Colorectal cancer screening

INTRODUCTION Colorectal cancer is a major public health burden. It is the fourth most common form of cancer worldwide and the most frequent in North America, Australia, New Zealand, Argentina, and parts of Europe[1]. When colorectal can- cer is detected a…     

Colorectal cancer screening in Europe

Colorectal cancer (CRC) is the second most freq uent malignant disease in Europe. Every year, 412 000 people are diagnosed with this condition, and 207 000 patients die of it. In 2003, recommendations for screening programs were issued by the Council of the European Union (EU), and these currently serve as the basis for the preparation of European guidelines for CRC screening. The manner in which CRC screening is carried out varies significantly from country to country within the EU, both in terms of organization and the screening test chosen. A screening program of one sort or another has been implemented in 19 of 27 EU countries. The most frequently applied method is test - ing stool for occult bleeding (fecal occult blood test, FOBT). In recent years, a screening colonoscopy has been introduced, either as the only method (Poland) or the method of choice (Germany, Czech Republic).     

国内医务人员大肠癌筛查认识现状分析及建议

目的了解我国医务人员对大肠癌筛查的认识现状,分析影响筛查的因素并提出建议。方法随机对300名来自不同地方、不同等级医疗机构的医务人员进行问卷调查并分析结果。结果147名医务人员填写调查表,应答率49.00%;55%～80%的被调查者不了解普通人群大肠癌筛查方式、起始年龄及频率;大肠肿瘤筛查的了解程度与被调查医务人员的专业、学历、工作年限、医院等级无明显关系;76.87%的被调查者推荐高危人群定期行大肠癌筛查并能指出正确的筛查方法。结论我国医务人员对大肠癌筛查的相关知识不甚清楚且重视程度不够;对高危人群大肠癌筛查有一定认识但对普通人群筛查知识了解较少。     

大肠癌筛查开始年龄的研究

早期大肠癌筛查是有效降低大肠癌发病率和死亡率的重要方法。近来研究表明,不同种族、性别及吸烟、肥胖状况的无症状平均风险人群,大肠癌的发病风险各有不同,筛查开始年龄也有所差异。因此,本文就目前大肠癌筛查开始年龄的研究进行概述。     

Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome

Worldwide diagnoses of bowel cancer approximate an estimated one million new cases per year, comprising 9% of all cancer cases, and this has continued to increase over the last 25 years. With the association between cancer risk and increasing age, together with the suggestion that by 2015 there will be a 22% increase in the proportion of the population aged over 65 years and a 50% increase in the proportion of people aged over 80 years, there is likely to be a significant increase in the demand on cancer services throughout Europe and the rest of the world. This article discusses the current state of bowel cancer screening within Europe. Competing interests  NJ West has no competing interests. C Boustière, W Fischbach, F Parente and RJ Leicester have served on advisory panels for Norgine. Disclaimer  This article was sponsored by Norgine. The company has had the opportunity to comment on the medical content and accuracy of the article; however, final editorial control resides with the authors/journal. No payment was received for the authorship of this article An erratum to this article can be found at     

Colorectal cancer screening behavior and willingness

The outpatient-based study by Deng et al [World J Gastroenterol 2011 July 14; 17(26): 3133-3139] on the factors that may influence the colorectal cancer (CRC) screening feasibility, encouraged our curiosity. Establishing a simple method for quickly assessing the educational level of patients and modulating a questionnaire for each type of patient, may be an effective protocol to increase the people participation, mainly in countries where sufficient medical resources and financial support are lacking. In fact, the knowledge directly affects the feasibility when screening is offered. Patient educational level influences the understanding of the knowledge and the screening method. This factor may affect patient's priority level on the study participation, the understanding of questions, and the motivation to complete the questionnaire and, consequently, the screening success. Recent studies have found a relationship between high educational level and CRC screening participation, and emphasized the questionnaire ineffectiveness in the illiterate people. Although the questionnaire is an excellent method for this kind of evaluation, physician's contribution could be the most important factor associated with the screening method. Thus, further studies should be conducted to explore the compliance of patients with low educational level and to look for the best solutions for their enrollment.     

大肠癌筛查方法的研究进展

定期大肠癌筛查是有效降低大肠癌发病率和死亡率的重要方法。近年来随着分子生物学、医学影像学等技术的发展,筛查方法不断获得改进和创新,为大肠癌的防治提供了更多技术选择。筛查方法因检测原理和目标的不同,效能不尽相同,本文就大肠癌常用筛查方法及研究进展进行综述。     

Colorectal cancer screening behavior and willingness: an outpatient survey in China

AIM:To identity the factors influencing colorectal cancer(CRC) screening behavior and willingness among Chinese outpatients.METHODS:An outpatient-based face-to-face survey was conducted from August 18 to September 7,2010 in Changhai Hospital.A total of 1200 consecutive patients aged ≥ 18 years were recruited for interview.The patient's knowledge about CRC and screening was pre-measured as a predictor variable,and other predictors included age,gender,educational level,monthly household income and health insu...     

Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy: A retrospective co-operative IG-IBD study

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.     

Proximalisation of Colorectal Carcinoma: A 10-year Study in Italy

Introduction Proximalisation of colon carcinoma has been reported over the course of the last 60 years. Changes in site distribution are receiving increasing attention on account of their implications for screening programmes. Objective A retrospective observational study to determine whether the site distribution of colorectal carcinoma in Italy has varied in the last years and whether changes have been influenced by age and sex. Methods Findings of colonscopies conducted at Turin University from 1992 to 2001 were examined. Inclusion criteria were: outpatients, screening, presence of anaemia or gastrointestinal bleeding, weight loss, constipation or changes in evacuation frequency. Exclusion criteria were: uncompleted, surgical endoscopies or conducted for positive flexible sigmoidoscopy, with doubtful findings. Carcinomas and benign polyps were diagnosed histologically. Age, sex, date of examination, nature and location of lesions were recorded. Lesions were classed as carcinoma, and polyps <1 and ≥1 cm. Data were grouped into different year periods and compared with the chi square test. We compared 1992–1993 vs. 2000–2001 and 1992–1996 vs. 1997–2001. Results Of the 8,132 colonoscopies performed, 7,342 were included in the study. Proximal carcinomas moved from 12.2% in 1992–1993 to 14.9% in 2000–2001 (P = 0.57), proximal polyps rose from 16.6% to 22.1% (P < 0.0001). Furthermore proximal carcinomas moved from 16.5% in 1992–1996 to 14.4% in 1997–2001 (P = 0.48); proximal polyps rose from 18.4% to 27.8% (P < 0.005). In the period 1996–2001 there was higher female prevalence (P = 0.0011) and older age (P = 0.0191). Discussion We can suppose that proximalisation of carcinoma has not yet appeared in Italy.     

Screening polypectomy rates below quality benchmarks: A prospective study

AIM:To estimate and compare sex-specific screening polypectomy rates to quality benchmarks of 40%in men and 30%in women.METHODS:A prospective cohort study was undertaken of patients aged 50-75,scheduled for colonoscopy,and covered by the Québec universal health insurance plan.Endoscopist and patient questionnaires were used to obtain screening and non-screening colonoscopy indications.Patient self-report was used to obtain history of gastrointestinal conditions/symptoms and prior colonoscopy.Sex-specific polypectomy rates(PRs)and95%CI were calculated using Bayesian hierarchical logistic regression.RESULTS:In total,45 endoscopists and 2134(mean age=61,50%female)of their patients participated.According to patients,screening PRs in males and females were 32.4%(95%CI:23.8-41.8)and19.4%(95%CI:13.1-25.4),respectively.According to endoscopists,screening PRs in males and females were 30.2%(95%CI:27.0-41.9)and 16.6%(95%CI:16.3-28.6),respectively.Sex-specific PRs did not meet quality benchmarks at all ages except for:males aged65-69(patient screening indication),and males aged70-74(endoscopist screening indication).For all patients aged 50-54,none of the CI included the quality benchmarks.CONCLUSION:Most sex-specific screening PRs in Québec were below quality benchmarks;PRs were especially low for all 50-54 year olds.     

Colorectal cancer disparities: Issues,controversies and solutions

Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.     

Colorectal cancer in geriatric patients： Endoscopic diagnosis and surgical treatment

AIM: To investigate the prevalence of colorectal cancer in geriatrie patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatrie patiente with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatrie patients is demonstrated.     

Colorectal cancer screening in countries of European Council outside of the EU-28

AIM: To provide an update on colorectal cancer (CRC) screening programmes in non-European Union (EU)-28 Council of Europe member states as of December 2015.METHODS: The mission of the Council of Europe is to protect and promote human rights in its 47 member countries. Its 19 non-EU member states are Albania, Andorra, Armenia, Azerbaijan, Bosnia and Herzegovina, Republika Srpska, Georgia, Iceland, Liechtenstein, Republic of Moldova, Monaco, Montenegro, Norway, Russian Federation, San Marino, Serbia, Switzerland, FYR of Macedonia, Turkey, and Ukraine (EU-19). The main data source were GLOBOCAN, IARC, WHO, EUCAN, NORDCAN, ENCR, volume X of the CI5, the ministerial and Public Health Agency websites of the individual countries, PubMed, EMBASE, registries of some websites and the www.cochranelibrary.com, Scopus, www.clinicaltrials.gov, www.clinicaltrialsregister.eu, Research gate, Google and data extracted from screening programme results.RESULTS: Our results show that epidemiological data quality varies broadly between EU-28 and EU-19 countries. In terms of incidence, only 30% of EU-19 countries rank high in data quality as opposed to 86% of EU-28 states. The same applies to mortality data, since 52% of EU-19 countries as against all EU-28 countries are found in the high ranks. Assessment of the method of collection of incidence data showed that only 32% of EU-19 countries are found in the top three quality classes as against 89% of EU-28 countries. For the mortality data, 63% of EU-19 countries are found in the highest ranks as opposed to all EU-28 member states. Interestingly, comparison of neighbouring countries offering regional screening shows, for instance, that incidence and mortality rates are respectively 38.9 and 13.0 in Norway and 29.2 and 10.9 in Sweden, whereas in Finland, where a national organised programme is available, they are respectively 23.5 and 9.3.CONCLUSION: Cancer screening should be viewed as a key health care tool, also because investing in screening protects the weakest in the population, decreases the social burden of cancer, and reduces all types of health care costs, including those for radical surgery, long-term hospitalisation, and chemotherapy.     

Colorectal surgery in octogenarian patients—outcomes and predictors of morbidity

Introduction  Surgery for elderly patients pose a constant challenge. This study aims to review the outcome and find predictors of adverse outcome in octogenarians undergoing major colorectal resection for cancer. Methods  A review of 121 octogenarians who underwent colorectal cancer surgery between September 1992 and May 2008 was performed. Comorbidities were quantified using the weighted Charlson Comorbidity Index and ASA classification. CR-POSSUM scores and ACPGBI scores and the predicted mortality rates were calculated. Outcome measures were morbidity rates and 30-day mortality rates. Results  The patients had a mean age of 83.5 years (range, 80–99). The mean index of comorbidity was 3.1 (2–7) and 12.5% of patients were classified ASA III and above. The mean predicted mortality rate based on CR-POSSUM and ACPGBI scoring models were 11.2% and 5.4% respectively. The overall observed morbidity rate was 30.7% and 30-day mortality was 1.6. Factors found on bivariate analysis to be significantly associated with an increased risk of morbidity were tumor presenting with complication, comorbid coronary heart disease, serum urea levels, ASA classification ≥3 and comorbidity index 3 of 5 ≥ 5. Multivariate analysis revealed the latter two factors to be independent predictors of morbidity. Conclusion  Octogenarians undergoing major colorectal resection have an acceptable perioperative morbidity and mortality rate and survival rate and should not be denied surgery based on age alone. Comorbidity index scores and ASA scores are useful tools to identify poor risk patients.     

Wait times from presentation to treatment for colorectal cancer: A population-based study

BACKGROUND:

The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada.

OBJECTIVE:

To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC).

METHODS:

Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living’s administrative databases, a patient’s first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT.

RESULTS:

The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT.

CONCLUSIONS:

The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.     

The role of colonoscopy and flexible sigmoidoscopy in screening for Colorectal Carcinoma

Six hundred thirty-two patients were referred to the Colorectal Clinic from February 1983 to February 1986 for screening with the Pentax 65 cm flexible sigmoidoscope. Forty-nine of these patients (8 percent) had adenomatous polyps. There were 27 males and 22 females. The mean distance examined by the 65 cm flexible sigmoidoscope was 55 cm. Five patients were excluded from analysis, leaving 44 patients who underwent colonoscopy to the cecum. At the time of colonoscopy, 15 of the 44 patients (34 percent) had one or more adenomatous polyps beyond reach of the 65 cm flexible sigmoidoscope. The remaining 29 patients who underwent colonoscopy had no polyps beyond reach of the 65 cm flexible sigmoidoscope. Thirty adenomatous polyps, one invasive carcinoma of the ascending colon, and one hyperplastic polyp were found in these 15 patients. In summary, 34 percent of patients found to have adenomatous polyps within reach of the 65 cm flexible sigmoidoscope harbored one or more adenomatous polyps in the proximal colon at the time of colonoscopy. A positive 65 cm flexible sigmoidoscope examination requires colonoscopy to identify and remove proximal premalignant lesions, thereby aborting the polyp-cancer sequence.     

Awareness and attitudes of Greek medical students on colorectal cancer screening

AIM: To prospectively assess the knowledge and attitudes of medical students (MS), as tomorrow’s physicians, about colorectal cancer (CRC) and its screening modalities.METHODS: Three hundred fourth year MS of the University of Athens were enrolled in this survey. Their selection was random, based on student identification card number. All participants completed an anonymous written questionnaire over a 4 month period. The questionnaire was divided into 4 sections and included queries about CRC-related symptoms, screening with colonoscopy and MS awareness and attitudes in this field. Following collection and analysis of the data, the results are presented as percentages of answers for each separate question. RESULTS: Two hundred and sixty-five students an-swered the questionnaire over a 4 mo period. Interestingly, only 69% of the study population considered CRC to be a high-risk condition for public health. However, the vast majority of participants identified CRC-related symptoms and acknowledged its screening to be of great value in reducing CRC incidence and mortality. A very small proportion (38%) had received information material regarding CRC screening (either during their medical training or as a part of information provided to the general public) and only 60% of the participants declared willingness to receive further information. Regarding colonoscopy, 85% would prefer an alternative to colonoscopy methods for CRC screening. Moreover, 53% considered it to be a painful method and 68% would appreciate more information about the examination.CONCLUSION: MS in Greece need to be better informed about CRC screening and screening colonoscopy.     

Colorectal cancer surveillance in inflammatory bowel disease: A critical analysis

Colonoscopic surveillance is advocated in patients with inflammatory bowel disease(IBD) for detection of dys-plasia. There are many issues regarding surveillance in IBD: the risk of colorectal cancer seems to be de-creasing in the majority of recently published studies, necessitating revisions of surveillance strategy; surveil-lance guidelines are not based on concrete evidence; commencement and frequency of surveillance, cost-effectiveness and adherence to surveillance have been issues that are only partly answered. The traditional technique of random biopsy is neither evidence-based nor easy to practice. Therefore, highlighting abnormal areas with newer technology and biopsy from these areas are the way forward. Of the newer technology, digital mucosal enhancement, such as high-definition white light endoscopy and chromoendoscopy(with magnification) have been incorporated in guidelines. Dyeless chromoendoscopy(narrow band imaging) has not yet shown potential, whereas some forms of digital chromoendoscopy(i-Scan more than Fujinon intelligent color enhancement) have shown promise for colonoscopic surveillance in IBD. Other techniquessuch as autofluorescence imaging, endomicroscopy and endocytoscopy need further evidence. Surveillance with genetic markers(tissue, serum or stool) is at an early stage. This article discusses changing epidemiology of colorectal cancer development in IBD and critically evaluates issues regarding colonoscopic surveillance in IBD.     

Additional mailing phase for FIT after a medical offer phase: The best way to improve compliance with colorectal cancer screening in France

BackgroundCompliance with colorectal cancer screening is critical to its effectiveness. The organisation of the mass screening programme in France has recently been modified with no evaluation of the consequences.AimsTo evaluate the impact of the way the screening test is delivered on compliance.Patients and methodsDuring the first six months of the screening campaign (Ille-Vilaine, Brittany), general practitioners were asked to propose a faecal immunochemical test (FIT), OC-Sensor, to individuals at average risk for colorectal cancer (n = 152,097). A subset of non-participants in the medical phase (n = 13,071) was randomly chosen to receive a reminder that included the screening test or a simple postal reminder without the screening test.ResultsCompliance was 31% if the screening test was proposed during a medical consultation. In non-participants during the medical phase, it was 45% in those receiving both a reminder and the screening test and 28% amongst those receiving a simple reminder. An estimated overall participation rate of 54% can be expected if non-participants in the medical phase are sent a reminder together with the screening test.ConclusionIn France, a compliance rate above the minimum uptake rate of 45% recommended by European Union experts can be achieved if the FIT is mailed to non-participants after the medical free-offer phase.