pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370–354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3–254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39–11.18) and a Site–Morphology–Size–Access score < 9 (OR 428, 95% CI 42–4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48–13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12–26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07–20.0), vascular infiltration (OR 8.24, 95% CI 2.72–25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62–12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08–298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05–50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55–37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26–14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39–14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32–17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process.

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National Colorectal Cancer Screening Program in Lithuania: Description of the 5-Year Performance on Population Level

Cancers ◽

10.3390/cancers13051129 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1129

Author(s):

Audrius Dulskas ◽

Tomas Poskus ◽

Inga Kildusiene ◽

Ausvydas Patasius ◽

Rokas Stulpinas ◽

...

Keyword(s):

Colorectal Cancer ◽

Quality Assurance ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Histopathological Examination ◽

Insurance Fund ◽

Crc Screening ◽

Cancer Screening Program ◽

The Impact

We aimed to report the results of the implementation of the National Colorectal Cancer (CRC) Screening Program covering all the country. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the program has its own administrative code. Information about services provided within the program was retrieved from the database of NHIF starting from the 1 January 2014 to the 31 December 2018. Exact date and type of all provided services, test results, date and results of biopsy and histopathological examination were extracted together with the vital status at the end of follow-up, date of death and date of emigration when applicable for all men and women born between 1935 and 1968. Results were compared with the guidelines of the European Union for quality assurance in CRC screening and diagnosis. The screening uptake was 49.5% (754,061 patients) during study period. Participation rate varied from 16% to 18.1% per year and was higher among women than among men. Proportion of test-positive and test-negative results was similar during all the study period—8.7% and 91.3% annually. Between 9.2% and 13.5% of test-positive patients received a biopsy of which 52.3–61.8% were positive for colorectal adenoma and 4.6–7.3% for colorectal carcinoma. CRC detection rate among test-positive individuals varied between 0.93% and 1.28%. The colorectal cancer screening program in Lithuania coverage must be improved. A screening database is needed to systematically evaluate the impact and performance of the national CRC screening program and quality assurance within the program.

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To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

BMC Health Services Research ◽

10.1186/s12913-020-06023-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jesper Bo Nielsen ◽

Gabriele Berg-Beckhoff ◽

Anja Leppin

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Demographic Data ◽

Survey Study ◽

Stepwise Logistic Regression ◽

Willingness To Participate ◽

Cross Sectional Survey ◽

Screening Programs ◽

Crc Screening ◽

Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

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Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

Endoscopy International Open ◽

10.1055/a-1452-9242 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1070-E1076

Author(s):

Marco Alburquerque ◽

Antonella Smarrelli ◽

Julio Chevarria Montesinos ◽

Sergi Ortega Carreño ◽

Ana Zaragoza Fernandez ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Complication Rates ◽

Withdrawal Time ◽

Equivalence Trial ◽

Crc Screening ◽

Intention To Treat ◽

Adenoma Detection ◽

Group A ◽

Cecal Intubation Rate

Abstract Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

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Geographical Variation and Factors Associated with Colorectal Cancer Mortality in a Universal Health Care System

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/707420 ◽

2014 ◽

Vol 28 (4) ◽

pp. 191-197 ◽

Cited By ~ 11

Author(s):

Mahmoud Torabi ◽

Christopher Green ◽

Zoann Nugent ◽

Salaheddin M Mahmud ◽

Alain A Demers ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Geographical Variation ◽

Geographical Area ◽

Capital City ◽

Universal Health Care ◽

Screening Programs ◽

Crc Screening ◽

Factors Associated ◽

Universal Health

OBJECTIVE: To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.METHODS: Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba’s universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.RESULTS: The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba’s capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.CONCLUSIONS: Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.

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Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

Hispanic Health Care International ◽

10.1177/1540415318818982 ◽

2018 ◽

Vol 17 (1) ◽

pp. 23-29 ◽

Cited By ~ 9

Author(s):

Theresa L. Byrd ◽

Jessica Calderón-Mora ◽

Rebekah Salaiz ◽

Navkiran K. Shokar

Keyword(s):

Colorectal Cancer ◽

Focus Groups ◽

Screening Program ◽

El Paso ◽

Barriers And Facilitators ◽

Hispanic Population ◽

Community Based ◽

Crc Screening ◽

Predominantly Hispanic ◽

9Th Grade

Introduction: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. Method: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. Results: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. Conclusion: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

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Psychosocial factors associated with the adherence to a colorectal cancer screening program

Cancer Detection and Prevention ◽

10.1016/j.cdp.2006.06.005 ◽

2006 ◽

Vol 30 (4) ◽

pp. 354-360 ◽

Cited By ~ 31

Author(s):

Margalida Gili ◽

Miquel Roca ◽

Victoria Ferrer ◽

Antoni Obrador ◽

Elena Cabeza

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Psychosocial Factors ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Factors Associated ◽

Cancer Screening Program

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Factors Associated with Participation in Colorectal Cancer Screening Using a Fecal Immunochemical Test (FIT) in Thai Population Aged 45 to 74 years in Namphong District, Khon Kaen Province

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.11904 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1067-1072

Keyword(s):

Public Health ◽

Colorectal Cancer ◽

Fecal Immunochemical Test ◽

Thai Population ◽

Screening Programs ◽

Crc Screening ◽

Factors Associated ◽

History Of ◽

Public Health Officials ◽

Immunochemical Test

Background: Presently, the level of participation in screening programs for colorectal cancer (CRC) with Fecal Immunochemical Test (FIT) is considerably low. Objective: To investigate factors associated with participation in CRC screening using a FIT in the Thai population age 45 to 74 years in the Namphong District of Khon Kaen Province. Materials and Methods: In the present study, the unmatched case-control study design was applied. Three hundred ten participants were equally divided into two groups with 155 participants in the study group and the other 155 in the control group. The data were collected by conducting interviews. Moreover, to explain the association between the factors, multiple logistic regressions were used with adjusted odds ratio (ORadj), a confidence level at 95%, and with p<0.05. Results: It was found that ages were equal to or higher than 60 years (ORadj 2.08; 95%CI 1.19 to 3.63), the lower education level (ORadj 3.70; 95% CI 1.86 to 7.33), a family history of cancer (ORadj 5.25; 95% CI 2.14 to 12.86), receiving advice from public health officials regarding CRC screening (ORadj 3.09; 95% CI 1.81 to 5.27), and high level of knowledge about CRC (ORadj 4.01; 95% CI 2.09 to 7.69) had all been related to participation in the CRC screening program with a statistical significance (p<0.05). Conclusion: The results revealed that receiving advice from public health officials regarding CRC screening and that proper knowledge had been related to participation in screening programs for CRC with the FIT. Thus, to raise awareness and create a greater understanding, public health officers should disseminate knowledge about CRC. Information about the colorectal screening with the FIT should especially be spread to those people who are younger than 60 years of age, have educational levels higher than the primary level, and to those, who have no family history of CRC. Keywords: Colorectal Cancer Screening; Fecal Immunochemical Test (FIT); Thai population

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Detection Rate of Colorectal Cancer or Precancer Adenoma by Colonoscopy After 1, 2, or 3 Positive Results via Fecal Immunochemical Testing

Laboratory Medicine ◽

10.1093/labmed/lmy075 ◽

2019 ◽

Vol 50 (3) ◽

pp. 263-267

Author(s):

Jill A Hancock ◽

Glen A Palmer

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Optimal Number ◽

Screening Methods ◽

Data Set ◽

Crc Screening ◽

Fecal Immunochemical Testing ◽

Fit Testing ◽

Risk Patients ◽

Standard Practices

Abstract Background Single-vial fecal immunochemical testing (FIT) is an accepted method of colorectal cancer (CRC) screening. The available 3-vial FIT data set allows for comparison of colonoscopy results using various screening methods. Objective To determine the optimal number of vials for a strong FIT-screening program by examining whether using only a single vial impacts the use of colonoscopy for CRC screening. Methods Patients were given 3-vial FIT collection kits that were processed with a positive hemoglobin cut-off detection level of 100 ng per mL. If FIT results were positive, colonoscopy testing was performed using standard practices. Results Detection of CRC and precursor adenoma was examined in 932 patients, with a positive colonoscopy sensitivity of 56.2% and 3.0% CRC detection after 3-vial FIT; after single-vial screening, those values were 60.9% and 4.7%, respectively. Conclusions Prescreening patients with FIT testing before colonoscopy allows colonoscopy testing to be targeted to higher-risk patients. Implementing use of only a single vial from the 3-vial FIT screening kit would reduce the colonoscopy reflex rate, colonoscopy complication numbers, facility costs, and patient distress by more than 40%, compared with 3-vial screening.

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Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City

JCO Global Oncology ◽

10.1200/go.20.43000 ◽

2020 ◽

Vol 6 (Supplement_1) ◽

pp. 46-46

Author(s):

Karla Unger-Saldaña ◽

Minerva Saldaña-Tellez ◽

Anabelle Bonvecchio ◽

Michael B. Potter ◽

Martin Lajous

Keyword(s):

Public Health ◽

Colorectal Cancer ◽

Primary Care ◽

Health Care ◽

Mexico City ◽

Screening Program ◽

Average Risk ◽

Culturally Competent ◽

Educational Materials ◽

Crc Screening

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.

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