoma.

METHODS

A detailed literature review was conducted in different databases, including Google Scholar, Web of Science, Scopus, and PubMed. Articles measuring serum concentrations of adiponectin and leptin in colorectal adenoma or cancer patients were analyzed. Pooled odds ratios (ORs) and their related 95% confidence intervals (CIs) were estimated through a random-effects meta-analysis.

RESULTS

In total, 30 articles were analyzed. According to the meta-analysis, higher adiponectin concentrations were inversely linked to a reduced CRC risk (OR: 0.85, 95% CI: 0.74-0.96), particularly in men. However, no notable connection was detected between higher leptin concentrations and risk of CRC (OR: 1.12, 95% CI: 0.96-1.31). In subgroup analyses, BMI adjustment reinforced the negative association between higher adiponectin levels and risk of CRC, while insulin adjustment yielded non-significant results. Additionally, higher leptin levels revealed a meaningful relationship with colorectal adenoma risk (OR: 1.39, 95% CI: 1.06-1.84), whereas higher levels of adiponectin were not significantly linked to adenoma (OR: 0.79, 95% CI: 0.46-1.36).

CONCLUSION

According to this meta-analysis, elevated adiponectin concentrations may play a protective role against CRC, while leptin could potentially contribute to an elevated colorectal adenoma risk. Further studies are required to explore the potential mechanisms underlying adipokine-mediated colorectal carcinogenesis.

Real-world repeat screening adherence to multi-target stool DNA for colorectal cancer in a large, national Spanish-speaking population

INTRODUCTION

Limited English proficiency may hinder completion of colorectal cancer (CRC) screening in Spanish speakers. This study evaluated CRC re-screening adherence using the multi-target stool DNA (mt-sDNA) test with Spanish language navigation, and patient characteristics associated with re-screening adherence.

METHODS

Data from Exact Sciences Laboratories, LLC, (01/01/2023-12/31/2023) were used. Patients (45-75 years) with insurance who indicated Spanish as their preferred language and were shipped an mt-sDNA test during the study period and had completed mt-sDNA screening with a negative result ≥2.5 years prior were included. Re-screening adherence and mean time to test return were compared among payer types; regression models were used to determine the relationship between these outcomes and patient characteristics.

RESULTS

Among 8,651 patients (45-64 years: 58.9%; female: 59.0%), partial digital with SMS only (46.3%) was the most frequent outreach type. Re-screening adherence was 80.4%, with numerically highest rates in patients insured through managed care organizations (83.7%). Mean (standard deviation) overall time to test return from shipment of mt-sDNA kit to receipt of valid test was 26.6 (38.2) days (range across payer types: 26.1 [38.9]-29.8 [41.5]). Medicare patients had a 42% higher likelihood of adherence than commercially insured patients (p = 0.004); patients who received SMS and email had a 59% higher likelihood of adherence than patients with no digital outreach (p < 0.001).

CONCLUSION

Re-screening adherence of the mt-sDNA tests with Spanish language navigation was high, at 80.4%, across all payer types in patients selecting Spanish as their preferred language.

Changes of peripheral blood lymphocytes, neutrophils, CEA, TAP and ferritin in colorectal adenoma and colorectal cancer and the diagnostic performance of these makers in evaluating colorectal cancer

BACKGROUND AND STUDY AIMS

Colorectal cancer (CRC) has been recognized as a multifactorial disease arising from precursor lesions and characterized by chronic inflammation. Therefore, the inflammatory response is one of the critical indicators for the diagnosis of CRC. Timely and effective screening is an effective strategy to reduce the incidence and mortality of CRC. The primary aim of this study was to analyze the differences in white blood cell count (WBC) in patients with colorectal adenoma (CRA) and CRC. The second aim was to estimate the diagnostic performance of using a panel of serum tumor markers and WBC for CRC screen.

PATIENTS AND METHODS

We retrospectively reviewed a database of patients who were diagnosed with CRA and CRC. Serum tumor markers and blood routine examination data were completed before receiving any anticancer therapy.

RESULTS

A total of 538 participants were enrolled, including 169 health participants, 195 patients with CRA and 174 patients with CRC. Lymphocyte counts were lower in CRC than CRA and healthy participants. Neutrophil counts were higher in CRC and CRA than healthy participants. The CEA levels were higher in CRA and CRC than healthy participants, and higher in CRC than CRA. The areas of tumor TAP were larger in CRC than CRA and healthy participants. The ferritin levels were lower in CRC than CRA and healthy participants. The 8-marker panel yielded an AUC of 0.854 higher than single marker. There is no difference in the diagnostic performance of TAP, CEA, ferritin and NLR.

CONCLUSIONS

There are a lot of high sensitivity and specificity methods for CRC screening. However, most screening programs suffer from poor participation rates. Herein, our 8-marker panel is cost-effective and high-performance screen system for the detection of CRC and is crucial for enhancing the participation rates in current screening programs.

Impact of Digital Navigation on Screening Adherence With the Multi-Target Stool DNA Test

Background: Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer-related deaths in the United States. Screening can prevent CRC by detecting advanced precancerous lesions. Adherence to screening is crucial in reducing CRC disease burden; however, there is limited research on the impact of digital outreach screening uptake and adherence. Objective: This study evaluated the impact of different digital outreach channels on patient adherence to CRC screening with a multi-target stool DNA (mt-sDNA) test in a real-world setting. Methods: Patients were individuals aged 45 to 85 years with a valid mt-sDNA test order from Exact Sciences Laboratories, LLC (Jan. 1, 2023-Sept. 23, 2023). All patients received letters and phone calls; some received short message service (SMS), email, or both. Adherence and time to test return were compared across digital outreach categories stratified by patient characteristics. Multivariable regression evaluated the association of digital outreach methods with adherence and time to test return. Results: Among 2 425 308 patients (43.5% between 50 and 64 years, 58.2% female), digital SMS only (62.7%) was the most common outreach method. Overall adherence was 70.1%, with highest adherence in the digital SMS-plus-email group (72.9%). Mean time to test return from shipment of mt-sDNA kit to receipt of valid test was 25.8 days. In adjusted analyses, patients receiving digital SMS plus email had the highest odds of test return (odds ratio, 1.75; 95% confidence interval [CI], 1.73-1.78; P<.001) and had return times 8.7% shorter than the no-digital-outreach group (95% CI, 8.2-9.2; P<.001). Discussion: Among nationally insured individuals within the recommended age range for CRC screening, overall adherence to the mt-sDNA test was in the 70s, with the highest rates in the digital (SMS and email) outreach group and the lowest in the no-digital-outreach group. Conclusions: These findings highlight the importance of multichannel navigation in facilitating completion of CRC screening with the mt-sDNA test.

Poor prognosis in stage III colorectal cancer with apical lymph node metastasis: a single-center retrospective study

The impact of apical lymph node (ALN) status on the prognosis of colorectal cancer (CRC) remains controversial, and ALN status is not included in the current Tumor Node Metastasis (TNM) staging system. This study aimed to evaluate the effect of ALN status on recurrence and survival rates. In this retrospective study, 117 stage 3 CRC patients aged over 18 who underwent surgery between 2015 and 2024 and had their ALN status determined were evaluated. Patients with metastatic disease at diagnosis, those with undetermined ALN status, and those with concurrent malignancies were excluded. Patients were analyzed based on demographic, clinical, pathological, and survival data. The median age was 61 years (range: 33–83), and 60.7% of the patients were male. The pN stage was significantly more advanced (p < 0.001) and the number of metastatic lymph nodes was significantly higher (p = 0.003) in the ALN ( +) group. During a median follow-up of 46 months, 14 local recurrences, 31 systemic recurrences, and 27 cancer-related deaths were observed. Local recurrence, systemic recurrence, and cancer-related deaths were significantly more frequent in the ALN ( +) group (p = 0.027, p < 0.001, and p < 0.001, respectively). Locoregional disease-free survival, systemic disease-free survival and overall survival were significantly shorter in the ALN ( +) group (p = 0.011, p < 0.001, and p < 0.001, respectively). In multivariate analysis, SDFS and OS were found to be significantly shorter in the ALN ( +) and pN2 groups. ALN metastasis can be considered as an additional adverse prognostic factor in CRC beyond the pN stage.

Validation of multiple deep learning models for colorectal tumor differentiation with endoscopic ultrasound images: a dual-center study

Background

Colorectal cancer (CRC) is one of the most common malignancies worldwide. Differentiating adenomas and cancers in colorectal lesions is essential for reducing morbidity and mortality associated with CRC. Endoscopic ultrasound (EUS) is crucial in the diagnosis of CRC, and artificial intelligence (AI) offers a promising approach for identifying colorectal lesions without the need for histopathological confirmation. The objective of this study was to validate the efficacy of EUS combined with AI for the diagnosis of colorectal adenoma and cancer and to compare it with that of conventional endoscopic diagnosis.

Methods

This retrospective study included 554 patients (167 with CRC, 136 with adenomas, and 251 controls) from two independent centers. The dataset was randomly divided into training and test sets in a 2:1 ratio (360 for the training dataset; 194 for the testing dataset). A model was developed using a "feature extractor + multilayer perceptron (MLP) classifier" framework, incorporating Residual Network 50 (ResNet50), EfficientNet-B0, Visual Geometry Group 11_BN (VGG_11_BN), and Vision Transformer (ViT) as feature extractors. Four AI systems were trained and validated, and the model with the highest F1 scores was subsequently compared to four endoscopists using the test dataset, and interobserver agreement measured by Fleiss' kappa.

Results

The accuracies for three-category classification (CRC, adenoma and controls) were 70.62% for ResNet50, 68.56% for EfficientNet-B0, 63.4% for ViT, and 70.10% for VGG_11_BN. ResNet50 achieved the highest F1 scores (70.37%) and diagnostic accuracy and was selected for comparison with endoscopists. For CRC diagnosis, ResNet50 outperformed endoscopists with an accuracy of 80.93%, sensitivity of 72.88%, and specificity of 84.44%, which were significantly higher than those of all endoscopists (P<0.05). For adenoma diagnosis, ResNet50 had a sensitivity of 47.92%, which was significantly higher than that of nonexpert endoscopists (P<0.05). The interobserver agreement was fair among AI systems (Fleiss' κ =0.674) and among experts (Fleiss' κ =0.557) and was slight among nonexperts (Fleiss' κ =0.284).

Conclusions

EUS-AI has high diagnostic accuracy for CRC and adenoma as compared to non-expert endoscopists. ResNet50 is a promising tool for enhancing diagnostic accuracy in clinical practice using EUS.

Optimizing prediction of metastasis among colorectal cancer patients using machine learning technology

BACKGROUND AND AIM

Colorectal cancer is among the most prevalent and deadliest cancers. Early prediction of metastasis in patients with colorectal cancer is crucial in preventing it from the advanced stages and enhancing the prognosis among these patients. So far, previous studies have been conducted to predict metastasis in colorectal cancer patients using clinical data. The current research attempts to leverage a combination of demographic, lifestyle, nutritional, and clinical factors, such as diagnostic and therapeutical factors, to construct an ML model with more predictive insights and generalizability than previous ones.

MATERIALS AND METHODS

In this retrospective study, we used 1156 CRC patients referred to the Masoud internal clinic in Tehran City from January 2017 to December 2023. The chosen machine learning algorithms, including LightGBM, XG-Boost, random forest, artificial neural network, support vector machine, decision tree, K-Nearest Neighbor and logistic regression, were utilized to establish prediction models for predicting metastasis among colorectal cancer patients. We also assessed features based on the best-performing model to improve clinical usability. To show the generalizability of the established prediction model for predicting CRC metastasis, we leveraged the data of 115 CRC patients from Imam Khomeini Hospital in Sari City. We assessed the predictive ability of LightGBM as the best-performing model based on external data.

RESULTS

The LightGBM model with a PPV of 97.32%, NPV of 84.67%, sensitivity of 83.14%, specificity of 93.14%, accuracy of 88.14%, F1-score of 87.51%, and an AU-ROC of 0.9 [Formula: see text]0.01 obtained satisfactory performance for prediction purposes on this topic. Factors including the history of IBD, family history of CRC, number of lymph nodes involved, fruit intake, and tumor size were considered as more strengthful predictors for metastasis in colorectal cancer and clinical usability. The external validation cohort showed a PPV of 0.8, NPV of 0.85, sensitivity of 0.78, specificity of 0.86, accuracy of 0.834, F1-score of 0.795, and AU-ROC of 0.77[Formula: see text]0.03, demonstrating satisfactory generalizability when leveraging external data from other clinical settings.

CONCLUSION

The current empirical results indicated that LighGBM has predictive competency that can be leveraged by physicians in clinical environments for early prediction of metastasis and enhanced prognosis in patients with colorectal cancer.

CLINICAL TRIAL NUMBER

Not applicable.

Pt(IV) Complexes as Anticancer Drugs and Their Relationship with Oxidative Stress

Despite continuous research, cancer is still a leading cause of death worldwide; therefore, new methods of cancer management improvement are emerging. It is well known that in the pathophysiology of cancer, oxidative stress (OS) is a significant factor. Nevertheless, there is currently no quick or easy way to identify OS in cancer patients using blood tests. Currently, in cancer treatments, Pt(IV) complexes are preferred to Pt(II) complexes in terms of adverse effects, drug resistance, and administration methods. Intracellular reductants convert Pt(IV) complexes to their Pt(II) analogs, which are Pt compounds with anti-carcinogenic effects. Our aim was to find out if Pt(IV) complexes could be used to assess blood oxidative stress indicators and, consequently, monitor the development of cancer. In this review, we analyzed previous research using the PubMed and Google Scholar public databases to verify the potential use of Pt(IV) complexes in cancer management. We found that two main serum antioxidants, glutathione and ascorbic acid, which are easily measured using conventional methods, react favorably with Pt(IV) complexes. Our research results suggest Pt(IV) complexes as therapeutic anticancer drugs and potential diagnosis agents. However, further research must be conducted to verify this hypothesis.

Epidemiology of colorectal cancer: A review with special emphasis on India

Colorectal cancer (CRC) is a common malignancy and cause for death around the world. In India, it ranks as the fourth most incident cancer in both sexes, with 64,863 cases and 38,367 deaths in 2022. With such high mortality, CRC survival in India is way lesser than that of developed countries. While western countries are facing an overall decline in CRC incidence, various regions in India are seeing an increasing trend. Within India, urban regions have markedly higher incidence than rural. Risk factors include consumption of red and processed meat, fried and sugary food, smoking and alcohol, comorbidities such as obesity, diabetes and inflammatory bowel disease (IBD), family history of CRC, adenomas and genetic syndromes, radiation exposure, pesticides and asbestos. Consumption of nutrient-rich well-balanced diets abundant in vegetables, dairy products, whole grains, nuts and legumes combined with physical activity are protective against CRC. Besides these, metformin, aspirin and micronutrient supplements were inversely associated with the development of CRC. Since a considerable proportion of CRC burden is attributed to modifiable risk factors, execution of population level preventive strategies is essential to limit the growing burden of CRC. Identifying the necessity, in this review, we explore opportunities for primary prevention and for identifying high-risk populations of CRC to control its burden in the near future.

Value of brief hematological characteristics in differentiating carcinoembryonic-antigen-negative colorectal cancer from benign colorectal diseases

BACKGROUND

Colorectal cancer (CRC) remains one of the most common malignancies worldwide, with a significant subset of patients exhibiting absence of carcinoembryonic-antigen (CEA) expression. The lack of effective diagnostic method for CEA-negative CRC prevents its early treatment.

AIM

To identify potentially valuable biomarkers for identifying CEA-negative CRC, the hematological characteristics of patients with CEA-negative CRC was investigated.

METHODS

In this retrospective analysis, 74 patients were included who had been pathologically confirmed to have CEA-negative CRC, along with 79 individuals diagnosed with benign colorectal conditions. The utility of various biomarkers was evaluated using analysis of the receiver operating characteristic (ROC) curve.

RESULTS

Compared with patients with benign colorectal diseases, those with CEA-negative CRC had lower hemoglobin-to-red blood cell distribution width ratio (HRR) and lymphocyte-to-red blood cell distribution width ratio (LRR), and higher platelet-to-lymphocyte ratio (PLR) (P < 0.05). Correlation analysis showed that HRR was negatively correlated with T stage (r = -0.237), LRR was negatively correlated with T stage (r = -0.265) and distant metastasis (r = -0.321), and PLR was positively correlated with T stage (r = 0.251) (all P < 0.05). ROC analysis indicated that HRR outperformed LRR and PLR in identifying CEA-negative CRC. Combining HRR and PLR provided the highest area under the curve (area under the curve = 0.808; sensitivity = 82.43%; specificity = 68.35%) for distinguishing CEA-negative CRC from benign colorectal diseases.

CONCLUSION

HRR, LRR, and PLR alone or in combination could be used to distinguish CEA-negative CRC from benign colorectal diseases.

Re-screening adherence to multi-target stool DNA test for colorectal cancer: real-world study in a large national population

PURPOSE

Adherence to colorectal cancer (CRC) re-screening is essential to maximize screening effectiveness. This study assessed adherence to a multi-target stool DNA (mt-sDNA) test among previous users in the USA across different payer types.

METHODS

Data from Exact Sciences Laboratories LLC (01/01/2023-12/31/2023) were used. Insured patients (45-85 years) who were shipped an mt-sDNA test during the data coverage period and had previously completed mt-sDNA screening with a negative result ≥ 2.5 years prior were included. Mt-sDNA re-screening adherence rate and mean time to test return were compared across payer types, and their associations with patient characteristics were assessed using multivariable regression models.

RESULTS

Of 793,567 patients (50-75 years: 89.0%; female: 62.0%), the re-screening adherence rate was 84.0% (from 66.5% for Medicaid to 90.2% for Medicare); mean (standard deviation) time to test return was 20.7 (20.8) days (from 19.2 [19.7] for Medicare to 22.4 [22.2] for Medicaid). Characteristics associated with higher likelihood of re-screening adherence included older ages (odds ratio [OR] = 1.25 and 1.11 for 65-75 and 76-85 years, respectively, relative to 45-49 years), living in a ZIP code with higher median household income (OR = 1.80 for > $200,000 relative to < $50,000), full digital outreach (OR = 1.84 relative to no digital outreach), and ≥ 3rd rounds of screening (OR = 2.44 relative to 2nd round of screening).

CONCLUSION

Adherence to CRC re-screening with mt-sDNA test was high across payer types, with sustained adherence in later rounds of screening. Strategies to improve re-screening rates in subgroups associated with lower re-screening adherence are warranted.

Areca catechu L. Extract Inhibits Colorectal Cancer Tumor Growth by Modulating Cell Apoptosis and Autophagy

Colorectal cancer (CRC) is a common cancer globally, and chemotherapy often causes severe complications, necessitating effective drugs with minimal side effects. As Areca catechu L. extract (ACE) is a Traditional Chinese Medicine that contains numerous active compounds with anticancer effects, in this study, the Cell Counting Kit-8 (CCK-8) assay was used to determine ACE's effect on CRC cell lines, revealing that it significantly inhibits CoLo320DM and HCT116 cells. In vivo experiments with NU-Foxn1nu mice indicated that ACE inhibits tumor growth, while a flow cytometry assay revealed that higher ACE concentrations increased cell apoptosis and ROS levels. Next-generation sequencing (NGS) showed that ACE increases the fold changes in apoptosis, DNA damage, and autophagy-related genes while inhibiting the fold changes in cell proliferation and Wnt signaling pathway genes. We conducted Western blotting to confirm these findings. Overall, ACE demonstrates potential as a drug candidate by promoting apoptosis and autophagy, and significantly reducing cell viability and tumor growth, thus offering a new approach for effective colorectal cancer treatment with minimal side effects.

Disparities in Cancer Screening Among the Foreign-Born Population in the United States: A Narrative Review

Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, barriers, and interventions influencing cancer screening rates among foreign-born individuals in the U.S. Methods: A comprehensive review of studies was conducted to assess colorectal, cervical, and breast cancer screening disparities among immigrants. Factors examined include length of residence, race and ethnicity, income, education, citizenship, insurance, usual source of care, language, medical literacy, and cultural barriers. Furthermore, the effectiveness of educational interventions, patient navigators, and at-home testing in addressing these screening disparities was evaluated. Results: Immigrants have lower screening rates for colorectal, cervical, and breast cancer compared to U.S.-born individuals, with the largest disparities observed in colorectal cancer. Factors influencing these gaps include shorter duration of residence, Asian ethnicity, and lower income and education levels. Lack of health insurance and of a usual source of care are currently the most significant barriers to screening. Interventions such as education, patient navigation, and at-home testing have shown moderate success in improving screening rates, though data on their effectiveness remain limited. Conclusions: Addressing cancer screening disparities within the U.S. foreign-born population is essential, especially as the immigrant population continues to reach record numbers. Targeted interventions are needed to improve screening among immigrant groups with the lowest completion rates. Future research on these interventions should prioritize larger sample sizes, longitudinal studies, and the utility of new technologies such as artificial intelligence.

Intestinal microbiota as biomarkers for different colorectal lesions based on colorectal cancer screening participants in community

Introduction

The dysregulation of intestinal microbiota has been implicated in the pathogenesis of colorectal cancer (CRC). However, the utilization of intestinal microbiota for identify the lesions in different procedures in CRC screening populations remains limited.

Methods

A total of 529 high-risk individuals who underwent CRC screening were included, comprising 13 advanced adenomas (Aade), 5 CRC, 59 non-advanced adenomas (Nade), 129 colon polyps (Pol), 99 cases of colorectal inflammatory disease (Inf), and 224 normal controls (Nor). 16S rRNA gene sequencing was used to profile the intestinal microbiota communities. The Gut Microbiota Health Index (GMHI) and average variation degree (AVD) were employed to assess the health status of the different groups.

Results

Our findings revealed that the Nor group exhibited significantly higher GMHIs and the lowest AVD compared to the four Lesion groups. The model incorporating 13 bacterial genera demonstrated optimal efficacy in distinguishing CRC and Aade from Nor, with an area under the curve (AUC) of 0.81 and a 95% confidence interval (CI) of 0.72 to 0.89. Specifically, the 55 bacterial genera combination model exhibited superior performance in differentiating CRC from Nor (AUC 0.98; 95% CI, 0.96-1), the 25 bacterial genera combination showed superior performance in distinguishing Aade from Nor (AUC 0.95). Additionally, the 27 bacterial genera combination demonstrated superior efficacy in differentiating Nade from Nor (AUC 0.82). The 13 bacterial genera combination exhibited optimal performance in distinguishing Inf from Nor (AUC 0.71).

Discussion

Our study has identified specific microbial biomarkers that can differentiate between colorectal lesions and healthy individuals. The intestinal microbiota markers identified may serve as valuable tools in community-based CRC screening programs.

Risk factors, prevention and screening of colorectal cancer: A rising problem

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide. The leading risk factors for CRC include male gender, age over 50, family history, obesity, tobacco smoking, alcohol consumption, and unhealthy diet. CRC screening methods vary considerably between countries and depend on incidence, economic resources and healthcare structure. Important aspects of screening include adherence, which can vary significantly across ethnic and socioeconomic groups. Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colonoscopy or radiologic imaging techniques. Technological capabilities for CRC screening are rapidly evolving and include stool DNA test, liquid biopsy, virtual colonography, and the use of artificial intelligence. A CRC prevention strategy should be comprehensive and include active patient education along with targeted implementation of screening.

A simple and enzyme-free method for sensitive p53 analysis based on DNAzyme-mediated signal amplification

There is an urgent demand for a simple yet extremely accurate biosensor to analyze tumorigenesis. Herein, we present a novel fluorescent and enzyme-free approach for detecting p53 gene cascading proximity ligation-mediated catalytic hairpin assembly and DNAzyme-assisted signal reaction. When the target p53 gene is present, the interaction between p53 and L1 and L2 chains initiates catalytic hairpin assembly and subsequently exposes DNAzyme in the P3 probe. The exposed DNAzyme binds with the loop region of the P4 probe and generates a nicking site, resulting in the release of a significant amount of ATMND that is conjugated in the stem section of P4. This leads to an amplified fluorescence response, which serves as a fluorescence signal for the detection of the p53 gene. This method allows for the accurate and sensitive identification of the p53 gene, exhibiting a linear reaction range of 1 fM to 1 nM, with a limit of detection as low as 0.23 fM. Furthermore, this fluorescent method has been utilized for the examination of clinical samples with a favorable recovery rate. Crucially, this versatile platform may be expanded to analyze different targets by changing the corresponding recognition unit, showing great potential for point-of-care testing in tumorigenesis analysis.

Enhancing CRC Screening in a Predominantly Hispanic Community: Effectiveness of 1-Day vs. 3-Day Stool-Based Testing Kits

Colorectal cancer (CRC) is the leading cause of cancer-related mortality among U.S. Hispanics, with screening proven to decrease both incidence and mortality. Despite rising CRC screening rates in the U.S., Hispanic participation remains disproportionately low. Stool-based tests, particularly popular for reaching underserved populations, may enhance screening adherence. This study evaluates the performance of a 1-day versus a 3-day stool-based testing kit in improving screening completion rates and reducing the need for reminder calls in a Hispanic community along the U.S.-Mexico border. In our quasi-experimental observational study, participants aged 45-75 years who were uninsured or underinsured and overdue for CRC screening were recruited. They received colorectal cancer education and no-cost stool-based screening facilitated by promotoras. Participants were randomly assigned to receive a 1-day or 3-day Fecal Immunochemical Test (FIT) kit. The promotoras swapped FIT kit distribution roles midway through the study period to mitigate performance bias. Our analysis covered 6,660 FITs-3,067 using the 3-day kit and 3,593 with the 1-day kit. Results indicated a higher return rate for the 1-day FIT kit (61.3% vs. 58.7%, adjusted odds ratio [aOR] = 1.22, p < 0.001), fewer reminders needed (69.7% vs. 78.1%, aOR = 0.65, p < 0.001), and lower abnormal FIT results (5.3% vs. 8.1%, aOR = 0.61, p < 0.001). Conclusively, the 1-day FIT kit required fewer reminders and significantly improved return rates, suggesting it may be a more effective option for increasing CRC screening completion among hard-to-reach Hispanic populations.

Conditional knockout of the NSD2 gene in mouse intestinal epithelial cells inhibits colorectal cancer progression

BACKGROUND

Nuclear receptor-binding SET domain 2 (NSD2) is a histone methyltransferase, that catalyzes dimethylation of lysine 36 of histone 3 (H3K36me2) and is associated with active transcription of a series of genes. NSD2 is overexpressed in multiple types of solid human tumors and has been proven to be related to unfavorable prognosis in several types of tumors.

METHODS

We established a mouse model in which the NSD2 gene was conditionally knocked out in intestinal epithelial cells. We used azoxymethane and dextran sodium sulfate to chemically induce murine colorectal cancer. The development of colorectal tumors were investigated using post-necropsy quantification, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA).

RESULTS

Compared with wild-type (WT) control mice, NSD2fl/fl-Vil1-Cre mice exhibited significantly decreased tumor numbers, histopathological changes, and cytokine expression in colorectal tumors.

CONCLUSIONS

Conditional knockout of NSD2 in intestinal epithelial cells significantly inhibits colorectal cancer progression.

Early Detection and Quality Indicators: Assessing the Clinical Impact and Effectiveness of Lowering the Colorectal Cancer Screening Age

Objective With colorectal cancer (CRC) being a leading cause of cancer-related deaths globally, early detection through screening is critical for improving survival rates. Recent guidelines recommend lowering the initial screening age from 50 to 45 years based on increasing CRC incidence among younger adults. Methodology This retrospective study evaluates the impact of this adjustment on adenoma detection rates (ADR), a validated quality indicator of screening colonoscopies. We conducted a retrospective analysis of 2,792 patients who underwent colonoscopy screening at a major healthcare institution. Patients were categorized into three age groups: 45-49, 50-59, and 60-75 years. We compared ADR across these groups with a focus on evaluating the consistency of ADR in the newly included younger age group against established benchmarks. Result The ADRs for the 45-49 age group were 51.2% (105/205) in male patients and 38.5% (116/301) in female patients, closely mirroring those of the 50-59 age group at 51.08% (188/368) in male patients and 34.80% (133/382) in female patients, with no significant reduction in detection rates. Gender-specific analysis revealed higher ADR in male patients across all age groups. These findings were statistically significant when comparing procedure type with age group and gender (p < 0.05). Conclusion The study supports maintaining the already established ADR for the new age group of 45-49 as the ADR was comparable to those in the older groups. Similar polyp biopsy +/- removal rates in the 45-49-year-old age group (43.6%; 221/506) compared to the older age group (42.7%; 320/750) is also an indirect measure of the effectiveness of early screening for colon cancer.

Endoscopic Screening and Surveillance of Gastrointestinal Cancer

Gastrointestinal (GI) cancer is a major health concern, contributing significantly to mortality rates in many regions, including Europe. It affects millions of people worldwide and leads to hundreds of thousands of deaths each year. Early detection and treatment through endoscopic methods play a vital role, providing less invasive and more affordable options compared to traditional surgical procedures. Targeted screening is vital for conditions such as Barrett's esophagus (BE), esophageal adenocarcinoma (EAC), gastric cancer (GC), ampullary carcinoma (AC), and colorectal cancer (CRC), particularly in high-risk populations. Endoscopic surveillance significantly reduces cancer incidence and improves survival rates, highlighting the importance of continuous advancements and updated guidelines to enhance screening efficacy and patient outcomes.

Molecular Mechanisms and Clinical Aspects of Colitis-Associated Cancer in Ulcerative Colitis

Inflammatory bowel diseases have long been recognized as entities with a higher risk of colorectal cancer. An increasing amount of information has been published regarding ulcerative colitis-associated colorectal cancer and its unique mechanisms in recent decades, as ulcerative colitis constitutes a chronic process characterized by cycles of activity and remission of unpredictable durations and intensities; cumulative genomic alterations occur during active disease and mucosal healing, resulting in a special sequence of events different to the events associated with sporadic colorectal cancer. The recognition of the core differences between sporadic colorectal cancer and colitis-associated cancer is of great importance to understand and guide the directions in which new research could be performed, and how it could be applied to current clinical scenarios. A DSS/AOM murine model has allowed for a better understanding of the pathogenic mechanisms in colitis-associated cancer, as it is currently the closest model to this unique scenario. In this review, we provide a summary of the main molecular mechanisms and the clinical aspects of colitis-associated cancer in ulcerative colitis.

The role of ferroptosis in colorectal cancer and its potential synergy with immunotherapy

Colorectal cancer (CRC) is one of the most prevalent and deadly malignancies worldwide. Recently, ferroptosis, a novel form of regulated cell death characterized by iron dependency and lipid peroxidation, has garnered significant attention from researchers. The mechanisms underlying ferroptosis, including intracellular iron levels, lipid peroxidation, and antioxidant system regulation, offer new insights into cancer treatment strategies. This study aims to explore the emerging role of ferroptosis in the context of immunotherapy for CRC, highlighting its potential mechanisms and clinical applications. We employed a comprehensive review of current literature to elucidate the biological mechanisms of ferroptosis, its relationship with CRC, and the interplay between ferroptosis and immunotherapy. Ferroptosis reshapes the tumor microenvironment (TME) by regulating intracellular iron levels, lipid metabolism, and antioxidant systems, significantly enhancing the efficacy of immune checkpoint inhibitors (ICIs). Meanwhile, traditional Chinese medicine therapies promote antitumor immunity by modulating the TME and inducing ferroptosis. Additionally, advances in nanotechnology have facilitated precise therapy by enabling targeted delivery of ferroptosis inducers or immunomodulators, transforming "cold" tumors into "hot" tumors and further boosting ICI efficacy. This study comprehensively reviews the latest developments in ferroptosis, immunotherapy, traditional Chinese medicine, and nanotechnology in CRC, highlighting the importance of ferroptosis-related biomarkers and novel inducers for personalized treatment. In summary, ferroptosis offers a promising strategy to overcome CRC therapy resistance and enhance immunotherapy efficacy, warranting further investigation and translational application.

The Proapoptotic Effect of MB-653 Is Associated with the Modulation of Metastasis and Invasiveness-Related Signalling Pathways in Human Colorectal Cancer Cells

Colorectal cancer is one of the most common cancers worldwide and has a high mortality rate. In this study, we investigated the cytotoxic, proapoptotic, and anti-invasive effects of the synthetic indole phytoalexin MB-653. The antiproliferative effect was determined using an MTT assay, showing IC50 values of 5.8 ± 0.3 μmol/L for HCT116 cells and 6.1 ± 2.1 μmol/L for Caco2 cells. Flow cytometry and Western blot analysis were employed to investigate the molecular mechanisms underlying cytotoxicity, proapoptotic action, and anti-invasion effects. The proapoptotic activity was evidenced by the activation of caspases 3 and 7, mitochondrial dysfunction, and an increased number of apoptotic cells, confirmed by annexin V/PI and AO/PI staining. Additionally, MB-653 induces dose-dependent G2/M phase cell cycle arrest, the cause of which could be cyclin B1/CDC2 complex dysfunction and/or a decrease in α-tubulin protein expression. Another important observation was that MB-653 modulated several signalling pathways associated with various cellular activities, including survival, proliferation, tumour invasiveness, metastasis, and epithelial-mesenchymal transition (EMT). We further demonstrated its safety for topical and parenteral application. To sum up, our results indicate the real potential of MB-653 in treating colorectal cancer.

Colorectal Cancer: Risk Factors, Novel Approaches in Molecular Screening and Treatment

By 2040 the burden of colorectal cancer will increase to 3.2 million new cases per year and 1.6 million deaths per year. This highlights the importance of improving preventive measures and treatment strategies. This piece concisely overviews the latest therapeutic and diagnostic approaches for colorectal cancer. In 2019, factors such as low milk intake, smoking, insufficient calcium consumption, and alcohol use had a significant impact on colorectal cancer DALYs worldwide. A comprehensive search was conducted in December 2023 using keywords related to drugs, therapeutic agents, colorectal cancer, diagnostic methods, epidemiology, and novel therapeutic approaches in the PubMed and Scopus databases. Initially, 325 articles were identified based on titles, abstracts, and publication dates. After removing duplicates, 170 unique articles were included. Medications like Nimotuzumab, Cetuximab, and Panitumumab target the Epidermal Growth Factor Receptor (EGFR), which EGF activates. HER2, activated by ligands, is the focus of drugs like Trastuzumab and Pertuzumab. The PD-1/PD-L1 and CTLA-4 pathways, as the immune checkpoints, which involve T cells, are targeted by medications like Ipilimumab. Adoptive cell therapy, including CAR-T cell therapy, TCR modification, and enhancing T cell activity through tumor-infiltrating lymphocytes, is used to combat cancer cell growth. In medical advancements, adoptive cell transfer therapy (ACT) and exosomes in the tumor immune microenvironment (TME) are notable treatment methods that boost the immune system. HIF1A-AS1, CRNDE-h, NEAT1, ZFAS1, and GAS5, along with IGFBP-2, have demonstrated significant CRC diagnostic capacity. Compared to CRC patients with low HIF1A-AS1 expression, individuals with high expression levels were linked to a worse 5-year survival rate.

Fecal methylated syndecan-2 (SDC2) testing for early screening of colorectal cancerous and precancerous lesions: A real-world retrospective study in China

Background

Colorectal cancer (CRC) is a major public health concern and the second leading cause of cancer-related deaths worldwide. However, challenges remain in deploying effective screening strategies for early-stage CRC. This study aimed to evaluate the effectiveness of a fecal-based syndecan-2 (SDC2) methylation test for the detection of colorectal lesions and CRC.

Methods

We retrospectively collected data on participants who underwent fecal SDC2 methylation testing from January 1, 2019, to May 30, 2023. Patients with positive results were recommended to undergo colonoscopy. Performance indicators associated with certain clinical characteristics, including positive rate (PR), positive predictive value (PPV), and colonoscopy compliance rate (CCR), were subjected to statistical analysis.

Results

We analyzed data from 113,209 participants, of whom 11,841 (10.4% PR) had positive fecal SDC2 methylation test results. A total of 4315 participants with positive results adhered to the colonoscopy recommendations, and the CCR was 36.4%. Finally, 3169 colorectal lesions were detected, including 1134 polyps, 875 non-advanced adenomas (NAAs), 770 advanced adenomas (AAs), and 390 CRCs, with PPV values of 26.3% (1134/4315), 20.3% (875/4315), 17.8% (770/4315), and 9.0% (390/4315), respectively. Notably, the PPV for CRC increased significantly with age (χ 2 = 164.40, P < 0.0001). In addition, as the cycle threshold (CT) values increased, the PPVs of AAs and CRCs generally decreased, whereas those of NAAs and polyps significantly increased. Moreover, the clinical patient group had the highest incidence of late-stage CRC (stage II and higher), whereas asymptomatic populations from the staff physical examination group and rural town-based screening programs had the highest number of stage 0 and I CRCs detected (P = 0.0107).

Conclusions

This study indicates that fecal SDC2 methylation testing combined with colonoscopy may be an effective screening method for colorectal lesions and CRC.

Colon Cancer Rates Among Asian Americans: A 2017-2021 Epidemiological Analysis

Background: Colon cancer (CC) is a significant public health concern. With Asian Americans (AAs) representing a rapidly growing demographic in the United States, our study examined CC prevalence among AAs. Methods: The study merged the 2017-2021 Medical Expenditure Panel Survey and County Health Ranking. Our analysis calculated age-adjusted CC rates and examined its prevalence across states. Regression analyses were conducted to study county-level risk factors of CC. Results: The CC age-adjusted rate among AAs increased by five-fold, from 155 per 100,000 in 2017 to 753 per 100,000 in 2021. State-level disparities revealed the highest CC prevalence in Arkansas, Rhode Island, and New Hampshire. Not speaking other languages and having insurance were significantly associated with higher CC rates, suggesting barriers to preventions and greater use of screening (p < 0.05). County-level analysis identified lower CC prevalence in regions with a greater socioeconomic advantage (p < 0.05). Socioeconomic advantage seemed to facilitate higher screening rates, which then translated into higher CC rates. Conclusions: Our findings underscore the need for early preventions to address rising CC rates among AAs. Future research should also explore geographic factors to better understand the disparities in CC risk.

Molecular characteristics of advanced colorectal cancer and multi-hit PIK3CA mutations

INTRODUCTION

Approximately 20% of patients living with colorectal cancer (CRC) have activating mutations in their tumors in the PIK3CA oncogene. Two or more activating mutations (multi-hit) for the PIK3CA allele increase PI3K⍺ signaling compared to single-point mutations, resulting in exceptional response to PI3K⍺ inhibition. We aimed to identify the prevalence of PIK3CA multi-hit mutations in metastatic CRC to identify patients who may benefit from PI3K inhibitors.

METHODS

The Foundation Medicine database (Boston, MA, USA) was analyzed for patients with CRC who underwent genomic profiling on tumor DNA isolated during routine clinical care from 2013 to 2021. Molecular and clinical variables were abstracted for patients with PIK3CA mutations.

RESULTS

We identified 49 051 patients with CRC who underwent Foundation Medicine testing. 710/41154 (1.7%) patients had multi-hit PIK3CA mutations, of which 53% were male (n = 448) with a median age of 60. Microsatellite status was available for 697 patients with multi-hit PIK3CA and 17.6% (123/697) were microsatellite instability-high. Clinically relevant mutations in KRAS and BRAFV600E were seen in 459/710 (64.7%) and 65/710 (9.1%), respectively. The 4 most common PIK3CA variants were H1047R (9.8%), E545K (9.2%), E542K (9.0%), and R88Q (7.1%). The most common variant pair was E542K-E545K (4.7%).

CONCLUSIONS

Multi-hit mutations in PIK3CA are seen in 1.7% of advanced CRC, a meaningful prevalence given the high burden of CRC worldwide, and may represent a subset of patients that have enhanced sensitivity to PI3K inhibition. Future investigation regarding the clinical utility of PI3K inhibitors is warranted in multi-hit PIK3CA CRC.

Colorectal cancer in older adults after the USPSTF's 2008 updated screening recommendation

BACKGROUND

Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.

METHODS

We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65-74).

RESULTS

There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = -4.0, -2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = -13.9 cases/100,000 population; C.I. = -22.6, -5.1) and mortality rates (Est. = -5.6 deaths/100,000 population; C.I. = -10.1, -1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.

DISCUSSION

The USPSTF's 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

Evaluation of the Relationship Between Colorectal Cancer Incidence and Colonoscopy: The Importance of Early Diagnosis

Objective The present study evaluated the relationship between the incidence of colorectal cancer and colonoscopy in Santa Catarina from 2018 to 2022.

Methods Observational study of ecological type, which includes all confirmed cases of CRC in the state of Santa Catarina from 2018 to 2022, across health macro-regions. The data were obtained from SINAN, through TABNET/DATASUS. The variables gender, age group, race, type of care, average cost per hospitalization, days of stay, deaths, and mortality rates were evaluated.

Results In the period from 2018 to 2022, there were more than 28,000 cases of CRC in the state of Santa Catarina, with the Grande Oeste region being responsible for the highest incidence throughout the studied period. The main age group is between 70 and 79 years old; As for gender, most cases are predominantly male; about race, white ethnicity is predominant; the nature of service is, for the most part, elective; the average value per hospital stay is 2,355.41; total hospital stay days are 120,924; the number of deaths is 1553 and the mortality rate is (5.44/100.00). Regarding colonoscopy, the largest number of colonoscopies performed was in Grande Florianópolis.

Conclusion There is a high incidence of CRC cases in the state of Santa Catarina. Males and those aged 70 to 79 are the most affected by CRC in Santa Catarina. The Grande Oeste region has a higher incidence of cases compared with other health macro-regions.

miR-122/NEGR1 axis contributes colorectal cancer liver metastasis by PI3K/AKT pathway and macrophage modulation

Colorectal cancer (CRC) is a prevalent malignant tumor in the gastrointestinal tract, with around 50% of patients experiencing distant metastases, predominantly to the liver. Colorectal cancer liver metastasis (CRLM) is a leading cause of CRC-related death, and effective treatments remain limited. This study aims to identify new targets for predicting and treating CRLM. Bioinformatics analysis highlighted the miR-122/NEGR1 axis as crucial in CRLM. In vitro assays (Colony formation, Wound healing, Transwell) explored the impact of this axis on CRC cell proliferation, invasion, and migration. Dual-Luciferase Reporter Gene Assay and RNA-pulldown confirmed miR-122/NEGR1 interaction. In vivo, CRLM model mice were used to investigate the axis's effects on tumor metastasis and macrophage polarization. Immunofluorescence (IF), Quantitative Real-time PCR (qRT-PCR), Enzyme-linked Immunosorbent Assay (ELISA), and Western Blot (WB) analyzed macrophage polarization markers and cytokine/protein/RNA expression. Results showed increased miR-122 and decreased NEGR1 in liver metastases compared to primary tumors. The miR-122/NEGR1 axis enhanced CRC cell proliferation, migration, invasion, and affected the PI3K/AKT pathway. Furthermore, reduced NEGR1 promoted M2 macrophage polarization and accelerated liver metastasis in CRLM model mice. In conclusion, the miR-122/NEGR1 axis drives CRC progression and liver metastasis through the PI3K/AKT pathway and M2 macrophage polarization, representing a potential target for the therapy of CRLM.

Triglyceride-glucose index (TyG index) is associated with a higher risk of colorectal adenoma and multiple adenomas in asymptomatic subjects

HYPOTHESIS

The objective of this study is to evaluate the predictive ability of the TyG index for the presence of adenoma and multiple adenomas in an asymptomatic population.

DESIGN

A secondary analysis was conducted on a prospective cohort of asymptomatic subjects aged between 50 and 75 who underwent CRC screening. Fasting blood glucose (FBG) and lipid profiles were measured within three months prior colonoscopy. TyG index was estimated as ln [fasting triglycerides (mg/dL) × FBG (mg/dL)/2]. Multivariate logistic regression was performed to assess the association between the TyG index and the risk of adenoma. Its association with multiple adenomas (≥5) and the continuous number of adenomas were assessed by multinomial regression and log-normal linear regression, respectively.

RESULTS

A total of 1,538 subjects were recruited among which 876 subjects (57%) had at least one adenoma detected. Elevated TyG index was positively associated with the incidence of adenoma (adjusted odds ratio [aOR]: 1.26, 95% confidence interval [CI]: 1.04-1.54). Compared with the lowest TyG index (≤ 8) group, the risk of adenoma was the highest among subjects in the highest TyG index (> 10) group (aOR: 3.36, 95% CI: 1.44-7.73). As compared to the non-adenoma group, the TyG index was also positively associated with multiple adenomas (aOR: 1.74, 95% CI: 1.17-2.57), and the estimate was also the highest in the highest TyG group (aOR: 14.49, 95% CI: 3.12-67.20). As for the number of adenomas, the positive association was maintained (Estimates: 1.06, 95% CI: 1.01-1.12) while the number of adenomas increase the most in the highest TyG index group (Estimates: 1.35, 95% CI: 1.10-1.65).

CONCLUSIONS

Elevated TyG index is associated with an increased risk of colorectal adenoma and an increased number of adenomas for asymptomatic subjects aged ≥50.

TRIAL REGISTRATION

This study was registered on clinicaltrials.gov (NCT03597204 and NCT04034953).

miR-559 rs58450758 polymorphism is associated with colorectal cancer risk and prognosis in Chinese Han population

Aim: This research examined the correlation between miR-559 rs58450758 and the clinical pathological characteristics and prognosis of CRC.Materials & methods: RT-qPCR was utilized to assess the miR-559 expression levels. Chi-square test was used to investigate the relationship between miR-559 and clinical features. The association between rs58450758 different genotypes and CRC risk, as well as clinical pathological parameters, was explored, utilizing logistic regression analysis and chi-square tests. The Cox regression model and Kaplan-Meier analysis evaluated overall survival in individuals with CRC.Results: The miR-559 was down-regulated in CRC patients' serum. The expressions of miR-559 were significantly associated with tumor size, differentiation, TNM stage and lymph node metastasis. The rs58450758 TT genotype and T allele carriers were more prevalent among CRC patients. The rs58450758 polymorphism was notably linked to tumor size, differentiation, TNM stage and lymph node metastasis in CRC patients. Furthermore, CC genotype carriers exhibited a longer survival period than CT/TT genotypes within the CRC population.Conclusion: The miR-559 rs58450758 polymorphism exhibits promise as a potential biomarker for prognosticating the outcomes of CRC.

Effect of self-efficacy on self-management ability for colorectal cancer patients with stoma: a path analysis

PURPOSE

Colorectal cancer threatens health and causes heavy social burdens. The purpose of this study is to analyze the pathway model for the effect of self-efficacy on self-management ability in colorectal cancer patients with stoma.

METHODS

A cross-sectional study was conducted from December 2022 to April 2023, with a convenience sample of 422 colorectal cancer patients with stoma at six tertiary grade A hospitals in Shandong Province, China. Statistical analysis was undertaken using SPSS 26.0 and Amos 24.0 software. A pathway model based on individual and family self-management theories was developed and analyzed by collecting data through onsite survey and online survey.

RESULTS

Chinese colorectal cancer patient's self-management ability score is 105.19 (17.19), which shows medium-level self-management ability. The self-efficacy of colorectal cancer patients with a stoma is influenced by social support, which ultimately leads to changes in their self-management ability.

CONCLUSION

The findings may help healthcare professionals to identify the factors that influence self-management skills of colorectal cancer patients with stoma and provide a basis for developing interventions.

Factors predict prolonged colonoscopy before the procedure: prospective registry study

BACKGROUND

Colonoscopy difficulty and procedure time can vary between cases, posing challenges for daily scheduling in endoscopy units. In the literature, cecal intubation time (CIT) is commonly used to assess colonoscopy difficulty, yet there is debate regarding the factors influencing CIT. This prospective observational study aimed to evaluate the factors influencing CIT.

METHODS

In this single-center, prospective, observational study, 915 patients who underwent colonoscopy between July 2023 and April 2024 were evaluated. Failure to achieve cecal intubation due to poor bowel preparation and a history of colorectal surgery were considered as exclusion criteria. Patients with a CIT ≥ 11 min or those with technically failed cecal intubation were categorized into the prolonged CIT subgroup, while those with a CIT < 11 min were analyzed in the normal CIT subgroup. Patients were evaluated based on demographic characteristics, clinical parameters, and colonoscopy results.

RESULTS

A total of 902 patients included in the final analysis. The median age was 55 years and 55.4% of them were women. The cecal intubation rate was 97.5% (892 patients). The polyp, adenoma, and malignancy detection rate were 27.4, 20.7, and 1.9%, respectively. Median cecal intubation time (CIT) was 6 min (Interquartile range: 4-8). In multivariate analysis, body mass index ≤ 18.5, previous abdominal surgery, increased Wexner Constipation Score, and lesser endoscopist experience were associated with prolonged CIT.

CONCLUSIONS

BMI, previous abdominal surgery, severity of constipation, and the experience of endoscopist may affect CIT. Considering these factors during daily planning in the endoscopy unit can lead to more efficient facility utilization.

Diagnostic Accuracy of Multitarget Stool DNA Test for Colorectal Cancer Screening and Detecting in Thailand

BACKGROUND

A multitarget stool DNA test offers high sensitivity and specificity for screening and detecting colorectal cancer (CRC) in Western populations. However, its accuracy in Asian people is not well known. This study aimed to examine the diagnostic performance of multitarget stool DNA tests in Thailand.

METHODS

A prospective cross-sectional study was conducted from January 2023 to November 2023 at a tertiary university hospital in Bangkok. The study included both asymptomatic and symptomatic patients who underwent stool DNA testing followed by colonoscopy. The multitarget stool DNA test targeted methylation statuses of SDC2, ADHFE1, and PPP2R5C genes. Sensitivity, specificity, and other diagnostic parameters were analyzed.

RESULTS

A total of 274 patients (mean age 62.1 years, 60.6% female) were enrolled. CRC was diagnosed in 17.2% of participants and 6.2% had advanced adenomas. The multitarget stool DNA test demonstrated a sensitivity of 91.5% (95% CI: 79.6-97.6) and specificity of 90.3% (95% CI: 85.7-93.8) for CRC detection. Its sensitivity for detecting CRC did not differ between right-sided lesions (92.3%) and left-sided lesions (91.2%) (P=0.901). The sensitivity for detecting CRC lesions size less than 2 cm was significantly lower than for larger lesions (25% vs 91.7%, p<0.001). Notably, the test's sensitivity and specificity for advanced colorectal neoplasms/cancer were 75.0% (95% CI: 62.6-85.0) and 91.9% (95% CI: 87.4-95.2), respectively.

CONCLUSIONS

Multitarget stool DNA testing is highly sensitive and specific for CRC detection in Thai individuals. This testing could represent as a viable non-invasive alternative to colonoscopy especially in settings where colonoscopy is less accessible or less accepted by patients.

A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations

BACKGROUND

Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity.

METHODS

A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant.

RESULTS

Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals).

CONCLUSIONS

A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

Circulating tumor cells: from new biological insights to clinical practice

The primary reason for high mortality rates among cancer patients is metastasis, where tumor cells migrate through the bloodstream from the original site to other parts of the body. Recent advancements in technology have significantly enhanced our comprehension of the mechanisms behind the bloodborne spread of circulating tumor cells (CTCs). One critical process, DNA methylation, regulates gene expression and chromosome stability, thus maintaining dynamic equilibrium in the body. Global hypomethylation and locus-specific hypermethylation are examples of changes in DNA methylation patterns that are pivotal to carcinogenesis. This comprehensive review first provides an overview of the various processes that contribute to the formation of CTCs, including epithelial-mesenchymal transition (EMT), immune surveillance, and colonization. We then conduct an in-depth analysis of how modifications in DNA methylation within CTCs impact each of these critical stages during CTC dissemination. Furthermore, we explored potential clinical implications of changes in DNA methylation in CTCs for patients with cancer. By understanding these epigenetic modifications, we can gain insights into the metastatic process and identify new biomarkers for early detection, prognosis, and targeted therapies. This review aims to bridge the gap between basic research and clinical application, highlighting the significance of DNA methylation in the context of cancer metastasis and offering new avenues for improving patient outcomes.

Evolving trends in CT colonography: A 10-year analysis of use and associated factors

PURPOSE

Computed tomographic colonography (CTC) is a non-invasive screening test for colorectal cancer (CRC) with high sensitivity and low risk of complications. We used a nationally representative sample of screening-eligible adults to examine trends in and factors associated with CTC use.

METHODS

We examined CTC use among 58,058 adults in the National Health Interview Survey in 2010, 2015, 2018, 2019, and 2021. For each survey year, we estimated CTC use by sociodemographic and health factors. We used multivariable logistic regression to identify factors associated with CTC use.

RESULTS

A total of 1.7 % adults reported receiving CTC across all survey years. CTC use was similar in 2010 (1.3 %), 2015 (0.8 %), 2018 (1.4 %), and 2019 (1.4 %) but increased in 2021 (3.5 %, p < 0.05). In multivariable analysis, survey year 2021 [vs. 2010, odds ratio (OR) 2.51, 95 % confidence interval (CI) 1.83-3.43], Hispanic (OR 1.73, 95 % CI 1.34-2.23), non-Hispanic Black (OR 2.07, 95 % CI 1.67-2.57), and household income <200 % federal poverty level (vs. >400 %, OR 1.25, 95 % CI 1.01-1.57) was associated with CTC use. Further, adults with a history of diabetes (OR 1.20, 95 % CI 1.01-1.45), chronic obstructive pulmonary disease (OR 1.58, 95 % CI 1.25-1.99), cancer (OR 1.29, 95 % CI 1.05-1.58), or past-year hospital admissions (OR 1.44, 95 % CI 1.18-1.78) were more likely to receive CTC.

CONCLUSION

CTC use remained low from 2010 to 2019 but increased in 2021. CTC use was more frequent among adults with chronic health conditions, minorities, and adults with lower income, and may help reduce disparities in CRC screening.

Early Diagnosis of Colorectal Cancer Based on Bisulfite-free Site-specific Methylation Identification PCR Strategy: High-Sensitivity, Accuracy, and Primary Medical Accessibility

Due to its decade-long progression, colorectal cancer (CRC) is most suitable for population screening to achieve a significant reduction in its incidence and mortality. DNA methylation has emerged as a potential marker for the early detection of CRC. However, the current mainstream methylation detection method represented by bisulfite conversion has issues such as tedious operation, DNA damage, and unsatisfactory sensitivity. Herein, a new high-performance CRC screening tool based on the promising specific terminal-mediated polymerase chain reaction (STEM-PCR) strategy is developed. CRC-related methylation-specific candidate CpG sites are first prescreened through The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases using self-developed bioinformatics. Next, 9 homebrew colorectal cancer DNA methylated STEM‒PCR assays (ColoC-mSTEM) with high sensitivity (0.1%) and high specificity are established to identify candidate sites. The clinical diagnostic performance of these selected methylation sites is confirmed and validated by a case-control study. The optimized diagnostic model has an overall sensitivity of 94.8% and a specificity of 95.0% for detecting early-stage CRC. Taken together, ColoC-mSTEM, based on a single methylation-specific site, is a promising diagnostic approach for the early detection of CRC which is perfectly suitable for the screening needs of CRC in primary healthcare institutions.

Exploring Colorectal Cancer Screening Reach Among United States Veterans: Analyzing Clinical, Sociodemographic, and Social Determinants of Health-Based Patient Factors Across Screening Methods: Analyzing Clinical, Sociodemographic, and Social Determinants of Health-based Patient Factors Across Screening Methods

INTRODUCTION

Mailed fecal immunochemical testing (mFIT), in-clinic FIT (cFIT), and colonoscopy are believed to reach distinct patient populations. This study aims to evaluate this belief.

METHODS

Sociodemographic, clinical, and social determinants of health (SDOH) characteristics of 201 patients completing mFIT, 203 patients completing cFIT, and 74 patients completing colonoscopy at a Northeastern United States Veterans Affairs center from August 2023 to January 2024 were compared using descriptive statistics, χ2, and ANOVA tests.

RESULTS

Patients completing mFIT (P=0.003) and cFIT (P=0.001) were older than those completing colonoscopy. mFIT patients had more private health insurance as compared with cFIT (P<0.0001) patients. Patients completing colonoscopy had higher average disability ratings as compared with cFIT patients (P<0.0001). mFIT (P<0.0001) and colonoscopy (P<0.0001) patients had more time elapsed since their last primary care visit as compared with cFIT patients. mFIT patients had lower rates of mental health disorders as compared with colonoscopy (P<0.0001) and cFIT (P<0.0001) patients. cFIT patients had higher rates of past stool test use as compared with mFIT (P<0.0001) and colonoscopy (P<0.0001) patients. mFIT patients had lower rates of past colonoscopy completion as compared with cFIT (P<0.0001) and colonoscopy (P<0.0001) patients. There were no significant differences in SDOH domains among patients completing each of the screening methods.

CONCLUSION

While each of the screening methods reaches a different patient population, mFIT does not reach a substantially more vulnerable population compared with cFIT and colonoscopy, highlighting the need for improvements in mFIT outreach.

EVALUATION OF QUALITY INDICATORS OF SCREENING COLONOSCOPY PERFORMED IN A PRIVATE QUARTERNARY HOSPITAL IN BRAZIL

BACKGROUND

Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions. Among the factors, the most used is the Adenoma Detection Rate, which should be at least 25% for general population.

AIMS

To evaluate the quality of the screening colonoscopies performed in a quarternary private Brazilian hospital.

METHODS

This is a retrospective study evaluating the quality indicators of colonoscopies performed at a private center since its inauguration. Only asymptomatic patients aged over 45 years who underwent screening colonoscopy were included. The primary outcome was the Adenoma Detection Rate, and secondary outcomes included polyps detection rate and safety profile. Subanalyses evaluated the correlation of endoscopic findings with gender and age and the evolution of detection rates over the years.

RESULTS

A total of 2,144 patients were include with a mean age of 60.54 years-old. Polyps were diagnosed in 68.6% of the procedures. Adenoma detection rate was 46.8%, with an increasing rate over the years, mainly in males. A low rate of adverse events was reported in 0.23% of the cases, with no need for surgical intervention and no deaths.

CONCLUSIONS

This study shows that high quality screening colonoscopy is possible when performed by experienced endoscopists and trained nurses, under an adequate infrastructure.

A novel dual-target Septin9 methylation assay for improved detection of early-stage colorectal cancer and high-grade intraepithelial neoplasia

BACKGROUND

Colorectal cancer (CRC) ranks as the third most common malignancies in the world, and periodic examination of the patient is advantageous in reducing the mortality of CRC. The first blood-based Septin9 gene methylation assay which recognized by the US FDA for CRC examination was Epi proColon. However, this assay was not broadly applied in the current clinical guideline because of its relatively lower sensitivity in the detection of early-stage CRC.

METHODS

This study aimed at developing a new multiplex Septin9 methylation assay (ColonUSK) which simultaneously evaluates two CpG-rich subregions in the promoter of the Septin9 gene and an internal control in a single reaction. ColonUSK proved increased sensitivity, with a detection limit as low as 12pg of the positive DNA compared with the Septin9 assay targeting one CpG-rich subregion. 1366 subjects were prospectively recruited from four comprehensive hospitals in China in an opportunistic screening study for assessing its value in CRC detection. Blind testing was developed to evaluate ColonUSK in comparison with clinical examination using clinical gold standard such as colonoscopy.

RESULTS

The assay demonstrates clinical sensitivity for diagnosing colorectal cancer (CRC) and advanced adenoma at rates of 77.34% and 25.26%, respectively. Furthermore, ColonUSK exhibits a high degree of specificity for non-CRC cases (95.95%) clinically. Significantly, the detection rate of cases in high-grade intraepithelial neoplasia increased to 54.29%. The value for the assay in the Kappa test was 0.76, showing a high degree of consistency between ColonUSK and clinical gold standard.

CONCLUSIONS

ColonUSK indicated moderate diagnostic value and could become a non-invasive detection way for CRC. The implementation of the ColonUSK assay has the capacity to markedly enhance CRC screening practices.

Unraveling the MicroRNA tapestry: exploring the molecular dynamics of locoregional recurrent rectal cancer

Introduction

Colorectal cancer (CRC) ranks as the third most prevalent malignancy globally, with a concerning rise in incidence among young adults. Despite progress in understanding genetic predispositions and lifestyle risk factors, the intricate molecular mechanisms of CRC demand exploration. MicroRNAs (miRNAs) emerge as key regulators of gene expression and their deregulation in tumor cells play pivotal roles in cancer progression.

Methods

NanoString's nCounter technology was utilized to measure the expression of 827 cancer-related miRNAs in tumor tissue and adjacent non-involved normal colon tissue from five patients with locoregional CRC progression. These expression profiles were then compared to those from the primary colon adenocarcinoma (COAD) cohort in The Cancer Genome Atlas (TCGA).

Results and discussion

Intriguingly, 156 miRNAs showed a contrasting dysregulation pattern in reccurent tumor compared to their expression in the TCGA COAD cohort. This observation implies dynamic alterations in miRNA expression patterns throughout disease progression. Our exploratory study contributes to understanding the regulatory landscape of recurrent CRC, emphasizing the role of miRNAs in disease relapse. Notable findings include the prominence of let-7 miRNA family, dysregulation of key target genes, and dynamic changes in miRNA expression patterns during progression. Univariate Cox proportional hazard models highlighted miRNAs associated with adverse outcomes and potential protective factors. The study underscores the need for more extensive investigations into miRNA dynamics during tumor progression and the value of stage specific biomarkers for prognosis.

Association of Serum Proteases and Acute Phase Factors Levels with Survival Outcomes in Patients with Colorectal Cancer

Colorectal cancer (CRC) represents a substantial burden on global healthcare, contributing to significant morbidity and mortality worldwide. Despite advances in screening methodologies, its incidence remains high, necessitating continued efforts in early detection and treatment. Neoplastic invasion and metastasis are primary determinants of CRC lethality, emphasizing the urgency of understanding underlying mechanisms to develop effective therapeutic strategies. This study aimed to explore the potential of serum biomarkers in predicting survival outcomes in CRC patients, with a focus on cathepsin B (CB), leukocytic elastase (LE), total sialic acid (TSA), lipid-associated sialic acid (LASA), antitrypsin activity (ATA), C-reactive protein (CRP), and cystatin C (CC). We recruited 185 CRC patients and 35 healthy controls, assessing demographic variables, tumor characteristics, and 7 serum biomarker levels, including (1) CB, (2) LE, (3) TSA, (4) LASA, (5) ATA, (6) CRP, and (7) CC. Statistical analyses included ANOVA with Tukey's post hoc tests and MANOVA for continuous variables. Student's t-test was used for dependent samples, while non-parametric tests like Mann-Whitney U and Wilcoxon signed-rank tests were applied for variables deviating from the normal distribution. Categorical variables were assessed using chi-square and Kruskal-Wallis tests. Spearman's rank correlation coefficient was utilized to examine variable correlations. Survival analysis employed the Kaplan-Meier method with a log-rank test for comparing survival times between groups. Significant associations were observed between CB (p = 0.04), LE (p = 0.01), and TSA (p = 0.008) levels and survival outcomes in CRC patients. Dukes' classification stages also showed a significant correlation with survival (p = 0.001). However, no significant associations were found for LASA, ATA, CRP, and CC. Multivariate analysis of LE, TSA, and ATA demonstrated a notable correlation with survival (p = 0.041), notwithstanding ATA's lack of significance in univariate analysis (p = 0.13). CB, LE, and TSA emerged as promising diagnostic markers with prognostic value in CRC, potentially aiding in early diagnosis and treatment planning. Further research is needed to validate these findings and explore additional prognostic indicators.

miR-455/GREM1 axis promotes colorectal cancer progression and liver metastasis by affecting PI3K/AKT pathway and inducing M2 macrophage polarization

BACKGROUND

Colorectal cancer is among the most common malignant tumors affecting the gastrointestinal tract. Liver metastases, a complication present in approximately 50% of colorectal cancer patients, are a considerable concern. Recently, studies have revealed the crucial role of miR-455 in tumor pathogenesis. However, the effect of miR-455 on the progression of liver metastases in colorectal cancer remains controversial. As an antagonist of bone morphogenetic protein(BMP), Gremlin 1 (GREM1) may impact organogenesis, body patterning, and tissue differentiation. Nevertheless, the role of miR-455 in regulating GREM1 in colorectal cancer liver metastases and how miR-455/GREM1 axis influences tumour immune microenvironment is unclear.

METHODS

Bioinformatics analysis shows that miR-455/GREM1 axis plays crucial role in liver metastasis of intestinal cancer and predicts its possible mechanism. To investigate the impact of miR-455/GREM1 axis on the proliferation, invasion, and migration of colorectal cancer cells, colony formation assay, wound healing and transwell assay were examined in vitro. The Dual-Luciferase reporter gene assay and RNA pull-down assay confirmed a possible regulatory effect between miR-455 and GREM1. In vivo, colorectal cancer liver metastasis(CRLM) model mice was established to inquiry the effect of miR-455/GREM1 axis on tumor growth and macrophage polarization. The marker of macrophage polarization was tested using immunofluorescence(IF) and quantitative real-time polymerase chain reaction(qRT-PCR). By enzyme-linked immunosorbent assay (ELISA), cytokines were detected in culture medium supernatants.

RESULTS

We found that miR-455 and BMP6 expression was increased and GREM1 expression was decreased in liver metastase compared with primary tumor. miR-455/GREM1 axis promotes colorectal cancer cells proliferation, migration, invasion via affected PI3K/AKT pathway. Moreover, downregulating GREM1 augmented BMP6 expression in MC38 cell lines, inducing M2 polarization of macrophages, and promoting liver metastasis growth in CRLM model mice.

CONCLUSION

These data suggest that miR-455/GREM1 axis promotes colorectal cancer progression and liver metastasis by affecting PI3K/AKT pathway and inducing M2 macrophage polarization. These results offer valuable insights and direction for future research and treatment of CRLM.

Association of hTERT Gene Polymorphism and Colorectal Cancer (CRC) Risk in the Chinese Han Population

The catalytic subunit telomerase reverse transcriptase (hTERT) is a prerequisite for malignant transformation of human cells. Colorectal cancer (CRC) is a common malignant tumor. The genetic association of hTERT gene rs2853669 and rs2736098 polymorphisms with CRC was surveyed in the Chinese population. Two hundreds patients with CRC and 200 healthy controls were taken for blood sample collection. Sanger sequencing was applied for genotyping. Multiple logistic regression analysis was performed, and odds ratio (OR) together with confidence interval (CI) were calculated to obtain the corresponding association power. Among CRC cases (49.50%), hTERT gene rs2736098 GA genotype carriers were more prevalent compared with the control group (41.00%, P = 0.035), which increased the risk of CRC by 1.576 times (95% CI, 1.031-2.409). Distribution of the rs2736098 genotypes was significantly associated with TNM stage, tumor differentiation, tumor size and lymph node metastasis (P < 0.05). The frequencies of hTERT gene rs2853669 polymorphism were not significantly different between CRC patients and healthy controls. Logistic regression analysis indicated that both body mass index (BMI) and hTERT gene rs2736098 polymorphism remained significantly correlated with CRC susceptibility. The frequencies of hTERT gene rs2853669 polymorphism did not differ significantly between CRC patients and control group (P > 0.05). The hTERT gene rs2736098 polymorphism was correlated with CRC risk in the Chinese Han population, and the GA genotype was a risk element for the onset of CRC.

Colonoscopy Outreach for Rural Communities (CORC): A study protocol of a pragmatic randomized controlled trial of a patient navigation program to improve colonoscopy completion for colorectal cancer screening

BACKGROUND

Colonoscopy is one of the primary methods of screening for colorectal cancer (CRC), a leading cause of cancer mortality in the United States. However, up to half of patients referred to colonoscopy fail to complete the procedure, and rates of adherence are lower in rural areas.

OBJECTIVES

Colonoscopy Outreach for Rural Communities (CORC) is a randomized controlled trial to test the effectiveness of a centralized patient navigation program provided remotely by a community-based organization to six geographically distant primary care organizations serving rural patients, to improve colonoscopy completion for CRC.

METHODS

CORC is a type 1 hybrid implementation-effectiveness trial. Participants aged 45-76 from six primary care organizations serving rural populations in the northwestern United States are randomized 1:1 to patient navigation or standard of care control. The patient navigation is delivered remotely by a trained lay-person from a community-based organization. The primary effectiveness outcome is completion of colonoscopy within one year of referral to colonoscopy. Secondary outcomes are colonoscopy completion within 6 and 9 months, time to completion, adequacy of patient bowel preparation, and achievement of cecal intubation. Analyses will be stratified by primary care organization.

DISCUSSION

Trial results will add to our understanding about the effectiveness of patient navigation programs to improve colonoscopy for CRC in rural communities. The protocol includes pragmatic adaptations to meet the needs of rural communities and findings may inform approaches for future studies and programs.

TRIAL REGISTRATION

National Clinical Trial Identifier: NCT05453630.

TRIAL REGISTRATION

ClinicalTrials.gov. Identifier: NCT05453630. Registered July 6, 2022.