scholarly journals Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036475
Author(s):  
Eleonora Feletto ◽  
Jie-Bin Lew ◽  
Joachim Worthington ◽  
Emily He ◽  
Michael Caruana ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Optimal Investment ◽  
User Engagement ◽  
Policy And Practice ◽  
Targeted Interventions ◽  
Relevant Evidence ◽  
Natural History Model ◽  
Best Value ◽  
Bowel Cancer Screening

IntroductionWith almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods.Methods and analysisPathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments.Ethics and disseminationEthics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.

scholarly journals Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

2011 ◽  
Vol 17 (4) ◽  
pp. 334 ◽  
Author(s):  
Paul R. Ward ◽  
Sara Javanparast ◽  
Carlene Wilson
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
South Australia ◽  
Linguistically Diverse ◽  
Population Based ◽  
Policy And Practice ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Bowel Cancer Screening

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

scholarly journals Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037011
Author(s):  
Christine Campbell ◽  
Anne Douglas ◽  
Linda Williams ◽  
Geneviève Cezard ◽  
David H Brewster ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Ethnic Group ◽  
Colorectal Cancer Screening ◽  
South Asian ◽  
Bowel Cancer ◽  
Index Number ◽  
Adjusted Risk ◽  
Targeted Interventions ◽  
Bowel Cancer Screening

ObjectiveCancer screening should be equitably accessed by all populations. Uptake of colorectal cancer screening was examined using the Scottish Health and Ethnicity Linkage Study that links the Scottish Census 2001 to health data by individual-level self-reported ethnicity and religion.SettingData on 1.7 million individuals in two rounds of the Scottish Bowel Cancer Screening Programme (2007–2013) were linked to the 2001 Census using the Scottish Community Health Index number.Main outcome measureUptake of colorectal cancer screening, reported as age-adjusted risk ratios (RRs) by ethnic group and religion were calculated for men and women with 95% CI.ResultsIn the first, incidence screening round, compared with white Scottish men, Other White British (RR 109.6, 95% CI 108.8 to 110.3) and Chinese (107.2, 95% CI 102.8 to 111.8) men had higher uptake. In contrast, men of all South Asian groups had lower uptake (Indian RR 80.5, 95% CI 76.1 to 85.1; Pakistani RR 65.9, 95% CI 62.7 to 69.3; Bangladeshi RR 76.6, 95% CI 63.9 to 91.9; Other South Asian RR 88.6, 95% CI 81.8 to 96.1). Comparable patterns were seen among women in all ethnic groups, for example, Pakistani (RR 55.5, 95% CI 52.5 to 58.8). Variation in uptake was also observed by religion, with lower rates among Hindu (RR (95%CI): 78.4 (71.8 to 85.6)), Muslim (69.5 (66.7 to 72.3)) and Sikh (73.4 (67.1 to 80.3)) men compared with the reference population (Church of Scotland), with similar variation among women: lower rates were also seen among those who reported being Jewish, Roman Catholic or with no religion.ConclusionsThere are important variations in uptake of bowel cancer screening by ethnic group and religion in Scotland, for both sexes, that require further research and targeted interventions.

scholarly journals Gene–Diet Interactions in Colorectal Cancer: Survey Design, Instruments, Participants and Descriptive Data of a Case–Control Study in the Basque Country

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2362
Author(s):  
Iker Alegria-Lertxundi ◽  
Carmelo Aguirre ◽  
Luis Bujanda ◽  
Francisco J. Fernández ◽  
Francisco Polo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Fatty Acids ◽  
Screening Program ◽  
Survey Design ◽  
Basque Country ◽  
Saturated Fatty Acids ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Related Quality ◽  
Bowel Cancer Screening

Epidemiologic studies have revealed inconsistent evidence of gene-diet interaction in relation to colorectal cancer (CRC). The aim of this study was to analyze them in a sample of cases and controls from the population-based bowel cancer screening program of the Osakidetza/Basque Health Service. This study analyzed dietetic, genetic, demographic, socioeconomic factors and lifestyles. In the present manuscript, the survey design, sampling, instruments, measurements and related quality management were presented. Moreover, we analyze differences between cases and controls in some data, especially those related to diet. The participants were 308 cases and 308 age- and sex-matched subjects as controls. Cases were more likely than controls to have overweight/obesity (67.5% vs. 58.1%, p < 0.05), a lower intake of vitamin B2 (0.86 ± 0.23 vs. 0.92 ± 0.23 mg/1000 kcal, p < 0.01) and calcium:phosphorus ratio (0.62 ± 0.12 vs. 0.65 ± 0.13, p < 0.01). A higher proportion of cases than controls did not meet the Nutritional Objectives for saturated fatty acids (85.7% vs. 67.5%, p < 0.001) or cholesterol (35.4% vs. 25.0%, p < 0.01). In conclusion, the present study provides valuable data for analyzing the complexity of gene-diet interaction in relation to CRC. The results presented here suggest that overweight/obesity and a high intake of certain dietary components, especially saturated fatty acids and cholesterol, are more frequent in cases than in controls.

scholarly journals Bowel Cancer Screening in Australia: Research and Tactics to Achieve an Advocacy Goal

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 145s-145s
Author(s):  
P. Grogan
Keyword(s):  
Cancer Screening ◽  
Screening Program ◽  
Bowel Cancer ◽  
Political Support ◽  
Policy And Practice ◽  
Pilot Studies ◽  
Change Policy ◽  
Cancer Council ◽  
Program Policy ◽  
Bowel Cancer Screening

Background and context: Bowel cancer is the second leading cause of cancer death in Australia, yet survival is above 90% if it is detected at stage one. Cancer Council Australia has advocated since 1997 (when RCT evidence was published) for a national government-run screening program—a challenge to any government, given the costs and changes across the health system, irrespective of the health benefits. Cancer Council Australia has advocated at every step in the program’s development, from pilot studies to securing bipartisan political support for the program´s introduction to funding allocations linked to our budget submissions. Yet cost pressures restricted the Australian Government in 2013 to implementation by 2034 - an unacceptable timeframe in view of preventable deaths over that period. To find a peer-reviewed “big number” to convince candidates in Australia´s 2013 federal election to support full implementation by 2020, Cancer Council commissioned a study of multiple screening scenarios submitted to a leading medical journal, showing our implementation plan would prevent 35,000 bowel cancer deaths by 2040. The incoming government, despite campaigning on national debt-reduction, allocated almost $100 million dollars—the centrepiece of its first health budget—to Cancer Council Australia´s plan, attributing the decision to our advice. Subsequent Cancer Council Australia research has shown the program´s life-saving benefits to be even greater if participation can be increased, and that it would achieve net savings. We continue to push for program promotion, with our peer-reviewed research showing 60% participation would prevent 84,000 bowel cancer deaths by 2040. Aim: To highlight how political advocacy and scientific research can work together by ensuring the advocacy is based on the best available evidence, with that evidence collected through a peer-reviewed study designed to deliver major policy reform. Strategy/Tactics: The key strategy/tactics were basic but often overlooked: collect the most compelling evidence of benefit, thereby making it difficult for politicians to dismiss the advocacy. The example of bowel cancer screening advocacy in Australia since 2012-13 has been presented in Australian research institutes to highlight how studies can be designed expressly to translate to a major policy outcome. Program/Policy process: Cancer Council Australia adhered to all government processes within its advocacy remit (budget submissions, being appointed to government committees, producing clinical practice guidelines) while working independently to drive the research and public policy agenda. Outcomes: The accelerated implementation of a landmark national screening program. What was learned: That even politicians obsessed with budget cuts can´t always argue with the best evidence—and that researchers can design studies that change policy and practice, if guided by political pragmatists.

Evidence of elevated colorectal cancer and adenoma rates for regional National Bowel Cancer Screening Program participants

2017 ◽  
Vol 26 (1) ◽  
pp. 63-64 ◽  
Author(s):  
Vincent L. Versace ◽  
Anton D. Forsyth ◽  
Rose Vaughan ◽  
Margie G. Morrice ◽  
Barry J. Morphett
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Bowel Cancer ◽  
Cancer Screening Program ◽  
Bowel Cancer Screening

Opportunistic Colorectal Cancer Screening using Colonoscopy. Comparative Results between two Historical Cohorts in Bucharest, Romania

2015 ◽  
Vol 24 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Elena Mirela Ionescu ◽  
Tudor Nicolaie ◽  
Serban Ion Gologan ◽  
Ana Mocanu ◽  
Cristina Ditescu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Advanced Adenoma ◽  
Detection Rates ◽  
Incidence And Mortality ◽  
Organized Screening Program ◽  
History Of ◽  
Comparative Results ◽  
Asymptomatic Individuals ◽  
Second Period

Background & Aims: Even though Romania has one of the highest incidence and mortality in colorectal cancer (CRC) in Europe, there is currently no organized screening program. We aimed to assess the results of our opportunistic CRC screening using colonoscopy.Methods: A single center retrospective study to include all opportunistic screening colonoscopies performed in two 18 month periods (2007-2008 and 2012-2013) was designed. All asymptomatic individuals without a personal or family history of adenoma or CRC and with complete colonoscopy performed in these two time periods were included.Results: We included 1,807 individuals, 882 in the first period, 925 in the second period. There were 389 individuals aged below 50, 1,351 between 50 and 75 and 67 older than 75 years. There were 956 women (52.9%), with a mean age of 58.5 (median 59, range 23-97). The detection rates were 12.6% for adenomas (6.1% for advanced adenoma) and 3.4% for adenocarcinoma. Adenoma incidence (4.9% in subjects under 50, 14.7% in those aged 50 to 75, and 16.4% in those older than 75, p<0.0001) and size (6.3mm in subjects younger than 50, 9.2mm in those 50 to 75 and 10.8mm in those older than 75, p=0.015) significantly increased with age. Adenoma incidence increased in the second period (14.8% vs. 10.3%, p=0.005), while adenoma size decreased in the second period (8.4mm vs. 10mm, p=0.006). There were no procedure related complications.Conclusions: The neoplasia detection rate was 16% (12.6% adenoma, 3.4% adenocarcinoma). Adenoma incidence and size increased with age in both cohorts. In the second screening period significantly more and smaller adenomas were detected.

Correlation between Faecal Tumour M2 Pyruvate Kinase and Colonoscopy for the Detection of Adenomatous Neoplasia in a Secondary Care Cohort

2016 ◽  
Vol 25 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Ashley D. Bond ◽  
Michael D. Burkitt ◽  
David Sawbridge ◽  
Bernard M. Corfe ◽  
Chris S. Probert
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Pyruvate Kinase ◽  
Predictive Value ◽  
Screening Programme ◽  
Occult Blood ◽  
Faecal Occult ◽  
Faecal Samples ◽  
Cancer Screening Programme ◽  
Bowel Cancer Screening

Background & Aims: Colorectal cancer screening programmes that target detection and excision of adenomatous colonic polyps have been shown to reduce colorectal cancer related mortality. Many screening programmes include an initial faecal occult blood test (FOBt) prior to colonoscopy. To refine the selection of patients for colonoscopy other faecal-based diagnostic tools have been proposed, including tumour M2-pyruvate kinase (tM2-PK). To determine whether tM2-PK quantification may have a role in diverse settings we have assessed the assay in a cohort of patients derived from both the England bowel cancer screening programme (BCSP) and symptomatic individuals presenting to secondary care. Method. Patients undergoing colonoscopy provided faecal samples prior to bowel preparation. Faecal tM2-PK concentrations were measured by ELISA. Sensitivity, specificity, positive predictive value, negative predictive value and ROC analyses were calculated. Results. Ninety-six patients returned faecal samples: 50 of these with adenomas and 7 with cancer. Median age was 68. Median faecal tM2-PK concentration was 3.8 U/mL for individuals without neoplastic findings at colonoscopy, 7.7 U/mL in those with adenomas and 24.4 U/mL in subjects with colorectal cancer (both, p=0.01). ROC analysis demonstrated an AUROC of 0.66 (sensitivity 72.4%, specificity 48.7%, positive predictive value 67.7%, negative predictive value 36.7%). Amongst BCSP patients with a prior positive FOBt faecal tM2-PK was more abundant (median 6.4 U/mL, p=0.03) and its diagnostic accuracy was greater (AUROC 0.82). Conclusion. Our findings confirm that faecal tM2-PK ELISA may have utility as an adjunct to FOBt in a screening context, but do not support its use in symptomatic patients. Abbreviations: BCSP: Bowel cancer screening programme; EMR: Endoscopic mucosal resection; FAP: Familial adenomatous polyposis; FOBt: Faecal occult blood testing; NHS: National Health Service; tM2-PK: tumour M2-pyruvate kinase.

Sign in / Sign up

Export Citation Format

Share Document