scholarly journals A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
J Tinmouth ◽  
A Paramalingam ◽  
A Bellini ◽  
M Cotterchio ◽  
E Dekker ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Family History ◽  
Expert Panel ◽  
Screening Program ◽  
Delphi Process ◽  
Evidence Based ◽  
Screening Programs ◽  
Crc Screening ◽  
Modified Delphi ◽  
Canadian Association

Abstract Background In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages & intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs. Aims To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline. Methods ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine & achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement. Results Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year & lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table). Conclusions Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma. Funding Agencies Ontario Health (Cancer Care Ontario)

scholarly journals Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

2021 ◽  
Vol 8 ◽  
Author(s):  
Rocío Aznar-Gimeno ◽  
Patricia Carrera-Lasfuentes ◽  
Rafael del-Hoyo-Alonso ◽  
Manuel Doblaré ◽  
Ángel Lanas
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Selection Process ◽  
Optimal Number ◽  
Evidence Based ◽  
Program Outcomes ◽  
Screening Programs ◽  
Crc Screening ◽  
Immunological Test ◽  
Number Of Individuals

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

scholarly journals To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriele Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

scholarly journals Cancer Care Ontario Colonoscopy Standards: Standards and Evidentiary Base

2007 ◽  
Vol 21 (suppl d) ◽  
pp. 5D-24D ◽  
Author(s):  
L Rabeneck ◽  
RB Rumble ◽  
J Axler ◽  
A Smith ◽  
D Armstrong ◽  
...  
Keyword(s):  
Cancer Care ◽  
Expert Panel ◽  
Screening Program ◽  
Present Report ◽  
Quality Assurance Program ◽  
Evidence Based ◽  
Men And Women ◽  
Crc Screening ◽  
Incidence And Mortality ◽  
Evidence Based Care

Colorectal cancer (CRC) is the most common cause of non-tobaccorelated cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario’s Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario’s CRC screening program.

scholarly journals Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joaquín Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

scholarly journals To do or not to do – A survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriela Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6,807 Danish citizens aged 50-80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling.Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

scholarly journals Patients’ participation in the colorectal cancer screening program and their health beliefs

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Kaseliene ◽  
O Mesceriakova-Veliuliene
Keyword(s):  
Colorectal Cancer ◽  
Health Beliefs ◽  
Screening Program ◽  
Family Doctor ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Cross Sectional ◽  
Family Doctors ◽  
Screening Programs ◽  
Crc Screening

Abstract Background Both morbidity and mortality rates from colorectal cancer (CRC) have been increasing in Lithuania. However, only about 50% of the target Lithuanian population was involved in CRC screening in 2018. The aim of this study was to evaluate associations between the involvement of 50- to 74-year-old primary care patients in CRC screening and their health beliefs as well as awareness about this screening. Methods A cross-sectional study was conducted in September-November 2016. A total of 390 patients aged 50-74 years were anonymously surveyed at 10 primary health care institutions of Šakiai region, Lithuania. The response rate was 86.7%. Chi-square and z tests were used to determine a relationship between two nominal (categorical) variables (α = 0.05). Results 43.1% of the respondents noted about their participation in the CRC screening program. Those who had participated in the program more often (p < 0.05) than nonparticipants reported to be worried about getting CRC (60.6% vs 43%) and thought that this could happen already in the next year (16.8% vs 6.5%), more frequently believed that the possibility of getting CRC for them was very high (74.8% vs 60.9%), that they had predisposition to CRC (44.9% vs 27.6%) and that CRC screening will prevent them from problems in the future (97.4% vs 90.9%). The participants of the CRC screening program also more frequently (p < 0.05) than nonparticipants noted that they had heard about this program before their involvement in it (98.8% vs 70.9%) and got this information from their family doctor 2.1 times more frequently (88.1% vs 41.4%). Nearly half (47.3%) of the program participants and 30.6% of the nonparticipants mentioned that the responsibility for participation in the CRC screening program should be taken by patients themselves (p < 0.05). Conclusions Participation of patients in the CRC screening program is related to their health beliefs, awareness and active engagement of family doctors in CRC screening programs. Key messages The patients who had participated in the CRC screening program had more negative health beliefs regarding CRC and were better informed on the program by their family doctor than nonparticipants. Family doctors should pay more attention to informing patients about CRC and its prevention.

scholarly journals Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience

2020 ◽  
Vol 37 (3) ◽  
pp. 321-324 ◽  
Author(s):  
José María Remes-Troche ◽  
Gabriela Hinojosa-Garza ◽  
Priscilla Espinosa-Tamez ◽  
Arturo Meixueiro-Daza ◽  
Peter Grube-Pagola ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Potential Benefit ◽  
Large Scale ◽  
Screening Program ◽  
Preliminary Evidence ◽  
Premalignant Lesions ◽  
Middle Income ◽  
Screening Programs ◽  
Crc Screening ◽  
Middle Income Countries

Abstract Background In middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico. Objective Since there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico. Methods We conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results >100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy. Results Of 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed >100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT >100 ng haemoglobin/ml for premalignant lesions was 33%. Conclusion These results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

scholarly journals Geographic Variation in Compliance With FOBT Colorectal Cancer Screening Programs: The Role of Attitudes Toward Health and Help Seeking

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 26s-26s
Author(s):  
B. Goodwin ◽  
S. March ◽  
M. Ireland ◽  
F. Crawford-Williams ◽  
D. Manski ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Urban Areas ◽  
Help Seeking ◽  
Screening Program ◽  
Suitable Alternative ◽  
Screening Programs ◽  
Crc Screening ◽  
Health Related ◽  
Future Consequences

Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

scholarly journals Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

2020 ◽  
Author(s):  
Joaquin Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study is to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).Results: We included 15,707 patients in the analysis with high (19.3%), intermediate (25.1%) low risk (21.7%) adenomas and normal colonoscopy (27.8%) detected in the analyzed period. Colorectal surgery was performed in 162 (10.3‰, 95% CI 8.7-11.9), due to colonoscopy complications (0.2‰, 95% CI 0.005-0.5) and resection of colorectal benign lesions (10.0‰, 95% CI 8.5-11.6). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications, one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years= 1.57, 95% CI 1.11-2.23), sex (female= 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk= 67.94, 95% CI 24.87-185.59; intermediate risk= 5.63, 95% CI 1.89-16.80; low risk= 1.43; 95% CI 0.36-5.75), the endoscopist’s ADR (Q4= 0.44, 95% CI 0.28-0.68; Q3= 0.44, 95% CI 0.27-0.71; Q2= 0.71, 95% CI 0.44-1.14) and the hospital (third level= 0.54, 95% CI 0.38-0.79). Conclusions: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are acceptable and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

scholarly journals To do or not to do – A survey study on factors associated with participating in the Danish screening program for colorectal cancer

2020 ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriela Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6,807 Danish citizens aged 50-80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling.Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. gender, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

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