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The New Zealand Medical Journal Aug 2023
Topics: Humans; Early Detection of Cancer; New Zealand; Colonoscopy; Sigmoidoscopy; Colorectal Neoplasms; Mass Screening; Occult Blood
PubMed: 37536307
DOI: No ID Found -
Crohn's & Colitis 360 Jul 2023Guidelines recommend performing a flexible sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). However, it is unclear if time to...
OBJECTIVES
Guidelines recommend performing a flexible sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). However, it is unclear if time to sigmoidoscopy affects relevant clinical outcomes. We aimed to assess the impact of early sigmoidoscopy on clinical outcomes using a well-characterized cohort of patients with ASUC.
METHODS
This is a single-center, retrospective study of all patients hospitalized with ASUC from January 1, 2012 to November 1, 2021. Early sigmoidoscopy was defined as occurring within 72 hours of admission while delayed sigmoidoscopy was defined as occurring >72 hours after admission. Primary outcomes were cumulative days of intravenous (IV) corticosteroid (CS) use, length of hospital stay, and colectomy rates. Secondary outcomes were time to infliximab (IFX) rescue and inpatient opioid medication use.
RESULTS
A total of 112 patients hospitalized with ASUC who underwent sigmoidoscopy were included in the analysis. Eighty-seven patients (78%) had early sigmoidoscopy and 25 (22%) had delayed sigmoidoscopy. Patients in the early sigmoidoscopy group were exposed to significantly fewer days of IV CS (4.5 vs 9.2 days; < .001), had shorter hospital stays (6.4 vs 19.3 days; < .001), and shorter time to IFX rescue (3.5 vs 6.4 days; = .004). Rates of colectomy in the early and delayed sigmoidoscopy groups were 17% versus 28%, respectively ( = .23). Longer time to sigmoidoscopy was associated with a 16% increased risk of colectomy (HR = 1.16, = .002).
CONCLUSIONS
In this well-characterized cohort, early sigmoidoscopy in ASUC was associated with favorable clinical outcomes. These findings highlight the benefits of early sigmoidoscopy in patients with ASUC. Larger prospective studies are needed to corroborate these findings.
PubMed: 37323477
DOI: 10.1093/crocol/otad032 -
JAMA Network Open Nov 2023Breast, cervical, and colorectal cancer-screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic.
IMPORTANCE
Breast, cervical, and colorectal cancer-screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic.
OBJECTIVE
To assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income.
DESIGN, SETTING, AND PARTICIPANTS
This population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country's most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed.
EXPOSURES
Neighborhood income quintile, immigrant status, and primary care model type.
MAIN OUTCOMES AND MEASURES
For each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years.
RESULTS
The overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, -9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, -3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was -1.16 (95% CI, -1.56 to -0.77); for immigrant vs nonimmigrant, the β estimate was -1.51 (95% CI, -1.84 to -1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was -1.29 (95% CI, 16 -1.53 to -1.06); for immigrant vs nonimmigrant, the β estimate was -1.41 (95% CI, -1.61 to -1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.
Topics: Adult; Humans; Female; Middle Aged; Male; Early Detection of Cancer; COVID-19; Cross-Sectional Studies; Pandemics; Uterine Cervical Neoplasms; Breast Neoplasms; Ontario; Colorectal Neoplasms
PubMed: 37983033
DOI: 10.1001/jamanetworkopen.2023.43796 -
MedRxiv : the Preprint Server For... Jul 2023The effectiveness of colonoscopy to reduce colorectal cancer (CRC) mortality is extrapolated from cohort studies in the absence of randomized controlled trial (RCT)...
OBJECTIVES
The effectiveness of colonoscopy to reduce colorectal cancer (CRC) mortality is extrapolated from cohort studies in the absence of randomized controlled trial (RCT) data, whereas flexible sigmoidoscopy is supported by RCT data and may be easier to implement in practice. We characterized the anatomic distribution of CRC to determine the proportion that is visible with sigmoidoscopy.
METHODS
Patients with a primary diagnosis of colorectal adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results program (2000-2020). Tumors from the rectum to descending colon were categorized as visible by sigmoidoscopy, whereas more proximal tumors as requiring colonoscopy. Differential prognosis between tumor locations, stratified by age groups and stage, were assessed using overall restricted mean survival time (RMST) at 2, 5, and 10 years.
RESULTS
Among 309,466 patients, 58% had tumors visible by sigmoidoscopy, including 73% of those under age 50 (OR 2.10, 95%CI 2.03-2.16 age <45, OR 2.20, 95%CI 2.13-2.27 age 45-49 versus age > 50). Male sex (OR 1.54, 95%CI 1.51-1.56) and Asian or Pacific Islander race (OR 1.60, 95%CI 1.56-1.64) were also positively associated with tumors visualizable by sigmoidoscopy. Across age groups, for local disease, RMST was comparable for tumors visible versus not visible on sigmoidoscopy. For regional and metastatic cancer, patients with tumors visible by sigmoidoscopy had improved RMST versus those with more proximal tumors.
CONCLUSIONS
Most CRC arise in locations visible by flexible sigmoidoscopy. Flexible sigmoidoscopy should be considered as a viable option for CRC screening, particularly in younger patients unwilling or unable to undergo colonoscopy.
PubMed: 37503174
DOI: 10.1101/2023.07.18.23292663 -
International Journal of Cancer Dec 2023Evidence suggests that aspirin use reduces the occurrence of colorectal neoplasia. Few studies have investigated the association among Black Americans, who are...
Evidence suggests that aspirin use reduces the occurrence of colorectal neoplasia. Few studies have investigated the association among Black Americans, who are disproportionately burdened by the disease. We assessed aspirin use in relation to colorectal adenoma among Black women. The Black Women's Health Study is a prospective cohort of self-identified Black American women established in 1995. Participants reported regular aspirin use on baseline and follow-up questionnaires. Beginning in 1999, participants reported undergoing a colonoscopy or sigmoidoscopy, the only procedures through which colorectal adenomas can be diagnosed. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between aspirin use and colorectal adenoma among 34 397 women who reported at least 1 colonoscopy or sigmoidoscopy. From 1997 through 2018, 1913 women were diagnosed with an adenoma. Compared to nonaspirin users, regular users had 14% (OR = 0.86, 95% CI: 0.78-0.95) lower odds of adenoma. The odds of adenoma decreased with increasing duration of aspirin use (≥10 years: OR = 0.80, 95% CI: 0.66-0.96). Initiating aspirin at a younger age was associated with a reduced adenoma occurrence (age < 40 years at initiation: OR = 0.69, 95% CI: 0.55-0.86). Regular aspirin use was associated with a decreased odds of colorectal adenoma in our study of Black women. These findings support evidence demonstrating a chemopreventive impact of aspirin on colorectal neoplasia and suggest that aspirin may be a useful prevention strategy among US Black women.
Topics: Adult; Female; Humans; Acetaminophen; Adenoma; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Black or African American; Colorectal Neoplasms; Prospective Studies; United States
PubMed: 37555819
DOI: 10.1002/ijc.34674 -
Frontiers in Oncology 2023The question of whether flexible sigmoidoscopy (FS) for colorectal cancer (CRC) affects incidence or mortality remains unclear. In this study, we conducted a...
BACKGROUND
The question of whether flexible sigmoidoscopy (FS) for colorectal cancer (CRC) affects incidence or mortality remains unclear. In this study, we conducted a meta-analysis and systematic review to explore this issue.
METHODS
A systematic search of , , and was performed for cohort studies (CS), case-control studies, and randomized controlled trials (RCTs) of people who underwent FS and reported mortality or incidence of CRC until 11 December 2022. Relative risk (RR) was applied as an estimate of the effect of interest. To combine the RRs and 95% confidence intervals, a random-effects model was used. The quality of the included studies and evidence was assessed by the Newcastle-Ottawa quality assessment scale, the Jadad scale, and the "Grading of Recommendations Assessment, Development and Evaluation System."
RESULTS
There were a total of six RCTs and one CS, comprising 702,275 individuals. FS was found to be associated with a 26% RR reduction in CRC incidence (RR, 0.74; 95% CI, 0.66-0.84) and a 30% RR reduction in CRC mortality (RR, 0.70; 95% CI, 0.58-0.85). In the incidence subgroup analysis, FS significantly reduced the incidence of CRC compared with non-screening, usual care, and fecal immunochemical testing. Significance was also shown in men, women, distal site, stages III-IV, ages 55-59, and age over 60. In terms of the mortality subgroup analysis, the results were roughly the same as those of incidence.
CONCLUSION
According to this study, FS might reduce the incidence and mortality of CRC. To confirm this finding, further prospective clinical studies should be conducted based on a larger-scale population.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023388925.
PubMed: 38162502
DOI: 10.3389/fonc.2023.1288086 -
Journal of Clinical Medicine Nov 2023Inflammatory Bowel Disease (IBD) significantly affects women in their reproductive years. Understanding the relationship between IBD and pregnancy is crucial, given its... (Review)
Review
Inflammatory Bowel Disease (IBD) significantly affects women in their reproductive years. Understanding the relationship between IBD and pregnancy is crucial, given its impact across pre-gestational, gestational, and postpartum phases. Monitoring IBD activity during pregnancy involves various modalities. This review discusses these modalities, focusing on the efficacy and safety of Small Intestine Ultrasound (IUS) as a noninvasive and reliable option. While IUS has gained popularity, its technique-sensitive nature necessitates trained staff for optimal usage.
PubMed: 38068395
DOI: 10.3390/jcm12237343 -
Expert Review of Anticancer Therapy 2023Our objective was to estimate the effect of flexible sigmoidoscopy (FS)-based screening on colorectal cancer (CRC) incidence and mortality by conducting an updated... (Meta-Analysis)
Meta-Analysis Review
Effect of flexible sigmoidoscopy-based screening on colorectal cancer incidence and mortality: an updated systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
Our objective was to estimate the effect of flexible sigmoidoscopy (FS)-based screening on colorectal cancer (CRC) incidence and mortality by conducting an updated meta-analysis of randomized controlled trials (RCTs).
METHODS
PubMed, Web of Science, Embase, and Cochrane Library searched for RCTs from database inception to December 2022. The methodological quality of the RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. RevMan 5.4 was used for this meta-analysis.
RESULTS
Four RCTs involving 457, 871 patients were included. This meta-analysis revealed that FS-based screening was associated with a 20% relative risk reduction in CRC incidence [RR = 0.80; 95% CI (0.75, 0.86); < 0.00001], and a 24% reduction in CRC mortality [RR = 0.76; 95% CI (0.70, 0.82); 0.00001]. In addition, this meta-analysis revealed that FS-based screening reduced the incidence[RR = 0.68; 95% CI (0.60, 0.77); < 0.00001] and mortality[RR = 0.64; 95% CI (0.49, 0.83); = 0.0007] of distal CRC, but had no significant effect on proximal colon cancer.
CONCLUSION
FS-based screening appeared to be effective in reducing distal CRC incidence and mortality in patients at average risk compared to no intervention, but had no significant effect on proximal colon cancer.
Topics: Humans; Sigmoidoscopy; Colorectal Neoplasms; Incidence; Early Detection of Cancer; Randomized Controlled Trials as Topic; Colonic Neoplasms; Mass Screening
PubMed: 37542427
DOI: 10.1080/14737140.2023.2245564 -
Frontiers in Oncology 2024We conducted a comprehensive analysis to compare colonoscopy and sigmoidoscopy with standard care or fecal immunochemistry regarding colorectal cancer incidence and...
Effectiveness of sigmoidoscopy or colonoscopy screening on colorectal cancer incidence and mortality: a systematic review and meta-analysis of randomized controlled trial.
OBJECTIVES
We conducted a comprehensive analysis to compare colonoscopy and sigmoidoscopy with standard care or fecal immunochemistry regarding colorectal cancer incidence and mortality risk.
METHODS
Until August 2023, literature from PubMed, Embase, Web of Science, and Cochrane was systematically reviewed. We examined the impact of colonoscopy or sigmoidoscopy versus standard care on colorectal cancer outcomes, including incidence, cancer-specific mortality, and overall mortality.
RESULTS
Among 4,265 screened articles, data from seven randomized controlled trials (involving 663,319 participants) were analyzed. The intervention group (colonoscopy or sigmoidoscopy) consisted of 258,938 participants, while the control group received standard care or fecal immunochemical testing, totaling 404,381 participants, with both groups having average colorectal cancer risk, without confounders. Pooled analyses indicated a 20% reduction in colorectal cancer incidence (RR: 0.80, 95% CI: 0.77-0.83) and a 26% decrease in colorectal cancer mortality (RR: 0.74, 95% CI: 0.69-0.80) in the intervention group compared to standard care. All-cause mortality remained unchanged (RR: 1.03, 95% CI: 0.99-1.07). Subgroup analysis favored sigmoidoscopy in reducing colorectal cancer morbidity and mortality.
CONCLUSION
This meta-analysis of randomized controlled trials underscores the effectiveness of colonoscopy and, notably, sigmoidoscopy in reducing colorectal cancer incidence and mortality among average-risk populations. In comparison to fecal immunochemical testing, both colonoscopy and sigmoidoscopy did not significantly impact colorectal cancer incidence and mortality in this population.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023460007.
PubMed: 38549924
DOI: 10.3389/fonc.2024.1364923 -
Cureus Aug 2023Diarrhoea is a common presentation in acute emergency with potentially multifactorial causes. Hence, the chances of misdiagnosis can be high. Among these causes are...
Diarrhoea is a common presentation in acute emergency with potentially multifactorial causes. Hence, the chances of misdiagnosis can be high. Among these causes are listed diseases which are primarily inflammatory in nature. Presented here is a rare case of Behcet's colitis with valuable clinical lessons, in a patient who is known to have Behcet's disease and was admitted with acute onset bloody diarrhoea. This was a gastrointestinal manifestation of the patient's multisystemic inflammatory disorder as proven by investigations via computed tomography (CT) scan, sigmoidoscopy, and histology. He was treated with steroids and mesalazine, and later switched to infliximab and made a quick recovery.
PubMed: 37750152
DOI: 10.7759/cureus.44101