A comprehensive systematic review of colorectal cancer screening clinical practices guidelines and consensus statements

Balancing early detection and over-screening: Evaluating colonoscopy's role in shaping colorectal cancer trends in Korea

This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer (CRC) in Korea. Different views are raised on the research methods and conclusions of Kim et al. It emphasizes the need to carefully consider the balance between the benefits of early detection and the risks of over-screening. This letter also suggests directions for future research and policy considerations in the field of CRC screening and prevention in Korea.

Global, Regional, and National Disease Burden and Prediction Analysis of Colorectal Cancer Attributable to Tobacco, Alcohol, and Obesity From 1990 to 2030

Background

Colorectal cancer (CRC) ranks among the highest in incidence and mortality rates globally. A significant portion of Colorectal cancer cases and deaths can be attributed to modifiable risk factors, with smoking, alcohol use, and high body mass index (BMI) being the three most prominent. However, the impact of these risk factors on Colorectal cancer across regions, genders, and age groups remains insufficiently characterized.

Methods

Utilizing data from the Global Burden of Disease (GBD) study 2019, restrictive cubic splines (RCS) and quantile regression analyses are applied to explore the relationship between the Socio-Demographic Index (SDI) and ASMR or ASDR. Additionally, gender differences, changes across different SDI levels, and age group trends in smoking, alcohol use, and high BMI over the 30-year period are analyzed. The Bayesian age-period-cohort (BAPC) model is employed to predict mortality trends from 2020 to 2030, aiming to explore the epidemiological and sociodemographic transitions in the Colorectal cancer disease burden attributed to smoking, alcohol use, and high BMI.

Results

In 2019, the number of colorectal cancer deaths globally attributable to risk factors as smoking, alcohol consumption, and obesity increased to 142,931, 52,495, and 85,882 cases respectively, collectively accounting for approximately one-third of all Colorectal cancer-related deaths. Notably, there is an upward trend in early-onset Colorectal cancer mortality associated with these factors.

Discussion

To reduce the burden of Colorectal cancer, it is recommended to enhance health education, promote smoking cessation and alcohol moderation, and increase the coverage and participation in Colorectal cancer screening, which are crucial for lowering Colorectal cancer mortality rates. These findings are vital for the development of public health policies and intervention measures to reduce the global disease burden. They provide guidance for Colorectal cancer prevention across different regions, genders, and age groups worldwide.

Multi-faceted strategies to advance health equity in colorectal cancer screening in primary care setting: quality improvement project

BACKGROUND

The aim of this quality improvement (QI) project was to increase Colorectal Cancer (CRC) screening in patients ages 50-75 years from a baseline of 27-40% within 12 months in a primary care clinic in limited resource communities.

METHODS

The multidisciplinary QI-team applied the Plan-Do-Study-Act method and developed stakeholder analysis, an Ishikawa fish bone diagram, a process flow map, and a driver diagram. Major barriers to suboptimal CRC screening included limited health literacy, language preferences, absence of stool test options, and knowledge gaps among patients and providers. The outcome measure was CRC screening rates, while stool test and colonoscopy completion rates served as process measures. Major interventions included the use of a patient-navigator, leveraging digital health technology to create a novel CRC screening data dashboard, educating patients and providers, patient centered-shared decision making, and creating messages and educational videos in patient's preferred languages. We used monthly run charts and statistical process control charts (SPC) for data analysis.

RESULTS

We observed a sustainable, steady increase in CRC screening rates from baseline rates of 27.0-40.0% (n = 1304/3271) during the study period and 45.6% (n = 1493/3,271) six months post-study, with median rates of 34.0% in the run chart and mean rates of 43.0% in the SPC chart. Furthermore, we observed an increase in colonoscopy completion rates during the study and six months post-study to 65.0% (n = 411/631) and 72.9% (n = 461/631) respectively, from a baseline rate of 25.0%, with a median of 63.0% in the monthly run chart.

CONCLUSION

The increase in CRC screening rates highlights the effectiveness of addressing barriers such as health literacy, language preferences, and knowledge gaps. This underscores the value of a multifaceted approach and the role of a patient navigator in enhancing preventive, patient-centered care. This project focused on population health and addressing social determinants of health to overcome disparities and improve CRC screening in a primary care setting. Continued emphasis on these strategies is likely to further advance colorectal cancer screening efforts.

A 5-Hydroxymethylcytosine-Based Noninvasive Model for Early Detection of Colorectal Carcinomas and Advanced Adenomas: The METHOD-2 Study

PURPOSE

Detection of colorectal carcinomas at a time when there are more treatment options is associated with better outcomes. This prospective case-control study assessed the 5-hydroxymethylcytosine (5hmC) biomarkers in circulating cell-free DNA (cfDNA) for early detection of colorectal carcinoma and advanced adenomas (AA).

EXPERIMENTAL DESIGN

Plasma cfDNA samples from 2,576 study participants from the multicenter METHOD-2 study (NCT03676075) were collected, comprising patients with newly diagnosed colorectal carcinoma (n = 1,074), AA (n = 356), other solid tumors (n = 80), and non-colorectal carcinoma/AA controls (n = 1,066), followed by genome-wide 5hmC profiling using the 5hmC-Seal technique and the next-generation sequencing. A weighted diagnostic model for colorectal carcinoma (stage I-III) and AA was developed using the elastic net regularization in a discovery set and validated in independent samples.

RESULTS

Distribution of 5hmC in cfDNA reflected gene regulatory relevance and tissue of origin. Besides being confirmed in internal validation, a 96-gene model achieved an area under the curve (AUC) of 90.7% for distinguishing stage I-III colorectal carcinoma from controls in 321 samples from multiple centers for external validation, regardless of primary location or mutation status. This model also showed cancer-type specificity as well as high capacity for distinguishing AA from controls with an AUC of 78.6%. Functionally, differential 5hmC features associated with colorectal carcinoma and AA demonstrated relevance to colorectal carcinoma biology, including pathways such as calcium and MAPK signaling.

CONCLUSIONS

Genome-wide mapping of 5hmC in cfDNA shows promise as a highly sensitive and specific noninvasive blood test to be integrated into screening programs for improving early detection of colorectal carcinoma and high-risk AA.

Optimization of colorectal cancer screening strategies: New insights

In this editorial, we discuss the article by Agatsuma et al. We concentrate specifically on the current routinely used screening tests recommended by society guidelines and delve into the significance of early diagnosis of colorectal cancer (CRC) and its substantial impact on both incidence and mortality rates. Screening is highly recommended, and an early diagnosis stands out as the most crucial predictor of survival for CRC patients. Therefore, it is essential to identify and address the barriers hindering adherence to screening measures, as these barriers can vary among different populations. Furthermore, we focus on screening strategy optimization by selecting high-risk groups. Patients with comorbidities who regularly visit hospitals have been diagnosed at an early stage, showing no significant difference compared to patients undergoing regular screening. This finding highlights the importance of extending screening measures to include patients with comorbidities who do not routinely visit the hospital.

Long-term care for community-dwelling older adults: A systematic review of clinical practice guidelines and consensus statements

This review identified clinical practice guidelines (CPGs) and consensus statements (CSs) that include recommendations on long-term care for community-dwelling older adults. Additionally, it assessed their quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool to determine high-quality guidelines and synthesis recommendations from high-quality guidelines and evaluate the quality of these guidelines using the AGREE-Recommendation Excellence (AGREE-REX) tool. A systematic search was performed (November 2023) in MEDLINE, PubMed, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Registered Nurses' Association of Ontario (RNAO), National Guideline Clearinghouse (NGC), and Scottish Intercollegiate Guidelines Network (SIGN). Two reviewers independently selected and assessed the articles using AGREE II. A meeting was held to appraise the quality of the guidelines (AGREE II mean score >70 %) using AGREE-REX. The analysis included 14 CPGs and 2 CSs. Of these, 7 CPGs reached the standard of >70 %, the 'Scope and purpose' domain obtained the highest score with 85.43 (± 17.87), and the 'Applicability' domain scored lowest with 46.93 (± 26.74). Regarding the score of AGREE-REX, the seven CPGs were considered as 'moderate', with the 'Clinical Applicability' domain having the highest score of 61.29 % (±10.80) and the 'Values and Preferences' domain having the lowest score of 38.14 % (±9.26). Four themes were synthesised from the seven high-quality CPGs: planning and delivering person-centred home care, cognitive impairment, and screening for impaired vision and falls. The quality of CPGs and CSs on long-term care for community-dwelling older adults has room for improvement, and higher-quality guidelines are required to meet the long-term care needs of community-dwelling older adults.

Quality in aesthetic medicine and surgery: a systematic review of clinical practice guidelines

Background

Guidelines in medicine are essential tools to provide quality and standardised medical care. We analysed the quality of aesthetic medicine guidelines.

Methods

A systematic review with a prospective registration protocol (https://osf.io/8pdyv) of databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR), web pages of scientific societies and grey literature was done from inception to February 2023 and without language restrictions. Quality was evaluated using AGREE II (% of the maximum score), RIGHT (% of the total 35 items) and a shared decision making (SDM) quality assessment tool (31 items score) individually and in duplicate, respectively.

Results

Six (86%) guidelines were classified as not recommended; one (14%) was recommended with modifications, and all were classified as poorly reported (7/7; 100%). The median overall quality was 27% (IQR: 26-43) and 26% (IQR 15-36) for AGREE II and RIGHT, respectively. No document used these tools for its development. SDM appeared superfluity in almost all of the guidelines explored.

Conclusions

Aesthetic medicine and surgical guidelines had low quality and must be improved. There is a wide range of improvement, especially in applicability, reporting of evidence, recommendations, conflict of interest, quality control and SDM. These guidelines require a rigorous methodology based on systematic reviews to ensure quality evidence-based recommendations.

Assessment of the methodological, recommendation and reporting quality of global guidelines for neck pain and synthesis of evidence and recommendations: a systematic review protocol

INTRODUCTION

Neck pain is a global health problem that can cause severe disability and a huge medical burden. Clinical practice guideline (CPG) is an important basis for clinical diagnosis and treatment. A high-quality CPG plays a significant role in clinical practice. However, the quality of the CPGs for neck pain lacks comprehensive assessment. This protocol aims to evaluate the methodological, recommendation, reporting quality of global CPGs for neck pain and identify key recommendations and gaps that limit evidence-based practice.

METHOD

CPGs from January 2013 to November 2023 will be identified through a systematic search on 13 scientific databases (PubMed, Cochrane Library, Embase, etc) and 7 online guideline repositories. Six reviewers will independently evaluate the quality of CPGs for neck pain by using the Appraisal of Guidelines for Research and Evaluation, the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence and the Reporting Items for Practice Guidelines in Healthcare tools. Intraclass correlation coefficient will be used to test the consistency of the assessment. We will identify the distribution of evidence and recommendations in each evidence-based CPGs for neck pain and regrade the level of evidence and strength of recommendations by adopting the commonly used Grading of Recommendations, Assessment, Development and Evaluations system. The key recommendations based on high-quality evidence will be summarised. In addition, we will categorise CPGs by different characteristics and conduct a subgroup analysis of the results of assessment.

ETHICS AND DISSEMINATION

No subjects will be involved in this systematic review, so there is no need for ethical approval. The finding of this review will be summarised as a paper for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023417717.

Clinical practice guidelines for the nutrition of colorectal cancer patients: a systematic review

PURPOSE

The aim of this study is to rigorously assess the methodological quality of published clinical practice guidelines (CPGs) related to nutrition among colorectal cancer patients, to compile consensus recommendations, and to evaluate the quality of the included CPGs.

METHODS

The systematic search covered eight electronic databases, two relevant professional association websites, and six guideline websites from their inception up to January 22, 2023. The methodological quality of the eligible guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, and then, consensus recommendations were synthesized. The scores for each domain were expressed as the mean ± standard deviation (SD). Using the mean score as the benchmark for comparison, they were subsequently ranked from highest to lowest. The included guidelines were then categorized as having "high," "moderate," or "low" quality based on their scores.

RESULTS

The literature search yielded ten guidelines. The findings indicated that the "Clarity of presentation" domain had the highest mean score (65.2 ± 7.7). This demonstrates how the guidelines effectively articulate recommendations. Additionally, the "Scope and purpose" domain achieved a mean score of 60.7 ± 10.9, followed by "Rigor of development" (51.7 ± 15.7), "Editorial independence" (51.1 ± 21), "Stakeholder involvement" (48 ± 16.8), and "Applicability" domains (47.5 ± 17.3). Two CPGs received an overall rating of "high quality" and were recommended; four CPGs received an overall rating of "moderate" and were recommended with modifications; and four CPGs received an overall rating of "low quality" and were not recommended. Furthermore, this study compiled twenty consensus recommendations related to nine distinct clinical issues.

CONCLUSION

This study identified disparities in the methodological quality of the included CPGs, particularly in the "Applicability" domain, thus emphasizing the need for advancement in clinical feasibility and implementation. Notably, there is few guidelines specifically targeting colorectal cancer nutrition. These synthesized findings provided an intuitive, convenient, and comprehensive reference for evaluating nutrition among colorectal cancer patients. When applying these results, users should make careful decisions based on their specific situations.

Esophagogastroscopic Abnormalities Potentially Guided Patients Younger than 50 Years Old to Undergo Colonoscopy Earlier: A Retrospective Cross-Sectional Study

BACKGROUND

The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50.

AIMS

To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years.

METHODS

A retrospective cross-sectional study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

RESULTS

A total of 3390 cases (38.44%) under 50 years old were diagnosed as colorectal polyps. Advanced age (OR 1.66, 95%CI 1.57-1.76), male sex (OR 2.67, 95%CI 2.33-3.08), Helicobacter pylori (H. pylori) infection (OR 1.43, 95%CI 1.24-1.65), gastric polyps (OR 1.29, 95%CI 1.10-1.52), and low-grade intraepithelial neoplasia (LGIN) (OR 2.52, 95%CI 1.39-4.57) were independent risk factors for colorectal adenomas. For non-adenomatous polyps, reflux esophagitis (OR 1.38, 95%CI 1.11-1.71) was also an independent risk factor. Besides, older age (OR 1.90, 95%CI 1.66-2.18), male sex (OR 2.15, 95%CI 1.60-2.87), and H. pylori infection (OR 1.67, 95%CI 1.24-2.24) were associated with a higher risk of advanced neoplasms (advanced adenoma and CRC).

CONCLUSIONS

Earlier colonoscopy for identification and screening may need to be considered for individuals younger than 50 years old with H. pylori infection, LGIN, gastric polyps, and reflux esophagitis. Risk-adapted CRC screening initiation age allows a personalized and precise screening.

Exploring the Therapeutic Potential of Ginkgo biloba Polyphenols in Targeting Biomarkers of Colorectal Cancer: An In-silico Evaluation

BACKGROUND

Colorectal cancer (CRC) is a major contributor to cancer-related deaths worldwide, driving the need for effective anticancer therapies with fewer side effects. The exploration of Ginkgo biloba, a natural source, offers a hopeful avenue for novel treatments targeting key colorectal biomarkers involved in CRC treatment.

OBJECTIVE

The aim of this study was to explore the binding affinity of natural molecules derived from G. biloba to essential biomarkers associated with CRC, including Kirsten rat sarcoma virus, neuroblastoma RAS mutations, serine/threonine-protein kinase B-Raf, phosphatidylinositol 3'-kinase, and deleted colorectal cancer, using molecular docking. The focus of this research was to evaluate how effectively these molecules bind to specified targets in order to identify potential inhibitors for the treatment of CRC.

METHODS

A total of 152 polyphenolic compounds from G. biloba were selected and subjected to molecular docking simulations to evaluate their interactions with CRC-related biomarkers. The docking results were analysed to identify ligands exhibiting strong affinities towards the targeted genes, suggesting potential inhibitory effects.

RESULTS

Docking simulations unveiled the strong binding affinities between selected polyphenolic compounds derived from G. biloba and genes associated with CRC. The complex glycoside structures that are found in flavonols are of significant importance. These compounds, including derivatives with distinctive arrangements, exhibited promising docking scores, signifying substantial interactions with the targeted biomarkers.

CONCLUSION

The study demonstrates the potential of G. biloba-derived molecules as effective anticancer agents for colorectal cancer. The identified ligands exhibit strong interactions with crucial CRC-related biomarkers, suggesting potential inhibition ability. Further in vitro and in vivo investigations are needed to validate and build upon these promising findings, advancing the development of novel and efficient CRC therapies.

Ferroptosis, Necroptosis, and Pyroptosis in Gastrointestinal Cancers: The Chief Culprits of Tumor Progression and Drug Resistance

In recent years, the incidence of gastrointestinal cancers is increasing, particularly in the younger population. Effective treatment is crucial for improving patients' survival outcomes. Programmed cell death, regulated by various genes, plays a fundamental role in the growth and development of organisms. It is also critical for maintaining tissue and organ homeostasis and takes part in multiple pathological processes. In addition to apoptosis, there are other types of programmed cell death, such as ferroptosis, necroptosis, and pyroptosis, which can induce severe inflammatory responses. Notably, besides apoptosis, ferroptosis, necroptosis, and pyroptosis also contribute to the occurrence and development of gastrointestinal cancers. This review aims to provide a comprehensive summary on the biological roles and molecular mechanisms of ferroptosis, necroptosis, and pyroptosis, as well as their regulators in gastrointestinal cancers and hope to open up new paths for tumor targeted therapy in the near future.

Early Screening of Colorectal Precancerous Lesions Based on Combined Measurement of Multiple Serum Tumor Markers Using Artificial Neural Network Analysis

Many patients with colorectal cancer (CRC) are diagnosed in the advanced stage, resulting in delayed treatment and reduced survival time. It is urgent to develop accurate early screening methods for CRC. The purpose of this study is to develop an artificial intelligence (AI)-based artificial neural network (ANN) model using multiple protein tumor markers to assist in the early diagnosis of CRC and precancerous lesions. In this retrospective analysis, 148 cases with CRC and precancerous diseases were included. The concentrations of multiple protein tumor markers (CEA, CA19-9, CA 125, CYFRA 21-1, CA 72-4, CA 242) were measured by electrochemical luminescence immunoassays. By combining these markers with an ANN algorithm, a diagnosis model (CA6) was developed to distinguish between normal healthy and abnormal subjects, with an AUC of 0.97. The prediction score derived from the CA6 model also performed well in assisting in the diagnosis of precancerous lesions and early CRC (with AUCs of 0.97 and 0.93 and cut-off values of 0.39 and 0.34, respectively), which was better than that of individual protein tumor indicators. The CA6 model established by ANN provides a new and effective method for laboratory auxiliary diagnosis, which might be utilized for early colorectal lesion screening by incorporating more tumor markers with larger sample size.