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Lau LHS, Ho JCL, Lai JCT, Ho AHY, Wu CWK, Lo VWH, Lai CMS, Scheppach MW, Sia F, Ho KHK, Xiao X, Yip TCF, Lam TYT, Kwok HYH, Chan HCH, Lui RN, Chan TT, Wong MTL, Ho MF, Ko RCW, Hon SF, Chu S, Futaba K, Ng SSM, Yip HC, Tang RSY, Wong VWS, Chan FKL, Chiu PWY. Effect of Real-Time Computer-Aided Polyp Detection System (ENDO-AID) on Adenoma Detection in Endoscopists-in-Training: A Randomized Trial. Clin Gastroenterol Hepatol 2024; 22:630-641.e4. [PMID: 37918685 DOI: 10.1016/j.cgh.2023.10.019] [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: 07/17/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The effect of computer-aided polyp detection (CADe) on adenoma detection rate (ADR) among endoscopists-in-training remains unknown. METHODS We performed a single-blind, parallel-group, randomized controlled trial in Hong Kong between April 2021 and July 2022 (NCT04838951). Eligible subjects undergoing screening/surveillance/diagnostic colonoscopies were randomized 1:1 to receive colonoscopies with CADe (ENDO-AID[OIP-1]) or not (control) during withdrawal. Procedures were performed by endoscopists-in-training with <500 procedures and <3 years' experience. Randomization was stratified by patient age, sex, and endoscopist experience (beginner vs intermediate level, <200 vs 200-500 procedures). Image enhancement and distal attachment devices were disallowed. Subjects with incomplete colonoscopies or inadequate bowel preparation were excluded. Treatment allocation was blinded to outcome assessors. The primary outcome was ADR. Secondary outcomes were ADR for different adenoma sizes and locations, mean number of adenomas, and non-neoplastic resection rate. RESULTS A total of 386 and 380 subjects were randomized to CADe and control groups, respectively. The overall ADR was significantly higher in the CADe group than in the control group (57.5% vs 44.5%; adjusted relative risk, 1.41; 95% CI, 1.17-1.72; P < .001). The ADRs for <5 mm (40.4% vs 25.0%) and 5- to 10-mm adenomas (36.8% vs 29.2%) were higher in the CADe group. The ADRs were higher in the CADe group in both the right colon (42.0% vs 30.8%) and left colon (34.5% vs 27.6%), but there was no significant difference in advanced ADR. The ADRs were higher in the CADe group among beginner (60.0% vs 41.9%) and intermediate-level (56.5% vs 45.5%) endoscopists. Mean number of adenomas (1.48 vs 0.86) and non-neoplastic resection rate (52.1% vs 35.0%) were higher in the CADe group. CONCLUSIONS Among endoscopists-in-training, the use of CADe during colonoscopies was associated with increased overall ADR. (ClinicalTrials.gov, Number: NCT04838951).
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Affiliation(s)
- Louis H S Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jacky C L Ho
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jimmy C T Lai
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Agnes H Y Ho
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Claudia W K Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent W H Lo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Carol M S Lai
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Markus W Scheppach
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Felix Sia
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Kyle H K Ho
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xiang Xiao
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Terry C F Yip
- Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Thomas Y T Lam
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR
| | - Hanson Y H Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Heyson C H Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rashid N Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ting-Ting Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Marc T L Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Man-Fung Ho
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rachel C W Ko
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sok-Fei Hon
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon Chu
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Koari Futaba
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Simon S M Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Hon-Chi Yip
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Philip W Y Chiu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
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Kang X, Ng SK, Liu C, Lin Y, Zhou Y, Kwong TNY, Ni Y, Lam TYT, Wu WKK, Wei H, Sung JJY, Yu J, Wong SH. Altered gut microbiota of obesity subjects promotes colorectal carcinogenesis in mice. EBioMedicine 2023; 93:104670. [PMID: 37343363 DOI: 10.1016/j.ebiom.2023.104670] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for colorectal cancer (CRC). The role of gut microbiota in mediating the cancer-promoting effect of obesity is unknown. METHODS Azoxymethane (AOM)-treated, ApcMin/+ and germ-free mice were gavaged with feces from obese individuals and control subjects respectively. The colonic tumor load and number were recorded at the endpoint in two carcinogenic models. The gut microbiota composition and colonic transcriptome were assessed by metagenomic sequencing and RNA sequencing, respectively. The anticancer effects of bacteria depleted in fecal samples of obese individuals were validated. FINDINGS Conventional AOM-treated and ApcMin/+ mice receiving feces from obese individuals showed significantly increased colon tumor formation compared with those receiving feces from control subjects. AOM-treated mice receiving feces from obese individuals showed impaired intestinal barrier function and significant upregulation of pro-inflammatory cytokines and activation of oncogenic Wnt signaling pathway. Consistently, transferring feces from obese individuals to germ-free mice led to increased colonic cell proliferation, intestinal barrier function impairment, and induction of oncogenic and proinflammatory gene expression. Moreover, germ-free mice transplanted with feces from obese human donors had increased abundance of potential pathobiont Alistipes finegoldii, and reduced abundance of commensals Bacteroides vulgatus and Akkermansia muciniphila compared with those receiving feces from human donors with normal body mass index (BMI). Validation experiments showed that B. vulgatus and A. muciniphila demonstrated anti-proliferative effects in CRC, while A. finegoldii promoted CRC tumor growth. INTERPRETATION Our results supported the role of obesity-associated microbiota in colorectal carcinogenesis and identified putative bacterial candidates that may mediate its mechanisms. Microbiota modulation in obese individuals may provide new approaches to prevent or treat obesity-related cancers including CRC. FUNDING This work was funded by National Key Research and Development Program of China (2020YFA0509200/2020YFA0509203), National Natural Science Foundation of China (81922082), RGC Theme-based Research Scheme Hong Kong (T21-705/20-N), RGC Research Impact Fund Hong Kong (R4632-21F), RGC-CRF Hong Kong (C4039-19GF and C7065-18GF), RGC-GRF Hong Kong (14110819, 14111621), and NTU Start-Up Grant (021337-00001).
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Affiliation(s)
- Xing Kang
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siu-Kin Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Changan Liu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yufeng Lin
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunfei Zhou
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas N Y Kwong
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunbi Ni
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y T Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - William K K Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Hong Wei
- Department of Laboratory Animal Science, College of Basic Medical Sciences, Third Military Medical University, Chongqing, China; Department of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Jun Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Xu H, Tang RSY, Lam TYT, Zhao G, Lau JYW, Liu Y, Wu Q, Rong L, Xu W, Li X, Wong SH, Cai S, Wang J, Liu G, Ma T, Liang X, Mak JWY, Xu H, Yuan P, Cao T, Li F, Ye Z, Shutian Z, Sung JJY. Artificial Intelligence-Assisted Colonoscopy for Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial. Clin Gastroenterol Hepatol 2023; 21:337-346.e3. [PMID: 35863686 DOI: 10.1016/j.cgh.2022.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [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: 03/15/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI)-assisted colonoscopy improves polyp detection and characterization in colonoscopy. However, data from large-scale multicenter randomized controlled trials (RCT) in an asymptomatic population are lacking. METHODS This multicenter RCT aimed to compare AI-assisted colonoscopy with conventional colonoscopy for adenoma detection in an asymptomatic population. Asymptomatic subjects 45-75 years of age undergoing colorectal cancer screening by direct colonoscopy or fecal immunochemical test were recruited in 6 referral centers in Hong Kong, Jilin, Inner Mongolia, Xiamen, and Beijing. In the AI-assisted colonoscopy, an AI polyp detection system (Eagle-Eye) with real-time notification on the same monitor of the endoscopy system was used. The primary outcome was overall adenoma detection rate (ADR). Secondary outcomes were mean number of adenomas per colonoscopy, ADR according to endoscopist's experience, and colonoscopy withdrawal time. This study received Institutional Review Board approval (CRE-2019.393). RESULTS From November 2019 to August 2021, 3059 subjects were randomized to AI-assisted colonoscopy (n = 1519) and conventional colonoscopy (n = 1540). Baseline characteristics and bowel preparation quality between the 2 groups were similar. The overall ADR (39.9% vs 32.4%; P < .001), advanced ADR (6.6% vs 4.9%; P = .041), ADR of expert (42.3% vs 32.8%; P < .001) and nonexpert endoscopists (37.5% vs 32.1%; P = .023), and adenomas per colonoscopy (0.59 ± 0.97 vs 0.45 ± 0.81; P < .001) were all significantly higher in the AI-assisted colonoscopy. The median withdrawal time (8.3 minutes vs 7.8 minutes; P = .004) was slightly longer in the AI-assisted colonoscopy group. CONCLUSIONS In this multicenter RCT in asymptomatic patients, AI-assisted colonoscopy improved overall ADR, advanced ADR, and ADR of both expert and nonexpert attending endoscopists. (ClinicalTrials.gov, Number: NCT04422548).
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Affiliation(s)
- Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Guijun Zhao
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - James Y W Lau
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunpeng Liu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Long Rong
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Weiran Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xue Li
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shuntian Cai
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guanyi Liu
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Tantan Ma
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xiong Liang
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hongzhi Xu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Peng Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tingting Cao
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Fudong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Zhenshi Ye
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Zhang Shutian
- Department of Gastroenterology and Hepatology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Tang RSY, Sattayalertyanyong O, Kuo Y, Park KH, Anastassiades C, Ligresti D, Hayashi N, Hasan A, Kim T, Pausawasdi N, Wang H, Lo SK, Ho K, Barresi L, Traina M, Yasuda I, Savides TJ, Koo C, Chan TT, Lam TYT, Sung JJY. Impact of COVID-19 infection and vaccination in pancreatobiliary IgG4-related disease patients: An international multicenter study. J Gastroenterol Hepatol 2023; 38:584-589. [PMID: 36582040 PMCID: PMC9880730 DOI: 10.1111/jgh.16100] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/21/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Dedicated studies evaluating the impact of COVID-19 on outcomes of pancreatobiliary IgG4 related disease (IgG4-RD) patients are scarce. Whether COVID-19 infection or vaccination would trigger IgG4-RD exacerbation remains unknown. METHODS Pancreatobiliary IgG4-RD patients ≥ 18 years old with active follow-up since January 2020 from nine referral centers in Asia, Europe, and North America were included in this multicenter retrospective study. Outcome measures include incidence and severity of COVID-19 infection, IgG4-RD disease activity and treatment status, interruption of indicated IgG4-RD treatment. Prospective data on COVID-19 vaccination status and new COVID-19 infection during the Omicron outbreak were also retrieved in the Hong Kong cohort. RESULTS Of the 124 pancreatobiliary IgG4-RD patients, 25.0% had active IgG4-RD, 71.0% were on immunosuppressive therapies and 80.6% had ≥ 1 risk factor for severe COVID. In 2020 (pre-vaccination period), two patients (1.6%) had COVID-19 infection (one requiring ICU admission), and 7.2% of patients had interruptions in indicated immunosuppressive treatment for IgG4-RD. Despite a high vaccination rate (85.0%), COVID-19 infection rate has increased to 20.0% during Omicron outbreak in the Hong Kong cohort. A trend towards higher COVID-19 infection rate was noted in the non-fully vaccinated/unvaccinated group (17.6% vs 33.3%, P = 0.376). No IgG4-RD exacerbation following COVID-19 vaccination or infection was observed. CONCLUSION While a low COVID-19 infection rate with no mortality was observed in pancreatobiliary IgG4-RD patients in the pre-vaccination period of COVID-19, infection rate has increased during the Omicron outbreak despite a high vaccination rate. No IgG4-RD exacerbation after COVID-19 infection or vaccination was observed.
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Affiliation(s)
- Raymond S Y Tang
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina
| | - Onuma Sattayalertyanyong
- Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversitySalayaThailand
| | - Yu‐Ting Kuo
- Department of Internal Medicine, National Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
| | - Kenneth H Park
- Karsh Division of Gastroenterology and HepatologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Constantinos Anastassiades
- Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic ServicesIRCCS ‐ ISMETTPalermoItaly
| | - Nobuhiko Hayashi
- Third Department of Internal MedicineUniversity of ToyamaToyamaJapan
| | - Aws Hasan
- Division of GastroenterologyUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Tae‐Hyeon Kim
- Department of Internal MedicineWonkwang University School of MedicineIksanKorea
| | - Nonthalee Pausawasdi
- Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversitySalayaThailand
| | - Hsiu‐Po Wang
- Department of Internal Medicine, National Taiwan University HospitalNational Taiwan University College of MedicineTaipeiTaiwan
| | - Simon K Lo
- Karsh Division of Gastroenterology and HepatologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Khek‐Yu Ho
- Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic ServicesIRCCS ‐ ISMETTPalermoItaly
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic ServicesIRCCS ‐ ISMETTPalermoItaly
| | - Ichiro Yasuda
- Third Department of Internal MedicineUniversity of ToyamaToyamaJapan
| | - Thomas J Savides
- Division of GastroenterologyUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Chieh‐Sian Koo
- Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Ting Ting Chan
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina
| | - Thomas Y T Lam
- Stanley Ho Big Data Decision Analytics Research CenterThe Chinese University of Hong KongHong KongChina
| | - Joseph J Y Sung
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
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Lam TYT, Cheung MFK, Munro YL, Lim KM, Shung D, Sung JJY. Randomized Controlled Trials of Artificial Intelligence in Clinical Practice: Systematic Review. J Med Internet Res 2022; 24:e37188. [PMID: 35904087 PMCID: PMC9459941 DOI: 10.2196/37188] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/13/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The number of artificial intelligence (AI) studies in medicine has exponentially increased recently. However, there is no clear quantification of the clinical benefits of implementing AI-assisted tools in patient care. OBJECTIVE This study aims to systematically review all published randomized controlled trials (RCTs) of AI-assisted tools to characterize their performance in clinical practice. METHODS CINAHL, Cochrane Central, Embase, MEDLINE, and PubMed were searched to identify relevant RCTs published up to July 2021 and comparing the performance of AI-assisted tools with conventional clinical management without AI assistance. We evaluated the primary end points of each study to determine their clinical relevance. This systematic review was conducted following the updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. RESULTS Among the 11,839 articles retrieved, only 39 (0.33%) RCTs were included. These RCTs were conducted in an approximately equal distribution from North America, Europe, and Asia. AI-assisted tools were implemented in 13 different clinical specialties. Most RCTs were published in the field of gastroenterology, with 15 studies on AI-assisted endoscopy. Most RCTs studied biosignal-based AI-assisted tools, and a minority of RCTs studied AI-assisted tools drawn from clinical data. In 77% (30/39) of the RCTs, AI-assisted interventions outperformed usual clinical care, and clinically relevant outcomes improved with AI-assisted intervention in 70% (21/30) of the studies. Small sample size and single-center design limited the generalizability of these studies. CONCLUSIONS There is growing evidence supporting the implementation of AI-assisted tools in daily clinical practice; however, the number of available RCTs is limited and heterogeneous. More RCTs of AI-assisted tools integrated into clinical practice are needed to advance the role of AI in medicine. TRIAL REGISTRATION PROSPERO CRD42021286539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286539.
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Affiliation(s)
- Thomas Y T Lam
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong., Hong Kong, Hong Kong
| | - Max F K Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yasmin L Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kong Meng Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Dennis Shung
- Department of Medicine (Digestive Diseases), Yale School of Medicine, New Haven, CT, United States
| | - Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Wang X, Cheng FTF, Lam TYT, Liu Y, Huang D, Liu X, Chen H, Zhang L, Ali Y, Wang MHT, Yu J, Gin T, Chan MTV, Wu WKK, Wong SH. Stress Hyperglycemia Is Associated With an Increased Risk of Subsequent Development of Diabetes Among Bacteremic and Nonbacteremic Patients. Diabetes Care 2022; 45:1438-1444. [PMID: 35275995 DOI: 10.2337/dc21-1682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/11/2021] [Accepted: 02/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent diabetes development compared with those who remained normoglycemic. RESEARCH DESIGN AND METHODS This retrospective observational study was conducted on 224,534 in-patients with blood culture records. Stress hyperglycemia was defined based on the highest random glucose level ≥7.8 mmol/L during the index admission period. Diagnosis of diabetes, as the primary end point of interest, was defined based on diagnostic codes, blood test results, or medication records. Differences in cumulative incidence and hazard ratios (HRs) of diabetes between groups were assessed using the Kaplan-Meier estimator and Cox regression. RESULTS After exclusion of patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and propensity score matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of diabetes (HR 1.7, 95% CI 1.2-2.4) compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a diabetes predictor independent of age, sex, comorbidity, and other serological markers. For the nonbacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of diabetes (HR 1.4, 95% CI 1.2-1.7). CONCLUSIONS Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent diabetes development compared with their normoglycemic counterparts. Recognition of an increased risk of diabetes in these patients can allow early detection and monitoring in their subsequent follow-ups.
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Affiliation(s)
- Xiansong Wang
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Frankie T F Cheng
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Thomas Y T Lam
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingzhi Liu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dan Huang
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiaodong Liu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Huarong Chen
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lin Zhang
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yusuf Ali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Maggie H T Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,CUHK Shenzhen Research Institute, Shenzhen, China
| | - Tony Gin
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - William K K Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,CUHK Shenzhen Research Institute, Shenzhen, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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7
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Tang RSY, Lee JWJ, Chang LC, Ong DEH, Chiu HM, Matsuda T, Kim HS, Sekiguchi M, Leong RW, Ho AMY, Lam TYT, Tse YK, Lin L, Yeoh KG, Lau JYW, Sung JJY. Two vs One Forward View Examination of Right Colon on Adenoma Detection: An International Multicenter Randomized Trial. Clin Gastroenterol Hepatol 2022; 20:372-380.e2. [PMID: 33065307 DOI: 10.1016/j.cgh.2020.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/16/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Second forward view (SFV) examination of the right colon (RC) in colonoscopy was suggested to improve the adenoma detection rate (ADR), but multicenter data to inform its routine use remain limited. We performed an international multicenter randomized trial comparing SFV vs a standard single forward view examination of the RC on adenoma detection. METHODS Asymptomatic individuals undergoing screening or surveillance colonoscopies from 6 Asia Pacific regions were invited for study. A forward view examination of the RC was first performed in all patients, followed by randomization at the hepatic flexure to either SFV examination of the RC and standard withdrawal examination from the hepatic flexure to rectum, or a standard withdrawal colonoscopy (SWC) examination from the hepatic flexure to rectum. The primary outcome was RC ADR. RESULTS Between 2016 and 2019, there were 1011 patients randomized (SFV group, 502 patients; SWC group, 509 patients). Forty-five endoscopists performed the colonoscopies. The RC ADR was significantly higher in the SFV group than in the SWC group (27.1% vs 21.6%; P = .042). The whole-colon ADR was high in both groups (49.0% vs 45.0%; P =.201). The SFV examination identified 58 additional adenomas in 49 patients (9.8%), leading to a change in surveillance recommendations in 15 patients (3.0%). The median overall withdrawal time was 1.5 minutes longer in the SFV group (12.0 vs 10.5 min; P < .001). Older age, male sex, ever smoking, and longer RC withdrawal time were independent predictors of right-sided adenoma detection. CONCLUSIONS In this multicenter trial, SFV examination significantly increased the RC ADR in screening and surveillance colonoscopies. Routine RC SFV examination should be considered. ClinicalTrials.gov ID: NCT03121495.
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Affiliation(s)
- Raymond S Y Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan W J Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - David E H Ong
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Takahisa Matsuda
- Cancer Screening Center, Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hyun-Soo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Seoul, Korea
| | - Masau Sekiguchi
- Cancer Screening Center, Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Rupert W Leong
- Department of Gastroenterology, Concord Hospital, Sydney, Australia; Faculty of Medicine and Health, Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Andrew M Y Ho
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee Kit Tse
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Lucy Lin
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Khay-Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - James Y W Lau
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
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8
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Lui RN, Kyaw MH, Lam TYT, Ching JYL, Chan VCW, Wong MCS, Sung JJY. Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population. J Gastroenterol Hepatol 2021; 36:1656-1662. [PMID: 33617148 DOI: 10.1111/jgh.15368] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) screening population of Chinese subjects. METHODS This is a case-control study of prospectively collected data from a territory-wide colorectal screening program in Hong Kong. Information on risk factors was obtained from questionnaires completed prior to screening colonoscopy. We compared subjects with SSLs against controls without these lesions to identify potential risk factors using multivariable logistic regression. RESULTS Of 12 039 asymptomatic screening subjects, 6011 subjects received a screening colonoscopy with 2214 subjects (36.8%) having conventional adenomas, 486 subjects (8.1%) having hyperplastic polyps, and 85 subjects (1.4%) having SSLs only. Of these subjects, three had synchronous advanced adenomas and were excluded from the analysis. More than 60% of these lesions were in the proximal colon. We compared these 82 subjects with SSLs only and 3226 controls without any polyps. After multivariable logistic regression, age ≥ 66 years, smoking, and diabetes mellitus (DM) were significant independent risk factors for SSLs. CONCLUSION In this study, we report the prevalence of SSLs to be 1.4%. Age ≥ 66 years, smoking, and DM were independent risk factors for these lesions. Our findings provide relevant new data that should be taken into consideration when designing region-specific surveillance programs for SSLs with the ultimate goal of reducing the risk of CRC.
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Affiliation(s)
- Rashid N Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Moe H Kyaw
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Victor C W Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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9
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Lam TYT, Hui AJ, Sia F, Wong MY, Lee CCP, Chung KW, Lau JYW, Wu PI, Sung JJY. Short Message Service reminders reduce outpatient colonoscopy nonattendance rate: A randomized controlled study. J Gastroenterol Hepatol 2021; 36:1044-1050. [PMID: 32803820 DOI: 10.1111/jgh.15218] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Nonattendance of outpatient colonoscopy leads to inefficient use of health-care resources. We aimed to study the effectiveness of using Short Message Service (SMS) reminder prior in patients scheduled for outpatient colonoscopy on their nonattendance rate. METHODS Patients who scheduled for an outpatient colonoscopy and had access of SMS were recruited from three clinics in Hong Kong. Patients were randomized to SMS group and standard care (SC) group. All patients were given a written appointment slip on the booking date. In addition, patients in the SMS group received an SMS reminder 7-10 days before their colonoscopy appointment. Patients' demographics, attendance, colonoscopy completion, and bowel preparation quality were recorded. Logistic regression was performed to identify predictors of nonattendance. RESULTS From November 2013 to October 2019, a total of 2225 eligible patients were recruited. A total of 1079 patients were allocated to the SMS group and 1146 to the SC group. The nonattendance rate of patients in the SMS group was significantly lower than that in the SC group (8.9% vs 11.9%, P = 0.022). There were no significant differences in their baseline characteristics and colonoscopy completion rate and bowel preparation quality. A trend towards a higher rate of adequate bowel preparation was observed in the SMS group when compared with the SC group (69.9% vs 65.8%, P = 0.053). Independent predictors for nonattendance included younger age, underprivilege, and existing diabetes. CONCLUSIONS An SMS reminder for outpatient colonoscopy is effective in reducing the nonattendance rate and may potentially improve the bowel preparation quality.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Aric J Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Felix Sia
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Mei Y Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | | | - Ka W Chung
- Wong Siu Ching Family Medicine Centre, Hong Kong
| | - James Y W Lau
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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10
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Sung JJY, Luk AKC, Ng SSM, Ng ACF, Chiu PKF, Chan EYY, Cheung PSY, Chu WCW, Wong SH, Lam TYT, Wong SYS. Effectiveness of One-Stop Screening for Colorectal, Breast, and Prostate Cancers: A Population-Based Feasibility Study. Front Oncol 2021; 11:631666. [PMID: 33718212 PMCID: PMC7948441 DOI: 10.3389/fonc.2021.631666] [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] [Received: 11/20/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC), prostate cancer (PC) and breast cancer (BC) are among the most common cancers worldwide with well-established screening strategies. We aim to investigate the effectiveness and compliance of a one-stop screening service for CRC, PC and BC. Asymptomatic subjects aged 50–75 years were invited. Eligible subjects were offered fecal immunochemical test (FIT) for CRC screening. Serum prostate specific antigen (PSA) and Prostate Health Index (PHI) were offered for male PC screening and mammogram (MMG) for female BC screening as a one-stop service. Colonoscopy was offered to FIT+ subjects, prostate biopsy to PSA/PHI+ (PSA>10/PHI≥35) males and breast biopsy to MMG+ (Breast Imaging-Reporting and Data System, BI-RADS≥4) females. From August 2018 to April 2020, 3165 subjects were recruited. All participants (1372 men and 1793 women) were willing to accept FIT for CRC screening, and PSA/PHI test or MMG as second cancer screening. 102 subjects diagnosed advanced neoplasms after colonoscopy. Thirty-three males diagnosed PC after prostate biopsy and 15 females diagnosed BC after breast biopsy. No major complication reported in first tier screening tests. Subjects who were willing to undergo CRC screening were highly likely to accept other cancer screening when offered in a one-stop program. In conclusion, the effectiveness and compliance of a one-stop service for CRC, PC, and BC screening among asymptomatic subjects were high. Future studies should be conducted to test various ways of integrating cancer screening programs.
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Affiliation(s)
- Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simon S M Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter K F Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Emily Y Y Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Winnie C W Chu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny H Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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11
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Tang RSY, Kyaw MH, Teoh AYB, Lui RNS, Tse YK, Lam TYT, Chan SL, Wong VWS, Wu JCY, Lau JYW, Sung JJY. Endoscopic ultrasound-guided cyanoacrylate injection to prevent rebleeding in hepatocellular carcinoma patients with variceal hemorrhage. J Gastroenterol Hepatol 2020; 35:2192-2201. [PMID: 32602261 DOI: 10.1111/jgh.15168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/07/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Secondary prophylaxis (SP) of variceal rebleeding was reported to improve outcomes of hepatocellular carcinoma (HCC) patients, but the optimal endoscopic approach is not well defined. We compared outcomes in HCC patients who underwent SP by endoscopic ultrasound-guided cyanoacrylate obturation (EUS-CYA) versus no SP. METHODS Between 2014 and 2018, 30 consecutive patients with inoperable HCC and recent endoscopically controlled variceal bleeding were prospectively recruited. Twenty-seven patients with persistent varices ≥ 3 mm on endoscopic ultrasound underwent EUS-CYA for SP. Thirty-three HCC patients treated by esophagogastroduodenoscopy-guided CYA obturation (EGD-CYA) alone for acute variceal bleeding between 2009 and 2013 were identified from a prospective gastrointestinal bleed registry as standard of care controls for comparison. Outcome measures were death-adjusted cumulative incidence of rebleeding, bleeding-free survival, technical success, and procedure-related adverse events of EUS-CYA. RESULTS The majority of patients in both groups had advanced HCC, portal vein thrombosis, and Child-Pugh B cirrhosis. EUS-CYA was successful in all 27 patients with no radiographic evidence of cyanoacrylate-lipiodol embolization. Significantly lower 30- and 90-day death-adjusted cumulative incidence of rebleeding (14.8% vs 42.4%, P = 0.023 and 18.5% vs 60.6%, P = 0.002, respectively) and significantly higher variceal bleeding-free survival at 3 and 6 months (51.9% vs 21.2%, P = 0.009, 40.7% vs 15.2%, P = 0.010, respectively) were observed in the EUS-CYA group when compared with standard of care group. CONCLUSIONS Secondary prophylaxis by EUS-CYA reduced rebleeding rate and improved variceal bleeding-free survival in patients with inoperable HCC and variceal bleeding when compared with no SP. Randomized studies are needed to confirm the benefits of EUS-CYA for this difficult-to-treat population.
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Affiliation(s)
- Raymond S Y Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Moe H Kyaw
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Anthony Y B Teoh
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Rashid N S Lui
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Stephen L Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Vincent W S Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - James Y W Lau
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.,Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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12
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Lam TYT, Wu PI, Tang RSY, Luk AKC, Ng S, Sung JJY. Mobile messenger-initiated reminders improve longitudinal adherence in a community-based, opportunistic colorectal cancer screening program: A single-blind, crossover randomized controlled study. Cancer 2020; 127:914-921. [PMID: 33216357 DOI: 10.1002/cncr.33336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors hypothesized that reminders sent via mobile messengers, such as WhatsApp, improve such adherence. METHODS In the current single-blind, randomized study, subjects from an opportunistic FIT screening program who had a negative FIT result the year prior were randomly allocated (1:1) to receive either a 1-off reminder via the WhatsApp messenger (WR) 1 month prior to the due appointments or no reminder (NR). All subjects were blinded to study participation and group allocation. At 24 months after randomization, a crossover of intervention was performed among those individuals who remained in the FIT program. The primary outcome was FIT adherence, defined as the pick-up and on-time return of the FIT. The secondary outcome was FIT adherence after the crossover. RESULTS A total of 500 subjects were randomized to receive WR (250 subjects) or NR (250 subjects). Three individuals were excluded from analysis (1 died and 2 underwent colonoscopy). Both the FIT pick-up rate (80.3% vs 59.3%; P < .001) and return rate (79.9% vs 57.3%; P < .001) were significantly higher in the WR group compared with the NR group. After crossover of intervention (452 subjects), the WR group again was found to have a higher FIT pick-up rate (79.1% vs 52.9%; P < .001) and return rate (78.2% vs 52.4%; P < .001). CONCLUSIONS Text reminders sent via mobile messenger appear to improve the longitudinal adherence to FIT-based opportunistic CRC screening programs. The routine use of this technology in CRC screening should be considered.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Raymond S Y Tang
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simpson Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
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13
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Wong MCS, Ching JYL, Lam TYT, Ng SKC, Wong JCT, Wu JCY, Chan FKL. Association of Interactive Reminders and Automated Messages With Persistent Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial. JAMA Oncol 2019; 3:1281-1283. [PMID: 28520919 DOI: 10.1001/jamaoncol.2017.1062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,J. C. School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Simpson K C Ng
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - John C T Wong
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Justin C Y Wu
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Francis K L Chan
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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14
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Sung JJY, Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Cheung W, Ching JYL. A modified colorectal screening score for prediction of advanced neoplasia: A prospective study of 5744 subjects. J Gastroenterol Hepatol 2018; 33:187-194. [PMID: 28561279 DOI: 10.1111/jgh.13835] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 04/24/2017] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM We validated a modified risk algorithm based on the Asia-Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia. METHODS Among 5744 Chinese asymptomatic screening participants undergoing a colonoscopy in Hong Kong from 2008 to 2012, a random sample of 3829 participants acted as the derivation cohort. The odds ratios for significant risk factors identified by binary logistic regression analysis were used to build a scoring system ranging from 0 to 6, divided into "average risk" (AR): 0; "moderate risk" (MR): 1-2; and "high risk" (HR): 3-6. The other 1915 subjects formed a validation cohort, and the performance of the score was assessed. RESULTS The prevalence of advanced neoplasia in the derivation and validation cohorts was 5.4% and 6.0%, respectively (P = 0.395). Old age, male gender, family history of colorectal cancer, smoking, and BMI were significant predictors in multivariate regression analysis. A BMI cut-off at > 23 kg/m2 had better predictive capability and lower number needed to screen than that of > 25 kg/m2 . Utilizing the score developed, 8.4%, 57.4%, and 34.2% in the validation cohort were categorized as AR, MR, and HR, respectively. The corresponding prevalence of advanced neoplasia was 3.8%, 4.3%, and 9.3%. Subjects in the HR group had 2.48-fold increased prevalence of advanced neoplasia than the AR group. The c-statistics of the modified score had better discriminatory capability than that using predictors of APCS alone (c-statistics = 0.65 vs 0.60). CONCLUSIONS Incorporating BMI into the predictors of APCS score was found to improve risk prediction of advanced neoplasia and reduce colonoscopy resources.
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Affiliation(s)
- Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,State Key Laboratory for Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Wilson Cheung
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
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15
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Wong SH, Kwong TNY, Chow TC, Luk AKC, Dai RZW, Nakatsu G, Lam TYT, Zhang L, Wu JCY, Chan FKL, Ng SSM, Wong MCS, Ng SC, Wu WKK, Yu J, Sung JJY. Quantitation of faecal Fusobacterium improves faecal immunochemical test in detecting advanced colorectal neoplasia. Gut 2017; 66:1441-1448. [PMID: 27797940 PMCID: PMC5530471 DOI: 10.1136/gutjnl-2016-312766] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [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] [Received: 07/30/2016] [Revised: 09/14/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a need for an improved biomarker for colorectal cancer (CRC) and advanced adenoma. We evaluated faecal microbial markers for clinical use in detecting CRC and advanced adenoma. DESIGN We measured relative abundance of Fusobacterium nucleatum (Fn), Peptostreptococcus anaerobius (Pa) and Parvimonas micra (Pm) by quantitative PCR in 309 subjects, including 104 patients with CRC, 103 patients with advanced adenoma and 102 controls. We evaluated the diagnostic performance of these biomarkers with respect to faecal immunochemical test (FIT), and validated the results in an independent cohort of 181 subjects. RESULTS The abundance was higher for all three individual markers in patients with CRC than controls (p<0.001), and for marker Fn in patients with advanced adenoma than controls (p=0.022). The marker Fn, when combined with FIT, showed superior sensitivity (92.3% vs 73.1%, p<0.001) and area under the receiver-operating characteristic curve (AUC) (0.95 vs 0.86, p<0.001) than stand-alone FIT in detecting CRC in the same patient cohort. This combined test also increased the sensitivity (38.6% vs 15.5%, p<0.001) and AUC (0.65 vs 0.57, p=0.007) for detecting advanced adenoma. The performance gain for both CRC and advanced adenoma was confirmed in the validation cohort (p=0.0014 and p=0.031, respectively). CONCLUSIONS This study identified marker Fn as a valuable marker to improve diagnostic performance of FIT, providing a complementary role to detect lesions missed by FIT alone. This simple approach may improve the clinical utility of the current FIT, and takes one step further towards a non-invasive, potentially more accurate and affordable diagnosis of advanced colorectal neoplasia.
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Affiliation(s)
- Sunny H Wong
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Shenzhen Research Institute, Shenzhen, China
| | - Thomas N Y Kwong
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tai-Cheong Chow
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Rudin Z W Dai
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Geicho Nakatsu
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Thomas Y T Lam
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lin Zhang
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Justin C Y Wu
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Francis K L Chan
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simon S M Ng
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Martin C S Wong
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Siew C Ng
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - William K K Wu
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Shenzhen Research Institute, Shenzhen, China
- Faculty of Medicine, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Yu
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Shenzhen Research Institute, Shenzhen, China
| | - Joseph J Y Sung
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Institute of Digestive Disease, Hong Kong, Hong Kong
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Shenzhen Research Institute, Shenzhen, China
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16
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Colorectal Cancer Screening Based on Age and Gender: A Cost-Effectiveness Analysis. Medicine (Baltimore) 2016; 95:e2739. [PMID: 26962772 PMCID: PMC4998853 DOI: 10.1097/md.0000000000002739] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 01/27/2023] Open
Abstract
We evaluated whether age- and gender-based colorectal cancer screening is cost-effective.Recent studies in the United States identified age and gender as 2 important variables predicting advanced proximal neoplasia, and that women aged <60 to 70 years were more suited for sigmoidoscopy screening due to their low risk of proximal neoplasia. Yet, quantitative assessment of the incremental benefits, risks, and cost remains to be performed.Primary care screening practice (2008-2015).A Markov modeling was constructed using data from a screening cohort. The following strategies were compared according to the Incremental Cost Effectiveness Ratio (ICER) for 1 life-year saved: flexible sigmoidoscopy (FS) 5 yearly; colonoscopy 10 yearly; FS for each woman at 50- and 55-year old followed by colonoscopy at 60- and 70-year old; FS for each woman at 50-, 55-, 60-, and 65-year old followed by colonoscopy at 70-year old; FS for each woman at 50-, 55-, 60-, 65-, and 70-year old. All male subjects received colonoscopy at 50-, 60-, and 70-year old under strategies 3 to 5.From a hypothetical population of 100,000 asymptomatic subjects, strategy 2 could save the largest number of life-years (4226 vs 2268 to 3841 by other strategies). When compared with no screening, strategy 5 had the lowest ICER (US$42,515), followed by strategy 3 (US$43,517), strategy 2 (US$43,739), strategy 4 (US$47,710), and strategy 1 (US$56,510). Strategy 2 leads to the highest number of bleeding and perforations, and required a prohibitive number of colonoscopy procedures. Strategy 5 remains the most cost-effective when assessed with a wide range of deterministic sensitivity analyses around the base case.From the cost effectiveness analysis, FS for women and colonoscopy for men represent an economically favorable screening strategy. These findings could inform physicians and policy-makers in triaging eligible subjects for risk-based screening, especially in countries with limited colonoscopic resources. Future research should study the acceptability, feasibility, and feasibility of this risk-based strategy in different populations.
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Affiliation(s)
- Martin C S Wong
- From the Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China (MCSW, JYLC, VCWC, TYTL, AKCL, SHW, SCN, SSN, JCYW, FKLC, JJYS), and School of Public Health and Primary Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China (MCSW)
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17
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Wong MCS, Ching JYL, Chan VCW, Tang RSY, Luk AKC, Lam TYT, Wong SSH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Validation of a risk prediction score for proximal neoplasia in colorectal cancer screening: a prospective colonoscopy study. Sci Rep 2016; 6:20396. [PMID: 26854201 PMCID: PMC4745041 DOI: 10.1038/srep20396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/08/2015] [Indexed: 01/14/2023] Open
Abstract
This study developed a clinical scoring system to predict the risks of PN among screening participants for colorectal cancer. We recruited 5,789 Chinese asymptomatic screening participants who received colonoscopy in Hong Kong (2008-2014). From random sampling of 2,000 participants, the independent risk factors were evaluated for PN using binary regression analysis. The odds ratios for significant risk factors were used to develop a scoring system, with scores stratified into 'average risk' (AR):0-2 and 'high risk' (HR):3-5. The other 3,789 subjects formed an independent validation cohort. Each participant received a score calculated based on their risk factors. The performance of the scoring system was evaluated. The proportion of PN in the derivation and validation cohorts was 12.6% and 12.9%, respectively. Based on age, gender, family history, body mass index and self-reported ischaemic heart disease, 85.0% and 15.0% in the validation cohort were classified as AR and HR, respectively. Their prevalence of PN was 12.0% and 18.1%, respectively. Participants in the HR group had 1.51-fold (95% CI = 1.24-1.84, p < 0.001) higher risk of PN than the AR group. The overall c-statistics of the prediction model was 0.71(0.02). The scoring system is useful in predicting the risk of PN to prioritize patients for colonoscopy.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Raymond S Y Tang
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Sunny S H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
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18
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Wong MCS, Ching JYL, Ng S, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. The discriminatory capability of existing scores to predict advanced colorectal neoplasia: a prospective colonoscopy study of 5,899 screening participants. Sci Rep 2016; 6:20080. [PMID: 26838178 PMCID: PMC4738273 DOI: 10.1038/srep20080] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/25/2015] [Indexed: 12/13/2022] Open
Abstract
We evaluated the performance of seven existing risk scoring systems in predicting advanced colorectal neoplasia in an asymptomatic Chinese cohort. We prospectively recruited 5,899 Chinese subjects aged 50–70 years in a colonoscopy screening programme(2008–2014). Scoring systems under evaluation included two scoring tools from the US; one each from Spain, Germany, and Poland; the Korean Colorectal Screening(KCS) scores; and the modified Asia Pacific Colorectal Screening(APCS) scores. The c-statistics, sensitivity, specificity, positive predictive values(PPVs), and negative predictive values(NPVs) of these systems were evaluated. The resources required were estimated based on the Number Needed to Screen(NNS) and the Number Needed to Refer for colonoscopy(NNR). Advanced neoplasia was detected in 364 (6.2%) subjects. The German system referred the least proportion of subjects (11.2%) for colonoscopy, whilst the KCS scoring system referred the highest (27.4%). The c-statistics of all systems ranged from 0.56–0.65, with sensitivities ranging from 0.04–0.44 and specificities from 0.74–0.99. The modified APCS scoring system had the highest c-statistics (0.65, 95% C.I. 0.58–0.72). The NNS (12–19) and NNR (5-10) were similar among the scoring systems. The existing scoring systems have variable capability to predict advanced neoplasia among asymptomatic Chinese subjects, and further external validation should be performed.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR.,School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Simpson Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, HKSAR
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19
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Tang RSY, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Determinants of Bowel Preparation Quality and Its Association With Adenoma Detection: A Prospective Colonoscopy Study. Medicine (Baltimore) 2016; 95:e2251. [PMID: 26765402 PMCID: PMC4718228 DOI: 10.1097/md.0000000000002251] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The predictors of poor bowel preparation in colorectal cancer screening participants have not been adequately studied, and the association between the quality of bowel preparation and adenoma detection has not been firmly established. This study examined the determinants of poor bowel preparation, and evaluated its relationship with adenoma detection.We included subjects aged between 50 and 70 years who received colonoscopy between 2008 and 2014 in a colorectal cancer screening program in Hong Kong. The quality of the bowel preparation was assessed by colonoscopists, and the factors associated with poor bowel cleansing were evaluated by a binary logistic regression analysis. A multivariate regression model was constructed to evaluate if poor bowel preparation was associated with detection of colorectal neoplasia.From 5470 screening participants (average age 57.7 years, SD 4.9), 1891 (34.6%) had poor or fair bowel preparation. The average cecal intubation time was 7.0 minutes (SD 5.4; range 1.22-36.9 minutes) and the average colonoscopy withdrawal time was 10.8 minutes (SD 6.9; range 6.0-107.0 minutes). Among all, 26.5% had colorectal neoplasia and 5.5% had advanced neoplasia. Older age (≥60 years; adjusted odds ratio [AOR] = 1.19-1.38, P = 0.02-0.04), male sex (AOR = 1.38, 95% confidence interval [CI] 1.19-1.60, P < 0.001), and current smoking (AOR = 1.41, 95% CI 1.14-1.75, P = 0.002) were significantly associated with poor/fair bowel preparation. Poorer cleansing resulted in significantly lower detection rate of neoplasia (AOR = 0.35-0.62) and advanced neoplasia (AOR = 0.36-0.50) irrespective of polyp size.Steps to improve proper procedures of bowel preparation are warranted, especially among subjects at risk of poor bowel preparation. Strategies should be implemented to improve bowel cleansing, which is now demonstrated as a definite quality indicator.
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Affiliation(s)
- Martin C S Wong
- From the Institute of Digestive Disease (MCSW, JYLC, VCWC, TYTL, AKCL, RSYT, SHW, SCN, SSMN, JCYW, FKLC, JJYS); and School of Public Health and Primary Care (MCSW), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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20
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Wong SH, Ng SC, Wong VWS, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history. Int J Cancer 2015; 138:576-83. [PMID: 26289421 DOI: 10.1002/ijc.29809] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/11/2015] [Indexed: 12/24/2022]
Abstract
Patients with nonalcoholic fatty liver disease (NAFLD) and family history of colorectal cancer (CRC) are at higher risks but how they should be screened remains uncertain. Hence, we evaluated the cost-effectiveness of CRC screening among patients with NAFLD and family history by different strategies. A hypothetical population of 100,000 subjects aged 40-75 years receive: (i) yearly fecal immunochemical test (FIT) at 50 years; (ii) flexible sigmoidoscopy (FS) every 5 years at 50 years; (iii) colonoscopy 10 yearly at 50 years; (iv) colonoscopy 10 yearly at 50 years among those with family history/NAFLD and yearly FIT at 50 years among those without; (v) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and yearly FIT at 50 years among those without and (vi) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and colonoscopy 10 yearly at 50 years among those without. The incremental cost-effectiveness ratio (ICER) was studied by Markov modeling. It was found that colonoscopy, FS and FIT reduced incidence of CRC by 49.5, 26.3 and 23.6%, respectively. Using strategies 4, 5 and 6, the corresponding reduction in CRC incidence was 29.9, 30.9 and 69.3% for family history, and 33.2, 34.7 and 69.8% for NAFLD. Compared with no screening, strategies 4 (US$1,018/life-year saved) and 5 (US$7,485) for family history offered the lowest ICER, whilst strategy 4 (US$5,877) for NAFLD was the most cost-effective. These findings were robust when assessed with a wide range of deterministic sensitivity analyses around the base case. These indicated that screening patients with family history or NAFLD by colonoscopy at 50 years was economically favorable.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China.,School of Public Health and Primary Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Vincent W S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, HKSAR, China
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21
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Shum JP, Luk AKC, Wong SSH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens. Clin Gastroenterol Hepatol 2015; 13:1472-9. [PMID: 25724708 DOI: 10.1016/j.cgh.2015.02.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 11/06/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We compared the accuracy of a qualitative fecal immunochemical test (FIT) in identifying patients with proximal vs distal advanced neoplasia and evaluated whether analysis of 2 specimens performed better than analysis of 1 specimen. Distal advanced neoplasia was defined as colorectal cancer (CRC), any colorectal adenoma ≥10 mm in diameter, high-grade dysplasia, or a lesion with villous or tubulovillous histologic characteristics in a location distal to the splenic flexure, including the descending colon, the rectosigmoid, and the rectum. METHODS We collected data from 5343 subjects (50-70 years old) who received 2 FITs (Hemosure; cutoff value, 10 μg hemoglobin/g feces) before colonoscopy in an invitational CRC screening program in Hong Kong from 2008 through 2012. We calculated the FIT's sensitivity, specificity, positive predictive value (PPV), and negative predictive value in detecting colorectal neoplasia. RESULTS Of the participants, 13.6%, 12.2%, and 6.0% had distal, proximal, and synchronous distal or proximal neoplasia, respectively. Advanced neoplasia was detected in 291 subjects (5.4%); 22 (0.4%) had CRC. FIT detected distal advanced adenoma with 39.7% sensitivity (95% confidence interval [CI], 32.0%-48.0%) vs proximal advanced adenoma with 25.0% sensitivity (95% CI, 17.3%-34.6%; P = .014), distal advanced neoplasia with 40.0% sensitivity (95% CI, 32.5%-47.9%) vs proximal advanced neoplasia with 27.9% sensitivity (95% CI, 20.0%-37.4%; P = .039), and any distal adenoma ≥10 mm, irrespective of other lesion characteristics, with 39.5% sensitivity (95% CI, 31.0%-48.7%) vs. proximal adenoma with 25.3% sensitivity (95% CI, 16.5%-36.6%; P = .038). The specificity of FIT in detecting CRC was similar between the proximal and distal colon. FIT detected distal lesions with higher PPV than proximal lesions. One FIT detected advanced neoplasia with 31.8% sensitivity (95% CI, 25.9%-38.4%) and 92.4% specificity (95% CI, 91.6%-93.2%), whereas 2 FITs detected advanced neoplasia with 34.1% sensitivity (95% CI, 28.0%-40.8%; P = .617) and 91.9% specificity (95% CI, 91.0%-92.7%; P = .327). FIT detected distal advanced neoplasia with greater sensitivity and higher PPV than proximal advanced neoplasia. CONCLUSIONS In an analysis of data from subjects who underwent CRC screening in Hong Kong, FIT detected distal advanced neoplasia with higher sensitivity than proximal advanced neoplasia. Analysis of 1 vs 2 specimens by FIT identified advanced neoplasia with similar test characteristics.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China; School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jeffrey P Shum
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Sunny S H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China.
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Hui AJ, Lau JY, Lam PPY, Chui AOM, Fan ASH, Lam TYT, Tse YK, Tang RSY, Ng SC, Wu JCY, Ching JYL, Wong MCS, Chan FKL, Sung J. Comparison of colonoscopic performance between medical and nurse endoscopists: a non-inferiority randomised controlled study in Asia. Gut 2015; 64:1058-62. [PMID: 25524261 DOI: 10.1136/gutjnl-2013-306293] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/16/2013] [Accepted: 11/28/2014] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To test the hypothesis that trained nurse endoscopists are not inferior to medical endoscopists in finding adenomas during colonoscopy. DESIGN This is a prospective, randomised, single-blind, non-inferiority study comparing nurses with medical endoscopists in performing screening colonoscopy. The nurse endoscopists had been trained according to the British Joint Advisory Group on GI Endoscopy curriculum and had completed at least 140 colonoscopic procedures prior to the study. The primary endpoint was the adenoma detection rate. Secondary endpoints included the caecal intubation rate, intubation time, complication rate, patient pain and satisfaction scores. RESULTS We enrolled and analysed a total of 731 patients over a 15-month period. At least one adenoma was found in 159 (43.8%) of 363 patients by nurse endoscopists and 120 (32.7%) of 367 patients by medical endoscopists and a proportion difference of +11.1% compared with the medical endoscopists (95% CI 4.1% to 18.1%). The withdrawal time was, however, significantly longer among nurses (998 vs 575 s, p<0.001). After adjusting for differences in a regression analysis, colonoscopy by nurses was associated with a lower adenoma detection rate (OR 0.475: 95% CI 0.311 to 0.725). Nurse endoscopists had a lower caecal intubation rate (97.3% vs 100%), received better pain and satisfaction scores and had a high rate of patient acceptance. CONCLUSIONS In this pragmatic trial, nurses can perform screening colonoscopy but require a longer procedural time to achieve a comparable adenoma detection rate as medical endoscopists. TRIAL REGISTRATION NUMBER NCT01923155.
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Affiliation(s)
- Aric J Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - James Y Lau
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Phyllis P Y Lam
- Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Alman O M Chui
- Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Alice S H Fan
- Combined Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Raymond S Y Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Siew C Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Martin C S Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Francis K L Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Wong MCS, Ching JYL, Ng SC, Wong S, Chan VCW, Shum JP, Lam TYT, Luk AKC, Sung JJY. Prediction of proximal advanced neoplasia: a comparison of four existing sigmoidoscopy-based strategies in a Chinese population. Gut 2015; 64:776-83. [PMID: 25179812 DOI: 10.1136/gutjnl-2014-308002] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/12/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the performance of existing sigmoidoscopy-based strategies in predicting advanced proximal neoplasia (APN) in an asymptomatic Chinese cohort. DESIGN We included all screening participants aged 50-70 years who received colonoscopy between 2008 and 2014 in Hong Kong. Sigmoidoscopy yield was estimated from the colonoscopic findings based on the: (1) UK flexible sigmoidoscopy; (2) Screening for COlon REctum (SCORE); (3) NORwegian Colorectal Cancer Prevention (NORCCAP) trials and (4) US clinical index based on age, gender and distal findings. The sensitivity, specificity, the number of subjects needed to screen (NNS) and the number of subjects needed to refer (NNR) for colonoscopy to detect one APN were evaluated. Binary logistic regression modelling identified the distal findings associated with APN. RESULTS From 5879 eligible subjects, 132 (2.2%) had APN. The US strategy achieved the highest sensitivity for APN detection (42.0%) and the UK criteria attained the highest specificity (96%). The US criteria led to the lowest NNS (92 vs 103-267) and the UK criteria required the least NNR (12 vs 16-21). Using the US strategy, the rates of APN detected were 1.4% (low-risk group), 2.2% (intermediate risk) and 5.9% (high risk). The c-statistics of the UK, SCORE, NORCCAP and the US criteria were 0.55±0.03; 0.59±0.03; 0.59±0.03 and 0.62±0.05 respectively. CONCLUSIONS The US criteria had the highest sensitivity for detection of APN and lowest NNS and the UK score had the highest specificity and the lowest NNR. The performance of all these four criteria to predict APN is limited, highlighting an urgent need to devise a novel APN prediction system for Asian subjects.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Therapeutics, State Key laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong
| | - Sunny Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Therapeutics, State Key laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeffrey P Shum
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
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Wong MCS, Ching JYL, Chan VCW, Bruggemann R, Lam TYT, Luk AKC, Wu JCY, Chan FKL, Sung JJY. Regret on choice of colorectal cancer screening modality was associated with poorer screening compliance: a 4-year prospective cohort study. PLoS One 2015; 10:e0125782. [PMID: 25875160 PMCID: PMC4397076 DOI: 10.1371/journal.pone.0125782] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/27/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose Very few studies examined the issue of regret on choosing colorectal cancer (CRC) screening tests. We evaluated the determinants of regret and tested the hypothesis that regret over screening choices was associated with poorer screening compliance. Methods A bowel cancer screening centre invited all Hong Kong citizens aged 50-70 years who were asymptomatic of CRC to participate in free-of-charge screening programmes. Upon attendance they attended health seminars on CRC and its screening, and were offered an option to choose yearly faecal immunochemical test (FIT) for up to four years vs. one direct colonoscopy. They were not allowed to switch the screening option after decision. A self-administered, four-item validated survey was used to assess whether they regretted over their choice (> 2 = regretful from a scale of 0 [no regret]-5 [extreme regret]). A binary logistic regression model evaluated if initial regret over their choice was associated with poorer programme compliance. Results From 4,341 screening participants who have chosen FIT or colonoscopy, 120 (2.8%) regretted over their decision and 1,029 (23.7%) were non-compliant with the screening programme. Younger subjects and people who felt pressure when making their decision were associated with regret. People who regretted their decision were 2.189 (95% C.I. 1.361-3.521, p = 0.001) times more likely to be non-compliant with the programme. Conclusions This study is the first to show that regret over the initial CRC screening choice was associated with later non-compliance. Screening participants who expressed regret over their choice should receive additional reminders to improve their programmatic compliance.
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Affiliation(s)
- Martin C. S. Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
- * E-mail:
| | - Jessica Y. L. Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C. W. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Renee Bruggemann
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y. T. Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K. C. Luk
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Justin C. Y. Wu
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Francis K. L. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J. Y. Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Ng SSM, Sung JJY. Factors associated with false-positive and false-negative fecal immunochemical test results for colorectal cancer screening. Gastrointest Endosc 2015; 81:596-607. [PMID: 25293827 DOI: 10.1016/j.gie.2014.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 06/10/2014] [Accepted: 08/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Certain subgroups have higher rates of false fecal immunochemical test (FIT) results, yet few studies have addressed this topic. OBJECTIVE To identify demographic factors associated with false-positive and false-negative FIT results in colorectal cancer screening. DESIGN Retrospective database review of prospectively collected data. SETTING A bowel cancer screening center in Hong Kong invited participants for colorectal cancer screening (2008-2012). PATIENTS Study participants who underwent both FIT and colonoscopy in the first year (n = 4482) and underwent colonoscopy after negative FIT results for 3 consecutive years (n = 857). MAIN OUTCOME MEASUREMENTS The diagnostic accuracy and predictive values of FIT according to participant characteristics. RESULTS The sensitivity, specificity, positive predictive values, and negative predictive values for advanced neoplasia were 33.1%, 91.9%, 19.0%, and 96.0%, respectively. Participants 66 to 70 years of age had higher sensitivity, whereas older age, smoking, and use of aspirin/nonsteroidal anti-inflammatory drugs were associated with lower specificity. The rates of false-positive and false-negative results were 8.1% and 66.9%, respectively. Older age (66-70 years; adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI], 1.35-2.81; P < .001), smoking (AOR 1.68; 95% CI, 1.08-2.61; P = .020), and the presence of polypoid adenoma (AOR 1.71; 95% CI, 1.14-2.57; P = .009) were associated with false-positive results. Younger participants (AOR for elderly participants 0.31) and the use of aspirin/nonsteroidal anti-inflammatory drugs (AOR 4.44) in participants with 1 FIT with negative results and the absence of high-grade dysplasia (AOR for presence 0.41) were associated with false-negative results. LIMITATIONS Self-referred participants who received one type of qualitative FIT. CONCLUSION These findings could be used to target screening more toward those with a higher risk of false-negative results and those with a lower risk of false-positive results for earlier colonoscopy.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China; School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
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Ng SC, Ching JYL, Chan VCW, Wong MCS, Tang R, Wong S, Luk AKC, Lam TYT, Gao Q, Chan AWH, Wu JCY, Chan FKL, Lau JYW, Sung JJY. Association between serrated polyps and the risk of synchronous advanced colorectal neoplasia in average-risk individuals. Aliment Pharmacol Ther 2015; 41:108-15. [PMID: 25339583 DOI: 10.1111/apt.13003] [Citation(s) in RCA: 32] [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: 08/14/2014] [Revised: 09/12/2014] [Accepted: 10/06/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Serrated polyps of the colorectum have distinct histological features and malignant potential. AIM To assess the association between the presence of serrated polyps and synchronous advanced colorectal neoplasia. METHODS Among 4989 asymptomatic Chinese individuals aged 50-70 years who underwent screening colonoscopy, 281 cases with advanced neoplasia (adenoma ≥1 cm, with tubulovillous/villous histology, with high-grade dysplasia, or invasive adenocarcinoma) were compared with 4708 controls without advanced neoplasia for age, sex, smoking history, body mass index, family history of colorectal cancer and the presence of serrated polyps. Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis. RESULTS The prevalence of advanced neoplasia and serrated polyps (excluding small distal hyperplastic polyps) was 5.7% and 5.6%, respectively. 3.7% and 0.4% subjects had proximal and large (≥10 mm) serrated polyps, respectively. Independent predictors of synchronous advanced colorectal neoplasia were the presence of sessile serrated adenomas (OR: 4.52; 95% CI: 2.40-8.49), proximal serrated polyps (OR: 2.23, 95% CI: 1.38-3.60), large serrated polyps (OR: 59.25; 95% CI: 18.85-186.21), hyperplastic polyps (OR: 1.66; 95% CI: 1.03-2.67), three or more serrated polyps (OR: 4.86; 95% CI: 1.24-19.15) and one or more non-advanced tubular adenomas (OR: 3.58, 95% CI: 2.59-4.96). CONCLUSION Detection of proximal, sessile and/or large serrated polyps at screening colonoscopy is independently associated with an increased risk for synchronous advanced neoplasia.
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Affiliation(s)
- S C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, State Key Laboratory of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong, China
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Wong MCS, Ching JYL, Chan VCW, Shum JP, Lam TYT, Luk AKC, Sung JJY. Should prior FIT results be incorporated as an additional variable to estimate risk of colorectal neoplasia? A prospective study of 5,813 screening colonoscopies. PLoS One 2014; 9:e114332. [PMID: 25479102 PMCID: PMC4257562 DOI: 10.1371/journal.pone.0114332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/06/2014] [Indexed: 02/06/2023] Open
Abstract
Background Recent studies showed that previous negative results from faecal immunochemical tests (FITs) for colorectal cancer (CRC) screening was associated with lower risk of advanced neoplasia (AN). We evaluated whether prior FIT results should be included to estimate the risk of AN in 2008–2012. Methods A community-based screening practice recruited 5,813 asymptomatic residents aged 50 to 70 years in Hong Kong for CRC screening. We included study participants who had (1). positive FIT with subsequent colonoscopy workup (FIT+ group; n = 356); (2). negative FIT in three consecutive years and received a colonoscopy (FIT- group; n = 857); (3). received colonoscopy without FIT (colonoscopy group; n = 473); and (4). received both colonoscopy and FIT at the same time (combined group; n = 4,127). One binary logistic regression model evaluated whether prior FIT results were associated with colonoscopy findings of AN. Results The proportion of participants having AN/CRC was 18.0% (FIT+), 5.5% (FIT-), 8.0% (colonoscopy group), and 4.3% (combined group), respectively. When compared with the colonoscopy group, those in the FIT- group were not significantly more or less likely to have AN/CRC (AOR = 0.77, 95% C.I. = 0.51 to 1.18, p = 0.230). Having one (AOR = 0.73, 95% C.I. 0.48–1.12, p = 0.151) or three consecutive negative FIT result (AOR = 0.98, 95% C.I. 0.60–1.62, p = 0.944) were not associated with lower risks of AN/CRC. Subjects in the FIT+ group was 3.32-fold (95% C.I. 2.07 to 5.32, p<0.001) more likely to have AN/CRC. Conclusions These findings indicated that subjects with negative FIT findings could be risk stratified similarly as those who had not previously received FIT.
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Affiliation(s)
- Martin C. S. Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
| | - Jessica Y. L. Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Victor C. W. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey P. Shum
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y. T. Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Arthur K. C. Luk
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J. Y. Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Wong SH, Ng SC, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Identification of subjects at risk of proximal advanced neoplasia for colorectal cancer screening. Eur J Cancer 2014; 51:37-44. [PMID: 25459390 DOI: 10.1016/j.ejca.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 06/13/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
Flexible sigmoidoscopy (FS) and colonoscopy are two commonly used screening tools for colorectal cancer (CRC), and FS mainly detects distal lesions. Colonoscopy resource is limited, yet there is no definite evidence on when flexible sigmoidoscopy is suitable as a screening alternative. This study evaluated the optimal cut-off score from a validated risk stratification system which best predicts proximal advanced neoplasia (PAN) by comparing the sensitivity, specificity and relative risk of PAN according to various cut-off scores. 5819 asymptomatic subjects aged between 50 and 70years (average age 57.7years, standard deviation (SD) 4.9) received colonoscopy between 2008 and 2014 in Hong Kong. Their prevalence of PAN was evaluated according to a prediction tool for colorectal neoplasia based on age, gender, smoking status, family history of CRC, body mass index (BMI) and diabetes (ranging from 0 to 6). One binary logistic regression model was performed with PAN as the outcome variable and the risk score as the variable tested for association. In multivariate regression analysis, risk score ⩾3 was associated with significantly higher risk of PAN (3.4-9.1%; AOR=3.18-8.09, p<0.001) when compared with those scoring 0. Risk scores 0-2 were associated with either insignificant or lower risks of PAN compared to the overall risk. Applying FS for screening those who scored 0-2 and colonoscopy for those who scored ⩾3 led to a very small proportion of PAN being missed (1.60%), whilst maintaining a high level of specificity (81.9%). Clinicians may use this scoring system to inform subjects and facilitate their choice between colonoscopy and FS.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region; School of Public Health and Primary Care, Chinese University of Hong Kong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Sunny H Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Siew C Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Justin C Y Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, 7/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region.
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Wong MCS, Lam TYT, Tsoi KKF, Hirai HW, Chan VCW, Ching JYL, Chan FKL, Sung JJY. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects. Gut 2014; 63:1130-6. [PMID: 24045331 DOI: 10.1136/gutjnl-2013-305639] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aim to develop and validate a clinical scoring system to predict the risks of colorectal neoplasia to better inform screening participants and facilitate their screening test choice. DESIGN We recruited 5220 Chinese asymptomatic screening participants who underwent colonoscopy in Hong Kong during 2008-2012. From random sampling of 2000 participants, independent risk factors were evaluated for colorectal neoplasia, defined as adenoma, advanced neoplasia, colorectal cancer or any combination thereof using binary regression analysis. The ORs for significant risk factors were used to develop a scoring system ranging from 0 to 6: 0-2 'average risk' (AR) and 3-6 'high risk' (HR). The other 3220 screening participants prospectively enrolled between 2008 and 2012 for screening colonoscopy formed an independent validation cohort. The performance of the scoring system for predicting colorectal neoplasia was evaluated. RESULTS The prevalence of colorectal neoplasia in the derivation and validation cohorts was 31.4% and 30.8%, respectively. Using the scoring system developed, 78.9% and 21.1% in the validation cohort were classified as AR and HR, respectively. The prevalence of colorectal neoplasia in the AR and HR groups was 27.1% and 44.6%, respectively. The subjects in the HR group had 1.65-fold (95% CI 1.49 to 1.83) increased prevalence of colorectal neoplasia than the AR group. CONCLUSIONS The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kelvin K F Tsoi
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoyee W Hirai
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Francis K L Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong
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Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Hirai HW, Ching JYL, Sung JJY. Predictors of advanced colorectal neoplasia for colorectal cancer screening. Am J Prev Med 2014; 46:433-9. [PMID: 24745632 DOI: 10.1016/j.amepre.2013.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 08/22/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Asia-Pacific Colorectal Screening (APCS) score based on age, gender, family history, and smoking is useful to predict advanced colorectal neoplasia (ACN) in asymptomatic Asian subjects. PURPOSE To evaluate the factors in addition to those of APCS associated with ACN colonoscopic findings. METHODS Data from 5,220 asymptomatic subjects aged between 50 and 70 years who underwent screening colonoscopy in a community center between 2008 and 2012 were analyzed. One binary logistic regression analysis was conducted in 2013 with the presence of ACN or cancer as the outcome, controlling for APCS score, alcohol consumption, BMI, hypertension, and other chronic diseases as independent variables. RESULTS The average participant age was 57.7 years (SD=4.9) and 47.5% were men. Advanced neoplasms or cancers were identified at colonoscopy in 5.6% of all screening participants. From multivariate regression analysis, APCS score≥4 (adjusted OR [AOR]=1.74, 95% CI=1.34, 2.25, p<0.001); overweight (BMI=23-24.9, AOR=1.52, 95% CI=1.12, 2.07, p=0.007); obesity (BMI≥25, AOR=1.56, 95% CI=1.15, 2.10, p=0.004); hypertension (AOR=1.58, 95% CI=1.21, 2.06, p=0.001); and alcohol consumption (AOR=1.47, 95% CI=1.05, 2.06, p=0.025) were associated with ACN. The c-statistic of APCS score alone was 0.560 (95% CI=0.524, 0.595, p=0.001) and that of APCS score plus BMI, hypertension, and alcohol consumption was 0.613 (95% CI=0.578, 0.648, p<0.001). CONCLUSIONS Alcohol consumption, hypertension, and BMI are independent predictors of ACN, which could be incorporated into the APCS for prioritizing Asian asymptomatic subjects for colorectal cancer screening.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong; School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Kelvin K F Tsoi
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Hoyee W Hirai
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong.
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Ng SC, Ching JYL, Chan V, Wong MCS, Suen BY, Hirai HW, Lam TYT, Lau JYW, Ng SSM, Wu JCY, Chan FKL, Sung JJY. Diagnostic accuracy of faecal immunochemical test for screening individuals with a family history of colorectal cancer. Aliment Pharmacol Ther 2013; 38:835-41. [PMID: 23957462 DOI: 10.1111/apt.12446] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 05/28/2013] [Revised: 06/13/2013] [Accepted: 07/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of a faecal immunochemical test (FIT) in screening individuals with a positive family history of colorectal cancer (CRC) is not clear. AIM To assess the diagnostic accuracy of FIT using colonoscopy findings as the gold standard in identifying colorectal neoplasms. METHODS We analysed data from 4539 asymptomatic subjects aged 50-70 years who had both colonoscopy and FIT (Hemosure; W.H.P.M., Inc, El Monte, CA, USA) at our bowel cancer screening centre between 2008 and 2012. A total of 572 subjects (12.6%) had a family history of CRC. Our primary outcome was the sensitivity of FIT in detecting advanced neoplasms and cancers in subjects with a family history of CRC. A family history of CRC was defined as any first-degree relative with a history of CRC. RESULTS Among 572 subjects with a family history of CRC, adenoma, advanced neoplasm and cancer were found at screening colonoscopy in 29.4%, 6.5% and 0.7% individuals, respectively. The sensitivity of FIT in detecting adenoma, advanced neoplasm and cancer was 9.5% [95% confidence interval (CI), 5.7-15.3], 35.1% (95% CI, 20.7-52.6) and 25.0% (95% CI, 1.3-78.1), respectively. Among FIT-negative subjects who have a family history of CRC, adenoma was found in 152 (29.6%), advanced neoplasm in 24 (4.7%) and cancer in 3 (0.6%) individuals. CONCLUSION Compared with colonoscopy, FIT is more likely to miss advanced neoplasms or cancers in individuals with a family history of CRC.
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Affiliation(s)
- S C Ng
- Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Wong MCS, Ching JYL, Lam TYT, Luk AKC, Hirai HW, Griffiths SM, Chan FKL, Sung JJY. Prospective cohort study of compliance with faecal immunochemical tests for colorectal cancer screening in Hong Kong. Prev Med 2013; 57:227-31. [PMID: 23732241 DOI: 10.1016/j.ypmed.2013.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 02/18/2013] [Revised: 04/28/2013] [Accepted: 05/27/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aims to examine the rate and determinants of faecal immunochemical test (FIT) compliance over a four-year period among asymptomatic participants in a colorectal cancer (CRC) screening programme in Hong Kong. METHOD Self-referred screening participants aged between 50 and 70 years who chose FIT for annual screening were followed up for four years (2008-2012). All participants were reminded up to three times yearly for FIT retrieval within two months of the expected screening date. The proportions of screening participants who failed to adhere to annual FIT tests in 1, 2, 3 and 4-years, respectively, after the initial screening uptake were evaluated. The factors associated with non-compliance with FITs in any year were assessed by a binary logistic regression analysis. RESULTS From 5700 consecutive screening participants, the compliance rates to FIT were 95.1%, 79.9%, 66.2% and 68.4% at years one to four, respectively. The proportions of people missing one, two and three tests were 6.2%, 19.6% and 2.1%, respectively. From multivariate regression analysis, male subjects, younger participants, smokers and those with positive family history of CRC were more likely to be non-compliant. CONCLUSION Participants identified as at higher risk for screening non-compliance should be especially considered for individual reminders to enhance screening effectiveness.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, 7/F, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Wong MCS, Ching JYL, Hirai HH, Lam TYT, Griffiths SM, Chan FKL, Sung JJY. Perceived obstacles of colorectal cancer screening and their associated factors among 10,078 Chinese participants. PLoS One 2013; 8:e70209. [PMID: 23894619 PMCID: PMC3720896 DOI: 10.1371/journal.pone.0070209] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/17/2013] [Indexed: 01/22/2023] Open
Abstract
Purpose to evaluate the proportion of self-referred screening participants having various psychological barriers and the factors associated with these barriers. Methods A territory-wide bowel cancer screening centre sent an invitation via the media to all Hong Kong residents aged 50–70 years who were asymptomatic of CRC to join a free screening programme. Upon attendance they were requested to complete self-administered surveys on their perceived barriers of screening. Binary logistic regression analyses were used to evaluate the factors associated with these barriers. Results From 10,078 consecutive screening participants (mean age 57.5 years; female 56.4%) completed the surveys between May 2008 to September 2012. There were high proportions who agreed or strongly agreed with the following barriers: financial difficulty (86.0%), limited service accessibility (58.2%), screening-induced bodily discomfort (55.2%), physical harm (44.4%), embarrassment (40.1%), apprehension (38.8%) and time constraints (13.9%). From regression models, older participants (aged ≥56) were less likely to have these barriers (Adjusted odds ratio [AOR] ranged from 0.738 to 0.952) but they encountered more difficulties to access to screening services (AOR ranged from 1.141 to 1.371). Female subjects were more likely to encounter most of these barriers (AOR ranged from 1.188 to 2.179). Participants who were uncertain of the necessity of CRC screening for people aged ≥50 were more likely to report these barriers (AOR ranged from 1.151 to 1.671). Conclusion The proportions of perceptual barriers of CRC screening were high among these participants. Those with these associated factors should receive more thorough explanation of the screening test procedures.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
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Wong MCS, Hirai HW, Luk AKC, Lam TYT, Ching JYL, Griffiths SM, Chan FKL, Sung JJY. The knowledge of colorectal cancer symptoms and risk factors among 10,078 screening participants: are high risk individuals more knowledgeable? PLoS One 2013; 8:e60366. [PMID: 23573248 PMCID: PMC3616059 DOI: 10.1371/journal.pone.0060366] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/25/2013] [Indexed: 12/31/2022] Open
Abstract
Objectives We tested the a priori hypothesis that self-perceived and real presences of risks for colorectal cancer (CRC) are associated with better knowledge of the symptoms and risk factors for CRC, respectively. Methods One territory-wide invitation for free CRC screening between 2008 to 2012 recruited asymptomatic screening participants aged 50–70 years in Hong Kong. They completed survey items on self-perceived and real presences of risks for CRC (advanced age, male gender, positive family history and smoking) as predictors, and knowledge of CRC symptoms and risk factors as outcome measures, respectively. Their associations were evaluated by binary logistic regression analyses. Results From 10,078 eligible participants (average age 59 years), the mean knowledge scores for symptoms and risk factors were 3.23 and 4.06, respectively (both score range 0–9). Male gender (adjusted odds ratio [AOR] = 1.34, 95% C.I. 1.20–1.50, p<0.01), self-perception as not having any risks for CRC (AOR = 1.12, 95% C.I. 1.01–1.24, p = 0.033) or uncertainty about having risks (AOR = 1.94, 95% C.I. 1.55–2.43, p<0.001), smoking (AOR 1.38, 95% C.I. 1.11–1.72, p = 0.004), and the absence of family history (AOR 0.61 to 0.78 for those with positive family history, p<0.001) were associated with poorer knowledge scores (≤4) of CRC symptoms. These factors remained significant for knowledge of risk factors. Conclusions Male and smokers were more likely to have poorer knowledge but family history of CRC was associated with better knowledge. Since screening of these higher risk individuals could lead to greater yield of colorectal neoplasm, educational interventions targeted to male smokers were recommended.
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Affiliation(s)
- Martin C. S. Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hoyee W. Hirai
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Arthur K. C. Luk
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y. T. Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Y. L. Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sian M. Griffiths
- School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Francis K. L. Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joseph J. Y. Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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Wong MCS, John GK, Hirai HW, Lam TYT, Luk AKC, Ching JYL, Ng SSM, Chan FKL, Griffiths SM, Sung JJY. Changes in the choice of colorectal cancer screening tests in primary care settings from 7,845 prospectively collected surveys. Cancer Causes Control 2012; 23:1541-8. [DOI: 10.1007/s10552-012-0031-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/10/2012] [Indexed: 12/01/2022]
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