scholarly journals Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 171
Author(s):  
Birgitte Skau ◽  
Ulrik Deding ◽  
Lasse Kaalby ◽  
Gunnar Baatrup ◽  
Morten Kobaek-Larsen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Status ◽  
Low Income ◽  
Educational Level ◽  
Odds Ratio ◽  
Screening Program ◽  
Crc Screening ◽  
Incomplete Colonoscopy ◽  
Immunochemical Test ◽  
Inadequate Bowel Preparation

The aim of this study is to investigate the association between socioeconomic status (SES) and the risk of having an incomplete colonoscopy (IC) in the Danish Colorectal Cancer (CRC) Screening Program. In this register-based study we included 71,973 participants who underwent colonoscopy after a positive fecal immunochemical test in the Danish CRC Screening Program. The main exposure, SES, was defined by income and education, and the outcome by complete or incomplete colonoscopy. Among the participants, 5428 (7.5%) had an incomplete colonoscopy. The odds ratio (OR) for ICs due to inadequate bowel preparation was 1.67 (95% CI: 1.46; 1.91) for income in the 1 quartile compared to income in the 4th quartile. ORs for income in the 2nd quartile was 1.38 (95% CI: 1.21; 1.56) and 1.17 (95% CI: 1.03; 1.33) for income in the 3rd quartile. For the educational level, an association was seen for high school/vocational education with an OR of 0.87 (95% CI: 0.79; 0.97) compared to higher education. For ICs due to other reasons, the level of income was associated with the risk of having an IC with an OR of 1.19 (95% CI: 1.05; 1.35) in the 1st quartile and an OR of 1.19 (95% CI: 1.06; 1.34) in the 2nd quartile. For the educational level, there were no significant associations. Low income is associated with high risk of having an IC, whereas educational level does not show the same unambiguous association.

scholarly journals A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

2017 ◽  
Vol 6 (3) ◽  
pp. 471-479 ◽  
Author(s):  
Clasine M de Klerk ◽  
Manon van der Vlugt ◽  
Patrick M Bossuyt ◽  
Evelien Dekker
Keyword(s):  
Colorectal Cancer ◽  
General Practitioner ◽  
Cancer Screening ◽  
Odds Ratio ◽  
Screening Program ◽  
Daily Practice ◽  
Fecal Immunochemical Test ◽  
Crc Screening ◽  
Advanced Neoplasia ◽  
Immunochemical Test

Background Symptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia. Methods We prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy. Results Of 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia. Conclusions A large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.

The Impact of Socioeconomic Status on Perceived Barriers to Colorectal Cancer Testing

2008 ◽  
Vol 23 (2) ◽  
pp. 97-100 ◽  
Author(s):  
Aimee S. James ◽  
Sandra Hall ◽  
K. Allen Greiner ◽  
Dan Buckles ◽  
Wendi K. Born ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Status ◽  
Low Income ◽  
Fecal Occult Blood ◽  
Low Ses ◽  
National Guidelines ◽  
Convenience Sample ◽  
Crc Screening ◽  
Screening Barriers ◽  
The Impact

Purpose. Colorectal cancer (CRC) screening is effective, but only one-half of age-eligible adults adhere to national guidelines. Lower socioeconomic status (SES) groups are less likely to be screened. Methods. Baseline data from a prospective study were used to examine the associations among CRC screening screening barriers, and SES. A convenience sample of adults (N = 291) aged 40 years and older was recruited from a federally qualified health center. Questionnaires were administered orally and included demographics, health, health behavior, and screening barriers. Results. In logistic regression, having health insurance was associated with greater odds of screening. Bivariate analyses detected few differences in fecal occult blood test (FOBT) barriers, but several endoscopy barriers were more common among the lowest SES groups. For example, fear of injury from endoscopy was more likely among low-income and uninsured participants. Discussion. The impact of SES on cancer screening is complex, but low-SES participants more often reported certain barriers than their higher-SES counterparts. This was more evident for endoscopy than for FOBT. Programs targeted at low-SES patients may need to focus on barriers that are not fully addressed in traditional promotion efforts.

scholarly journals Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program

2018 ◽  
Vol 06 (09) ◽  
pp. E1140-E1148 ◽  
Author(s):  
Liseth Rivero-Sánchez ◽  
Jaume Grau ◽  
Josep María Augé ◽  
Lorena Moreno ◽  
Angels Pozo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Colorectal Adenomas ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Screening Strategies ◽  
Immunochemical Test ◽  
Low Incidence

Abstract Background and study aims Colorectal cancer (CRC) risk after a positive fecal immunochemical test (FIT) and negative colonoscopy is unknown. We aimed to ascertain the cumulative incidence of post-colonoscopy colorectal cancer (PCCRC) and the manifestation of other lesions that could explain the test positivity in individuals with a negative colonoscopy in a population screening program. Patients and method Observational study in participants from the first round of a CRC screening program (2010 – 2012) with positive-FIT (≥ 20 μg/g of feces) and negative colonoscopy (without neoplasia). A 42- to 76-month follow-up was performed searching in the National Health Service database and by a brief structured telephonic interview. Results Of 2659 FIT-positive individuals who underwent colonoscopy, 811 (30.5 %) had a negative colonoscopy. Three PCCRC (0.4 %) were detected within 11 – 28 months and accelerated carcinogenesis was ruled out. Among those with normal colonoscopy, 32 (5 %) relevant lesions were detected at follow-up. One-third of them (11/32) were significant neoplasias: a gastric cancer, a small-bowel lymphoma, six advanced colorectal adenomas, and the three PCCRC. The 21 remaining lesions were inflammatory, vascular disorders, or non-advanced colorectal adenomas. Conclusions The vast majority (95 %) of individuals did not present any subsequent lesion that could explain the FIT positivity. The very low incidence (0.4 %) and characteristics of PCCRC observed in our cohort reinforce the concept that, although a positive FIT preselects high risk individuals, a high quality colonoscopy is the paramount factor in preventing PCCRC. Improving quality standards of colonoscopy are required to strengthen the current CRC screening strategies.

Adaptation of a Mailed-FIT Kit and Patient Navigation Intervention to Increase Colorectal Cancer (CRC) Screening Among Spanish-Speaking Hispanic/Latino Patients

2021 ◽  
pp. 154041532110241
Author(s):  
Sou Hyun Jang ◽  
Allison Cole ◽  
Emily V.R. Brown ◽  
Linda Ko
Keyword(s):  
Colorectal Cancer ◽  
Patient Navigation ◽  
Screening Program ◽  
Qualitative Content Analysis ◽  
Future Research ◽  
Care Needs ◽  
Crc Screening ◽  
Spanish Speaking ◽  
Immunochemical Test ◽  
First Time

Background: Hispanic/Latino populations experience significant barriers to colorectal cancer (CRC) screening. ProCRCScreen is a multicomponent CRC screening program that can help primary care clinics improve CRC screening rates, but it needs adaptation to better meet the health care needs of Spanish-speaking Hispanic/Latino populations. Methods: We conducted four focus groups with 22 Spanish-speaking Latino patients and used inductive qualitative content analysis to identify potential program adaptations. Results: We identified lack of social support for CRC screening and confusion about completing stool-based testing as important barriers to CRC screening. Participants recommended increased specificity of the fecal immunochemical test (FIT) instructions to increase the likelihood of successful test completion, especially for first-time screening. They also endorsed patient navigation for support in completing CRC screening. Discussion: We adapted the informational materials and workflows for the ProCRCScreen program. Future research to test the adapted program is needed.

Impact of sedation on the Performance Indicator of Colonic Intubation

Endoscopy ◽  
2020 ◽  
Author(s):  
Karlijn J. Nass ◽  
Sascha C. van Doorn ◽  
Manon van der Vlugt ◽  
Paul Fockens ◽  
Evelien Dekker
Keyword(s):  
Odds Ratio ◽  
Performance Indicator ◽  
Screening Program ◽  
National Database ◽  
Median Dose ◽  
Cecal Intubation ◽  
Crc Screening ◽  
Adenoma Detection ◽  
Immunochemical Test ◽  
Pathology Data

Abstract Background The Performance Indicator of Colonic Intubation (PICI) is a new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. This study assessed achievement of PICI within the Dutch colorectal cancer (CRC) screening program, and determined the association between PICI and adenoma detection rate (ADR). PICI achievement when using the Dutch median midazolam dose was also assessed. Methods This retrospective study was conducted within the Dutch fecal immunochemical test-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between January 2016 through January 2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) of 1 – 3, and use of ≤ 2.5 mg midazolam. Results 107 328 colonoscopies were performed during the study period. Adequate PICI was achieved in 49 500 colonoscopies (46.1 %). In colonoscopies with inadequate PICI, inadequacy was due to higher sedation doses in 87.8 %. Adequate PICI was associated with higher ADR (odds ratio 1.16, 95 % confidence interval 1.12 – 1.20). When using a cutoff of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95 410 colonoscopies (88.9  %). Conclusion PICI appeared to be heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as a quality indicator is limited.

scholarly journals Current Colorectal Cancer in Thailand

2020 ◽  
Vol 36 (2) ◽  
pp. 78-82
Author(s):  
Varut Lohsiriwat ◽  
Nopdanai Chaisomboon ◽  
Jirawat Pattana-Arun ◽  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Public Awareness ◽  
Population Based ◽  
Current Status ◽  
General Surgeon ◽  
Crc Screening ◽  
Common Cancer ◽  
Immunochemical Test ◽  
Colorectal Surgeons

This article aimed to summarize the current status of colorectal cancer (CRC) in Thailand. In brief, CRC is the third most common cancer and accounts for 11% of the cancer burden in Thailand. It is the only malignancy with an increased incidence in both sexes in Thailand. Over 10,000 new CRC cases occur annually, and about 40% are rectal cancer. Due to the lack of CRC screening and public awareness, nonmetastatic cancer accounts only for 60%–70% of overall cases. The demand for general or colorectal surgeons outmatches the supply at a ratio of 1 general surgeon to 35,000 individuals. There are about 70 board-certified colorectal surgeons serving Thailand’s population of nearly 70 million. As a result, >25% of cancer patients wait more than 1 month before surgery. Regarding training for colorectal surgery, there are 3 major institutes in Bangkok providing a 2-year fellowship program. Cadaveric workshops are an important part of training – especially in laparoscopy for CRC. Recently, a population-based CRC screening program was launched using a fecal immunochemical test. The Ministry of Public Health of Thailand has established additional platforms for laparoscopy to support the potential detection of early CRC following implementation of this nationwide screening program.

scholarly journals Quality Monitoring of a FIT-Based Colorectal Cancer Screening Program

2019 ◽  
Vol 65 (3) ◽  
pp. 419-426 ◽  
Author(s):  
Esther Toes-Zoutendijk ◽  
Johannes M G Bonfrer ◽  
Christian Ramakers ◽  
Marc Thelen ◽  
Manon C W Spaander ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Small Difference ◽  
Regression Analyses ◽  
Detection Rates ◽  
Screening Programs ◽  
Crc Screening ◽  
Specimen Collection ◽  
Cancer Screening Program ◽  
Immunochemical Test

Abstract BACKGROUND Quality assessment is crucial for consistent program performance of colorectal cancer (CRC) screening programs using fecal immunochemical test for hemoglobin (FIT). However, literature on the consistency of FIT performance in laboratory medicine was lacking. This study examined the consistency of FIT in testing positive or detecting advanced neoplasia (AN) for different specimen collection devices, lot reagents, and laboratories. METHODS All participants with a FIT sample with a cutoff concentration of 47 μg Hb/g feces in the Dutch CRC screening program in 2014 and 2015 were included in the analyses. Multivariable logistic regression analyses were performed to estimate the odds ratios of collection devices, reagents, and laboratories on testing positive or detecting AN and positive predictive value (PPV). RESULTS In total, 87519 (6.4%) of the 1371169 participants tested positive. Positivity rates and detection rates of AN differed between collection devices and reagents (all P < 0.01). In contrast, PPVs were not found to vary between collection devices, reagents, or laboratories (all P > 0.05). Positivity rates showed a small difference for laboratories (P = 0.004) but not for detection rates of AN. Size of the population affected by the deviating positivity rates was small (0.1% of the total tested population). CONCLUSIONS Variations were observed in positivity and detection rates between collection devices and reagents, but there was no detected variation in PPV. Although the overall population effect of these variations on the screened population is expected to be modest, there is room for improvement.

Can a biomarker triage test reduce colonoscopy burden in fecal immunochemical test screening?

2020 ◽  
Vol 9 (8) ◽  
pp. 563-571
Author(s):  
Marjolein JE Greuter ◽  
Beatriz Carvalho ◽  
Meike de Wit ◽  
Evelien Dekker ◽  
Manon CW Spaander ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Cancer Model ◽  
Crc Screening ◽  
Serrated Pathway ◽  
Immunochemical Test ◽  
Screening Effectiveness ◽  
Triage Test

Aim: To assess the potential of biomarker triage testing (BM-TT) in the Dutch colorectal cancer (CRC) screening program. Materials & methods: Using the Adenoma and Serrated pathway to Colorectal CAncer model, we simulated fecal immunochemical test (FIT)47-screening and various FIT plus BM-TT screening scenarios in which only individuals with both a positive FIT and BM-TT are referred to colonoscopy. Results: Adding a low polyp sensitivity BM-TT to FIT-screening reduced colonoscopy burden (89–100%) while increasing CRC mortality (27–41%) compared with FIT47-screening only. The FIT plus high polyp sensitivity BM-TT scenarios also decreased colonoscopy burden (71–89%) while hardly affecting CRC mortality (FIT47 0–4% increase, FIT15 2–7% decrease). Conclusion: Adding a BM-TT to FIT-screening considerably reduces colonoscopy burden, but could also decrease screening effectiveness. Combining FIT15 with a high polyp sensitivity BM-TT seems most promising.

Risk of Colonoscopy-related Complications in a Fecal Immunochemical Test-based Population Colorectal Cancer Screening Program

Endoscopy ◽  
2020 ◽  
Author(s):  
Wen-Feng Hsu ◽  
Chi-Yang Chang ◽  
Chun-Chao Chang ◽  
Li-Chun Chang ◽  
Chien-Hua Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Complication Rate ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Research Database ◽  
Complication Rates ◽  
Related Complication ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Immunochemical Test

Background and study aims: The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive subjects than in the general population. The magnitude of colonoscopy-related complication rate in FIT-positive subjects, however, remains unknown. This study aims to elucidate the colonoscopy-related complication rate after positive FIT and compared with colonoscopy performed for other purposes. Patients and methods: Information regarding colonoscopy after positive FIT (FIT-colonoscopy) and ordinary colonoscopy related severe complications during 2010-2014 was ascertained from the Taiwanese Colorectal Cancer (CRC) Screening Program Database and National Health Insurance Research Database (NHIRD). Severe complications included significant bleeding, perforation, and cardiopulmonary events <14 days of colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications in comparison with ordinary colonoscopy. Results: A total of 319,114 FIT-colonoscopies (214,955 subjects) were identified. Of those, 51,242 (16.1%) underwent biopsy and 94,172 (29.5%) underwent polypectomy; 2,125 had significant bleeding (6.7‰) and 277 had perforation (0.9‰) <14 days after colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications [adjusted odds ratio (aOR)= 4.41 (95% Confidence Interval {CI}=4.05–4.81); 1.35 (95%CI=1.12–1.53); and 1.88 (95%CI=0.61–5.84), respectively]. Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding [aOR= 3.10 (95%CI=2.90–3.32)]. Conclusions: FIT-colonoscopy was associated with more than two-fold risk of significant bleeding, especially when polypectomy is performed.

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

Cancers ◽  
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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