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Clinical Colorectal Cancer Dec 2016To evaluate the effectiveness of colorectal cancer (CRC) screening in asymptomatic adults. A search was conducted of the Medline, Embase, and the Cochrane Library... (Meta-Analysis)
Meta-Analysis Review
To evaluate the effectiveness of colorectal cancer (CRC) screening in asymptomatic adults. A search was conducted of the Medline, Embase, and the Cochrane Library databases. A targeted search of PubMed was conducted for on-topic randomized controlled trials (RCTs). Meta-analysis across 4 RCTs for guaiac fecal occult blood testing (gFOBT) and flexible sigmoidoscopy (FS) screening showed a reduction of 18% (risk ratio [RR], 0.82; 95% CI [CI], 0.73-0.92) and 26% (RR, 0.74; 95% CI, 0.67-0.83) in CRC mortality for the screening group compared to controls, respectively. The number needed to screen (NNS) were 377 (95% CI, 249-887) and 864 (95% CI, 672-1266) for gFOBT and FS screening, respectively. A reduction of 8% and 27% in incidence of late-stage CRC was also observed for gFOBT and FS screening, respectively, but both had no significant effect on all-cause mortality. A single RCT found that screening with immunochemical fecal occult blood test (iFOBT) had no significant impact on CRC mortality (RR, 0.88; 95% CI, 0.72-1.07). Screening with FS has potential harms such as perforation, major and minor bleeding, and death from the procedure or from follow-up colonoscopy. gFOBT and FS screening reduce CRC mortality and incidence of late-stage disease. The absolute effect and NNS were much more favorable for older adults (≥ 60 years), suggesting that a targeted screening approach may avoid exposing younger adults to the harms of CRC screening, from which they are unlikely to derive any significant benefit. Although there is insufficient RCT evidence on the impact of iFOBT on mortality outcomes. compared to gFOBT, this test showed higher sensitivity and comparable specificity, indicating the need to update and reevaluate the evidence in light of future high-quality research. The protocol for this systematic review have been published with PROSPERO 2014: CRD42014009777.
Topics: Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 27133893
DOI: 10.1016/j.clcc.2016.03.003 -
Gastroenterology Mar 2017
Topics: Adult; Biopsy; Gastrointestinal Hemorrhage; Humans; Intussusception; Male; Peutz-Jeghers Syndrome; Rectal Prolapse; Sigmoidoscopy
PubMed: 28157517
DOI: 10.1053/j.gastro.2016.08.021 -
FP Essentials May 2022Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. CRC screening reduces CRC deaths. Although the median age at diagnosis is 67...
Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. CRC screening reduces CRC deaths. Although the median age at diagnosis is 67 years, the incidence in younger individuals has been increasing, and younger patients are more likely to present with more advanced disease. In the past, guidelines recommended initiating screening at age 50 years. However, guidelines from multiple organizations now recommend initiating screening at age 45 years. Screening should start even earlier in individuals with genetic risks for CRC. Recommendations about when to discontinue screening vary, but all guidelines recommend continuing at least to age 75 years. After age 75 years, screening should be based on patients' life expectancy, medical status, and values and goals. Colonoscopy is considered the gold standard screening test, but many patients decline colonoscopy because of its invasive nature and associated bowel preparation. Other tests recommended in guidelines include guaiac-based fecal occult blood test, fecal immunochemical and DNA tests, flexible sigmoidoscopy, and computed tomography colonography. Recommended screening intervals vary for each of these tests. Two newer screening tests, not yet included in guidelines, are Epi proColon (methylated septin DNA) assay (which detects methylation of the SEPT9 gene associated with CRC) and capsule colonography. All patients also should be informed about lifestyle and diet-related interventions that can decrease CRC risk.
Topics: Aged; Colonoscopy; Colorectal Neoplasms; DNA; Early Detection of Cancer; Humans; Mass Screening; Middle Aged; Occult Blood; Sigmoidoscopy; United States
PubMed: 35507309
DOI: No ID Found -
Gastrointestinal Endoscopy Clinics of... Jul 2020This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule... (Review)
Review
This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in average-risk individuals, but is not approved for CRC screening at the current time.
Topics: Capsule Endoscopy; Colonography, Computed Tomographic; Colorectal Neoplasms; Early Detection of Cancer; Humans; Imaging, Three-Dimensional; Mass Screening; Sigmoidoscopy
PubMed: 32439089
DOI: 10.1016/j.giec.2020.02.009 -
Nature May 2015
Topics: Aged; Australia; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Europe; False Positive Reactions; Humans; Mass Screening; Middle Aged; Occult Blood; Patient Compliance; Proto-Oncogene Proteins; Proto-Oncogene Proteins p21(ras); Septins; Sigmoidoscopy; United States; ras Proteins
PubMed: 25970456
DOI: 10.1038/521S4a -
American Journal of Preventive Medicine Mar 2020Family Medicine Groups, implemented in Quebec in 2002, are interprofessional primary care teams designed to improve timely access to high-quality primary care. This...
INTRODUCTION
Family Medicine Groups, implemented in Quebec in 2002, are interprofessional primary care teams designed to improve timely access to high-quality primary care. This study investigates whether Family Medicine Groups increased rates of guideline-recommended screenings for 3 chronic diseases: colorectal cancer (colonoscopy/sigmoidoscopy), breast cancer (mammography), and osteoporosis (bone mineral density testing).
METHODS
Using population-based administrative health data from the provincial insurer (2000-2010), the authors examined elderly and chronically ill patients who registered with a general practitioner in the first 15 months of the Family Medicine Group policy. Propensity score weighting and a difference-in-differences model estimated differential change in biennial screening rates among Family Medicine Group and non-Family Medicine Group patients over 5 years of follow-up (analysis, 2016-2018).
RESULTS
Rates of mammography, colonoscopy/sigmoidoscopy, and bone mineral density testing increased after patient registration with a general practitioner, similarly for both Family Medicine Group and non-Family Medicine Group patients. Colonoscopy/sigmoidoscopy rates increased by 9.7% and 10.4% for Family Medicine Group and non-Family Medicine Group patients, mammography rates by 5.3% and 3.4%, and bone mineral density testing by 4.2% and 7.1%. Difference-in-differences estimates showed no detectable effect of Family Medicine Groups on disease screening rates: -0.06 percentage points (95% CI= -0.32, 0.20) for colonoscopy/sigmoidoscopy, 1.01 percentage points (95% CI= -0.25, 2.27) for mammography, and -0.32 (95% CI= -0.71, -0.07) for bone mineral density testing.
CONCLUSIONS
This study found no evidence that Family Medicine Groups affected screening rates for these 3 chronic diseases. Limitations in the implementation of the Family Medicine Group policy in its early years may have contributed to this lack of impact. Interprofessional primary care teams may need to include elements other than organizational changes to increase disease prevention efforts.
Topics: Aged; Aged, 80 and over; Breast Neoplasms; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Family Practice; Female; Humans; Male; Mammography; Mass Screening; Middle Aged; Osteoporosis; Practice Guidelines as Topic; Primary Health Care; Propensity Score; Quebec; Retrospective Studies; Sigmoidoscopy
PubMed: 31952941
DOI: 10.1016/j.amepre.2019.10.019 -
BioMed Research International 2015Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the... (Review)
Review
BACKGROUND
Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening.
METHODS
We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News.
RESULTS
Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising "third-eye retroscope." Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market.
CONCLUSIONS
Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities.
Topics: Barium; Capsule Endoscopy; Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; DNA, Neoplasm; Early Detection of Cancer; Feces; Female; Humans; Magnetic Resonance Imaging; Male; Mass Screening; Occult Blood; Sigmoidoscopy; United States
PubMed: 26504799
DOI: 10.1155/2015/326728 -
Journal of the College of Physicians... Jun 2017The month of March is dedicated to Colon Cancer Awareness. Worldwide, colorectal cancer (CRC) incidence has been on the rise. It is currently the third most common...
The month of March is dedicated to Colon Cancer Awareness. Worldwide, colorectal cancer (CRC) incidence has been on the rise. It is currently the third most common cancer in men (746,000 cases, 10.0% of the total) and the second in women (614,000 cases, 9.2% of the total).1 Arecent meta-analysis reported a 61% risk reduction in CRC incidence with colonoscopy.2 Unlike screening programs for breast and prostate cancers, not only has CRC screening reduced mortality from colon cancer and detected early CRC, it has also decreased the incidence of CRC through detection and removal of pre-cancerous lesions. Studies have shown that screening for colorectal cancer provided 152 to 313 life-years-gained (LYG) per 1000 forty-year-old individuals.3 Anumber of modalities exist for CRC screening, which can broadly be categorized into stool-based tests and direct visualization tests. Stool-based tests include fecal occult blood testing (FOBT), fecal immunochemical testing (FIT) and stool DNAtesting. Direct visualization tests include endoscopic procedures such as colonoscopy and flexible sigmoidoscopy; and radiographic tests such as CT colonography, which has largely replaced air contrast barium enemas.4 The only reported population-based data for CRC in Pakistan comes from Bhurgri et al. in 2011.5It described Pakistan as a low risk region with an age standardized incidence rate (ASR) world per 100,000 of 7.1 in males and 5.2 in females, but with a much younger age and advanced stage at diagnosis. The ratio for individuals diagnosed with CRC under the age of 40, as oppose to over 40 years, was 3:1, which is much higher than the international average. Noteworthy as well, is an increase in incidence especially among men, noted between the study periods of 1995-1997 and 1997-2002. It ranks 7th in incidence among males, and 8th among females, with tobacco related malignancies topping the list.6 There has since been additional cross-sectional data from Pakistan echoing these findings of a younger age and advanced disease at presentation.7 Speaking from a public health perspective, Pakistan, while still battling communicable diseases, is now seeing an increasing incidence of non-communicable diseases population-based screening programs for CRC were not justified in most developing countries, citing low reported incidence and low resource health authorities; but that in limited regions with an ageing population and a shift to Western lifestyle, organized screening strategies needed to be developed. This can well be extrapolated to large urban centers in Pakistan. In a resource poor, conservative country like Pakistan, with poor health literacy, there exist many barriers to CRC screening which were summed up very articulately by Ahmed F in 2013. Quite appropriately, areas identified for further pursuit included, among others, the training of gastroenterologists, especially female ones, less expensive and more culturally acceptable screening options, and cost-effectiveness analyses. The recipe for any cancer screening program to be successful, begins with epidemiological data to document disease burden. There has not been any population-based cancer registry to report incidence data for the past few years. There is also no centralized cancer registry to effectively unify and coordinate data from across the country. Furthermore, even with a cancer registry there is no mandated reporting of malignancies from a health policy standpoint, as exists in the more developed world. The last population-based data we have for CRC was for cases reported until 2002, and there was already an increase in incidence noted in less than a decade, starting in 1995.5 Health awareness is another important factor. There is no data from Pakistan regarding patient or physician awareness regarding colon cancer. If one is to extrapolate, a cross-sectional study on breast cancer awareness, for which Pakistan demonstrates one of the highest incidences worldwide,6 reported that a mammogram had been performed in only 4.9 % of women in the cohort, while 61.5 % of the remainder had never even heard about it.7 It is also unclear if we have the infrastructure including endoscopy centers and adequate numbers of gastroenterologists to service the population at large. FOBTis available and cheap, but there is no data regarding the availability of FITor stool DNAtesting. In the absence of health insurance, it will certainly be a challenge to make CRC screening widely accessible. At what point does a disease warrant attention? While we may not have the luxury or the immediate necessity to introduce mass population-based CRC screening, we can certainly start with individual screening in populations who are at high risk of colorectal cancer due to family history and have adequate access to healthcare. There should be a concerted drive to revitalize cancer registration in order to guide health policy and to have an effective national cancer control program. Awareness programs are also needed to be established for the public and, specifically, for physicians as well.
Topics: Colonic Neoplasms; Colonoscopy; Cost-Benefit Analysis; Early Detection of Cancer; Health Knowledge, Attitudes, Practice; Humans; Mass Screening; Occult Blood; Pakistan; Sigmoidoscopy
PubMed: 28689518
DOI: No ID Found -
Diseases of the Colon and Rectum Mar 2021A 54-year-old otherwise healthy woman presented for screening colonoscopy, during which 4 pedunculated 5- to 12-mm polyps distributed throughout the colon were found...
A 54-year-old otherwise healthy woman presented for screening colonoscopy, during which 4 pedunculated 5- to 12-mm polyps distributed throughout the colon were found (Fig. 1). The 12-mm sigmoid polyp was removed with hot snare polypectomy in a nonpiecemeal fashion. Pathology demonstrated 3 tubular adenomas and a poorly differentiated invasive carcinoma in a sigmoid polyp without tumor budding, invading 0.8 mm into the submucosa, with lymphovascular invasion and with a deep margin of 0.6 mm. The next week, she underwent repeat flexible sigmoidoscopy with tattooing of the polypectomy site. She had a normal staging CT chest/abdomen/pelvis as well as CEA level and later underwent uneventful laparoscopic sigmoid resection, which included the area of endoscopic tattoo. Final pathology confirmed the presence of the tattooed area and polypectomy scar and showed no residual primary tumor and 2/18 positive lymph nodes (Fig, 2). She was referred to medical oncology for adjuvant chemotherapy.
Topics: Adenoma; Algorithms; Carcinoma; Chemotherapy, Adjuvant; Clinical Decision-Making; Colonic Polyps; Colonoscopy; Female; Humans; Laparoscopy; Margins of Excision; Middle Aged; Neoplasm Invasiveness; Neoplasm, Residual; Practice Guidelines as Topic; Referral and Consultation; Sigmoid Neoplasms; Sigmoidoscopy
PubMed: 33337601
DOI: 10.1097/DCR.0000000000001930 -
Endoscopy Nov 2017
Topics: Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Occult Blood; Pain; Sigmoidoscopy
PubMed: 29073695
DOI: 10.1055/s-0043-118216