Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program

Background and aims Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program. Methods We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection. Results For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%). Conclusions Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.

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Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

Journal of Medical Screening ◽

10.1177/0969141320957361 ◽

2020 ◽

pp. 096914132095736

Author(s):

Lawrence F Paszat ◽

Rinku Sutradhar ◽

Elyse Corn ◽

Jin Luo ◽

Nancy N Baxter ◽

...

Keyword(s):

Colorectal Cancer ◽

Large Bowel ◽

Bowel Resection ◽

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Operative Complications ◽

Large Bowel Resection ◽

Post Operative Complications

Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

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Endoscopists Are Independent Predictors of Adenoma Detection Rates in a Colorectal Cancer Screening Program Based On Biennial Fecal Occult Blood Test (FOBT): A Population-Based Study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.03.464 ◽

2009 ◽

Vol 69 (5) ◽

pp. AB206

Author(s):

Jean-François Bretagne ◽

Stéphanie Hamonic ◽

Emmanuelle Leray ◽

Christine Piette ◽

Sylvain Manfredi ◽

...

Keyword(s):

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Population Based Study ◽

Detection Rates ◽

Fecal Occult ◽

Cancer Screening Program ◽

Adenoma Detection ◽

Adenoma Detection Rates

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Delayed Colonoscopy Following a Positive Fecal Test Result and Cancer Mortality

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz024 ◽

2019 ◽

Vol 3 (2) ◽

Cited By ~ 6

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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Upper Gastrointestinal Cancer in a Population-based Screening Program with Fecal Occult Blood Test for Colorectal Cancer

Scandinavian Journal of Gastroenterology ◽

10.1080/003655202753387428 ◽

2002 ◽

Vol 37 (1) ◽

pp. 95-98 ◽

Cited By ~ 11

Author(s):

M. Rasmussen ◽

O. Kronborg

Keyword(s):

Blood Test ◽

Fecal Occult Blood Test ◽

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Occult Blood Test ◽

Fecal Occult ◽

Upper Gastrointestinal Cancer ◽

Upper Gastrointestinal

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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

Canadian Journal of Gastroenterology ◽

10.1155/2007/810941 ◽

2007 ◽

Vol 21 (6) ◽

pp. 371-377 ◽

Cited By ~ 6

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.

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SCREENING FOR COLORECTAL CANCER USING THE FECAL OCCULT BLOOD TEST: AN ACTUARIAL ASSESSMENT OF THE IMPACT OF A POPULATION-BASED SCREENING PROGRAM IN CANADA

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462303000692 ◽

2003 ◽

Vol 19 (4) ◽

pp. 715-723 ◽

Cited By ~ 2

Author(s):

Paul J. Villeneuve ◽

Ann Coombs

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Controlled Trials ◽

Randomized Controlled ◽

Fecal Occult ◽

The Impact

Objectives:A series of randomized controlled trials have demonstrated that screening for colorectal cancer (CRC) using the fecal occult blood (FOB) test can decrease mortality from this disease. These findings were used to develop an actuarial model to estimate the impact that a FOB screening program for colorectal cancer would have on the Canadian population.Methods:The mortality experience of the year 2000 cohort of Canadians fifty to seventy-four years of age, with follow-up extending to 2010, was modelled according to three scenarios: no screening, annual screening, biennial screening. The primary screening tool was the FOB test using unrehydrated samples, with follow-up of positive test results using colonoscopy. The framework of the model was developed based on published findings from the relevant randomized controlled trials, available data, and a literature review that yielded parameter values for some model items.Results:During the 10-year follow-up of the cohort, we estimated that 4,444 and 2,827 deaths would be averted with annual and biennial FOB screening, respectively. We estimated that for an annual FOB screening program, approximately 3,400 FOB tests would be required to prevent one death, whereas 2,700 tests would be required within a biennial program.Conclusions:Our analysis documents the population health impact of using the FOB test to screen for CRC. Additional information on the natural history of the disease, and Canadian pilot data are needed to better model the effectiveness of population-based FOB screening programs.

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116 Surveillance Colonoscopies in an Organized Colorectal Cancer Screening Program With Guaiac Fecal Occult Blood Test: A Population-Based Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(14)60111-6 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-32

Author(s):

Bernard Denis ◽

Isabelle Gendre ◽

Philippe Perrin

Keyword(s):

Colorectal Cancer ◽

Blood Test ◽

Fecal Occult Blood Test ◽

Screening Program ◽

Occult Blood ◽

Population Based ◽

Fecal Occult Blood ◽

Occult Blood Test ◽

Fecal Occult ◽

Cancer Screening Program

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

Tumori Journal ◽

10.1177/030089160008600503 ◽

2000 ◽

Vol 86 (5) ◽

pp. 384-388 ◽

Cited By ~ 15

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.

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