scholarly journals Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xu-xia He ◽  
Si-yi Yuan ◽  
Wen-bin Li ◽  
Hong Yang ◽  
Wen Ji ◽  
...  
Keyword(s):  
High Risk ◽  
Fecal Immunochemical Test ◽  
Asia Pacific ◽  
Average Risk ◽  
Predictive Values ◽  
C Statistic ◽  
Increased Risk ◽  
Immunochemical Test ◽  
Validation Set ◽  
Colorectal Screening

Abstract Background The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT). This paper aimed to improve the APCS score and evaluate its use with the FIT in stratifying the risk of ACN. Methods This prospective and multicenter study enrolled 955 and 1201 asymptomatic Chinese participants to form the derivation and validation set, respectively. Participants received the risk factor questionnaire, colonoscopy and FIT. Multiple logistic regression was applied, and C-statistic, sensitivity and negative predictive values (NPVs) were used to compare the screening efficiency. Results A modified model was developed incorporating age, body mass index (BMI), family history, diabetes, smoking and drinking as risk factors, stratifying subjects into average risk (AR) or high risk (HR). In the validation set, the HR tier group had a 3.4-fold (95% CI 1.8–6.4) increased risk for ACN. The C-statistic for the modified score was 0.69 ± 0.04, and 0.67 ± 0.04 for the original score. The sensitivity of the modified APCS score combined with FIT for screening ACN high-risk cohorts was 76.7% compared with 36.7% of FIT alone and 70.0% of the modified APCS score alone. The NPVs of the modified score combined with FIT for ACN were 98.0% compared with 97.0% of FIT alone and 97.9% of the modified APCS score alone. Conclusions The modified score and its use with the FIT are efficient in selecting the HR group from a Chinese asymptomatic population.

scholarly journals Improvement of Asia-Pacific Colorectal Screening score and evaluation of its use combined with fecal occult blood test

2019 ◽  
Author(s):  
Xuxia He ◽  
Siyi Yuan ◽  
Wenbin Li ◽  
Hong Yang ◽  
Wen Ji ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Occult Blood ◽  
Asia Pacific ◽  
Fecal Occult Blood ◽  
Fecal Occult ◽  
C Statistic ◽  
Validation Set ◽  
Colorectal Screening

Abstract Background The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal occult blood test (FOBT). This paper aimed to improve the APCS score and evaluate its use with the FOBT in stratifying the risk of ACN. Methods This prospective and multicenter study enrolled 955 and 1201 asymptomatic Chinese participants to form the derivation and validation set, respectively. Participants received the risk factor questionnaire, colonoscopy and immunochemical FOBT. Multiple logistic regression was applied, and C-statistic, sensitivity and negative predictive values (NPVs) were used to compare the screening efficiency. Results A modified model was developed incorporating age, body mass index (BMI), family history, diabetes, smoking and drinking as risk factors, stratifying subjects into average risk (AR) or high risk (HR). In the validation set, the HR tier group had a 3.4-fold (95% CI 1.8-6.4) increased risk for ACN. The C-statistic for the modified score was 0.69 ± 0.04, and 0.67 ± 0.04 for the original score. The sensitivity of the modified APCS score combined with FOBT for screening ACN high-risk cohorts was 76.7% compared with 36.7% of FOBT alone and 70.0% of the modified APCS score alone. The NPVs of the modified score combined with FOBT for ACN were 98.0% compared with 97.0% of FOBT alone and 97.9% of the modified APCS score alone. Conclusions The modified score and its use with the FOBT are efficient in selecting the HR group from a Chinese asymptomatic population.

scholarly journals Performance of the Fecal Immunochemical Test in Patients With a Family History of Colorectal Cancer

2019 ◽  
Author(s):  
Sarvee Moosavi ◽  
Laura Gentile ◽  
Lovedeep Gondara ◽  
Colleen Mcgahan ◽  
Robert Alan Enns ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Family History ◽  
High Risk ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Study Cohort ◽  
Predictive Values ◽  
Two Samples ◽  
Immunochemical Test

Abstract Objective To assess the performance of a fecal immunochemical test (FIT) among participants of a population-based colorectal cancer (CRC) screening program with one or more first-degree relatives (FDR) with CRC. Methods Asymptomatic 50 to 74 years olds with a FDR diagnosed with CRC, enrolled in a colon screening program completed FIT (two samples, cut-off 20 µg Hemoglobin/gram feces) and underwent colonoscopy. FIT-interval CRCs were identified from the British Columbia cancer registry. Logistic regression analysis was used to identify variables associated with the detection of CRC and high-risk polyps (nonmalignant findings that required a 3-year surveillance colonoscopy) in those patients undergoing FIT and colonoscopy. Results Of the 1387 participants with a FDR with CRC, 1244 completed FIT with a positivity rate of 10.8%, 52 declined FIT but underwent colonoscopy and 90 declined screening. Seven CRCs were identified: six in patients with a positive FIT, one in a patient who only had colonoscopy. No CRCs were found in patients with a negative FIT. The positive and negative predictive values of FIT in the detection of CRC were 4.8% and 100%, respectively. On multivariate logistic regression, positive FIT, and not type of family history, was the only variable associated with detection of CRC or high-risk polyps. At 2-year follow-up, there was no FIT interval cancer detected in the study cohort. Conclusion FIT is more strongly associated with high-risk findings on colonoscopy than type of family history. FIT may be an alternative screening strategy to colonoscopy in individuals with a single FDR with CRC.

scholarly journals Adherence to fecal immunochemical test screening among adults at average risk for colorectal cancer

2021 ◽  
Author(s):  
Deborah A. Fisher ◽  
Nicole Princic ◽  
Lesley-Ann Miller-Wilson ◽  
Kathleen Wilson ◽  
Kathryn DeYoung ◽  
...  
Keyword(s):  
Fecal Immunochemical Test ◽  
Administrative Claims ◽  
Average Risk ◽  
Repeat Testing ◽  
Future Studies ◽  
Increased Risk ◽  
Potential Benefits ◽  
Immunochemical Test ◽  
Alternative Test

Abstract Purpose This study examined adherence to screening for fecal immunochemical test (FIT). Methods Adults (≥ 50–75) with a FIT between 1/1/2014 and 6/30/2019 in MarketScan administrative claims were selected (index = earliest FIT). Patients were followed for 10 years pre- and 3 years post-index. Patients at increased risk for CRC or with prior screening were excluded. Year over year adherence was measured post-index. Results Of 10,253 patients, the proportion adherent to repeat testing at year 2 was 23.4% and 10.6% at year 3. Of 76.6% not adherent in year 2, 5.4% were adherent in year 3. Conclusion Results suggest adherence to FIT tests is poor, minimizing potential benefits. Future studies are needed to consider alternative test options and whether more choice will improve long-term adherence.

scholarly journals Current and Future Directions of Breast MRI

2021 ◽  
Vol 10 (23) ◽  
pp. 5668
Author(s):  
Margaret Houser ◽  
David Barreto ◽  
Anita Mehta ◽  
Rachel F. Brem
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Digital Breast Tomosynthesis ◽  
Breast Mri ◽  
Preoperative Assessment ◽  
Average Risk ◽  
Dense Breast Tissue ◽  
Increased Risk ◽  
High Risk Populations ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient’s response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.

Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 871-876 ◽  
Author(s):  
Manuel Zorzi ◽  
Cesare Hassan ◽  
Giulia Capodaglio ◽  
Maddalena Baracco ◽  
Giulio Antonelli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Screening Program ◽  
Waiting Times ◽  
Multivariable Analysis ◽  
Latex Agglutination ◽  
Old Patients ◽  
Screening Programs ◽  
Increased Risk ◽  
Immunochemical Test

Background Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. Methods In a cohort of 50–69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. Results 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31–180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15–2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03–7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. Conclusion In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

scholarly journals Methodology of an Analysis of Snow Disaster Risk for Establishing Climate Change Adaptation Measures

2020 ◽  
Vol 20 (1) ◽  
pp. 351-364
Author(s):  
Yu Insang
Keyword(s):  
Climate Change ◽  
Standard Deviation ◽  
High Risk ◽  
Adaptive Capacity ◽  
Climate Change Adaptation ◽  
Spatial Information ◽  
Average Risk ◽  
Adaptation Measures ◽  
Increased Risk ◽  
Very High

This study applies the concept of risk defined by IPCC’s fifth assessment report to Daegu City, Ulsan City, Gyeongsangbuk Province, and Gangwon Province to assess and analyze snow disaster risks. Sub-indicators of three hazards, six exposures, four vulnerabilities, and five adaptive capacities were selected, and spatial information based on grids or administrative districts was constructed. The weight of each indicator was calculated with the Analytic Hierarchy Process (AHP), and the maximum inconsistency of the expert survey result was 9.86%, indicating high consistency. The results show that administrative districts with an space average risk of “very high” are Ulleung, Gangneung, Sokcho, Yangyang, Pyeongchang, Goseong, Donghae, Samcheok, and Jeongseon, accounting for 16.7% of the entire administrative district. One region has a “high” risk, Taebaek (1.9%), and those with a “moderately high” risk were Uljin and Inje (3.8%). These regions have very high levels of hazards, very low exposure, very high vulnerability, and low adaptive capacity; hence, hazard, vulnerability, and adaptive capacity had a significant effect on the increased risk. Pyeongchang had the highest standard deviation of gridded risk among the 12 regions with a risk above moderately high. The standard deviation of gridded risk for Pyeongchang was estimated to be 1.0 with the highest value, followed by Inje, with 0.69, and Jeongseon, with 0.55; therefore, differentiated climate change adaptation measures should be established according to gridded risks.

Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults

Gut ◽  
2020 ◽  
pp. gutjnl-2020-321698
Author(s):  
Thomas F Imperiale ◽  
Patrick O Monahan ◽  
Timothy E Stump ◽  
David F Ransohoff
Keyword(s):  
High Risk ◽  
Colorectal Neoplasia ◽  
Risk Groups ◽  
Low Risk ◽  
Screening Tests ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Intermediate Risk ◽  
C Statistic ◽  
Advanced Colorectal Neoplasia

ObjectiveKnowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models.DesignAverage-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.ResultsAmong 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value <0.001), containing 23%, 59% and 18% of subjects, respectively. In the validation set of 1475 subjects (AN prevalence of 8.4%), model performance was comparable (c-statistic=0.78), with AN risks of 2.73% (CI 1.25% to 5.11%), 5.57% (CI 4.12% to 7.34%) and 25.79% (CI 20.51% to 31.66%) in low-risk, intermediate-risk and high-risk subgroups, respectively (p<0.001), containing proportions of 23%, 59% and 18%.ConclusionAmong average-risk persons, this model estimates AN risk with high discrimination, identifying a lower risk subgroup that may be screened non-invasively and a higher risk subgroup for which colonoscopy may be preferred. The model could help guide patient–provider discussions of screening options, may increase screening adherence and conserve colonoscopy resources.

Prospective validation of a risk model for first cycle neutropenic complications in patients receiving cancer chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8561-8561 ◽  
Author(s):  
G. H. Lyman ◽  
N. M. Kuderer ◽  
J. Crawford ◽  
D. A. Wolff ◽  
E. Culakova ◽  
...  
Keyword(s):  
High Risk ◽  
Test Performance ◽  
Risk Model ◽  
Selection Process ◽  
Low Risk ◽  
Validation Dataset ◽  
Cancer Type ◽  
General Applicability ◽  
C Statistic ◽  
Increased Risk

8561 Background: A nationwide, prospective cohort study was undertaken to develop and validate a risk model for neutropenic complications (NC) in cancer patients receiving chemotherapy. Methods: 3,596 patients initiating a new chemotherapy regimen with solid tumors or lymphoma were registered at 115 randomly selected sites. Data on at least 1 cycle of chemotherapy were available on 3,468. A logistic regression model for cycle 1 NC was derived and then validated using a split sample random selection process. Results: The risk of cycle 1 NC ranged from 5.5%-30.2%, averaging 18.5% across tumor types. No significant differences in distribution of NC or predictive factors were observed between the derivation dataset (n=2,592) or the validation dataset (n=876). Major independent baseline clinical risk factors for cycle 1 NC in the derivation model include: prior chemotherapy (P=.044), number of myelosuppressive agents (P<.0001), anthracycline-based regimens (P<.0001), planned delivery >85% of standard (P<.0001), cancer type (P<.0001), concurrent antibiotics (P=.023) or phenothiazines (P=.006), abnormal alkaline phosphatase (P=.002), elevated bilirubin (P=.031), low platelets (P=.004), elevated glucose (P=.023) and reduced glomerular filtration rate (P=.013). Reduced risk of cycle 1 NC was associated with primary prophylaxis with a myeloid growth factor (P<.0001). Model R2 was 0.273 and c-statistic 0.80 [95% CI: 0.78–0.82; P<.0001]. At the median predicted risk of cycle 1 NC of 11%, model test performance consisted of: sensitivity 84%; specificity 57% and diagnostic odds ratio (DOR) 7.2 while cycle 1 NC risk was 31% and 6% among high risk and low risk half, respectively. The model performed well in the smaller validation dataset with a model R2 of 0.354 and c-statistic of 0.84 [95% CI: 0.81–0.87, P<.0001]. Test performance of the model in the validation sample included: sensitivity 90%; specificity 62%; DOR 14.1 and risks of 35% and 4% in high risk and low risk patients, respectively. Conclusions: Validation in a randomly selected patient sample suggests that this model has general applicability in identifying patients at increased risk for NC. Further validation in other independent cancer patient populations receiving chemotherapy is planned. [Table: see text]

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