scholarly journals Resource Implications for a Population-Based Colorectal Cancer Screening Program in Canada: A Study of the Impact on Colonoscopy Capacity and Costs in London, Ontario

2007 ◽  
Vol 21 (6) ◽  
pp. 371-377 ◽  
Author(s):  
Agatha Lau ◽  
James C Gregor
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Crc Screening ◽  
Fecal Occult ◽  
Annual Screening

OBJECTIVE: Cancer Care Ontario has recommended a population-based colorectal cancer (CRC) screening program using fecal occult blood testing. Patients who test positive should undergo further investigation, preferably colonoscopy. So far, no studies have been performed to quantify the costs or demands on the health care system at the community level. The number of consultations, colonoscopies and polypectomies, and the corresponding direct medical costs generated by the CRC screening program, between 2006 and 2015 in London, Ontario, were estimated using a decision analysis model in comparison with the population health model.METHODS: A faxed survey study was conducted to examine the current CRC screening practice among family physicians in London. Data from the survey and randomized studies were applied to a decision analysis model, which simulated the steps involved in population-based biennial and annual CRC screening between 2006 and 2015. The number of consultations, colonoscopies and polypectomies, and their associated costs were calculated.RESULTS: For a cohort population of 140,000, between 50 and 74 years of age, in 2006 to 2015, it is estimated that an average of 412 consultations, 463 colonoscopies and 174 polypectomies will be performed per 100,000 screen eligible population per year in biennial screening, and double in annual screening, reflecting an average of 8.7% or 17.6% increase annually in outpatient colonoscopies, respectively, compared with 2003. A mean of $285,000 or $562,000 per year would be required to support the extra consultation and endoscopic procedures generated by the biennial or annual screening.CONCLUSION: Population-based fecal occult blood testing screening for CRC appears to be a manageable strategy if a modest increase in endoscopic resources is allocated.

Colorectal Cancer Screening by Fecal Occult Blood Testing: Results of a Population-Based Experience

2000 ◽  
Vol 86 (5) ◽  
pp. 384-388 ◽  
Author(s):  
Grazia Grazzini ◽  
Guido Castiglione ◽  
Antonio Isu ◽  
Paola Mantellini ◽  
Tiziana Rubeca ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Blood Testing ◽  
Fecal Occult ◽  
Oncological Screening

Aims and background The study evaluated the results of an experimental screening protocol for colorectal cancer by fecal occult blood testing in a municipality of the Province of Florence. Methods A total of 15,235 subjects aged 50–70 years were invited to perform a 1-day immunochemical fecal occult blood testing without any dietary restrictions. All eligible subjects were sent a personal invitation letter, followed by a postal reminder to non-responders. Subjects with a negative stool test were advised to repeat screening after 2 years. Subjects with a positive screening test were invited to undergo full colonoscopy or a combination of left colonoscopy and a double contrast barium enema. Results A total of 6,418 subjects performed the screening test, with an overall compliance of 42.1%. A total of 268 compilers had positive test results. The positivity rate was 4.2%. Detection rate for cancer and for adenomas was 5.1‰ and 11.6‰, respectively. The positive predictive value was 14.3% for cancer and 32.5% for adenoma. A higher compliance was recorded in subjects born in the province of Florence or living in the centre of the town, in married subjects, and in women. The best results in compliance were associated with the direct distribution of fecal occult blood testing kits by general practitioners to their outpatients. Conclusions The study provides useful information about the efficiency and feasibility of a screening program for colorectal cancer using fecal occult blood testing. Compliance results confirm the importance of GP involvement in oncological screening.

scholarly journals Gastroscopy Following a Positive Fecal Occult Blood Test and Negative Colonoscopy: Systematic Review and Guideline

2010 ◽  
Vol 24 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Johane Allard ◽  
Roxanne Cosby ◽  
M Elisabeth Del Giudice ◽  
E Jan Irvine ◽  
David Morgan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Crc Screening ◽  
Fecal Occult

BACKGROUND: A sizeable number of individuals who participate in population-based colorectal cancer (CRC) screening programs and have a positive fecal occult blood test (FOBT) do not have an identifiable lesion found at colonoscopy to account for their positive FOBT screen.OBJECTIVE: To evaluate the evidence and provide recommendations regarding the use of routine esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancers in patients participating in a population-based CRC screening program who are FOBT positive and colonoscopy negative.METHODS: A systematic review was used to develop the evidentiary base and to inform the evidence-based recommendations provided.RESULTS: Nine studies identified a group of patients who were FOBT positive and colonoscopy negative. Three studies found no cases of UGI cancer. Four studies reported cases of UGI cancer; three found UGI cancer in 1% or less of the population studied, and one study found one case of UGI cancer that represented 7% of their small subgroup of FOBT-positive/colonoscopy-negative patients. Two studies did not provide outcome information that could be specifically related to the FOBT-positive/colonoscopy-negative subgroup.CONCLUSION: The current body of evidence is insufficient to recommend for or against routine EGD as a means of detecting gastric or esophageal cancers for patients who are FOBT positive/colonoscopy negative, in a population-based CRC screening program. The decision to perform EGD should be individualized and based on clinical judgement.

scholarly journals Colorectal Cancer Screening: Physicians’ Knowledge of Risk Assessment and Guidelines, Practice, and Description of Barriers and Facilitators

2006 ◽  
Vol 20 (11) ◽  
pp. 713-718 ◽  
Author(s):  
Maida J Sewitch ◽  
Pascal Burtin ◽  
Martin Dawes ◽  
Mark Yaffe ◽  
Linda Snell ◽  
...  
Keyword(s):  
Care Delivery ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Health Care Delivery System ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Barriers To Screening ◽  
Fecal Occult ◽  
Risk Patients

BACKGROUND: Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening.OBJECTIVE: To assess physicians’ knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours.METHODS: Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours.RESULTS: All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities.CONCLUSIONS: Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.

scholarly journals Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Jill Tinmouth ◽  
Emily T. Vella ◽  
Nancy N. Baxter ◽  
Catherine Dubé ◽  
Michael Gould ◽  
...  
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Fecal Occult ◽  
Evidence Summary ◽  
Screening Intervals ◽  
Meta Analyses

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC.Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions.Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality.Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

scholarly journals Evaluation of Effectiveness, Benefit Harm and Cost Effectiveness of Colonoscopy and Occult Blood Tests for an Organized Population-based Colorectal Cancer Screening in Austria

2019 ◽  
Author(s):  
Beate Jahn ◽  
Gaby Sroczyn ◽  
Marvin Bundo ◽  
Nikolai Mühlberger ◽  
Sibylle Puntscher ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Test ◽  
Occult Blood ◽  
Population Based ◽  
Positive Test ◽  
Fecal Occult Blood ◽  
Test Results ◽  
Crc Screening ◽  
Fecal Occult ◽  
Psychological Harm

Abstract Background: Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods: A decision-analytic Markov cohort model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results: The most effective strategies were FIT and COL. The IHBR to move from COL to FIT has an expected incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. gFOBT was dominated by FIT. Moving from COL to FIT has an ICER of 15000 EUR/LYG. Conclusions: Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.

scholarly journals Delayed Colonoscopy Following a Positive Fecal Test Result and Cancer Mortality

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Anath A Flugelman ◽  
Nili Stein ◽  
Ori Segol ◽  
Idit Lavi ◽  
Lital Keinan-Boker
Keyword(s):  
Positive Result ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Primary Outcome Measure ◽  
Delay Group ◽  
Screening Strategy ◽  
Fecal Occult Blood ◽  
Fecal Occult

Abstract Background A fecal test followed by diagnostic colonoscopy for a positive result is a widely endorsed screening strategy for colorectal cancer (CRC). However, the relationship between the time delay from the positive test to the follow-up colonoscopy and CRC mortality has not been established. Methods From a population-based screening program, we identified CRC patients newly diagnosed from 2005 through 2015 by a positive fecal occult test followed by a colonoscopy. The primary outcome measure was CRC-specific mortality according to four categories for the time elapsed between the positive result and the subsequent colonoscopy. Results The 1749 patients underwent colonoscopies within 0–3 months (n = 981, 56.1%), 4–6 months (n = 307, 17.5%), 7–12 months (n = 157, 9.0%), and later than 12 months (n = 304, 17.4%). CRC-specific deaths according to exposure groups were: 13.8% (135 of 981) for 0–3 months, 10.7% (33 of 307) for 4–6 months (crude hazards ratio [HR] = 0.74, 95% confidence interval [CI] = 0.51 to 1.14), 11.5% (18 of 157) for 7–12 months (crude HR = 0.83, 95% CI = 0.51 to 1.42), and 22.7% (69 of 304) for longer than 12 months (crude HR = 1.40, 95% CI = 1.04 to 1.90). The only variable that was associated with mortality risk was the number of positive slides (P = .003). High positivity was twice the value in the 0–3 as the longer-than-12 months group: 51.9% vs 25.0% and similar for the 4–6 and 7–12 months groups (38.1% and 36.5%), respectively. The adjusted HRs for CRC mortality were 0.81 (95% CI = 0.55 to 1.19); 0.83 (95% CI = 0.50 to 1.41), and 1.53 (95% CI = 1.13 to 2.12, P = .006) for the 4–12, 7–12, and longer-than-12-months groups, respectively, compared with the shortest delay group. Conclusions Among screen-diagnosed CRC patients, performance of colonoscopy more than 12 months after the initial positive fecal occult blood test was associated with more advanced disease and higher mortality due to CRC.

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