Temporal trends in colorectal cancer screening (CRCS).

356 Background: The rate of CRCS continues to be suboptimal. Our study objectives were to characterize temporal trends in CRCS in general and within specific subpopulations and identify clinical and system factors that pose barriers to CRCS. Methods: Data from respondents aged ≥50 years who were classified as average risk (no personal or family history of colorectal cancer) from the 2001 to 2009 California Health Interview Survey were analyzed. Up-to-date CRCS was defined as having had a sigmoidoscopy or colonoscopy within the past 10 years. Using multivariate regression analyses that adjusted for confounders, rates of CRCS over consecutive periods of 2 calendar years were determined. Stratified analyses that explored for effect modification based on gender, ethnicity, smoking history, educational attainment, income level, health insurance status, and urban vs. rural residence were conducted. Results: A total of 126,873 screening-eligible respondents was included: median age was 63 years (range 50-85); 50,303 (46%) were men, and 95,534 (63%) were white. In the entire cohort, only 73,589 (55%) reported up-to-date CRCS. Over time, there was a significant trend towards increased CRCS, ranging from 48% in 2001 to 61% in 2009 (p<0.01). After adjusting for confounding variables, this trend persisted with higher odds of up-to-date CRCS in more recent years (see Table). Specific characteristics were associated with decreased likelihood of CRCS: women (OR 0.63), low education (OR 0.72), poor income (OR 0.84), no insurance (OR 0.44), and rural residence (OR 0.93) (p<0.01 for all). Temporal increases in CRCS were most prominent in particular groups, such as women (OR 3.55 in 2009 vs. 2001) and the uninsured (OR 11.48 in 2009 vs. 2001) (p<0.01 for both). Conclusions: Although CRCS improved over time, there is still room for significant improvement. Temporal increases in CRCS were most substantial among women and the uninsured. Interventions used to improve CRCS in these groups should be harnessed and implemented within other minorities to enhance screening. [Table: see text]

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MRI screening of women at average risk of breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.21 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 21-21 ◽

Cited By ~ 3

Author(s):

Simone Schrading ◽

Christiane K. Kuhl

Keyword(s):

Breast Cancer ◽

High Risk ◽

Pulse Sequence ◽

Mammographic Breast Density ◽

Average Risk ◽

High Grade ◽

Entire Cohort ◽

History Of ◽

Mean Size ◽

Screening Mammograms

21 Background: In asymptomatic women at average risk, mammography alone, possibly amended by the US, is recommended for screening. MRI is established for screening women at high risk, but there are no data available to support its use in women at average risk. Methods: Between Jan 2005 and Dec 2012, 1,387 women at average risk, i.e. without personal or family history of breast or ovarian cancer or tissue diagnosis of atypias underwent 1,705 annual MRI screening studies. Mean/median age was 55/56, range 40-79. All women had normal CBE and normal double-read 2-view digital screening mammograms. In women with breast densities, additional US had been performed and women were included if also US was normal. Patients underwent bilateral DCE MRI at 1.5T using a 2D GE pulse sequence. Results: A total of 54 MRIs were rated positive (MR-BI-RADS 4/5) (54/1705; 3.2%). Biopsies performed in these women were positive for breast cancer or DCIS in 18, and revealed high risk lesions in 8 patients, yielding an additional cancer yield of 11/1,000. In 28 women, biopsy revealed benign changes only. This translates into a PPV of 33% (18/54), or 48% (26/54) if high risk lesions are included. Of the 18 cancers, 11 (61%) were invasive and 7 (39%) DCIS. Mean size of invasive cancers was 11 mm (median 10, range 4 -22). Invasive cancers were intermediate or high grade in 9/11, DCIS in 6/7. All invasive cancers were staged pN0, M0. Minimal cancer rate was 13/18 (72%). Distribution of mammographic breast densities in women with MRI-diagnosed cancer was as follows: ACR I in 2 (11%), ACR II in 3 (17%), ACR III in 8 (44%), ACR IV in 5 (28%). This was equivalent to the distribution of breast densities in the entire cohort. Conclusions: In this cohort of heavily pre-screened women at average risk, the additional cancer yield achieved through MRI was high (11/1,000). Although the biologic profile of MRI-only detected additional cancers was indicative of prognostically relevant disease, with a high proportion of high-grade cancers, stage distribution of cancers was favorable. Mammographic breast density did not predict the likelihood with which additional cancers were identified through MRI. In women with dense breasts who underwent screening US in addition to mammography, there is still a significant reservoir of undetected cancers.

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Increase in Prevalence of Diabetic Ketoacidosis at Diagnosis Among Youth With Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

10.2337/figshare.14489001.v1 ◽

2021 ◽

Author(s):

Elizabeth T Jensen ◽

Jeanette M Stafford ◽

Sharon Saydah ◽

Ralph B D'Agostino, Jr ◽

Lawrence M Dolan ◽

...

Keyword(s):

Type 1 Diabetes ◽

Temporal Trends ◽

Sociodemographic Factors ◽

Diabetes Diagnosis ◽

Adjusted Relative Risk ◽

Incident Type ◽

Health Insurance Status ◽

Search Site ◽

Over Time

Objective: We previously reported a high (~30%), but stable prevalence of DKA at youth-onset diagnosis of type 1 diabetes (2002 and 2010). Given the changing demographics of youth-onset type 1 diabetes, we sought to evaluate temporal trends in the prevalence of DKA at diagnosis of type 1 diabetes from 2010 to 2016 among youth <20 years of age and evaluate whether any change observed was associated with changes in sociodemographic distribution of those recently diagnosed. Research Design and Methods: We calculated prevalence of DKA within 1 month of type 1 diabetes diagnosis by year and evaluated trends over time (2010-2016) (n=7,612 incident diabetes cases, mean (SD) age 10.1 (4.5) at diagnosis). To assess whether trends observed were attributable to the changing distribution of sociodemographic factors among youth with incident type 1 diabetes, we estimated an adjusted relative risk (aRR) of DKA in relation to calendar year, adjusting for age, sex, race/ethnicity, income, education, health insurance status, language, season of diagnosis, and SEARCH site. Results: DKA prevalence increased from 35.3% (95% CI: 32.2, 38.4) in 2010, to 40.6% (95% CI: 37.8, 43.4) in 2016 (p for trend=0.01). Adjustment for sociodemographic factors did not substantively change the observed trends. We observed a 2% annual increase in prevalence of DKA at or near diagnosis of type 1 diabetes (crude RR: 1.02; 95% CI: 1.01, 1.04 and aRR: 1.02; 95% CI: 1.01, 1.04; p=0.01 for both). Conclusions: Prevalence of DKA at or near type 1 diabetes diagnosis has increased from 2010 to 2016, following the high but stable prevalence observed from 2002-2010. This increase does not seem to be attributable to the changes in distribution of sociodemographic factors over time.

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Temporal trends in receipt of adjuvant chemotherapy for veterans with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19171 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19171-e19171

Author(s):

Richard Lewis Martin ◽

Gretchen C. Edwards ◽

Lauren R. Samuels ◽

Cathy Eng ◽

Christianne L. Roumie

Keyword(s):

Colorectal Cancer ◽

Quality Improvement ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Temporal Trends ◽

Stage Ii ◽

Stage Iii ◽

Health Administration ◽

Co Morbidity ◽

Over Time

e19171 Background: For patients with National Comprehensive Cancer Network (NCCN) high risk stage II or stage III colorectal cancer (CRC), adjuvant chemotherapy improves disease free (DFS) and overall survival (OS). Rates of use vary significantly across health care settings. Several demographic and healthcare factors are associated with decreased receipt of chemotherapy; however, few studies have assessed utilization patterns over time. We evaluated receipt of chemotherapy from 2000-2015 among patients treated at a Southeast Regional Veterans Health Administration (VHA) facility to determine local targets for quality improvement initiatives. Methods: We reviewed 1,107 electronic medical records of patients undergoing colorectal surgery from January 1, 2000 to December 31, 2015 at VHA Tennessee Valley Healthcare System. We included patients with NCCN eligible pathologic high risk stage II (T4/perf, R1, < 12LN, LVI) or stage III CRC and excluded for age ≥80, age ≥75 hospitalized in the prior year with a major co-morbidity, and death or hospice within 30 days of surgery. The primary predictor was year of surgery, partitioned 2000-2005 (N = 60), 2006-2010 (N = 64), 2011-2015 (N = 56) to reflect changes in NCCN guidelines. The primary outcome was receipt of any chemotherapy. Results: Of 1,107 colorectal surgeries, we excluded 623 for non-cancers, 212 for stage I or low-risk stage II cancer, 47 for metastatic disease, and 45 for age, co-morbidity, death, and hospice, yielding a final cohort of 121 colon and 59 rectal cancers. Most patients were male (96%), white (79%), with median age 64 years [Interquartile Range 60, 70]. Overall, 117 of 180 (65%) received chemotherapy with a median time to treatment of 50.5 days [40,64]. Adjusting for known correlates, receipt of chemotherapy decreased over time; 2000-2005 (72%), 2006-2010 (69%), 2011-2015 (53%) p = 0.02. Regardless of CRC stage, more patients declined chemotherapy in 2011-2015 (27%) compared to 2000-2005 (6%) and 2006-2010 (8%) p < 0.01. Conclusions: We identified decreased utilization of adjuvant chemotherapy in a non-elderly veteran cohort, which appeared to be due to patients declining chemotherapy regardless of cancer stage. Understanding patient and provider decisions around adjuvant chemotherapy and evaluating trends outside the VHA may offer important insights to implementing quality improvement measures.

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The evolution of lower gastrointestinal endoscopy: where are we now?

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774520979591 ◽

2020 ◽

Vol 13 ◽

pp. 263177452097959

Author(s):

Arun Sivananthan ◽

Ben Glover ◽

Lakshmana Ayaru ◽

Kinesh Patel ◽

Ara Darzi ◽

...

Keyword(s):

Colorectal Cancer ◽

Gastrointestinal Endoscopy ◽

New Technologies ◽

Global Burden ◽

Scientific Disciplines ◽

History Of ◽

Diagnostic Technologies ◽

Over Time ◽

Fundamental Design

Lower gastrointestinal endoscopy has evolved over time, fulfilling a widening diagnostic and therapeutic remit. As our understanding of colorectal cancer and its prevention has improved, endoscopy has progressed with improved diagnostic technologies and advancing endoscopic therapies. Despite this, the fundamental design of the endoscope has remained similar since its inception. This review presents the important role lower gastrointestinal endoscopy serves in the prevention of colorectal cancer and the desirable characteristics of the endoscope that would enhance this. A brief history of the endoscope is presented. Current and future robotic endoscopic platforms, which may fulfil these desirable characteristics, are discussed. The incorporation of new technologies from allied scientific disciplines will help the endoscope fulfil its maximum potential in preventing the increasing global burden of colorectal cancer. There are a number of endoscopic platforms under development, which show significant promise.

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A64 REVIEW OF PATIENTS REFERRED TO THE DIVISION OF DIGESTIVE CARE AND ENDOSCOPY AT DALHOUSIE UNIVERSITY FOR COLORECTAL CANCER SCREENING BASED ON A FAMILY HISTORY OF COLORECTAL CANCER: HOW MANY UNDERWENT COLONOSCOPY?

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.062 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 23-25

Author(s):

M Miles

Keyword(s):

Colorectal Cancer ◽

Family History ◽

High Risk ◽

Average Risk ◽

Cross Sectional ◽

Crc Screening ◽

Increased Risk ◽

Fit Testing ◽

Quality Assessment Study ◽

History Of

Abstract Background Nova Scotia has provincial colorectal cancer (CRC) screening for asymptomatic, average risk individuals age 50–74 using fecal immunochemical testing (FIT) every 2 years. However, individuals with 1 or more first degree relatives (FDR) diagnosed with CRC by age 60 have a 2–4 fold increased risk for developing CRC. For these high risk individuals, current guidelines recommend CRC screening with colonoscopy rather than FIT testing. Annually, the Division of Digestive Care & Endoscopy (DCE) at Dalhousie University receives many referrals for patients with a family history of CRC but the percentage of patients who require this procedure is unclear. Aims The objectives of this quality assessment study were to review patients referred to DCE for a family history of CRC to (1) better understand the indication for referral; and (2) determine the percentage of patients undergoing colonoscopy Methods This was a retrospective cross sectional review of a prospectively updated database. The study population was patients referred to DCE from 2012–2019 based on a family history of CRC, as indicated on the referral. Family history of CRC was defined as 1 or more FDRs diagnosed with CRC. High risk patients were those with 2 or more FDRs with CRC or 1 FDR diagnosed by age 60. All patients were reviewed by a single gastroenterologist in clinic. Results A total of 107 referrals from 2012–2019 were reviewed. Of patients age 50 or older, 51/78 (65.4%) had performed at least 1 FIT. The indications for referral were 2 or more FDR diagnosed with CRC for 6/107 (5.6%) patients, 1 FDR diagnosed with CRC by age 60 for 37/107 patients (34.6%) and 1 FDR diagnosed with CRC over age 60 for 33/107 patients (30.8%). The remaining 31/107 patients (29.0%) had no FDR with CRC. Of the 43/107 patients (40.2%) considered high risk based on family history alone, 34/43 (79.1%) underwent colonoscopy and 8/43 (18.6%) opted for FIT testing. Of the 64/107 patients (59.8%) considered average risk based on family history alone, 26/64 (40.6%) had another indication for colonoscopy and 35/64 (54.7%) resumed FIT testing. Conclusions The majority of patients (71.0%) referred to the DCE for a family history of CRC had at least 1 FDR with CRC. Just over half of patients (55.1%) referred to the DCE for a family history of CRC underwent colonoscopy. Strategies to improve the referral process by better capturing high risk individuals are needed. Funding Agencies None

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595 Post-Colonoscopy Colorectal Cancer Rates Have Decreased Over Time in Average-Risk Patients Aged 50 to 74: A Population-Based Study from Ontario, Canada

Gastroenterology ◽

10.1016/s0016-5085(16)30512-1 ◽

2016 ◽

Vol 150 (4) ◽

pp. S120

Author(s):

Sanjay K. Murthy ◽

Robin Ducharme ◽

Alaa Rostom ◽

Catherine Dube ◽

Paul D. James ◽

...

Keyword(s):

Colorectal Cancer ◽

Population Based ◽

Average Risk ◽

Population Based Study ◽

Risk Patients ◽

Cancer Rates ◽

Over Time

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Risk Model for Colorectal Cancer in Spanish Population Using Environmental and Genetic Factors: Results from the MCC-Spain study

Scientific Reports ◽

10.1038/srep43263 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 17

Author(s):

Gemma Ibáñez-Sanz ◽

Anna Díez-Villanueva ◽

M. Henar Alonso ◽

Francisco Rodríguez-Moranta ◽

Beatriz Pérez-Gómez ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Model ◽

Vegetable Consumption ◽

Environmental Data ◽

Average Risk ◽

Nucleotide Polymorphisms ◽

Genetic Score ◽

Single Nucleotide ◽

Risk Alleles ◽

History Of

Abstract Colorectal cancer (CRC) screening of the average risk population is only indicated according to age. We aim to elaborate a model to stratify the risk of CRC by incorporating environmental data and single nucleotide polymorphisms (SNP). The MCC-Spain case-control study included 1336 CRC cases and 2744 controls. Subjects were interviewed on lifestyle factors, family and medical history. Twenty-one CRC susceptibility SNPs were genotyped. The environmental risk model, which included alcohol consumption, obesity, physical activity, red meat and vegetable consumption, and nonsteroidal anti-inflammatory drug use, contributed to CRC with an average per factor OR of 1.36 (95% CI 1.27 to 1.45). Family history of CRC contributed an OR of 2.25 (95% CI 1.87 to 2.72), and each additional SNP contributed an OR of 1.07 (95% CI 1.04 to 1.10). The risk of subjects with more than 25 risk alleles (5th quintile) was 82% higher (OR 1.82, 95% CI 1.11 to 2.98) than subjects with less than 19 alleles (1st quintile). This risk model, with an AUROC curve of 0.63 (95% CI 0.60 to 0.66), could be useful to stratify individuals. Environmental factors had more weight than the genetic score, which should be considered to encourage patients to achieve a healthier lifestyle.

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Cigarette smoking as a risk factor for recurrence of aneurysms treated by endosaccular occlusion

Journal of Neurosurgery ◽

10.3171/jns/2008/108/4/0672 ◽

2008 ◽

Vol 108 (4) ◽

pp. 672-675 ◽

Cited By ~ 34

Author(s):

Rafael Ortiz ◽

Michael Stefanski ◽

Robert Rosenwasser ◽

Erol Veznedaroglu

Keyword(s):

Cigarette Smoking ◽

Coil Embolization ◽

Statistical Significance ◽

Retrospective Chart Review ◽

Smoking History ◽

Low Grade ◽

Entire Cohort ◽

Published Evidence ◽

Increased Risk ◽

History Of

Object Aneurysms treated by endovascular coil embolization have been associated with coil compaction, and the rate of recanalization has been reported to be as high as 40%. The authors report the first published evidence of a correlation between aneurysm recanalization correlated with a history of cigarette smoking. Methods The authors conducted a retrospective chart review of all cases involving patients admitted to their institution from January 1, 2003, to December 31, 2003, for treatment of a cerebral aneurysm. Cases in which patients were treated with coil embolization were reviewed for inclusion. Coil compaction was defined as change in the shape of the coil mass. Aneurysm recanalization was defined as an increase in inflow to the aneurysm in comparison with baseline. The incidence of coil compaction and the relationship with cigarette smoking history were compared in patients with and without recurrence. Results A total of 110 patients qualified for inclusion. The odds ratio (OR) for aneurysm recanalization after endosaccular occlusion with respect to history of cigarette smoking was significant for the entire cohort (OR 4.53, 95% confidence interval [CI] 1.95–10.52) and especially for the female cohort (OR 3.72, 95% CI 1.45–9.54). The male cohort demonstrated a trend toward a direct correlation, but the sample size was not large enough for statistical significance (OR 7.50, 95% CI 1.02–55.00). Conclusions There was an increased risk of recanalization especially in patients with low-grade subarachnoid hemorrhage who had a history of cigarette smoking. These data suggest a correlation between cigarette smoking and aneurysm recurrence.

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Rapid evolution and biogeographic spread in a colorectal cancer

Nature Communications ◽

10.1038/s41467-019-12926-8 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 15

Author(s):

Joao M. Alves ◽

Sonia Prado-López ◽

José Manuel Cameselle-Teijeiro ◽

David Posada

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Positive Selection ◽

Rapid Evolution ◽

Population Expansion ◽

Metastatic Colonization ◽

Biogeographic History ◽

History Of ◽

Tumoral Cells ◽

Over Time

Abstract How and when tumoral clones start spreading to surrounding and distant tissues is currently unclear. Here we leveraged a model-based evolutionary framework to investigate the demographic and biogeographic history of a colorectal cancer. Our analyses strongly support an early monoclonal metastatic colonization, followed by a rapid population expansion at both primary and secondary sites. Moreover, we infer a hematogenous metastatic spread under positive selection, plus the return of some tumoral cells from the liver back to the colon lymph nodes. This study illustrates how sophisticated techniques typical of organismal evolution can provide a detailed, quantitative picture of the complex tumoral dynamics over time and space.

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