Quality of life in participants of a CRC screening program

Background:

Little is known about the effect of participating in a colorectal cancer (CRC) screening programme on quality of life (QOL), neither for participants with a negative nor for those with a positive test result. These findings, however, are important to evaluate the impact of CRC screening.

Methods:

Participants from CRC screening trials were sent a questionnaire, which included validated measures on generic health-related QOL, generic anxiety and screen-specific anxiety. Both faecal immunochemical test (FIT) and flexible sigmoidoscopy (FS) participants, either with negative or positive test results, were addressed.

Results:

The response rate was 73% (1289 out of 1772) for FIT and 78% (536 out of 689) for FS participants, with mean ages varying from 63–66 years. Positive FIT participants had worse physical (PCS-12, 47.1 vs 48.3, P=0.02), but equal mental QOL scores (MCS-12, 51.1 vs 51.6, P=0.26). Positive and negative FS participants had similar QOL scores. Both FIT and FS participants with a positive test result reported more screen-specific anxiety than negative FIT and FS participants. Positive and negative FS participants had similar generic anxiety scores.

Conclusion:

Our findings indicate that the burden of participating in CRC screening may be limited. Conducting a prospective study to confirm these results is recommended.     

Analytical sensitivity and stability of DNA methylation testing in stool samples for colorectal cancer detection

Background

Stool-based molecular tests hold large potential for improving colorectal cancer screening. Here, we investigated the analytical sensitivity of a DNA methylation assay on partial stool samples, and estimated the DNA degradation in stool over time. In addition, we explored the detection of DNA methylation in fecal immunochemical test (FIT) fluid.

Materials and Methods

Partial stool samples of colonoscopy-negative individuals were homogenized with stool homogenization buffer, spiked with different numbers of HCT116 colon cancer cells and kept at room temperature for 0, 24, 48, 72 and 144?h before DNA isolation. Analytical sensitivity was determined by the lowest number of cells that yielded positive test results by DNA methylation or mutation analysis. DNA methylation in FIT fluid was measured in 11 CRC patients and 20 control subjects.

Results

The analytical sensitivity for detecting DNA methylation was 3000 cells per gram stool, compared to 60000 cells per gram stool for detection of DNA mutations in the same stool samples. No degradation up to 72?h was noted when a conservation buffer was used. DNA methylation was detected in 4/11 CRC FIT samples and in none of the 20 control FIT samples.

Conclusions

Methylation based stool DNA testing showed a high analytical sensitivity for tumor DNA in partial stool samples, which was hardly influenced by DNA degradation over time, provided an adequate buffer was used. The feasibility of detecting DNA methylation in FIT fluid demonstrates the opportunity to combine testing for occult blood with DNA methylation in the same collection device.     

Screening practices of Australian men and women categorized as “at or slightly above average risk” of colorectal cancer

Purpose

Australia has one of the highest incidences of colorectal cancer (CRC) in the world. In 2006, the federal government introduced a screening program consisting of a one-off fecal occult blood test offered to people turning 50, 55, or 65?years. We conducted a population-based study to estimate CRC screening practices existing outside the current program.

Methods

A total of 1887 unaffected subjects categorized “at or slightly above average risk” of CRC were selected from the Australasian Colorectal Cancer Family Registry. We calculated the proportions of participants that reported appropriate, under- and over-screening according to national guidelines. We performed a logistic regression analysis to evaluate associations between over-screening and a set of socio-demographic factors.

Results

Of 532 participants at average risk of CRC, eligible for screening, 4 (0.75?%) reported appropriate screening, 479 (90?%) reported never having been screened, 18 (3?%) reported some but less than appropriate screening, and 31 (6?%) reported over-screening. Of 412 participants aged 50?years or over, slightly above average risk of CRC, 1 participant (0.25?%) reported appropriate screening, 316 (77?%) reported no screening, and 11 (3?%) reported some but less than appropriate screening. Among participants under age 50?years, 2?% of those at average risk and 10?% of those slightly above average risk reported over-screening. Middle-aged people, those with a family history of CRC and those with a university degree, were more likely to be over-screened.

Conclusion

Overall, the level of CRC screening participation was low and the vast majority of screening tests undertaken were inappropriate in terms of timing, modality, or frequency.     

Changes in colorectal cancer incidence rates in young and older adults in the United States: what does it tell us about screening

Purpose

Colorectal cancer (CRC) incidence rates have increased among young adults and have decreased among older adults. We re-evaluated these trends using more recent data covering about 96 % of the United States population.

Methods

Colorectal cancer incidence rates were abstracted from the National Program of Cancer Registries and the Surveillance Epidemiology and End Results analytic files for diagnosis years 1998–2009. We report rates for young adults (age <50 years) and for older adults (age 50 years or older) by four race/ethnicity groupings. We examined CRC incidence rates by stage at diagnosis, tumor subsite, and state. We calculated the correlation between state-specific CRC incidence and prevalence of colonoscopy reported in the Behavioral Risk Factor Surveillance System.

Results

Rectal cancer incidence rates increased from 1998 through 2009 among young non-Hispanic white adults and young blacks. Among older adults, CRC incidence rates decreased among all four race/ethnicity groupings and in all states. The decline was apparent for all stages and for all subsites. States with greater decreases in CRC incidence rates had higher colonoscopy screening rates.

Conclusion

Rectal cancer is increasing among younger adults, for reasons largely unknown. Among older adults, CRC incidence continues to decrease, probably because of increasing uptake of colonoscopy screening. Decreases in CRC incidence are correlated with increased use of colonoscopy, indicating that CRC may be largely preventable through colonoscopy screening. Efforts to increase screening rates in underserved populations would help reduce health disparities associated with this type of cancer.     

Colonoscopy for Colorectal Cancer Screening Above Age 75: Outcomes in Symptomatic African American and Hispanic Adults

Background

US Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adults above 75 years of age. Considerations to support screening in an individual patient are not clearly described. There is limited data to support recommendations in African American (AA) and Hispanics population.

Methods

We reviewed records of 568 inpatient colonoscopies carried out at our Mt. Sinai Hospital Medical Center, Chicago during 2006–2008 for symptomatic adults ≥75 years of age. Subjects with previous normal screening colonoscopies and presence of one or more “generally indicated” indications as per American Society for Gastrointestinal Endoscopy guidelines were included in the study.

Results

A total of 155 adults (mean age, 81.8 years; 29% males and 71% females; 83.8% AAs and 16.1% Hispanics) met the inclusion criteria. Seventy-nine percent had one previous colonoscopy, whereas 21% of the patients had two or more previous colonoscopies. Common indications for a repeat colonoscopy were anemia 69.7%, hematochezia 39.4%, and fecal occult blood 19.4%. Colonoscopy was completed to the cecum in 65.2% of the subjects. Advanced adenomas/cancers were found in 15/155 (9.7%) colonoscopies. CRC detection rate was 14/155 (9%), of which 9/14 (75%) were staged III/IV. Two (1.3%) patients had complications which resolved conservatively.

Conclusion

Symptomatic AAs and Hispanics ≥75 have a high incidence of CRC despite a previous normal colonoscopy. Presence of male sex, new onset anemia and hematochezia, and longer colonoscopy intervals are associated with CRC detection on colonoscopy. The detection of advanced cancer and high comorbidity/low life expectancy limit the benefit of CRC detection.     

Participation and detection rates by age and sex for colonoscopy versus fecal immunochemical testing in colorectal cancer screening

Purpose

To compare two strategies for colorectal cancer screening: one-time colonoscopy versus fecal immunochemical testing (FIT) (and colonoscopy for positive) every 2 years, in order to determine which strategy provides the highest participation and detection rates in groups of sex and age.

Methods

This analysis was performed with data from the first screening round within the COLONPREV study, a population-based, multicenter, nationwide trial carried out in Spain. Several logistic regression models were applied to identify the influence of the screening test on participation rates and detection of proximal and distal neoplasms, as well to identify the influence of age and sex: women aged 50–59 years, women aged 60–69 years, men aged 50–59 years, and men aged 60–69 years.

Results

Participation was higher in women than in men, especially among women aged 50–59 years (25.91 % for colonoscopy and 35.81 % for FIT). Crossover from colonoscopy to FIT was higher among women than men, especially among those aged 60–69 years (30.37 %). In general, detection of any neoplasm and advanced adenoma was higher with colonoscopy than with FIT, but no significant differences were found between the two strategies for colorectal cancer detection. Detection of advanced adenoma in both arms was lower in women [specifically in women aged 50–59 years (OR 0.31; 95 % CI 0.25–0.38) than in men aged 60–69 years]. Women aged 50–59 years in the colonoscopy arm had a higher probability of detection of advanced adenoma (OR 4.49; 95 % CI 3.18–6.35), as well as of detection of neoplasms in proximal and distal locations (proximal OR 19.34; 95 % CI 12.07–31.00; distal OR 11.04; 95 % CI 8.13–15.01) than women of the same age in the FIT arm. These differences were also observed in the remaining groups but to a lesser extent.

Conclusion

Women were more likely to participate in a FIT-based strategy, especially those aged 50–59 years. The likelihood of detection of any neoplasm was higher in the colonoscopy arm for all the population groups studied, especially in women aged 50–59 years. Distinct population groups should be informed of the benefits of each screening strategy so that they may take informed decisions.     

Colonoscopy reduced distal colorectal cancer risk and excess cancer risk associated with family history

Purpose

Colonoscopy efficacy at preventing proximal colorectal cancer (CRC) is questioned, and little is known about efficacy in high-risk versus medium-risk populations. We investigated the relationship between colonoscopy screening, family history of colorectal cancer (FHCC), and CRC risk by site.

Methods

Among 92,078 women of the E3N prospective cohort, 692 CRCs have been diagnosed after a median follow-up of 15.4 years. Cox proportional hazard models estimated adjusted hazards ratios according to subsites of cancer and FHCC.

Results

A personal history of colonoscopy (PHC; n = 37,470) was associated with decreased rectal and distal colon cancer risks (hazard ratio (HR) = 0.57; 95 % Confidence Interval (CI) = 0.42–0.78 and HR = 0.37; 95 % CI = 0.26–0.52, respectively), but not proximal colon cancer risk (HR = 0.87; 95 % CI = 0.64–1.18). In women with no prior colonoscopy, those with FHCC had a 80 % higher CRC risk than those without FHCC. In women with previous colonoscopy, CRC risk was similar in women with and without FHCC (p for interaction = 0.04).

Conclusions

Results showed colonoscopy ability to prevent distal cancers, but not proximal cancers in women. Colonoscopy screening also reduced the excess risk of women with FHCC to that of women with no FHCC.     

Ethnic disparities in colonoscopy use among colorectal cancer survivors: a systematic review

Purpose

After curative treatment for colorectal cancer (CRC), routine colonoscopies are recommended. We aimed to identify all studies of ethnic disparities in CRC surveillance and examine any association between race/ethnicity and colonoscopy use.

Methods

We conducted a systematic literature review to address the association between race/ethnicity and colonoscopy use among CRC survivors. We searched Medline for relevant articles. Two authors reviewed titles, abstracts, and articles based on pre-determined inclusion/exclusion criteria.

Results

Of the 1,544 titles reviewed, eight studies published since 2001 investigated racial/ethnic disparities in colonoscopy use. Four articles showed a small significant ethnic disparity in the receipt of timely colonoscopy, and the remaining four articles showed a nonsignificant trend in the same direction. The effect did not vary by time of diagnosis or proportion of minorities in each study, though studies with larger samples showed somewhat greater racial/ethnic disparities in colonoscopy use.

Conclusions

We found at least a small disparity in the use of colonoscopy among CRC survivors, suggesting that ethnic disparities continue beyond prevention, detection, and treatment of CRC. It is important to identify areas of unequal care in CRC survivorship and to promote timely surveillance among CRC survivors who belong to racial/ethnic minorities to decrease disparities in mortality.

Implications for Cancer Survivors

CRC survivors who belong to racial/ethnic minorities may be less likely to receive follow-up colonoscopies on time, which could contribue to higher rates of death from CRC among minorities.     

Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study

Background

Despite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528–1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771–793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros–cons).

Methods

One hundred and eighteen individuals (mean age = 56.08, SD = 5.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening.

Results

One in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (p < .05), it was a decrease in fatalism (p < .05) and an increase in decisional balance (p < .05) that was associated with post-intervention screening behavior.

Discussion

These preliminary results suggest that fatalistic beliefs and an individual’s assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.     

Do no harm: no psychological harm from colorectal cancer screening

Background:

Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway.

Methods:

In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire.

Results:

A positive screening result did not increase participants'' level of anxiety or depression, or decrease participants'' level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance.

Conclusion:

The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.     

The psychological impact of participating in colorectal cancer screening by faecal immuno-chemical testing – the Australian experience

Background:

Occult blood-based colorectal cancer (CRC) screening may result in adverse psychological outcomes for participants. The aims of this study were to measure the psychological consequences of participating in screening at key points along the screening and diagnostic pathway, and examine variation over time within or between test outcome groups.

Methods:

A total of 301 people (positives=165, negatives=136) aged 50–76 years were surveyed via validated psychological questionnaires after result notification, post colonoscopy (positives only) and 1 year following result notification.

Results:

Negatives scored significantly higher in quality of life domains and lower state anxiety, anger and depression in comparison to positives both after result notification and at 1 year follow-up. Positives had significantly decreased state anxiety and depression at 1 year and improvement in HLoC power and reduced screening decision doubtfulness post colonoscopy. Positives experienced heightened CRC risk perception both after result notification and at 1 year follow-up in comparison to negatives, but reported less difficulty participating in ongoing screening.

Conclusions:

In positives, increased anxiety and doubtfulness about the decision to screen declined over time. Lower CRC risk perception in negatives indicates the need for education to promote CRC screening participation.     

Risk perception among Brazilian individuals with high risk for colorectal cancer and colonoscopy

Background

Risk perception is considered a motivating factor for adopting preventive behaviors. This study aimed to verify the demographic characteristics and cancer family history that are predictors of risk perception and to verify if risk perception is a predictor of colonoscopy adherence.

Methods

Individuals with a family colorectal cancer history as indicated by a proband with cancer were interviewed by telephone. They responded to a questionnaire covering demographic characteristics, colonoscopy history and four questions on risk perception. Tests of multiple linear regression and logistic regression were used to identify associations between dependent and independent variables.

Results

The 117 participants belonged to 62 families and had a mean age of 45.2 years. The majority of these individuals were female (74.4%) and from families who met the Amsterdam Criteria (54.7%). The average risk perception was 47.6%, with a median of 50%. The average population perception of individual risk was 55.4%, with a median of 50%. Variables associated with a higher risk perception were age, gender, religion, school level, income, and death of a family member. The variable predicting colonoscopy was receiving medical information regarding risk (odds ratio OR 8.40).

Conclusions

We found that family cancer history characteristics (number of relatives with cancer, risk classification) are associated with adequate risk perception. Risk perception does not predict colonoscopy in this sample. The only variable that predicted colonoscopy was receiving medical information recommending screening.     

Colorectal Cancer Screening in Women with Endometrial Cancer: Are We Following the Guidelines?

Introduction

Colorectal cancer (CRC) is the most common gastrointestinal malignancy. There is an association between CRC and endometrial cancer (EC). Up to 10% of this linkage may be due to hereditary non-polyposis colorectal cancer but in the majority of patients a genetic disorder is not found. The National Comprehensive Cancer Network (NCCN) guidelines on CRC since 2005 have suggested that women with endometrial or ovarian cancer diagnosed at less than 60 years of age have CRC screening with colonoscopy beginning at age 40 or at time of diagnosis of the gynecologic tumor. We assessed our population of women with EC to determine if women were receiving CRC screening after a diagnosis of EC.

Methods

Electronic medical records of all women diagnosed at our institution with EC predominantly between 1997 and 2007 were reviewed. We assessed age at diagnosis, tumor type, family history of malignancy, CRC screening, and findings at CRC screening and recorded the information in a database. Patients were evaluated for the Amsterdam and Bethesda criteria. This study was approved by the Institutional Review Board.

Results

Two hundred sixty-seven women with EC were evaluated. The median age was 66; 39% were less than age 60 at diagnosis. Family history of CRC was present in 25 (9.4%) of EC patients. Of these women, 125 (46.8%) had CRC screening, with 12 (9.6%) being screened for CRC within 1 year of diagnosis and 33 (26.4%) screened for CRC before diagnosis of endometrial cancer. Of the women, 142 (53.2%) did not have CRC screening reported. Of the women screened, ten had adenomatous polyps with one of those polyps being greater than 1 cm, four had tubulovillous histology, and three had CRC. Colonoscopy was performed in 59.2% of women who underwent CRC screening. One woman met criteria for Amsterdam and Bethesda criteria.

Conclusions

Less than half of women with EC received screening for CRC. Women who were screened had significant pathology in 13.6% of cases and 2.4% had colon cancer. The NCCN guidelines should be more aggressively followed by physicians who care for women. A prospective colonoscopy screening study on these women with EC to assess the yield and utility in screening in this population is needed.

     

Obesity, Metabolic Factors, and Colorectal Adenomas: a Retrospective Study in a Racially Diverse New York State Hospital

Objective

We studied a racially diverse population and the relationship with colorectal adenomas (CA) further looking for risks related to BMI and metabolic factors.

Designs

Seven hundred seventy-nine patients who underwent screening colonoscopies between 2007 and 2009 meeting exclusion criteria were included. To evaluate the association between race, BMI, and other metabolic factors with having one or more CA detected at colonoscopy, adjusted odds ratios and 95 % CI were estimated using unconditional logistic regression models.

Outcomes

CA were detected in 167 out of 779 (21.4 %) patients. Compared to Whites, Hispanics were less likely to have one or more adenomas detected during a screening colonoscopy (OR?=?0.52, 95 % CI, 0.31–0.88; p?=?0.01). There was no significant statistical difference between Blacks and Whites, or other races and Whites. There was an association between the presence of CA and smoking (OR?=?1.57, 95 % CI, 1.02–2.43; p?=?0.04).

Conclusion

Our results showed that Hispanics were less likely to have an adenoma detected during a screening colonoscopy than Whites. No statistical significant difference was found between patients with metabolic factors and the presence of colorectal adenoma.     

Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study

Purpose

Some cancers are largely preventable through modification of certain behavioral risk factors and preventive screening, even among those with a family history of cancer. This study examined the associations between (1) family cancer history and cancer screening, (2) family history and cancer preventive lifestyle behaviors, and (3) cancer screening and lifestyle behaviors.

Methods

Data were from the 2009 California Health Interview Survey (n = 12,603). Outcomes included screening for breast cancer (BC) and colorectal cancer (CRC) and six cancer preventive lifestyle behaviors, based on World Cancer Research Fund recommendations. Multivariate logistic regression analyses, stratified by gender and race–ethnicity, examined associations. Predicted probabilities of cancer screening by family cancer history, race–ethnicity, and sex were computed.

Results

Family history of site-specific cancer—CRC for men and women, and BC for women—was associated with higher probability of cancer screening for most groups, especially for CRC, but was largely unrelated to other lifestyle behaviors. In the few cases in which family history was significantly associated with lifestyle—for example, physical activity among White and Latino males, smoking among White and Asian females—individuals with a family history had lower odds of adherence to recommendations than those with no family history. Greater overall adherence to lifestyle recommendations was associated with higher odds of up-to-date CRC screening among White and Asian males, and lower odds among Asian females (no significant association with BC screening); this relationship did not vary by family cancer history.

Conclusion

The fact that family history of cancer is not associated with better lifestyle behaviors may reflect shared behavioral risks within families, or the lack of knowledge about how certain lifestyle behaviors impact personal cancer risk. Findings can inform interventions aimed at lifestyle behavioral modification for individuals at increased cancer risk due to family history.     

Colorectal cancer incidence in <Emphasis Type="Italic">path_MLH1</Emphasis> carriers subjected to different follow-up protocols: a Prospective Lynch Syndrome Database report

Background

We have previously reported a high incidence of colorectal cancer (CRC) in carriers of pathogenic MLH1 variants (path_MLH1) despite follow-up with colonoscopy including polypectomy.

Methods

The cohort included Finnish carriers enrolled in 3-yearly colonoscopy (n?=?505; 4625 observation years) and carriers from other countries enrolled in colonoscopy 2-yearly or more frequently (n?=?439; 3299 observation years). We examined whether the longer interval between colonoscopies in Finland could explain the high incidence of CRC and whether disease expression correlated with differences in population CRC incidence.

Results

Cumulative CRC incidences in carriers of path_MLH1 at 70-years of age were 41% for males and 36% for females in the Finnish series and 58% and 55% in the non-Finnish series, respectively (p?>?0.05). Mean time from last colonoscopy to CRC was 32.7 months in the Finnish compared to 31.0 months in the non-Finnish (p?>?0.05) and was therefore unaffected by the recommended colonoscopy interval. Differences in population incidence of CRC could not explain the lower point estimates for CRC in the Finnish series. Ten-year overall survival after CRC was similar for the Finnish and non-Finnish series (88% and 91%, respectively; p?>?0.05).

Conclusions

The hypothesis that the high incidence of CRC in path_MLH1 carriers was caused by a higher incidence in the Finnish series was not valid. We discuss whether the results were influenced by methodological shortcomings in our study or whether the assumption that a shorter interval between colonoscopies leads to a lower CRC incidence may be wrong. This second possibility is intriguing, because it suggests the dogma that CRC in path_MLH1 carriers develops from polyps that can be detected at colonoscopy and removed to prevent CRC may be erroneous. In view of the excellent 10-year overall survival in the Finnish and non-Finnish series we remain strong advocates of current surveillance practices for those with LS pending studies that will inform new recommendations on the best surveillance interval.

     

Burden of Emergency and Non-emergency Colorectal Cancer Surgeries in West Virginia and the USA

Purpose

Elective surgical resection is the curative treatment for colorectal cancer (CRC). Up to 30 % of patients present as surgical emergencies. The objective was to determine the association between presenting with an emergency condition and consequent outcomes of CRC surgery in the Appalachian state of West Virginia (WV) in comparison to the rest of the USA.

Methods

Patients diagnosed with CRC who underwent a surgical procedure from January 1, 2003 to December 31, 2007 were selected, and those with a diagnosis requiring emergency surgery were identified. Primary outcome measures were length of stay (LOS), total hospital charges, and inpatient death.

Results

Mean LOS was higher for WV. Mean charges were higher for the USA than for WV. Inpatient deaths in WV were greater than the rest of the USA. Those undergoing emergency surgery spent 51.9 % (β?=?0.40) more days in the hospital than those who did not. For WV, LOS was 7.6 % (β?=?0.07) higher than that of the US. Hospital charges for those that underwent emergency resection were 68.3 % (β?=?0.52) higher than those who did not. The odds of in-hospital death were 1.68 (95 % CI?=?1.42–1.98) times greater in WV than in the USA. Those that underwent emergency surgery had a nearly four times (OR 3.88; 95 % CI?=?3.74–4.03) greater chance of in-hospital death.

Conclusions

The study stresses the ongoing burden of emergency surgeries in many states around the nation and the need to increase awareness about CRC screening practices, especially in patients who are at increased risk of the disease.     

Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation?

Purpose

The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans.

Methods

This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai’s Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline.

Results

The mean BMI of the sample was 31.17 kg/m², with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight status. Adjusting for age, gender, race/ethnicity, family history of colorectal cancer, smoking status, comorbid conditions, income, marital status, insurance, and education, obesity status was not significantly associated with screening behavior among the entire sample (adjusted OR 0.81, CI 0.49–1.32, p = 0.39) or among stratified race/ethnicity and gender groups.

Conclusions

These findings suggest that obesity may not negatively influence receipt of colonoscopy screening in the context of patient navigation among minority participants. Further studies are needed to determine whether this finding will be observed in other populations, with and without the assistance of a patient navigator.     

Colorectal Cancer among Arab–Israeli Women—Possible Reasons for Increased Incidence and Mortality

Background

Colorectal cancer (CRC) screening is effective in reducing its incidence by discovering precancerous polyps and detecting early cancer. Evidence indicates lower participation in screening programs among minority ethnic groups. In addition, the Israel Cancer Registry published an increase in the incidence of CRC among Israeli–Arab women. It is important to attempt to understand attitudes toward screening among Israeli–Arab women, assuming it has to do to lack of knowledge and compliance.

Methods

During the study period, a female team gave lectures in Arabic regarding CRC to women in 16 Arab villages. Prior to the lecture, the participants were asked to complete a questionnaire, obtaining information regarding CRC knowledge and screening. Following the lecture, FOBT kits were distributed. Two weeks later, a telephone survey was performed, regarding whether the FOBT was performed, the result of the test, and, if FOBT was not performed, the reasons for not completing the test.

Results

FOBT was performed by 17.8% prior to the lecture; 61% performed the FOBT following our lecture. Reasons cited for avoiding FOBT: 37% was “afraid of a positive result,” 32% avoided performing the test as they were concerned they would be further examined by a male physician; 47.8% concluded that Arab women lack knowledge regarding screening interventions; 23.9% neglect themselves from a health point of view; 11.6% advised that Arab women have no free time to perform tests.

Conclusions

Israeli–Arab women may be less knowledgeable concerning CRC. Educational efforts must be made to increase awareness and promote benefits of CRC screening, by targeting ethnic minorities and women in Israel.