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Robertson DJ, Rex DK, Ciani O, Drummond MF. Colonoscopy vs the Fecal Immunochemical Test: Which is Best? Gastroenterology 2024; 166:758-771. [PMID: 38342196 DOI: 10.1053/j.gastro.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
Although there is no debate around the effectiveness of colorectal cancer screening in reducing disease burden, there remains a question regarding the most effective and cost-effective screening modality. Current United States guidelines present a panel of options that include the 2 most commonly used modalities, colonoscopy and stool testing with the fecal immunochemical test (FIT). Large-scale comparative effectiveness trials comparing colonoscopy and FIT for colorectal cancer outcomes are underway, but results are not yet available. This review will separately state the "best case" for FIT and colonoscopy as the screening tool of first choice. In addition, the review will examine these modalities from a health economics perspective to provide the reader further context about the relative advantages of these commonly used tests.
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Affiliation(s)
- Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
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Clark GRC, Godfrey T, Purdie C, Strachan J, Carey FA, Fraser CG, Steele RJC. Interval cancers in a national colorectal screening programme based on faecal immunochemical testing: Implications for faecal haemoglobin concentration threshold and sex inequality. J Med Screen 2024; 31:21-27. [PMID: 37469171 PMCID: PMC10878005 DOI: 10.1177/09691413231188252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage. METHODS The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design. RESULTS With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively. FIT had a significantly higher proportion of SDC compared to IC than gFOBT. For FIT and gFOBT, ICP was significantly higher in women than men. As f-Hb threshold increased, ICP increased and, for any f-Hb threshold for men, a lower threshold was required for comparable ICP in women. In Scotland, the current threshold of ≥80 µg Hb/g faeces would have to be lowered to ≥40 µg Hb/g faeces for women to achieve sex equality for ICP. In the FIT-based SBoSP, there were four times as many stage I SDC than IC. This was reversed in advanced stages, with twice as many stage IV CRC diagnosed as IC versus SDC. CONCLUSIONS Reducing the numbers of IC requires lowering the f-Hb threshold. Using different f-Hb thresholds for women and men could eliminate the sex disparity, but with additional colonoscopy.
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Affiliation(s)
- Gavin RC Clark
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | - Judith Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, UK
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Golder AM, Conlan O, McMillan DC, Mansouri D, Horgan PG, Roxburgh CS. Adverse Tumour and Host Biology May Explain the Poorer Outcomes Seen in Emergency Presentations of Colon Cancer. Ann Surg 2023; 278:e1018-e1025. [PMID: 37036099 DOI: 10.1097/sla.0000000000005872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To examine the association between tumor/host factors (including the systemic inflammatory response), mode of presentation, and short/long-term outcomes in patients undergoing curative resectional surgery for TNM I to III colon cancer. BACKGROUND Emergency presentations of colon cancer are associated with worse long-term outcomes than elective presentations despite adjustment for TNM stage. A number of differences in tumor and host factors have been identified between elective and emergency presentations and it may be these factors that are associated with adverse outcomes. METHODS Patients undergoing curative surgery for TNM I to III colon cancer in the West of Scotland from 2011 to 2014 were identified. Tumor/host factors independently associated with the emergency presentation were identified and entered into a subsequent survival model to determine those that were independently associated with overall survival/cancer-specific survival (OS/CSS). RESULTS A total of 2705 patients were identified. The emergency presentation was associated with a worse 3-year OS and CSS compared with elective presentations (70% vs 86% and 91% vs 75%). T stage, age, systemic inflammatory grade, anemia (all P < 0.001), N stage ( P = 0.077), extramural venous invasion ( P = 0.003), body mass index ( P = 0.001), and American Society of Anesthesiologists Classification classification ( P = 0.021) were independently associated with emergency presentation. Of these, body mass index [hazard ratio (HR), 0.82], American Society of Anesthesiologists Classification (HR, 1.45), anemia (HR, 1.29), systemic inflammatory grade (HR. 1.11), T stage (HR, 1.57), N stage (HR, 1.80), and adjuvant chemotherapy (HR, 0.47) were independently associated with OS. Similar results were observed for CSS. CONCLUSIONS Within patients undergoing curative surgery for colon cancer, the emergency presentation was not independently associated with worse OS/CSS. Rather, a combination of tumor and host factors account for the worse outcomes observed.
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Affiliation(s)
- Allan M Golder
- Academic Unit of Surgery-Glasgow Royal Infirmary, Glasgow, UK
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Astolfi M, Rispoli G, Anania G, Zonta G, Malagù C. Chemoresistive Nanosensors Employed to Detect Blood Tumor Markers in Patients Affected by Colorectal Cancer in a One-Year Follow Up. Cancers (Basel) 2023; 15:1797. [PMID: 36980683 PMCID: PMC10046137 DOI: 10.3390/cancers15061797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Colorectal cancer (CRC) represents 10% of the annual tumor diagnosis and deaths occurring worldwide. Given the lack of specific symptoms, which could determine a late diagnosis, the research for specific CRC biomarkers and for innovative low-invasive methods to detect them is crucial. Therefore, on the basis of previously published results, some volatile organic compounds (VOCs), detectable through gas sensors, resulted in particularly promising CRC biomarkers, making these sensors suitable candidates to be employed in CRC screening devices. A new device was employed here to analyze the exhalations of blood samples collected from CRC-affected patients at different stages of their pre- and post-surgery therapeutic path, in order to assess the sensor’s capability for discriminating among these samples. The stages considered were: the same day of the surgical treatment (T1); before the hospital discharge (T2); after one month and after 10–12 months from surgery (T3 and T4, respectively). This device, equipped with four different sensors based on different metal–oxide mixtures, enabled a distinction between T1 and T4 with a sensitivity and specificity of 93% and 82%, respectively, making it suitable for clinical follow-up protocols, patient health status monitoring and to detect possible post-treatment relapses.
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Grobbee EJ, Wisse PHA, Schreuders EH, van Roon A, van Dam L, Zauber AG, Lansdorp-Vogelaar I, Bramer W, Berhane S, Deeks JJ, Steyerberg EW, van Leerdam ME, Spaander MC, Kuipers EJ. Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals. Cochrane Database Syst Rev 2022; 6:CD009276. [PMID: 35665911 PMCID: PMC9169237 DOI: 10.1002/14651858.cd009276.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Worldwide, many countries have adopted colorectal cancer (CRC) screening programmes, often based on faecal occult blood tests (FOBTs). CRC screening aims to detect advanced neoplasia (AN), which is defined as CRC or advanced adenomas. FOBTs fall into two categories based on detection technique and the detected blood component: qualitative guaiac-based FOBTs (gFOBTs) and faecal immunochemical tests (FITs), which can be qualitative and quantitative. Screening with gFOBTs reduces CRC-related mortality. OBJECTIVES To compare the diagnostic test accuracy of gFOBT and FIT screening for detecting advanced colorectal neoplasia in average-risk individuals. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, BIOSIS Citation Index, Science Citation Index Expanded, and Google Scholar. We searched the reference lists and PubMed-related articles of included studies to identify additional studies. SELECTION CRITERIA We included prospective and retrospective studies that provided the number of true positives, false positives, false negatives, and true negatives for gFOBTs, FITs, or both, with colonoscopy as reference standard. We excluded case-control studies. We included studies in which all participants underwent both index test and reference standard ("reference standard: all"), and studies in which only participants with a positive index test underwent the reference standard while participants with a negative test were followed for at least one year for development of interval carcinomas ("reference standard: positive"). The target population consisted of asymptomatic, average-risk individuals undergoing CRC screening. The target conditions were CRC and advanced neoplasia (advanced adenomas and CRC combined). DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected studies for inclusion. In case of disagreement, a third review author made the final decision. We used the Rutter and Gatsonis hierarchical summary receiver operating characteristic model to explore differences between tests and identify potential sources of heterogeneity, and the bivariate hierarchical model to estimate sensitivity and specificity at common thresholds: 10 µg haemoglobin (Hb)/g faeces and 20 µg Hb/g faeces. We performed indirect comparisons of the accuracy of the two tests and direct comparisons when both index tests were evaluated in the same population. MAIN RESULTS We ran the initial search on 25 June 2019, which yielded 63 studies for inclusion. We ran a top-up search on 14 September 2021, which yielded one potentially eligible study, currently awaiting classification. We included a total of 33 "reference standard: all" published articles involving 104,640 participants. Six studies evaluated only gFOBTs, 23 studies evaluated only FITs, and four studies included both gFOBTs and FITs. The cut-off for positivity of FITs varied between 2.4 μg and 50 µg Hb/g faeces. For each Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 domain, we assessed risk of bias as high in less than 20% of studies. The summary curve showed that FITs had a higher discriminative ability than gFOBTs for AN (P < 0.001) and CRC (P = 0.004). For the detection of AN, the summary sensitivity of gFOBTs was 15% (95% confidence interval (CI) 12% to 20%), which was significantly lower than FITs at both 10 μg and 20 μg Hb/g cut-offs with summary sensitivities of 33% (95% CI 27% to 40%; P < 0.001) and 26% (95% CI 21% to 31%, P = 0.002), respectively. Results were simulated in a hypothetical cohort of 10,000 screening participants with 1% CRC prevalence and 10% AN prevalence. Out of 1000 participants with AN, gFOBTs missed 850, while FITs missed 670 (10 μg Hb/g cut-off) and 740 (20 μg Hb/g cut-off). No significant differences in summary specificity for AN detection were found between gFOBTs (94%; 95% CI 92% to 96%), and FITs at 10 μg Hb/g cut-off (93%; 95% CI 90% to 95%) and at 20 μg Hb/g cut-off (97%; 95% CI 95% to 98%). So, among 9000 participants without AN, 540 were offered (unnecessary) colonoscopy with gFOBTs compared to 630 (10 μg Hb/g) and 270 (20 μg Hb/g) with FITs. Similarly, for the detection of CRC, the summary sensitivity of gFOBTs, 39% (95% CI 25% to 55%), was significantly lower than FITs at 10 μg and 20 μg Hb/g cut-offs: 76% (95% CI 57% to 88%: P = 0.001) and 65% (95% CI 46% to 80%; P = 0.035), respectively. So, out of 100 participants with CRC, gFOBTs missed 61, and FITs missed 24 (10 μg Hb/g) and 35 (20 μg Hb/g). No significant differences in summary specificity for CRC were found between gFOBTs (94%; 95% CI 91% to 96%), and FITs at the 10 μg Hb/g cut-off (94%; 95% CI 87% to 97%) and 20 μg Hb/g cut-off (96%; 95% CI 91% to 98%). So, out of 9900 participants without CRC, 594 were offered (unnecessary) colonoscopy with gFOBTs versus 594 (10 μg Hb/g) and 396 (20 μg Hb/g) with FITs. In five studies that compared FITs and gFOBTs in the same population, FITs showed a higher discriminative ability for AN than gFOBTs (P = 0.003). We included a total of 30 "reference standard: positive" studies involving 3,664,934 participants. Of these, eight were gFOBT-only studies, 18 were FIT-only studies, and four studies combined both gFOBTs and FITs. The cut-off for positivity of FITs varied between 5 µg to 250 µg Hb/g faeces. For each QUADAS-2 domain, we assessed risk of bias as high in less than 20% of studies. The summary curve showed that FITs had a higher discriminative ability for detecting CRC than gFOBTs (P < 0.001). The summary sensitivity for CRC of gFOBTs, 59% (95% CI 55% to 64%), was significantly lower than FITs at the 10 μg Hb/g cut-off, 89% (95% CI 80% to 95%; P < 0.001) and the 20 μg Hb/g cut-off, 89% (95% CI 85% to 92%; P < 0.001). So, in the hypothetical cohort with 100 participants with CRC, gFOBTs missed 41, while FITs missed 11 (10 μg Hb/g) and 11 (20 μg Hb/g). The summary specificity of gFOBTs was 98% (95% CI 98% to 99%), which was higher than FITs at both 10 μg and 20 μg Hb/g cut-offs: 94% (95% CI 92% to 95%; P < 0.001) and 95% (95% CI 94% to 96%; P < 0.001), respectively. So, out of 9900 participants without CRC, 198 were offered (unnecessary) colonoscopy with gFOBTs compared to 594 (10 μg Hb/g) and 495 (20 μg Hb/g) with FITs. At a specificity of 90% and 95%, FITs had a higher sensitivity than gFOBTs. AUTHORS' CONCLUSIONS FITs are superior to gFOBTs in detecting AN and CRC in average-risk individuals. Specificity of both tests was similar in "reference standard: all" studies, whereas specificity was significantly higher for gFOBTs than FITs in "reference standard: positive" studies. However, at pre-specified specificities, the sensitivity of FITs was significantly higher than gFOBTs.
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Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter HA Wisse
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Aafke van Roon
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Leonie van Dam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wichor Bramer
- Medical Library , Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Whyte S, Thomas C, Chilcott J, Kearns B. Optimizing the Design of a Repeated Fecal Immunochemical Test Bowel Cancer Screening Programme With a Limited Endoscopy Capacity From a Health Economic Perspective. Value Health 2022; 25:954-964. [PMID: 35667783 DOI: 10.1016/j.jval.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In 2016, it was announced that the fecal immunochemical test (FIT) would replace the guaiac fecal occult blood test in the UK Bowel Cancer Screening Programme. England has limited endoscopy capacity. This study informed decision making by determining the most cost-effective FIT screening strategy (age range, frequency, and FIT threshold) under a constrained endoscopy capacity. METHODS An economic model with a colorectal cancer natural history component was used to model 60 221 screening strategies with first screening at age 50 to 60 years, screening interval of 1 to 6 years, 3+ screening episodes, and FIT integer threshold of 20 to 180 μg hemoglobin/g feces. Screening strategies requiring the same endoscopy capacity were compared to determine the characteristics of the most cost-effective strategies. RESULTS With 50 000 annual screening referral colonoscopies, the 20 most cost-effective strategies had a starting age of 50 to 53 years, 2-yearly screening, 7 or 8 rounds of screening, and FIT threshold of 127 to 166. Compared with a 2-yearly screening interval, screening less frequently (3-, 4-, 5-, or 6-yearly) with a more sensitive FIT was less cost-effective. CONCLUSIONS The UK Bowel Cancer Screening Programme should use a 2-yearly FIT screening interval. When endoscopy capacity increases, the screening starting age should be reduced first followed by reducing the FIT threshold. These findings are relevant for other colorectal cancer screening programs with constrained endoscopy capacity.
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Affiliation(s)
- Sophie Whyte
- The University of Sheffield, Sheffield, England, UK.
| | - Chloe Thomas
- The University of Sheffield, Sheffield, England, UK
| | - Jim Chilcott
- Healthcare Decision Modelling, The University of Sheffield, Sheffield, England, UK
| | - Ben Kearns
- The University of Sheffield, Sheffield, England, UK
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Wu WM, Gu K, Yang YH, Bao PP, Gong YM, Shi Y, Xu WH, Fu C. Improved risk scoring systems for colorectal cancer screening in Shanghai, China. Cancer Med 2022; 11:1972-1983. [PMID: 35274820 PMCID: PMC9089226 DOI: 10.1002/cam4.4576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022] Open
Abstract
Background An optimal risk‐scoring system enables more targeted offers for colonoscopy in colorectal cancer (CRC) screening. This analysis aims to develop and validate scoring systems using parametric and non‐parametric methods for average‐risk populations. Methods Screening data of 807,695 subjects and 2806 detected cases in the first‐round CRC screening program in Shanghai were used to develop risk‐predictive models and scoring systems using logistic‐regression (LR) and artificial‐neural‐network (ANN) methods. Performance of established scoring systems was evaluated using area under the receiver operating characteristic curve (AUC), calibration, sensitivity, specificity, number of high‐risk individuals and potential detection rates of CRC. Results Age, sex, CRC in first‐degree relatives, chronic diarrhoea, mucus or bloody stool, history of any cancer and faecal‐immunochemical‐test (FIT) results were identified as predictors for the presence of CRC. The AUC of LR‐based system was 0.642 when using risk factors only in derivation set, and increased to 0.774 by further incorporating one‐sample FIT results, and to 0.808 by including two‐sample FIT results, while those for ANN‐based systems were 0.639, 0.763 and 0.805, respectively. Better calibrations were observed for the LR‐based systems than the ANN‐based ones. Compared with the currently used initial tests, parallel use of FIT with LR‐based systems resulted in improved specificities, less demands for colonoscopy and higher detection rates of CRC, while parallel use of FIT with ANN‐based systems had higher sensitivities; incorporating FIT in the scoring systems further increased specificities, decreased colonoscopy demands and improved detection rates of CRC. Conclusions Our results indicate the potentials of LR‐based scoring systems incorporating one‐ or two‐sample FIT results for CRC mass screening. External validation is warranted for scaling‐up implementation in the Chinese population. The established scoring systems derived from the logistic regression (LR) models, incorporating one‐ or two‐sample faecal immunochemical test (FIT) results as a predictor, have the potential to triage high‐risk individuals for colonoscopy in mass screening of colorectal cancer (CRC). More importantly, the cut‐off points of the scoring systems can be adjusted flexibly, facilitating the choices of cut‐off values for populations with abundant or limited resources.
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Affiliation(s)
- Wei-Miao Wu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Kai Gu
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yi-Hui Yang
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Ping-Ping Bao
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yang-Ming Gong
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Wang-Hong Xu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Chen Fu
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
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Clark GRC, Strachan JA, McPherson A, Digby J, Mowat C, Steele RJC, Fraser CG. Faecal haemoglobin distributions by sex, age, deprivation and geographical region: consequences for colorectal cancer screening strategies. Clin Chem Lab Med 2021; 58:2073-2080. [PMID: 32324157 DOI: 10.1515/cclm-2020-0268] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
Objectives Faecal immunochemical tests for haemoglobin (FIT) are becoming widely used in colorectal cancer (CRC) screening and assessment of symptomatic patients. Faecal haemoglobin concentration (f-Hb) thresholds are used to guide subsequent investigation. We established the distributions of f-Hb in a large screening population by sex, age, deprivation and geography. Methods Single estimates of f-Hb were documented for all individuals participating in the first 18 months of the Scottish Bowel Screening Programme (SBoSP). The distributions of f-Hb were generated for all participants, all men and women, and men and women by age quintile and deprivation quintile. Distributions were also generated by geographical region for all participants, men and women, and by deprivation. Comparisons of f-Hb distributions with those found in a pilot evaluation of FIT and three other countries were performed. Results f-Hb was documented for 887,248 screening participants, 422,385 men and 464,863 women. f-Hb varied by sex, age, deprivation quintile and geographical region. The f-Hb distributions by sex and age differed between the SBoSP and the pilot evaluation and the three other countries. Conclusions f-Hb is higher in men than in women and increases with age and deprivation in both sexes. f-Hb also varies by geographical region, independently of deprivation, and by country. The f-Hb distribution estimated by pilot evaluation may not represent the population distribution. Decision limits have advantages over reference intervals. Use of partitioned f-Hb thresholds for further investigation, based on the data generated, has advantages and disadvantages, as do risk scores based on a spectrum of influencing variables.
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Affiliation(s)
- Gavin R C Clark
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK.,Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Alisson McPherson
- Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Young GP, Chen G, Wilson CJ, McGrane E, Hughes-Barton DLA, Flight IHK, Symonds EL. "Rescue" of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options. Cancer Prev Res (Phila) 2021; 14:803-810. [PMID: 34127509 DOI: 10.1158/1940-6207.capr-21-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, participation was significantly higher with FIT (9.7%, 28/290) compared with the blood test (3.8%, 11/290, P = 0.005). The only variable significantly associated with participation was socioeconomic status when offered FIT, and age when offered choice but there was none when offered the blood test. Survey respondents indicated that convenience, time-saving, comfort, and familiarity were major influences on participation. There was no clear advantage between a fecal test, blood test, or choice of test although, when given a choice, the fecal test was preferred. Differences in variables associated with participation according to invitation strategy warrant consideration when deciding upon an invitation strategy for screening nonparticipants. PREVENTION RELEVANCE: This trial of screening for those at average risk for colorectal cancer targeted past fecal-test nonparticipants and compared participation rates for mailed invitations offering a fecal test, blood test, or choice of either. Although there was no clear advantage between strategies, factors associated with participation differed between each strategy.
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Affiliation(s)
- Graeme Paul Young
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia. .,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caufield East, Victoria, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Ellen McGrane
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Donna Lee-Ann Hughes-Barton
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ingrid Helen K Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin Leigh Symonds
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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10
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Azulay R, Valinsky L, Hershkowitz F, Elran E, Lederman N, Kariv R, Braunstein B, Heymann A. Barriers to completing colonoscopy after a positive fecal occult blood test. Isr J Health Policy Res 2021; 10:11. [PMID: 33573698 PMCID: PMC7879608 DOI: 10.1186/s13584-021-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.
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Affiliation(s)
| | - Liora Valinsky
- Public Health Nursing, Ministry of Health, Jerusalem, Israel
| | | | - Einat Elran
- Maccabi Healthcare Services, Tel aviv, Israel
| | | | - Revital Kariv
- Maccabi Healthcare Services, Tel aviv, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony Heymann
- Meuhedet Health Care, 5 Pesach Lev, Lod, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
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11
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Hsu WF, Hsu CY, Yen AMF, Chen SLS, Chiu SYH, Fann JCY, Lee YC, Chiu HM, Chen HH. Classifying interval cancers as false negatives or newly occurring in fecal immunochemical testing. J Med Screen 2021; 28:286-294. [PMID: 33461420 DOI: 10.1177/0969141320986830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To classify interval colorectal cancers as false negatives or newly occurring cases in a biennial Fecal immunochemical test (FIT) screening program and by various interscreening intervals. SETTING Data from the Taiwanese biennial colorectal cancer screening program involving FIT from 2004 to 2014 were used to estimate the incidence rate of asymptomatic colorectal cancer and the rate of its subsequent progression to clinical mode. METHODS The sensitivity of detecting asymptomatic colorectal cancers excluding newly developed colorectal cancers was compared to the conventional estimate of sensitivity, the complementary FIT interval cancer rate as a percentage of the expected incidence rate ((1-I/E)%). The relative contribution of newly developed or false-negative cases to FIT interval colorectal cancers was estimated by age and interscreening intervals. RESULTS The Taiwanese biennial fecal immunochemical test screening program had a conventional sensitivity estimate of 70.2%. After newly developed colorectal cancers were separated from FIT interval cancers, the ability to detect asymptomatic colorectal cancers increased to 75.5%. FIT interval colorectal cancers from the biennial program mainly resulted from newly developed colorectal cancers (68.8%). The corresponding figures decreased to 61.1% for the annual program but increased to 74.7% for the triennial program. The preponderance of newly developed colorectal cancers among FIT interval cancers was more prominent in screenees aged 50-59 than in those aged 60-69. CONCLUSIONS Newly developed colorectal cancers showed a predominance among the FIT interval colorectal cancers in particular in the younger population screened. It is desirable to identify high-risk individuals to offer them a short interscreening interval or advanced detection methods to reduce their odds of developing interval cancer.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Medicine, National Taiwan University Cancer Center, Taipei.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,Master of Public Health Program, College of Public Health, National Taiwan University, Taipei
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan.,Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
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12
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Clark G, Strachan JA, Carey FA, Godfrey T, Irvine A, McPherson A, Brand J, Anderson AS, Fraser CG, Steele RJ. Transition to quantitative faecal immunochemical testing from guaiac faecal occult blood testing in a fully rolled-out population-based national bowel screening programme. Gut 2021; 70:106-113. [PMID: 32234803 DOI: 10.1136/gutjnl-2019-320297] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Faecal immunochemical tests (FIT) are replacing guaiac faecal occult blood tests (FOBT) in colorectal cancer (CRC) screening. Data from the first year of FIT screening were compared with those from FOBT screening and assumptions based on a pilot evaluation of FIT. DESIGN Data on uptake, positivity, positive predictive value (PPV) for CRC and higher-risk adenoma from participants in the first year of the FIT-based Scottish Bowel Screening Programme (n=919 665), with a threshold of 80 µg Hb/g faeces, were compared with those from the penultimate year of the FOBT-based programme (n=862 165) and those from the FIT evaluation (n=66 225). RESULTS Overall, uptake of FIT was 63.9% compared with 56.4% for FOBT. Positivity was 3.1% and 2.2% with FIT and FOBT; increases were seen in both sexes, and across age range and deprivation. More CRC and adenomas were detected by FIT, but the PPV for CRC was less (5.2% with FIT and 6.4% with FOBT). However, for higher-risk adenoma, PPV was greater with FIT (24.3% with FIT and 19.3% with FOBT). In the previous FIT evaluation, uptake was 58.5% with FIT compared with 54.0% with FOBT; positivity was 2.5% with FIT and 2.0% with FOBT. CONCLUSION Transition to FIT from FOBT produced higher uptake and positivity with lower PPV for CRC and higher PPV for adenoma. The FIT pilot evaluation underestimated uptake and positivity. Introducing FIT at the same threshold as the evaluation caused a 67.2% increase in colonoscopy demand instead of a predicted 10%.
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Affiliation(s)
- Gavin Clark
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - Judith A Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Frank A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Thomas Godfrey
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - Audrey Irvine
- Scottish Bowel Screening Centre, Dundee, Scotland, UK
| | - Alisson McPherson
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Jess Brand
- National Specialist and Screening Services Directorate, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition, University of Dundee, Dundee, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Robert Jc Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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13
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Paszat LF, Sutradhar R, Luo J, Baxter NN, Tinmouth J, Rabeneck L. Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program. J Med Screen 2020; 28:261-267. [PMID: 33153368 PMCID: PMC8366188 DOI: 10.1177/0969141320967960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background and aims Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program. Methods We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection. Results For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%). Conclusions Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.
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Affiliation(s)
- Lawrence F Paszat
- Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jin Luo
- Cancer Program, Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Nancy N Baxter
- Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jill Tinmouth
- Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Linda Rabeneck
- Institute for Health Care Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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14
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Libby G, Barnett KN, Fraser CG, Steele RJC. Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study. J Clin Pathol 2020; 74:664-667. [PMID: 33051288 DOI: 10.1136/jclinpath-2020-206986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
AIMS The presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal blood loss. This effect is independent of taking medicines that increase the risk of bleeding. To further investigate the association of f-Hb with chronic disease, the relationship between f-Hb and prescription of medicines for a variety of conditions was studied. METHODS All subjects (134 192) who participated in guaiac faecal occult blood test (gFOBT) screening in Tayside, Scotland, between March 2000 and March 2016, were studied in a cross-sectional manner by linking their gFOBT result (abnormal or normal) with prescribing data at the time of the test. RESULTS The screening participants with an abnormal gFOBT result were more likely to have been being prescribed medicines for heart disease, hypertension, diabetes and depression than those with a normal test result. This association persisted after adjustment for sex, age and deprivation (OR 1.35 (95%CI 1.23 to 1.48), 1.39 (1.27 to 1.52), 1.35 (1.15 to 1.58), 1.36 (1.16 to 1.59), all p<0.0001, for the four medicine categories, respectively). CONCLUSIONS The results of this study confer further substantial weight to the concept that detectable f-Hb is associated with a range of common chronic conditions that have a systemic inflammatory component; we speculate that f-Hb might have potential in identifying individuals who are high risk of developing chronic conditions or are at an early stage of disease.
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Affiliation(s)
- Gillian Libby
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Faculty of Medicine and Health, Leeds, West Yorkshire, UK
| | - Karen N Barnett
- Division of Public Health and Genomics, University of Dundee School of Medicine, Dundee, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention & Screening, University of Dundee School of Medicine, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention & Screening, University of Dundee School of Medicine, Dundee, Scotland, UK
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15
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Guimarães DP, Mantuan LA, de Oliveira MA, Junior RL, Costa AMD, Rossi S, Fava G, Taveira LN, Giardina KM, Talarico T, Costa M, Scapulatempo-Neto C, Matsushita MM, Véo CA, Fregnani JHT, Reis RM, Hawk ET, Mauad EC. The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital. Cancer Prev Res (Phila) 2020; 14:241-252. [PMID: 32998941 DOI: 10.1158/1940-6207.capr-20-0179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/01/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
Colorectal cancer is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution that cares for underserved patients. BCH developed a fecal immunochemical test (FIT)-based organized colorectal cancer screening program to improve colorectal cancer outcomes.This study aims to present the quality/performance measures of the first 2 years of the FIT-based colorectal cancer screening program and its impact on the colorectal cancer disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, ages 50 to 65 years, were personally invited by a health agent/nurse practitioner. Exclusion criteria were personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, and colonoscopy, or flexible sigmoidoscopy performed in the past 5 years. European Union (EU) guidelines for colorectal cancer screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma, and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed colorectal cancer cancers reported at BCH and Brazilian cancer registries. Our colorectal cancer screening program achieved desirable quality metrics, aligned with the EU guidelines. The observed shift toward earlier colorectal cancer stages suggests an exciting opportunity to improve colorectal cancer-related cancers in Brazil.
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Affiliation(s)
- Denise Peixoto Guimarães
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil. .,Department of Prevention, Barretos Cancer Hospital, Barretos, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | - Silvana Rossi
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | - Gilberto Fava
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | - Thais Talarico
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Maraisa Costa
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | - Carlos Augusto Véo
- Department of Lower Digestive Surgery, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Ernest T Hawk
- Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Clark GR, Anderson AS, Godfrey TG, Strachan JA, Fraser CG, Steele RJ. Variation in changes in the incidence of colorectal cancer by age and association with screening uptake: an observational study. BMJ Open 2020; 10:e037925. [PMID: 32963068 PMCID: PMC7509976 DOI: 10.1136/bmjopen-2020-037925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES In developed countries, the incidence of colorectal cancer (CRC) has declined in the over 50 years age group but increased in younger people. We studied CRC incidence by age and the influence of screening uptake. DESIGN Age-standardised and sex-standardised incidences for CRC from 1997 to 2017 were obtained from the Scottish Cancer Registry (SCR). In addition, linkage between the Scottish Bowel Screening Database and the SCR allowed investigation of any association between screening participation and CRC incidence. SETTING Scotland and the Scottish Bowel Screening Programme, in which guaiac faecal occult blood test screening was piloted from March 2000 and fully rolled by December 2009. PARTICIPANTS From the introduction of screening in 2000 through to 2017, 2 395 172 were invited to participate, of whom 1 487 999 participated at least once. MAIN OUTCOME MEASURES Incidence of CRC. RESULTS In the screening age range (50-74 years), CRC incidence peaked at 156.5 cases per 100 000 in 2010 after full roll-out of screening across Scotland but fell to 123.9 per 100 000 in 2017. However, under 50 years, there was a rise from 5.3 cases per 100 000 in 2000 to 6.8 per 100 000 in 2017. When CRC incidence was examined in those who had been offered screening, incidence fell in the participant group more than in the non-participant group after roll-out of screening was complete. Analysis of cumulative incidence demonstrated that CRC incidence in the participant group remained consistently below that of the non-participant from around 7 years of follow-up. CONCLUSIONS The incidence of CRC in Scotland has declined in the over 50 years age group but increased in younger people. It is likely that population screening has contributed to the reduction in CRC incidence in the over 50 years age group.
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Affiliation(s)
- Gavin Rc Clark
- Information Services Division, NHS Scotland National Services Division, Edinburgh, Scotland, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
| | - Thomas G Godfrey
- Information Services Division, NHS Scotland National Services Division, Edinburgh, Scotland, UK
| | | | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Robert Jc Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
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17
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Kotzur M, McCowan C, Macdonald S, Wyke S, Gatting L, Campbell C, Weller D, Crighton E, Steele RJC, Robb KA. Why colorectal screening fails to achieve the uptake rates of breast and cervical cancer screening: a comparative qualitative study. BMJ Qual Saf 2020; 29:482-490. [PMID: 31879320 DOI: 10.1136/bmjqs-2019-009998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/04/2019] [Accepted: 11/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories. METHODS We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal ('colorectal-specific non-participants'); (3) participated in none. To identify the sample we linked the data for all women eligible for all three screening programmes in Glasgow, Scotland (aged 51-64 years; n=68 324). Interviews covered perceptions of cancer, screening and screening decisions. Framework method was used for analysis. RESULTS Of the 2924 women invited, 86 expressed an interest, and 59 were interviewed. The three groups' perceptions differed, with the colorectal-specific non-participants expressing that: (1) treatment for colorectal cancer is more severe than for breast or cervical cancer; (2) colorectal symptoms are easier to self-detect than breast or cervical symptoms; (3) they worried about completing the test incorrectly; and (4) the colorectal test could be more easily delayed or forgotten than breast or cervical screening. CONCLUSION Our comparative approach suggested targets for future interventions to increase colorectal screening uptake including: (1) reducing fear of colorectal cancer treatments; (2) increasing awareness that screening is for the asymptomatic; (3) increasing confidence to self-complete the test; and (4) providing a suggested deadline and/or additional reminders.
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Affiliation(s)
- Marie Kotzur
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Sara Macdonald
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Gatting
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David Weller
- General Practice, University of Edinburgh, Edinburgh, UK
| | - Emilia Crighton
- Public Health Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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18
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Toes-Zoutendijk E, Kooyker AI, Dekker E, Spaander MCW, Opstal-van Winden AWJ, Ramakers C, Buskermolen M, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, Velthuysen MLF, Thomeer MGJ, van Veldhuizen H, van Ballegooijen M, Nagtegaal ID, de Koning HJ, van Leerdam ME, Lansdorp-Vogelaar I, Otte J, Wiersma T, Masclee A, van Bergeijk J, Meijer G, de Graaf E, van Grevenstein W, Frasa M, Jacobs L, Stoker J, Vink G, Elferink M. Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age. Clin Gastroenterol Hepatol 2020; 18:1493-1500. [PMID: 31442598 DOI: 10.1016/j.cgh.2019.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We evaluated the incidence of interval cancers between the first and second rounds of colorectal cancer (CRC) screening with the FOB-Gold fecal immunochemical test (FIT), and the effects of different cutoff values and patient sex and age. METHODS We collected data from participants in a population-based CRC screening program in the Netherlands who had a negative result from a first-round of FIT screening. We calculated the cumulative incidence of interval cancer after a negative result from a FIT and the sensitivity of the FIT for detection of CRC at a low (15 μg Hb/g feces) and high (47 μg Hb/g feces) cutoff value. RESULTS Among the 485,112 participants with a negative result from a FIT, 544 interval cancers were detected; 126 were in the 111,800 participants with negative results from a FIT with the low cutoff value and 418 were in the 373,312 FIT participants with negative results from a FIT with the high cutoff value. The mean age of participants tested with the low cutoff value was 72.0 years and the mean age of participants tested the high cutoff value was 66.7 years. The age-adjusted 2-year cumulative incidence of interval cancer after a negative result from a FIT were 9.5 per 10,000 persons at the low cutoff value vs 13.8 per 10,000 persons at the high cutoff value (P < .005). The age-adjusted sensitivity of the FIT for CRC were 90.5% for the low cutoff value vs 82.9% for the high cutoff (P < .0001). The FIT identified men with CRC with 87.4% sensitivity and women with CRC with 82.6% sensitivity (P < .001). CONCLUSIONS In an analysis of data from a FIT population-based screening program in the Netherlands, we found that incidence of interval CRC after a negative result from a FIT to be low. Although the sensitivity of detection of CRC decreased with a higher FIT cutoff value, it remained above 80%.
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Affiliation(s)
- Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Arthur I Kooyker
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Academic University Medical Centers, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maaike Buskermolen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Maarten G J Thomeer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harriët van Veldhuizen
- Department of Quality Improvement, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Digby J, Cleary S, Gray L, Datt P, Goudie DR, Steele RJC, Strachan JA, Humphries A, Fraser CG, Mowat C. Faecal haemoglobin can define risk of colorectal neoplasia at surveillance colonoscopy in patients at increased risk of colorectal cancer. United European Gastroenterol J 2020; 8:559-566. [PMID: 32213041 PMCID: PMC7268942 DOI: 10.1177/2050640620913674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Quantitative faecal immunochemical tests measure faecal haemoglobin concentration (f-Hb), which increases in the presence of colorectal neoplasia. Objective We examined the diagnostic accuracy of faecal immunochemical test (FIT)in patients at increased risk of colorectal cancer (CRC) attending for surveillance colonoscopy as per national guidelines. Methods A total of 1103 consecutive patients were prospectively invited to complete a FIT before their scheduled colonoscopy in two university hospitals in 2014– 2016. F-Hb was analysed on an OC-Sensor io automated analyser (Eiken Chemical Co., Ltd, Tokyo, Japan) with a limit of detection of 2 µg Hb/g faeces. The diagnostic accuracy of f-Hb for CRC and higher-risk adenoma was examined. Results A total of 643 patients returned a faecal test. After excluding 4 patients with known inflammatory bowel disease, 639 (57.9%) remained in the study: age range: 25–90 years (median: 64 years, interquartile range (IQR): 55–71): 54.6% male. Of 593 patients who also completed colonoscopy, 41 (6.9%) had advanced neoplasia (4 CRC, 37 higher-risk adenoma). Of the 238 patients (40.1%) who had detectable f-Hb, 31 (13.0%) had advanced neoplasia (2 CRC, 29 higher-risk adenoma) compared with 10 (2.8%) in those with undetectable f-Hb (2 CRC, 8 higher-risk adenoma). Detectable f-Hb gave negative predictive values of 99.4% for CRC and 97.2% for CRC plus higher-risk adenoma. Conclusion In patients at increased risk of CRC under colonoscopy surveillance, a test measuring faecal haemoglobin can provide an objective estimate of the risk of advanced neoplasia, and could enable tailored scheduling of colonoscopy.
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Affiliation(s)
- Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Shirley Cleary
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Lynne Gray
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Pooja Datt
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - David R Goudie
- Department of Clinical Genetics, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Adam Humphries
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Patasius A, Smailyte G. Changing Incidence and Stage Distribution of Prostate Cancer in a Lithuanian Population-Evidence from National PSA-Based Screening Program. Int J Environ Res Public Health 2019; 16:ijerph16234856. [PMID: 31816821 PMCID: PMC6926594 DOI: 10.3390/ijerph16234856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022]
Abstract
Background: The aim of this study was to examine the impact of screening introduction on prostate cancer incidence changes, and changes in stage distribution in Lithuania between 1998–2016. Methods: Age-standardized incidence as well as stage-specific incidence rates were calculated. Joinpoint regression was used to estimate the annual percentage change in the incidence changes by determined stage: Localized, advanced, distant and unknown. Results: Over the study period, a total number of 48,815 new prostate cancer cases was identified. Age-standardized incidence rose from 51.9 per 100,000 in 1998 to 279.3 per 100,000 in 2007 (by 20.3% per year) and then decreased thereafter by 3.8% annually. Highest incidence rates after introduction of prostate specific antigene (PSA)-based screening was found for localized disease, followed by advanced. Incidence of localized disease rose by 38.2% per year until 2007 reaching the highest rate of 284.6 per 100,000, with a subsequent decrease of 5.5% every year thereafter. Advanced stage of disease experienced rise till 2007, and continuous decrease by 11.1% every year thereafter. Incidence of disease with distant metastasis was lowest, and rose till 2003, thereafter incidence significantly decreased by 8.1% every year. Conclusions: To our knowledge, this is the first report of stage migration effect in Lithuania, following the introduction of nationwide PSA-based screening. Prostate cancer screening substantially increased the overall incidence and incidence of localized cancer.
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Affiliation(s)
- Ausvydas Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, LT-08406 Vilnius, Lithuania;
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-5278-6756
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, LT-08406 Vilnius, Lithuania;
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
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Bretagne JF, Piette C, Cosson M, Durand G, Lièvre A. Switching from guaiac to immunochemical faecal occult blood test increases participation and diagnostic yield of colorectal cancer screening. Dig Liver Dis 2019; 51:1461-1469. [PMID: 31151896 DOI: 10.1016/j.dld.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Compared with the guaiac-faecal occult blood test (gFOBT), faecal immunological tests (FIT) are considered to be more effective for colorectal cancer (CRC) screening. However, only scarce research has examined the outcomes of switching to FIT within a mature gFOBT-based CRC screening programme. METHODS We reported a 15-year experience of biennial FOBT screening in a well-defined population of approximately one million inhabitants, including six gFOBT-based screening rounds and one round with FIT at the 30 μg Hb/g cut-off. The main outcome measures were screening participation, FOBT positivity and advanced neoplasia detection in each round. RESULTS In this study, 647 676 screenings were performed in 228 716 different individuals, leading to 17 819 positives and 16 580 follow-up colonoscopies. Compared with the last gFOBT round, switching to FIT led to an increased participation of nearly 20% points, and a fivefold increased detection of CRC and advanced adenoma among invitees (3-fold among attendees). The numbers needed to screen and scope to detect one advanced neoplasia declined from 221 to 66 and from 4.7 to 2.6, respectively. CONCLUSIONS The present population-based study demonstrated a dramatical increase in the diagnostic yield of advanced neoplasia by switching to FIT within a mature gFOBT-based CRC screening programme.
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Affiliation(s)
- Jean-François Bretagne
- Rennes 1 University, Rennes, France; Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France.
| | - Christine Piette
- Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France
| | - Mathilde Cosson
- Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France
| | - Gérard Durand
- Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France
| | - Astrid Lièvre
- Rennes 1 University, Rennes, France; Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France; Department of Gastroenterology, CHU Pontchaillou, Rennes, France; INSERM UMR 1242, COSS "Chemistry, Oncogenesis, Stress Signaling", Rennes, France
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Yamamoto H, Hayashi K, Scherb H. Association between the detection rate of thyroid cancer and the external radiation dose-rate after the nuclear power plant accidents in Fukushima, Japan. Medicine (Baltimore) 2019; 98:e17165. [PMID: 31517868 PMCID: PMC6750239 DOI: 10.1097/md.0000000000017165] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (μSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per μSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 μSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per μSv/h 1.555 (1.096, 2.206).The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.
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Affiliation(s)
- Hidehiko Yamamoto
- Osaka Red Cross Hospital Attached Facility of Physically Handicapped Children, 5-30 Fudegasaki-cho, Tennouji-ku
| | - Keiji Hayashi
- Hayashi Children's Clinic, 4-6-11-1F Nagata, Joto-ku, Osaka-Shi Osaka, Japan
| | - Hagen Scherb
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Computational Biology, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany
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Goulding A, Clark GRC, Anderson AS, Strachan JA, Fraser CG, Steele RJC. Changes in prevalence of faecal occult blood positivity over time. J Med Screen 2019; 26:191-196. [DOI: 10.1177/0969141319866880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives Changes in the prevalence of faecal occult blood test positivity over time have not been previously reported, but could have important implications. This study examined the positivity of the initial guaiac faecal occult blood test, a surrogate marker for colorectal bleeding, in participants aged 50 in a national bowel screening programme. Methods Data from the Scottish Bowel Screening Programme were used to study the initial positivity of the guaiac faecal occult blood test between 2007 and 2017. Positive predictive values of the testing process for colorectal cancer and adenoma were assessed over the same time period. Results Across Scotland, the initial guaiac faecal occult blood test positivity increased from 4.1 to 10.8%. In NHS Grampian and NHS Fife, two of the three NHS Boards which began roll-out of screening in 2007, it increased from 4.0 to 10.9%. In the Scottish Bowel Screening Programme, the positive predictive value declined from 11.0 to 6.6% for colorectal cancer and increased from 31.6 to 39.8% for adenoma. Conclusions In the Scottish programme over a decade, initial guaiac faecal occult blood test positivity increased in participants aged 50. This may be associated with changes in lifestyle and might have implications for screening clinical outcomes, including positive predictive value.
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Affiliation(s)
- Anna Goulding
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland
| | - Gavin RC Clark
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland
| | - Annie S Anderson
- Centre for Public Health Nutrition, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Judith A Strachan
- Department of Blood Sciences and Scottish Bowel Screening Laboratory, NHS Tayside, Dundee, Scotland
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
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Schreuders EH, Grobbee EJ, Nieuwenburg SAV, Kapidzic A, van Roon AHC, van Vuuren AJ, Lansdorp-Vogelaar I, Spijker WWJ, Izelaar K, Bruno MJ, Kuipers EJ, Spaander MCW. Multiple rounds of one sample versus two sample faecal immunochemical test-based colorectal cancer screening: a population-based study. Lancet Gastroenterol Hepatol 2019; 4:622-631. [PMID: 31196734 DOI: 10.1016/s2468-1253(19)30176-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Faecal immunochemical test (FIT)-based colorectal cancer screening requires successive rounds for maximum preventive effect. Advanced neoplasia can bleed intermittently and thus might be missed by single faecal sampling. Few studies have been done on two sample FIT (2-FIT) screening over multiple rounds. Therefore, we compared multiple rounds of one sample FIT (1-FIT) with 2-FIT screening with respect to participation, positive predictive value (PPV), diagnostic yield, and interval colorectal cancer. METHODS In this population-based study, a random selection of asymptomatic individuals aged 50-74 years in the Rotterdam-Rijnmond region, Netherlands, were invited by post for four rounds (every 2 years) of 1-FIT or 2-FIT screening. Key exclusion criteria were a history or colorectal cancer or inflammatory bowel disease, colon imaging in the previous 2 years, and life expectancy of less than 5 years. Per round, invitees received one or two FITs to sample either one or two consecutive bowel movements. OC-Sensor Micro (Eiken Chemical Co., Ltd, Japan) FITs were used by all participants, except the fourth round of screening for the 1-FIT cohort, for which participants used either an OC-Sensor or a FOB-Gold (Sentinel Diagnostics, Milan, Italy). A faecal haemoglobin cutoff concentration of 10 μg/g of faeces in at least one test was used for referral for colonoscopy. FINDINGS Between 2006 and 2015, of 10 008 invited individuals for the 1-FIT cohort, 9787 were eligible for inclusion, of whom 7310 participated at least once in four successive rounds. Of 3197 invited individuals for the 2-FIT cohort, 3131 were eligible for inclusion, and 2269 participated at least once in four successive rounds. In the 1-FIT screening cohort, 74·7% (7310 of 9787) of invitees participated at least once versus 72·5% (2269 of 3131) of invitees in the 2-FIT cohort (p=0·013). Among participants who participated at least once, the cumulative positivity rate over four rounds was 19·2% (1407 of 7310) for the 1-FIT cohort versus 28·5% (647 of 2269) for the 2-FIT cohort (p<0·0001). The cumulative PPV for advanced neoplasia was 33·0% (432 of 1308 colonoscopies) for the 1-FIT cohort versus 24·2% (147 of 607 colonoscopies) for the 2-FIT cohort (p<0·0001). The cumulative diagnostic yield of advanced neoplasia among invited individuals was 4·4% (432 of 9787) for 1-FIT versus 4·7% (147 of 3131) for 2-FIT screening (p=0·46)). FIT interval colorectal cancers were detected in eight (0·1%) of 7310 participants in the 1-FIT cohort and two (0·1%) of 2269 with 2-FIT screening (p=1·00). INTERPRETATION Four rounds of 2-FIT screening with a low faecal haemoglobin cutoff level did not result in a significant increase in diagnostic yield or a decrease in interval colorectal cancers compared with 1-FIT, despite higher colonoscopy demand. Therefore, 1-FIT colorectal cancer screening programmes should be preferred. FUNDING None.
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Affiliation(s)
- Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Atija Kapidzic
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Aafke H C van Roon
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Wolfert W J Spijker
- Regional Organization for Population Screening South-West Netherlands, Rotterdam, Netherlands
| | - Kirsten Izelaar
- Regional Organization for Population Screening South-West Netherlands, Rotterdam, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
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He E, Alison R, Blanks R, Pirie K, Reeves G, Ward RL, Steele R, Patnick J, Canfell K, Beral V, Green J. Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England. Int J Epidemiol 2019; 48:549-558. [PMID: 30668711 PMCID: PMC6469304 DOI: 10.1093/ije/dyy271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding. METHODS By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders. RESULTS RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively. CONCLUSIONS Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.
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Affiliation(s)
- Emily He
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Prince of Wales Clinical School, University of New South Wales Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Rupert Alison
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roger Blanks
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kirstin Pirie
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robyn L Ward
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robert Steele
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Canfell
- Prince of Wales Clinical School, University of New South Wales Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Benito L, Travier N, Binefa G, Vidal C, Espinosa J, Milà N, Garcia M. Longitudinal Adherence to Immunochemical Fecal Occult Blood Testing vs Guaiac-based FOBT in an Organized Colorectal Cancer Screening Program. Cancer Prev Res (Phila) 2019; 12:327-334. [PMID: 30890542 DOI: 10.1158/1940-6207.capr-18-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 11/29/2018] [Accepted: 03/13/2019] [Indexed: 11/16/2022]
Abstract
Longitudinal adherence is a critical component of the efficacy of stool-based screening programs because they should be repeated every 1-2 years. Few data have been published on the uptake in multiple rounds of fecal occult blood test-based (FOBT) colorectal cancer (CRC) screening. We calculated two measures of longitudinal adherence to biennial FOBT (guaiac fecal occult blood test:gFOBT or fecal immunochemical test:FIT) to better understand its impact on the programmatic effectiveness of a population-based CRC screening program (2000-2017). Ongoing population-based CRC program of men and women aged 50-69 years. Variables: Age at first CRC screening invitation, sex, number of screening invitations, number of screens, deprivation score, and uptake rate. Logistic regression models were used to assess the independent effect of sex, age at first invitation, deprivation, and the type of screening test offered on adherence. The uptake rate for guaiac fecal occult blood test (gFOBT) was 23.9%, and for the fecal immunochemical test (FIT), it was 37.4%. The overall rate of consistently screened invitees after seven rounds of screening was 14.2%, being 20.6% for those individuals who used FIT and 14.3% for those who used gFOBT. Factors associated with continued participation (consistent vs. inconsistent screenees) showed that the longitudinal adherence was associated with age, screening test used, and number of invitations. Continued participation was lower in individuals who were screened using FIT than among those screened using gFOBT [OR, 0.68; 95% confidence interval (CI), 0.57-0.81]. The overall rate of consistently screened invitees for colorectal cancer screening was higher with FIT than gFOBT. Studying the rate of individuals being current for screening may help to anticipate potential benefits before the long-term outcome data are available.
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Affiliation(s)
- Llucia Benito
- School of Nursing, University of Barcelona, Fundamental Care and Medical-Surgical Nursing Department, Hospitalet de Llobregat, Barcelona, Spain
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
| | - Noemie Travier
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Binefa
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carmen Vidal
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
| | - Jose Espinosa
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Milà
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Montse Garcia
- IDIBELL, Institute of Biomedical Research, Hospitalet de Llobregat, Barcelona, Spain.
- Catalan Institute of Oncology, Cancer Prevention and Control Program, Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Azulay R, Valinsky L, Hershkowitz F, Magnezi R. Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e11114. [PMID: 30720439 PMCID: PMC6379817 DOI: 10.2196/11114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/25/2018] [Accepted: 10/26/2018] [Indexed: 01/09/2023] Open
Abstract
Background Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation. Objective The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result. Methods This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude. Results Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001). Conclusions A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests. Trial Registration ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl)
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Affiliation(s)
- Revital Azulay
- Master of Health Administration Program, Department of Management, Bar Ilan University, Ramat Gan, Israel.,Central Laboratory, Meuhedet Health Care, Lod, Israel
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, Tel Aviv, Israel
| | | | - Racheli Magnezi
- Master of Health Administration Program, Department of Management, Bar Ilan University, Ramat Gan, Israel
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Atkin W, Cross AJ, Kralj-Hans I, MacRae E, Piggott C, Pearson S, Wooldrage K, Brown J, Lucas F, Prendergast A, Marchevsky N, Patel B, Pack K, Howe R, Skrobanski H, Kerrison R, Swart N, Snowball J, Duffy SW, Morris S, von Wagner C, Halloran S. Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study. Health Technol Assess 2019; 23:1-84. [PMID: 30618357 PMCID: PMC6340104 DOI: 10.3310/hta23010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications. OBJECTIVES To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs). DESIGN Diagnostic accuracy study with health psychology assessment and economic evaluation. SETTING Participants were recruited from 30 January 2012 to 30 December 2013 within the Bowel Cancer Screening Programme in England. PARTICIPANTS Men and women, aged 60-72 years, deemed to be at intermediate risk of CRC following adenoma removal after a positive guaiac faecal occult blood test were invited to participate. Invitees who consented and returned an analysable FIT were included. INTERVENTION We offered participants quantitative FITs at 1, 2 and 3 years post polypectomy. Participants testing positive with any FIT were referred for colonoscopy and not offered further FITs. Participants testing negative were offered colonoscopy at 3 years post polypectomy. Acceptibility of FIT was assessed using discussion groups, questionnaires and interviews. MAIN OUTCOME MEASURES The primary outcome was 3-year sensitivity of an annual FIT versus colonoscopy at 3 years for detecting advanced colorectal neoplasia (ACN) (CRC and/or AA). Secondary outcomes included participants' surveillance preferences, and the incremental costs and cost-effectiveness of FIT versus colonoscopy surveillance. RESULTS Of 8008 invitees, 5946 (74.3%) consented and returned a round 1 FIT. FIT uptake in rounds 2 and 3 was 97.2% and 96.9%, respectively. With a threshold of 40 µg of haemoglobin (Hb)/g faeces (hereafter referred to as µg/g), positivity was 5.8% in round 1, declining to 4.1% in round 3. Over three rounds, 69.2% (18/26) of participants with CRC, 34.3% (152/443) with AAs and 35.6% (165/463) with ACN tested positive at 40 µg/g. Sensitivity for CRC and AAs increased, whereas specificity decreased, with lower thresholds and multiple rounds. At 40 µg/g, sensitivity and specificity of the first FIT for CRC were 30.8% and 93.9%, respectively. The programme sensitivity and specificity of three rounds at 10 µg/g were 84.6% and 70.8%, respectively. Participants' preferred surveillance strategy was 3-yearly colonoscopy plus annual FITs (57.9%), followed by annual FITs with colonoscopy in positive cases (31.5%). FIT with colonoscopy in positive cases was cheaper than 3-yearly colonoscopy (£2,633,382), varying from £485,236 (40 µg/g) to £956,602 (10 µg/g). Over 3 years, FIT surveillance could miss 291 AAs and eight CRCs using a threshold of 40 µg/g, or 189 AAs and four CRCs using a threshold of 10 µg/g. CONCLUSIONS Annual low-threshold FIT with colonoscopy in positive cases achieved high sensitivity for CRC and would be cost saving compared with 3-yearly colonoscopy. However, at higher thresholds, this strategy could miss 15-30% of CRCs and 40-70% of AAs. Most participants preferred annual FITs plus 3-yearly colonoscopy. Further research is needed to define a clear role for FITs in surveillance. FUTURE WORK Evaluate the impact of ACN missed by FITs on quality-adjusted life-years. TRIAL REGISTRATION Current Controlled Trials ISRCTN18040196. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment programme, NIHR Imperial Biomedical Research Centre and the Bobby Moore Fund for Cancer Research UK. MAST Group Ltd provided FIT kits.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eilidh MacRae
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carolyn Piggott
- Bowel Cancer Screening Programme Southern Hub, Guildford, UK
| | - Sheena Pearson
- Bowel Cancer Screening Programme Southern Hub, Guildford, UK
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jeremy Brown
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Aaron Prendergast
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalie Marchevsky
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bhavita Patel
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rosemary Howe
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hanna Skrobanski
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Nicholas Swart
- Department of Applied Health Research, University College London, London, UK
| | - Julia Snowball
- Bowel Cancer Screening Programme Southern Hub, Guildford, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventative Medicine, Queen Mary University, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Azulay R, Valinsky L, Hershkowitz F, Magnezi R. Is the patient activation measure associated with adherence to colonoscopy after a positive fecal occult blood test result? Isr J Health Policy Res 2018; 7:74. [PMID: 30577883 PMCID: PMC6303990 DOI: 10.1186/s13584-018-0270-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 12/10/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide, but these can be reduced significantly with population screening using annual fecal occult blood tests (FOBT)A positive FOBT requires timely follow-up with colonoscopy to maximize screening benefits.. Several barriers to follow-up have been identified, with patient health behaviors and choices comprising a significant part of these. The Patient Activation Measure (PAM) assesses knowledge, skills, beliefs, and confidence in managing health. Increased patient activation is related to positive health outcomes. The aim of this study is to examine the association between patient empowerment, as reflected in the PAM, and follow-up colonoscopy within 90 days of a positive FOBT result. METHODS This case-control study included 429 patients with a positive FOBT, 174 who had a colonoscopy within 90 days, and 255 who did not.. Participants completed a PAM telephone questionnaire (Cronbach's α = 0.785). We used both univariate and multivariate analyses to examine the effect of the PAM score as on the likelihood of undergoing colonoscopy, after adjusting for the independent variables. RESULTS In this study we did not find a significant association between PAM and adherence to colonoscopy, using both univariate and multivariate analyses (p = .334 and p = .697, whether PAM was defined as a continuous or as categorical, respectively). CONCLUSIONS This study was the first to examine the association between patient empowerment, as reflected in the patient activation measure, and adherence to colonoscopy after a positive FOBT. The findings did not support such an association. Further examination is required to clarify the relation between patient empowerment and activation and personal healthcare in general, and in the Israeli population in particular. Future policy should include specific, technical interventions to improve FOBT follow-up among all groups, until the patient-related barriers are better understood. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02534142 https://clinicaltrials.gov/ct2/show/NCT02534142.
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Affiliation(s)
- Revital Azulay
- Department of Management, MHA Program, Bar Ilan University, Ramat Gan, Israel. .,Central Laboratory, Meuhedet Health Care, 5 Pesach lev, Lod, Israel.
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, 124 Eben Gvirol, Tel Aviv, Israel
| | | | - Racheli Magnezi
- Department of Management, MHA Program, Bar Ilan University, Ramat Gan, Israel
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O'Donoghue D, Sheahan K, MacMathuna P, Stephens RB, Fenlon H, Morrin M, Mooney J, Fahy LE, Mooney T, Smith A. A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges. Cancer Prev Res (Phila) 2018; 12:89-94. [PMID: 30514807 DOI: 10.1158/1940-6207.capr-18-0182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/25/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022]
Abstract
Colorectal cancer accounts for 11% of all cancer-related deaths in Ireland. With the aim of diagnosing these cancers at an earlier stage, and detecting premalignant lesions, the National Screening Service (NSS) offered a fecal immunochemical test (FIT) to all individuals aged 60 to 69. All individuals in the age range were contacted by post and invited to participate in the programme. Those with a positive FIT result were offered a colonoscopy in an internationally accredited unit. From an eligible population of 488,628, 196,238 individuals participated giving an uptake of 40.2%. Commencing at a FIT threshold of 20 μg Hg/g feces, the positivity rate was 8.6%, which overwhelmed colonoscopy capacity and, thus, the threshold was increased to 45 μg, resulting in an overall 5% positivity rate. A total of 520 individuals had cancer detected (68.3% stage I or II), of which 104 were removed endoscopically (pT1s). Adenomas were present in 54.2% of all colonoscopies, 17.4% deemed high risk. Despite a lower uptake, males were twice as likely to have colorectal cancers as females and had a 59% increased rate of high-risk adenomas diagnosed. Challenges facing the programme include increasing participation, especially among males, and increasing colonoscopy capacity. The ability to alter the sensitivity of FIT to match colonoscopy capacity is a valuable option for such a programme as it ensures that the maximum public health benefit can be achieved within available resources.
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Affiliation(s)
- Diarmuid O'Donoghue
- BowelScreen, The National Screening Service, Dublin, Ireland. bowelscreen.q&
| | - Kieran Sheahan
- Clinical Advisory Group. The National Screening Service, Dublin, Ireland
| | - Padraic MacMathuna
- Clinical Advisory Group. The National Screening Service, Dublin, Ireland
| | - Richard B Stephens
- Clinical Advisory Group. The National Screening Service, Dublin, Ireland
| | - Helen Fenlon
- Clinical Advisory Group. The National Screening Service, Dublin, Ireland
| | - Martina Morrin
- Clinical Advisory Group. The National Screening Service, Dublin, Ireland
| | - Jenny Mooney
- BowelScreen, The National Screening Service, Dublin, Ireland
| | - Lorraine E Fahy
- BowelScreen, The National Screening Service, Dublin, Ireland
| | - Therese Mooney
- BowelScreen, The National Screening Service, Dublin, Ireland
| | - Alan Smith
- BowelScreen, The National Screening Service, Dublin, Ireland
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Libby G, Fraser CG, Carey FA, Brewster DH, Steele RJC. Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality. Gut 2018; 67:2116-2123. [PMID: 30012724 PMCID: PMC6241609 DOI: 10.1136/gutjnl-2018-316483] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE An association between detectable faecal haemoglobin (f-Hb) and both the risk of death from colorectal cancer (CRC) and all-cause mortality has been reported. We set out to confirm or refute this observation in a UK population and to explore the association between f-Hb, as indicated by a positive guaiac faecal occult blood test (gFOBT) result, and different causes of death. DESIGN All individuals (134 192) who participated in gFOBT screening in Tayside, Scotland between 29/03/2000 and 29/03/2016 were studied by linking their test result (positive or negative) with mortality data from the National Records of Scotland database and following to 30/03/2016. RESULTS Those with a positive test result (n=2714) had a higher risk of dying than those with a negative result, from CRC: HR 7.79 (95% CI 6.13 to 9.89), p<0.0001, (adjusted for, gender, age, deprivation quintile and medication that can cause bleeding) and all non-CRC causes: HR 1.58 (95% CI 1.45 to 1.73), p<0·0001.· In addition, f-Hb detectable by gFOBT was significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding CRC), neuropsychological disease, blood and endocrine disease and non-CRC. CONCLUSION The presence of detectable f-Hb is associated with increased risk of death from a wide range of causes.
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Affiliation(s)
- Gillian Libby
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Callum G Fraser
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Frank A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - David H Brewster
- Scottish Cancer Registry, National Services Division, Edinburgh, Scotland
| | - Robert J C Steele
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
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Quyn AJ, Fraser CG, Stanners G, Carey FA, Rees CJ, Moores B, Steele RJ. Scottish Bowel Screening Programme colonoscopy quality - scope for improvement? Colorectal Dis 2018; 20:O277-O283. [PMID: 29863812 DOI: 10.1111/codi.14281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
AIM The delivery of the Scottish Bowel Screening Programme (SBoSP) is rooted in the provision of a high quality, effective and participant-centred service. Safe and effective colonoscopy forms an integral part of the process. Additional accreditation as part of a multi-faceted programme for participating colonoscopists, as in England, does not exist in Scotland. This study aimed to describe the quality of colonoscopy in the SBoSP and compare this to the English national screening standards. METHODS Data were collected from the SBoSP between 2007 and 2014. End-points for analysis were caecal intubation, cancer, polyp and adenoma detection, and complications. Overall results were compared with 2012 published English national standards for screening and outcomes from 2006 to 2009. RESULTS During the study period 53 332 participants attended for colonoscopy. The colonoscopy completion rate was 95.6% overall. The mean cancer detection rate was 7.1%, the polyp detection rate was 45.7% and the adenoma detection rate was 35.5%. The overall complication rate was 0.47%. CONCLUSION Colonoscopy quality in the SBoSP has exceeded the standard set for screening colonoscopy in England, despite not adopting a multi-faceted programme for screening colonoscopy. However, the overall adenoma detection rate in Scotland was 9.1% lower than that in England which has implications for colonoscopy quality and may have an impact on cancer prevention rates, a key aim of the SBoSP.
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Affiliation(s)
- A J Quyn
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - C G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - G Stanners
- Information Services Division, NHS National Services Scotland, Glasgow, UK
| | - F A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - C J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK.,University of Newcastle, Newcastle, UK
| | - B Moores
- Public Health England, Manchester, UK
| | - R J Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Villéger R, Lopès A, Veziant J, Gagnière J, Barnich N, Billard E, Boucher D, Bonnet M. Microbial markers in colorectal cancer detection and/or prognosis. World J Gastroenterol 2018; 24:2327-2347. [PMID: 29904241 PMCID: PMC6000297 DOI: 10.3748/wjg.v24.i22.2327] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/03/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer worldwide. CRC is still associated with a poor prognosis among patients with advanced disease. On the contrary, due to its slow progression from detectable precancerous lesions, the prognosis for patients with early stages of CRC is encouraging. While most robust methods are invasive and costly, actual patient-friendly screening methods for CRC suffer of lack of sensitivity and specificity. Therefore, the development of sensitive, non-invasive and cost-effective methods for CRC detection and prognosis are necessary for increasing the chances of a cure. Beyond its beneficial functions for the host, increasing evidence suggests that the intestinal microbiota is a key factor associated with carcinogenesis. Many clinical studies have reported a disruption in the gut microbiota balance and an alteration in the faecal metabolome of CRC patients, suggesting the potential use of a microbial-based test as a non-invasive diagnostic and/or prognostic tool for CRC screening. This review aims to discuss the microbial signatures associated with CRC known to date, including dysbiosis and faecal metabolome alterations, and the potential use of microbial variation markers for non-invasive early diagnosis and/or prognostic assessment of CRC and advanced adenomas. We will finally discuss the possible use of these markers as predicators for treatment response and their limitations.
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Affiliation(s)
- Romain Villéger
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
| | - Amélie Lopès
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Research Biologics, Sanofi R&D, Vitry-Sur-Seine 94400, France
| | - Julie Veziant
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Chirurgie digestive, Centre Hospitalier Universitaire, Clermont-Ferrand 63000, France
| | - Johan Gagnière
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Chirurgie digestive, Centre Hospitalier Universitaire, Clermont-Ferrand 63000, France
| | - Nicolas Barnich
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Elisabeth Billard
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Delphine Boucher
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
| | - Mathilde Bonnet
- Université Clermont Auvergne, Inserm U1071, USC-INRA 2018, M2iSH, CRNH Auvergne, Clermont-Ferrand 63000, France
- Université Clermont Auvergne, Institut Universitaire de Technologie de Clermont-Ferrand, Clermont-Ferrand 63000, France
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van der Meulen MP, Lansdorp-Vogelaar I, Goede SL, Kuipers EJ, Dekker E, Stoker J, van Ballegooijen M. Colorectal Cancer: Cost-effectiveness of Colonoscopy versus CT Colonography Screening with Participation Rates and Costs. Radiology 2018; 287:901-911. [PMID: 29485322 DOI: 10.1148/radiol.2017162359] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To compare the cost-effectiveness of computed tomographic (CT) colonography and colonoscopy screening by using data on unit costs and participation rates from a randomized controlled screening trial in a dedicated screening setting. Materials and Methods Observed participation rates and screening costs from the Colonoscopy or Colonography for Screening, or COCOS, trial were used in a microsimulation model to estimate costs and quality-adjusted life-years (QALYs) gained with colonoscopy and CT colonography screening. For both tests, the authors determined optimal age range and screening interval combinations assuming a 100% participation rate. Assuming observed participation for these combinations, the cost-effectiveness of both tests was compared. Extracolonic findings were not included because long-term follow-up data are lacking. Results The participation rates for colonoscopy and CT colonography were 21.5% (1276 of 5924 invitees) and 33.6% (982 of 2920 invitees), respectively. Colonoscopy was more cost-effective in the screening strategies with one or two lifetime screenings, whereas CT colonography was more cost-effective in strategies with more lifetime screenings. CT colonography was the preferred test for willingness-to-pay-thresholds of €3200 per QALY gained and higher, which is lower than the Dutch willingness-to-pay threshold of €20 000. With equal participation, colonoscopy was the preferred test independent of willingness-to-pay thresholds. The findings were robust for most of the sensitivity analyses, except with regard to relative screening costs and subsequent participation. Conclusion Because of the higher participation rates, CT colonography screening for colorectal cancer is more cost-effective than colonoscopy screening. The implementation of CT colonography screening requires previous satisfactory resolution to the question as to how best to deal with extracolonic findings. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Miriam P van der Meulen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - S Lucas Goede
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Ernst J Kuipers
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Evelien Dekker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Jaap Stoker
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
| | - Marjolein van Ballegooijen
- From the Departments of Public Health (M.P.v.d.M., I.L.V., S.L.G., M.v.B.), Gastroenterology and Hepatology (E.J.K.), and Internal Medicine (E.J.K.), Erasmus Medical Centre, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology (E.D.) and Department of Radiology (J.S.), Academic Medical Center, Amsterdam, the Netherlands
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Quyn AJ, Fraser CG, Rodger J, Digan A, Anderson AS, Steele RJC. Participation in bowel screening among men attending abdominal aortic aneurysm screening. Br J Surg 2018; 105:529-534. [PMID: 29465743 DOI: 10.1002/bjs.10758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/31/2017] [Accepted: 10/17/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Uptake of population-based screening for colorectal cancer in Scotland is around 55 per cent. Abdominal aortic aneurysm (AAA) screening has recently been introduced for men aged 65 years and the reported uptake is 78 per cent. The aim was to determine the impact of a brief intervention on bowel screening in men who attended AAA screening, but previously failed to complete bowel screening. METHODS Men invited for AAA screening between September 2015 and March 2016 within NHS Tayside were included. Attendees who had not responded to their latest bowel screening invitation were seen by a colorectal cancer clinical nurse specialist. Reasons for not completing the faecal occult blood test (FOBT) were recorded; brief information on colorectal cancer screening was communicated, and participants were offered a further invitation to complete a FOBT. Those who responded positively were sent a further FOBT from the Scottish Bowel Screening Centre. Subsequent return of a completed FOBT within 6 months was recorded. RESULTS A total of 556 men were invited for AAA screening, of whom 38·1 per cent had not completed a recent FOBT. The primary reason stated for not participating was the time taken to complete the test or forgetting it (35·1 per cent). Other reasons included: lack of motivation (23·4 per cent), confusion regarding the aim of screening (16·2 per cent), disgust (19·8 per cent), fear (6·3 per cent) and other health problems (9·9 per cent). Following discussion, 81·1 per cent agreed to complete the FOBT and 49 per cent subsequently returned the test. CONCLUSION A substantial proportion of previous bowel screening non-responders subsequently returned a completed FOBT following a brief intervention with a nurse specialist. Attendance at non-bowel screening appointments may provide a valuable opportunity to improve bowel screening uptake.
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Affiliation(s)
- A J Quyn
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - C G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - J Rodger
- Department of Colorectal Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - A Digan
- Scottish Bowel Screening Centre, Dundee, UK
| | - A S Anderson
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - R J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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Barnett KN, Weller D, Smith S, Steele RJ, Vedsted P, Orbell S, Moss SM, Melia JW, Patnick J, Campbell C. The contribution of a negative colorectal screening test result to symptom appraisal and help-seeking behaviour among patients subsequently diagnosed with an interval colorectal cancer. Health Expect 2018; 21:764-773. [PMID: 29457677 PMCID: PMC6117494 DOI: 10.1111/hex.12672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer. Methods Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result. Results Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help. Conclusion Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized.
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Affiliation(s)
| | | | - Steve Smith
- Midlands and NW Bowel Cancer Screening Programme Hub, Rugby, UK
| | | | | | | | - Sue M Moss
- Queen Mary University of London, London, UK
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Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50-75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%-33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.
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Affiliation(s)
- Roisin Bevan
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Durham, UK
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
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James PD, Rabeneck L, Yun L, Paszat L, Baxter NN, Govindarajan A, Antonova L, Tinmouth JM. Repeated faecal occult blood testing is associated with decreased advanced colorectal cancer risk: A population-based study. J Med Screen 2017; 25:141-148. [PMID: 28862521 DOI: 10.1177/0969141317718860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the association between repeated faecal occult blood testing and advanced colorectal cancer risk at population level in Canada. METHODS A retrospective cohort study of all Ontario residents aged 56-74 diagnosed with colorectal cancer from 1 April 2007 to 31 March 2010, identified using health administrative data. The primary outcome was stage IV colorectal cancer, and primary exposure was faecal occult blood testing use within five years prior to colorectal cancer diagnosis. Patients were categorized into four mutually exclusive groups based on their exposure to faecal occult blood testing in the five years prior to colorectal cancer diagnosis: none, pre-diagnostic, repeated, and sporadic. Logistic regression was utilized to adjust for confounders. RESULTS Of 7753 patients (median age 66, interquartile range 61-70, 62% male) identified, 1694 (22%) presented with stage I, 2056 (27%) with stage II, 2428 (31%) with stage III, and 1575 (20%) with stage IV colorectal cancer. There were 4092 (53%) with no record of prior faecal occult blood testing, 1485 (19%) classified as pre-diagnostic, 1693 (22%) as sporadic, and 483 (6%) as repeated faecal occult blood testing. After adjusting for confounders, patients who had repeated faecal occult blood testing were significantly less likely to present with stage IV colorectal cancer at diagnosis (Odds ratio 0.46, 95% Confidence Interval 0.34-0.62) than those with no prior faecal occult blood testing. CONCLUSIONS Repeated faecal occult blood testing is associated with a decreased risk of advanced colorectal cancer. Our findings support the use of organized screening programmes that employ repeated faecal occult blood testing to improve colorectal cancer outcomes at population level.
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Affiliation(s)
- Paul D James
- 1 The Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada.,2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Linda Rabeneck
- 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,4 Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,7 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,8 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lingsong Yun
- 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Lawrence Paszat
- 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Nancy N Baxter
- 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,4 Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,5 Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,6 Li Ka Shing Research Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anand Govindarajan
- 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,5 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lilia Antonova
- 1 The Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jill M Tinmouth
- 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,4 Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lee YC, Li-Sheng Chen S, Ming-Fang Yen A, Yueh-Hsia Chiu S, Ching-Yuan Fann J, Chuang SL, Chiang TH, Chou CK, Chiu HM, Wu MS, Wu CY, Chia SL, Chiou ST, Chen HH. Association Between Colorectal Cancer Mortality and Gradient Fecal Hemoglobin Concentration in Colonoscopy Noncompliers. J Natl Cancer Inst 2017; 109:2740720. [PMID: 28376228 PMCID: PMC5441293 DOI: 10.1093/jnci/djw269] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023] Open
Abstract
Background: To what extent the risk for colorectal cancer (CRC) death among noncompliers of colonoscopy is elevated following positive fecal immunological testing and whether the elevated risk varies with the fecal hemoglobin concentration (f-Hb) and location of CRC have not been researched. Methods: We used data on 59 389 individuals (4.0%) among 1 489 937 Taiwanese screenees age 50 to 69 years with f-Hb 20 μg hemoglobin or more per gram of feces from 2004 to 2009. They were classified into 41 995 who received colonoscopy and 10 778 who received no confirmatory examination; the latter was categorized into three risk groups according to f-Hb (20–49, 50–99, and 100+). Mortality from CRC as the primary end point was monitored until December 31, 2012. Results: A 1.64-fold (95% confidence interval [CI] = 1.32 to 2.04) increased risk for CRC death for the noncolonoscopy group as opposed to the colonoscopy group adjusting for differences in baseline characteristics. A gradient relationship was noted between cumulative mortality and age- and sex-adjusted f-Hb categories with 1.31-fold (95% CI = 1.04 to 1.71), 2.21-fold (95% CI = 1.55 to 3.34), and 2.53-fold (95% CI = 1.95 to 3.43) increased risk, respectively, for the 20–49, 50–99, and 100+ risk groups in the noncolonoscopy group compared with the colonoscopy group. The noncolonoscopy group led to a statistically significant 1.75-fold increased risk (95% CI = 1.35 to 2.33) for CRC of the distal colon but a statistically nonsignificant 1.11-fold increased risk (95% CI = 0.70 to 1.75) for the proximal colon, compared with the colonoscopy group. When the comparator was limited to subjects whose colonoscopy was completed to the cecum, the statistically significantly elevated risk for CRC mortality was seen for both distal and proximal colon in the noncolonoscopy group. Conclusions: After a positive fecal immunochemical test, colonoscopy can reduce by about half the number of deaths from CRC. Among colonoscopy noncompliers, higher f-Hb is associated with an increased risk of mortality from CRC in a dose-response manner.
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Affiliation(s)
- Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
| | | | - Shu-Lin Chuang
- College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsung-Hsien Chiang
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chu-Kuang Chou
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Yuan Wu
- Health Promotion Administration, Ministry of Health and Welfare, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taiwan
| | - Shu-Ti Chiou
- Health Promotion Administration, Ministry of Health and Welfare, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Rim JH, Youk T, Kang JG, Park BK, Gee HY, Kim JH, Yoo J. Fecal Occult Blood Test Results of the National Colorectal Cancer Screening Program in South Korea (2006-2013). Sci Rep 2017; 7:2804. [PMID: 28584248 DOI: 10.1038/s41598-017-03134-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/25/2017] [Indexed: 12/13/2022] Open
Abstract
There has been controversy regarding the clinical utility of fecal occult blood test (FOBT) as a screening tool for colorectal cancer (CRC) in the general population. The purpose of this study was to examine the results of Korea national CRC screening using FOBT from 2006 to 2013 and to evaluate the implementation of the program. We analyzed the results of FOBT, colonoscopy, and the side effects during colonoscopy for the subjects (n = 20,609,909) from the Korea National Health Insurance Cancer Screening database. For evaluation of Korea national CRC screening program implementation over the 8-year period, we calculated uptake rate, FOBT positivity rate, and subsequent test compliance rate. The overall uptake rate was 30.1%, with an increasing pattern from 2006 to 2011. A relatively higher FOBT positivity rate (6.4%) and lower subsequent test compliance rate (46.6%) were observed in comparison to the results previously reported in Western countries. Side effects reported within 3 months period after colonoscopy accounted for 0.17% of all procedures, with bleeding being the most prevalent type. Although the implementation of CRC screening program using FOBT in Korea seems successful, trends in key indicators for Korea national CRC screening program should be monitored continuously.
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Affiliation(s)
- Caitlin C Murphy
- Division of Epidemiology, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John A Baron
- Department of Epidemiology and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Quyn AJ, Fraser CG, Stanners G, Carey FA, Carden C, Shaukat A, Steele RJ. Uptake trends in the Scottish Bowel Screening Programme and the influences of age, sex, and deprivation. J Med Screen 2017; 25:24-31. [PMID: 29183246 DOI: 10.1177/0969141317694065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Age, sex, and deprivation are known factors influencing colorectal (bowel) cancer screening uptake. We investigated the influence of these factors on uptake over time. Methods Data from the Scottish Bowel Screening Programme (SBoSP) were collected between 2007 and 2014. End-points for analysis were uptake, faecal occult blood test positivity, and disease detection, adjusted for age, sex, deprivation, and year of screening. Results From 5,308,336 individual screening episodes documented, uptake gradually increased with increasing age up to 65-69 and was lower in men than women (52.4% vs. 58.7%, respectively). Deprivation had a significant effect on uptake by men and women of all age groups, with the most deprived least likely to complete a screening test. Uptake has increased with time in both sexes and across the deprivation gradient. The number needed to screen to detect significant neoplasia was significantly lower in men than women overall (170 vs. 365), and this held over all age and deprivation groups. The number needed to screen was also lower in the more deprived population. Conclusions Although lower age, male sex, and increased deprivation are associated with lower bowel cancer screening uptake in Scotland, uptake has increased since SBoSP introduction in all age groups, both sexes, and across the deprivation gradient. Despite a lower uptake, the number needed to screen to find significant disease was lower in men and in those with higher levels of deprivation.
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Affiliation(s)
- Aaron J Quyn
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Callum G Fraser
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Greig Stanners
- 2 Information Services Division, NHS National Services Scotland, Glasgow, UK
| | - Francis A Carey
- 3 Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Claire Carden
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Aasma Shaukat
- 4 University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Robert Jc Steele
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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Vermeer N, Snijders H, Holman F, Liefers G, Bastiaannet E, van de Velde C, Peeters K. Colorectal cancer screening: Systematic review of screen-related morbidity and mortality. Cancer Treat Rev 2017; 54:87-98. [DOI: 10.1016/j.ctrv.2017.02.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
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Mancini S, Ravaioli A, Falcini F, Giuliani O, Corradini R, De Girolamo G, Goldoni C, Finarelli A, Naldoni C, Landi P, Sassoli de Bianchi P, Bucchi L. Strategies for delivery of faecal occult blood test kits and participation to colorectal cancer screening in the Emilia-Romagna Region of Italy. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
- S. Mancini
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | - A. Ravaioli
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | - F. Falcini
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
- Azienda Usl della Romagna; Forlì Italy
| | - O. Giuliani
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | | | | | | | - A.C. Finarelli
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | - C. Naldoni
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | - P. Landi
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | | | - L. Bucchi
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
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Campbell LA, Blake JT, Kephart G, Grunfeld E, MacIntosh D. Understanding the Effects of Competition for Constrained Colonoscopy Services with the Introduction of Population-level Colorectal Cancer Screening. Med Decis Making 2016; 37:253-263. [PMID: 27681989 DOI: 10.1177/0272989x16670638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Median wait times for gastroenterology services in Canada exceed consensus-recommended targets and have worsened substantially over the past decade. Meanwhile, efforts to control colorectal cancer have shifted their focus to screening asymptomatic, average-risk individuals. Along with increasing prevalence of colorectal cancer due to an aging population, screening programs are expected to add substantially to the existing burden on colonoscopy services, and create competition for limited services among individuals of varying risk. Failure to understand the effects of operational programmatic screening decisions may cause unintended harm to both screening participants and higher-risk patients, make inefficient use of limited health care resources, and ultimately hinder a program's success. METHODS We present a new simulation model (Simulation of Cancer Outcomes for Planning Exercises, or SCOPE) for colorectal cancer screening which, unlike many other colorectal cancer screening models, reflects the effects of competition for limited colonoscopy services between patient groups and can be used to guide planning to ensure adequate resource allocation. We include verification and validation results for the SCOPE model. RESULTS A discrete event simulation model was developed based on an epidemiological representation of colorectal cancer in a sample population. Colonoscopy service and screening modules were added to allow observation of screening scenarios and resource considerations. The model reproduces population-based data on prevalence of colorectal cancer by stage, and mortality by cause of death, age, and sex, and attendant demand and wait times for colonoscopy services. CONCLUSIONS The study model differs from existing screening models in that it explicitly considers the colonoscopy resource implications of screening activities and the impact of constrained resources on screening effectiveness.
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Affiliation(s)
- Leslie Anne Campbell
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS (LAC)
| | - John T Blake
- Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS (JTB)
| | - George Kephart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS (GK)
| | - Eva Grunfeld
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON (EG)
| | - Donald MacIntosh
- Division of Digestive Care & Endoscopy, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS (DM)
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Barnett KN, Weller D, Smith S, Orbell S, Vedsted P, Steele RJC, Melia JW, Moss SM, Patnick J, Campbell C. Understanding of a negative bowel screening result and potential impact on future symptom appraisal and help-seeking behaviour: a focus group study. Health Expect 2016; 20:584-592. [PMID: 27414462 PMCID: PMC5512994 DOI: 10.1111/hex.12484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 12/19/2022] Open
Abstract
Background Colorectal cancer (CRC) screening using a faecal occult blood test (FOBt) has the potential to reduce cancer‐related mortality. Symptom vigilance remains crucial as a proportion of cancers will be diagnosed between screening rounds. A negative FOBt has the potential to influence how participants respond to future symptoms of CRC. Objective To explore (i) understanding of a negative FOBt and (ii) the potential impact of a negative FOBt upon future symptom appraisal and help‐seeking behaviour. Design Qualitative methodology utilizing focus groups with participants who received a negative FOBt within the National Bowel Cancer Screening Programme in Coventry and Lothian. Topics explored included: experience of screening participation, interpretation and understanding of a negative result, symptom awareness and attitudes towards help‐seeking. Results Four broad themes were identified: (i) emotional response to a negative FOBt, (ii) understanding the limitations of FOBt screening, (iii) symptom knowledge and interpretation and (iv) over‐reassurance from a negative FOBt. Participants were reassured by a negative FOBt, but there was variability in the extent to which the result was interpreted as an “all clear”. Some participants acknowledged the residual risk of cancer and the temporal characteristic of the result, while others were surprised that the result was not a guarantee that they did not have cancer. Discussion and conclusions Participants recognized that reassurance from a negative FOBt could lead to a short‐term delay in help‐seeking if symptoms developed. Screening programmes should seek to emphasize the importance of the temporal nature of FOBt results with key messages about symptom recognition and prompt help‐seeking behaviour.
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Affiliation(s)
| | | | - Steve Smith
- Midlands and NW Bowel Cancer Screening Programme Hub, UHCW NHS Trust, Rugby, UK
| | | | | | | | | | - Sue M Moss
- Queen Mary University of London, London, UK
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Abstract
Transanal endoscopic surgery is a safe, established technique to remove lesions in the rectum via the anus. This article reviews its evolution, approaches, indications and evidence for its role in treating benign rectal polyps. The future of transanal endoscopic surgery in rectal cancer and inflammatory bowel disease is also explored.
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Affiliation(s)
- Kai J Leong
- Specialty Registrar in the Department of Colorectal Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry CV2 2DX
| | - John Evans
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, Northampton General Hospital NHS Trust, Northampton
| | - Michael M Davies
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, University Hospital of Wales, Cardiff
| | - Adam Scott
- Consultant Colorectal Surgeon in the Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester
| | - Paul Lidder
- Consultant Colorectal Surgeon in the Department of Surgery, Royal Cornwall Hospitals NHS Trust, Cornwall
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Digby J, Fraser CG, Carey FA, Diament RH, Balsitis M, Steele RJC. Faecal haemoglobin concentration is related to detection of advanced colorectal neoplasia in the next screening round. J Med Screen 2016; 24:62-68. [DOI: 10.1177/0969141316653983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To examine associations between faecal haemoglobin concentrations below the cut-off used in colorectal cancer screening and outcomes in the next screening round. Methods In the Scottish Bowel Screening Programme, faecal haemoglobin concentrations and diagnostic outcomes were investigated for participants with a negative result (faecal haemoglobin concentrations < 80.0 µg Hb/g faeces), followed by a positive result within two years. Results Of 37,780 participants with negative results, at the next screening round, 556 (1.5%) screened positive and 30,293 (80.2%) negative. Initial median faecal haemoglobin concentrations (2.1 µg Hb/g faeces, IQR: 0.0–13.2) were higher in those with subsequent positive results than those with subsequent negative results (0.0 µg Hb/g faeces, IQR: 0.0–1.4; p < 0.0001). Using faecal haemoglobin concentrations 0.0–19.9 µg Hb/g faeces as reference, logistic regression analysis showed high adjusted odds ratios for advanced neoplasia (advanced neoplasia: colorectal cancer or higher risk adenoma) detection at the next round of 14.3 (95% CI: 8.9–23.1) in those with initial faecal haemoglobin concentrations 20.0–39.9 µg Hb/g faeces, and 38.0 (95% CI: 20.2–71.2) with 60.0–79.9 µg Hb/g faeces. Conclusions A higher proportion of participants with faecal haemoglobin concentrations of ≥ 20 µg Hb/g faeces had advanced neoplasia detected at the next round than participants with lower faecal haemoglobin concentrations. Although most relevant when using high faecal haemoglobin concentrations cut-offs, studies of faecal haemoglobin concentrations and outcomes over screening rounds may provide strategies to direct available colonoscopy towards those at highest risk.
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Affiliation(s)
- Jayne Digby
- Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Callum G Fraser
- Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Robert H Diament
- Department of Surgery, Crosshouse Hospital, Kilmarnock, Ayrshire, Scotland
| | - Margaret Balsitis
- Department of Pathology, Crosshouse Hospital, Kilmarnock, Ayrshire, Scotland
| | - Robert JC Steele
- Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland
- Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Scotland
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Jensen CD, Corley DA, Quinn VP, Doubeni CA, Zauber AG, Lee JK, Zhao WK, Marks AR, Schottinger JE, Ghai NR, Lee AT, Contreras R, Klabunde CN, Quesenberry CP, Levin TR, Mysliwiec PA. Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study. Ann Intern Med 2016; 164:456-63. [PMID: 26811150 PMCID: PMC4973858 DOI: 10.7326/m15-0983] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown. OBJECTIVE To assess FIT performance characteristics over 4 rounds of annual screening. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Northern and Southern California. PATIENTS 323 349 health plan members aged 50 to 70 years on their FIT mailing date in 2007 or 2008 who completed the first round of FIT and were followed for up to 4 screening rounds. MEASUREMENTS Screening participation, FIT positivity (≥20 µg of hemoglobin/g), positive predictive values for adenoma and CRC, and FIT sensitivity for detecting CRC obtained from Kaiser Permanente electronic databases and cancer registries. RESULTS Of the patients invited for screening, 48.2% participated in round 1. Of those who remained eligible, 75.3% to 86.1% participated in subsequent rounds. Median follow-up was 4.0 years, and 32% of round 1 participants crossed over to endoscopy over 4 screening rounds-7.0% due to a positive FIT result. The FIT positivity rate (5.0%) and positive predictive values (adenoma, 51.5%; CRC, 3.4%) were highest in round 1. Overall, programmatic FIT screening detected 80.4% of patients with CRC diagnosed within 1 year of testing, including 84.5% in round 1 and 73.4% to 78.0% in subsequent rounds. LIMITATION Screening detection, rather than long-term cancer prevention, was evaluated. CONCLUSION Annual FIT screening was associated with high sensitivity for CRC, with high adherence to annual follow-up screening among initial participants. The findings indicate that annual programmatic FIT screening is feasible and effective for population-level CRC screening. PRIMARY FUNDING SOURCE National Institutes of Health.
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Fitzpatrick-Lewis D, Ali MU, Warren R, Kenny M, Sherifali D, Raina P. Screening for Colorectal Cancer: A Systematic Review and Meta-Analysis. Clin Colorectal Cancer 2016; 15:298-313. [PMID: 27133893 DOI: 10.1016/j.clcc.2016.03.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/22/2016] [Indexed: 12/15/2022]
Abstract
To evaluate the effectiveness of colorectal cancer (CRC) screening in asymptomatic adults. A search was conducted of the Medline, Embase, and the Cochrane Library databases. A targeted search of PubMed was conducted for on-topic randomized controlled trials (RCTs). Meta-analysis across 4 RCTs for guaiac fecal occult blood testing (gFOBT) and flexible sigmoidoscopy (FS) screening showed a reduction of 18% (risk ratio [RR], 0.82; 95% CI [CI], 0.73-0.92) and 26% (RR, 0.74; 95% CI, 0.67-0.83) in CRC mortality for the screening group compared to controls, respectively. The number needed to screen (NNS) were 377 (95% CI, 249-887) and 864 (95% CI, 672-1266) for gFOBT and FS screening, respectively. A reduction of 8% and 27% in incidence of late-stage CRC was also observed for gFOBT and FS screening, respectively, but both had no significant effect on all-cause mortality. A single RCT found that screening with immunochemical fecal occult blood test (iFOBT) had no significant impact on CRC mortality (RR, 0.88; 95% CI, 0.72-1.07). Screening with FS has potential harms such as perforation, major and minor bleeding, and death from the procedure or from follow-up colonoscopy. gFOBT and FS screening reduce CRC mortality and incidence of late-stage disease. The absolute effect and NNS were much more favorable for older adults (≥ 60 years), suggesting that a targeted screening approach may avoid exposing younger adults to the harms of CRC screening, from which they are unlikely to derive any significant benefit. Although there is insufficient RCT evidence on the impact of iFOBT on mortality outcomes. compared to gFOBT, this test showed higher sensitivity and comparable specificity, indicating the need to update and reevaluate the evidence in light of future high-quality research. The protocol for this systematic review have been published with PROSPERO 2014: CRD42014009777.
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Affiliation(s)
- Donna Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada.
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - Rachel Warren
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - Meghan Kenny
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre (MERSC), McMaster University, Hamilton, Ontario, Canada.
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