Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study

Objectives

Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has been disrupted in many countries during the COVID-19 pandemic. Performing catch-up of missed screens while maintaining regular screening services requires additional colonoscopy capacity that may not be available. This study aimed to compare strategies that clear the screening backlog using limited colonoscopy resources.

Methods

A range of strategies were simulated using four country-specific CRC natural-history models: Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada). Strategies assumed a 3-month screening disruption with varying recovery period lengths (6, 12, and 24 months) and varying FIT thresholds for diagnostic colonoscopy. Increasing the FIT threshold reduces the number of referrals to diagnostic colonoscopy. Outcomes for each strategy were colonoscopy demand and excess CRC-related deaths due to the disruption.

Results

Performing catch-up using the regular FIT threshold in 6, 12 and 24 months could prevent most excess CRC-related deaths, but required 50%, 25% and 12.5% additional colonoscopy demand, respectively. Without exceeding usual colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented by increasing the FIT threshold for 12 or 24 months. Large increases in FIT threshold could lead to additional deaths rather than preventing them.

Conclusions

Clearing the screening backlog in 24 months could avert most excess CRC-related deaths due to a 3-month disruption but would require a small increase in colonoscopy demand. Increasing the FIT threshold slightly over 24 months could ease the pressure on colonoscopy resources.

Is the Patient Outcomes Of Surgery (POS)-Hand/Arm questionnaire a reliable, valid and responsive measurement of patient-based outcomes in hand and upper limb surgery?

The purpose of our study was to evaluate a new region-specific outcome measure in hand and upper limb surgery: the Patient Outcomes of Surgery (POS)-Hand/Arm questionnaire using the generic Short Form Health Survey (SF)-36 questionnaire as a 'gold standard' comparative measure. The POS-Hand/Arm preop questionnaire and the SF-36 questionnaire were completed by 214 patients on the day of their hand or upper limb surgery; and a postop POS-Hand/Arm and the SF-36 questionnaire were completed by patients 3 months after their initial surgery. The POS-Hand/Arm questionnaire responses were psychometrically evaluated and it was shown to have high internal consistency; high total-item correlations; signification scale correlations with the SF-36; and a low proportion of missing data. The POS-Hand/Arm questionnaire is a psychometrically sound instrument that can be used pre- and post-surgery to evaluate patient-based outcomes for a wide range of conditions in hand and upper limb surgery.

Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria . This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.