Association between known risk factors and colorectal cancer risk in Indigenous people participating in the Ontario Familial Colon Cancer Registry

Measurement of diet quality among First Nations peoples in Canada and associations with health: a scoping review

BACKGROUND

Given the increasing number and the diversity of dietary quality indices used for research, and the differences between settings, there is a need to identify valid indices of dietary quality in different contexts and populations and to identify their associations with health-related outcomes.

OBJECTIVES

The primary objective of this scoping review is to identify the tools used in determining dietary quality among First Nations and to describe the changes in diet. The second objective is to describe the associations identified in studies that have measured the relationship between health and dietary quality among First Nations; and the third objective is to identify factors associated with diet quality.

METHODS

PubMed, Embase, CINAHL, Global Health, and Web of Science were searched from inception to June 2021 and updated in February 2022. Articles were included if the research subjects were First Nations, or if articles reported disaggregated subset data for First Nations. Eligible studies focused on nutrition and diet and were published in English or French.

RESULTS

A total of 151 articles were included in the analysis. Studies used several indicators to measure if individuals adhered to dietary guidelines. Traditional food consumption was frequently used as an indicator of diet quality (n = 96). The consumption of store-bought foods was used as an indicator in 28 studies. Some studies used other diet quality indicators such as the Healthy Eating Index (n = 5) and ultra-processed food "NOVA" classification (n = 6). A trend for decreasing traditional food intake over time was apparent, alongside an increase in store-bought food intake. This trend was accompanied with declining health status, including the increased prevalence of overweight and obesity, diabetes, metabolic diseases, and dental caries.

CONCLUSION

This scoping review showed that diet quality among First Nations is improved when traditional foods are consumed. Reduced diet quality was associated with increased risk of noncommunicable diseases.

Uptake and Short-term Outcomes of High-risk Screening Colonoscopy Billing Codes: A Population-based Study Among Young Adults

Background

Persons suspected or confirmed with familial colorectal cancer syndrome are recommended to have biennial colonoscopy from late adolescence or early adulthood. Persons without a syndrome but with one or more affected first-degree relatives are recommended to begin colonoscopy 10 years before the age at diagnosis of the youngest affected relative, and every 5 to 10 years. Ontario introduced colonoscopy billing codes for these two indications in 2011.

Methods

We identified persons in Ontario under 50 years of age, without a prior history of colorectal cancer or inflammatory bowel disease, with one or more of these billing claims between 2013 and 2017. We described the index colonoscopy, and subsequent colonoscopy up-to-date status. We computed average annual rates of colorectal and other cancer diagnoses, and displayed mean cumulative function plots, stratified by billing code, age and sex.

Results

Billing claims for ‘familial syndrome’ high-risk screening colonoscopy were identified among 14,846 persons; the average annual rate of CRC diagnoses was 38.6 per 100,000 among males and 22.2 among females. Colonoscopy up-to-date status fell to 50% within 7 years. Billing claims for ‘first-degree relative’ screening colonoscopy was identified among 49,505 persons; average annual rates of CRC diagnoses were 16.3 among males and 13.5 per 100,000 among females, respectively.

Conclusion

Colorectal cancer was more frequent following billing claims for high-risk screening colonoscopy for familial syndromes, as were noncolorectal malignancies potentially associated with these syndromes. This billing claim for familial colorectal cancer syndrome colonoscopy appears to identify a group at elevated short-term risk for cancer.

Distinctive Clinico-Pathological Characteristics of Colorectal Cancer in Sabahan Indigenous Populations

Background:

Malaysia is an ethnically diverse nation, comprising Malay, Chinese, Indian and indigenous groups. However, epidemiological studies on colorectal cancer have mainly focused on the three main ethnic groups. There is evidence that the clinico-pathological characteristics of some cancers may differ in indigenous populations, namely that they occur earlier and behave more aggressively. We aimed to determine if there were similar differences in colorectal cancer, focusing on the indigenous populations of Sabah.

Methods:

Histopathological reports of all patients diagnosed with colorectal carcinoma from January 2012 to December 2016 from public hospitals in Sabah were retrieved from the central computerized database of the Pathology Department of Queen Elizabeth Hospital in Kota Kinabalu, Sabah. Supplementary data was obtained from patients’ case files from each hospital. Clinico-pathological data were analysed using the IBM SPSS Statistical Software Version 23 for Windows for descriptive statistics (mean, median, ASR, AR, relative risk) and inferential statistics (Chi square test).

Results:

A total of 696 patients met the inclusion criteria. The median age for colorectal cancer in Sabah was 62 years (95% CI 60.3 to 62.3), with an age specific incidence rate of 21.4 per 100 000 population. The age specific incidence rate in the indigenous populations was 26.6 per 100 000, much lower than the Chinese, at 65.0 per 100 000. The risk of colorectal cancer occurring before the age of 50 was three times higher in the indigenous population compared to the Chinese. The tumours were mainly left-sided (56.5%), adenocarcinoma in histology (98.4%) and moderately differentiated (88.7%). Approximately 79.2% of patients received curative treatment.

Conclusion:

Indigenous populations in Sabah develop colorectal cancer at an earlier age, and present at more advanced stages. This has implications for screening and therapeutic strategic planning.