Screening Colonoscopy Research Articles

Reevaluating colonoscopy screening intervals: extending the timeline to 15 years for Low-Risk individuals.

Reevaluating colonoscopy screening intervals: extending the timeline to 15 years for Low-Risk individuals.

Acute respiratory distress following an otherwise normal, uneventful, screening colonoscopy

A 62-year-old man with a past history of sleep apnea syndrome, umbilical and left inguinal hernia repairs, was referred to the emergency room for acute respiratory distress. He had underwent a screening colonoscopy 12 h earlier for a family history of colonic adenoma. This colonoscopy was complete, normal, and uneventful.A plain chest X-ray showed a distended colon extending to the upper third of the right side of the chest (Fig. 1). Further anamnesis helped the patient to remember a right diaphragmatic hernia, well-documented by CT-scan years ago. He had not previously mentioned this condition, when evaluated for colon screening.The patient was admitted to the surgical intensive care unit. A CT-scan confirmed a right diaphragmatic hernia with terminal ileum and ascending colon content, no sign of mesenteric ischemia, and massive pulmonary collapse. Conservative treatment with nasogastric suction quickly improved the patient's condition. He was discharged at day-6. Diaphragmatic hernia repair was scheduled 10 weeks later. Laparoscopy showed a complete agenesis of the right diaphragmatic dome (Fig. 2; Fig. 3), and was therefore converted into laparotomy for complete surgical repair. Postoperative course was unremarkable. Patient was discharged on day-6. Follow-up at 1 month was uneventful.Congenital diaphragmatic hernias are rare and usually diagnosed in the pre- natal period or in neonates with respiratory distress, calling for emergency neonatal repair [1,2]. In underdiagnosed or neglecting adults, the condition can be life-threatening, as seen in our patient [3,4]. Surgical repair is therefore strongly recommended, even in asymptomatic patients [5]. Recurrences are exceptional.

EPH153 Screening Interval for Colonoscopic Screening for Colorectal Cancer: A Systematic Review of Interval Cancer Rates of Colonoscopic Screening for Colorectal Cancer

EPH153 Screening Interval for Colonoscopic Screening for Colorectal Cancer: A Systematic Review of Interval Cancer Rates of Colonoscopic Screening for Colorectal Cancer

The Impact of an Educational 3D Virtual Reality Video Method on Bowel Preparation for Colonoscopy: First Results

Objective. Adequate bowel preparation is essential for diagnostic, screening, surveillance, and therapeutic colonoscopy. 3D virtual reality (3D-VR) has the characteristics of depth, interactivity and visuality and is widely used in medicine, so it can be used for patient education and training. The aim of our study is to determine the impact of using 3D virtual reality video for patients education on bowel preparation before colonoscopy. Materials and methods. A prospective, blind, randomized clinical trial was launched at the Republican Vilnius University Hospital (RVUL) on 07.03.2021, which included 50 outpatients who had indications for colonoscopy until 28.02.2022. Patients were randomly assigned to control and experimental groups. The first group was given the bowel preparation information in the standard form used by RVUL – in writing, and the second – in a 3D virtual reality video. The content of the information provided to both groups was the same. The quality of bowel preparation was assessed based on the Boston and Ottawa bowel preparation scales. Results. Of the 50 outpatients who participated in the study, 26 were assigned to the control group, 24 to the study group. The patients of both groups were identical in terms of sex, age, body mass index, comorbidities. The mean (SD) BBPS score was statistically significantly lower in the control group compared to the 3D-VR video group (5.96(±1) vs. 7.58(±1.47); p < 0.001). The mean (SD) scores of OBPS were higher in the control group (6.58(±2.44) than in the study group 1.83(±2.32); p < 0.001). The rate of adequate bowel preparation in the 3D-VR video group was higher than in the control group (18(69.23%) vs. 23(95.83%); the difference was statistically significant (p = 0.024)). The rate of terminal ileum intubation in the control group was 50% compared to 83.33% in the 3D-VR video group (p = 0.02).The mean (SD) colonoscopy time was statistically significantly shorter in the 3D-VR video group 23.04(±3.66) minutes and 16.5(±4.28) minutes, p = <0.001. Conclusions. Patients who were informed by 3D-VR method before colonoscopy had statistically significantly better bowel preparation, as well as reduced procedure time and possibly increased detection rates of polyps and adenomas.

Patient reported colonoscopy barriers: A cross sectional survey.

e23149 Background: As a leading cause of cancer-related death in the United States, colorectal cancer (CRC) screening is an acceptable cost-effective strategy to reducing mortality indices in the country. 10-yearly colonoscopy screening is the most effective with a mortality reduction of 73%. Despite this, CRC screening rates remain low. The purpose of this study was to describe barriers associated with colonoscopy screening in primary care settings. Methods: Postage pre-paid return envelopes and surveys were sent to all established patients aged > 50 from primary care practices (n = 4) in an employed physician group; the group also serves as a residency continuity clinic for a community teaching hospital. Variables included demographics and literature-reported barriers to colonoscopy screening. Whether or not a patient had a colonoscopy (including if > 10 years since a colonoscopy) was compared to patient reported barriers and demographics. Statistical significance was set at p < 0.05; strength of association was measured by Cramer’s V. Results: Average age of patients was 62 + 6 years; 61.4% were female; 35.3% were privately insured; and 10.3% were non-white. Older patients were slightly more likely to get screened, 63 + 6 years vs. 60 + 7 years (p = 0.006). Neither race, sex, insurance guarantor, education, marital status or income were associated with screening. Rate of colonoscopy screening in this series was 76.7% (n = 276/360), which was greater than rates reported by CDC for Ohio. In those screened, the rate of colonic or rectal polyps was remarkably noted to be up to 47.5% (131/276). The most important barriers to colonoscopy screening were knowledge of insurance coverage (p < 0.001; Cramer’s V = 0.216, p < 0.001); transportation to procedure (p = 0.001; Cramer’s V = 0.172, p = 0.001); someone to accompany patient (p = 0.002; Cramer’s V = 0.164, p = 0.002); and unaware of screening or lack of perceived health threat (p = 0.019; Cramer’s V = 0.150, p = 0.019). The remaining barriers were not associated with increased likelihood of colonoscopy: fear of finding cancer, belief in screening effectiveness, embarrassment or anxiety, or fear of invasive test. While bowel prep is often cited as a barrier to colonoscopy, this factor was not statistically significant. Likewise, physician-initiated discussion and time off from employment were not associated with screening. The most important colonoscopy barrier was patient knowledge regarding insurance for the procedure; overall, 29% of patients reported that they were unsure if colonoscopy was covered. Among those not screened, the rate rose to 47%. Conclusions: The most important colonoscopy barrier identified was patient knowledge regarding insurance for the procedure. While physician counseling for colonoscopy needs to include bowel prep and procedure risks, greater awareness of insurance coverage and social factors may facilitate physician understanding of colonoscopy screening hesitancy.

AI-assisted colonoscopy in gastroenterology fellowship training: An interim analysis of a randomized controlled trial.

e15642 Background: Artificial intelligence (AI) assisted colonoscopy may increase adenoma detection rates (ADR) for endoscopists, but its role for trainees in learning endoscopy has not been delineated. This randomized control trial explores the impact of AI on ADR by year of fellowship and anatomical location. Methods: In a registered randomized controlled trial (NCT05423964), gastroenterology fellows were assigned to AI (GI Genius, Medtronic; Minneapolis, MN) vs. conventional colonoscopy(CC). We included all symptomatic or screening colonoscopies with adequate bowel prep by trainees (postgraduate year 4-6). Baseline demographics, polyp pathology, size in 5mm increments, and location, and ADR was collected and compared for AI versus CC arms. A multivariate regression was used to identify factors influencing ADR of the right colon. Results: Of 685 colonoscopies between March 15th to July 28th, 2023, a total of 381 procedures performed by 17 fellows met criteria. Patient characteristics were similar between arms. In the CC arm, there was no difference in ADR among fellow years (1st 39% vs. 2nd 33% vs. 3rd 36%, p = 0.63; Right colon: 1st 31% vs 2nd 21% vs 3rd 30%, P = 0.21). Within 2nd year fellows, there was higher ADR using AI vs. CC for screening colonoscopies (52% vs 17%, p = 0.025). In the right colon, ADR was significantly higher using AI vs. CC for screening alone colonoscopies within 1st and 2nd year fellows (1st 50% vs 13%, p = 0.04; 2nd 57% vs 9%, p < 0.001). 2nd year fellows also increased ADR in the right colon using AI vs CC for symptomatic and screening colonoscopies (44% vs 21%, p = 0.001). There was no difference in procedural time with addition of AI, but a trend to longer withdrawal time. Multivariable logistic regression analysis also showed AI assisted colonoscopies was associated with enhanced ADR in right colon for trainees performing colonoscopy for symptomatic and screening (OR [95%CI]: 2 [1.3-3.3]) and screening alone (OR [95%CI]: 8.3 [2.5-26.6]). Conclusions: This randomized control trial shows AI assisted colonoscopies improve ADR, particularly in the right colon for postgraduate trainees. We propose a use case for AI assisted colonoscopy guiding targeted improvement of ADR in in the right colon which has been highlighted by the American Gastroenterology Association as an area of need. Clinical trial information: NCT05423964 . [Table: see text]

Expanding diversity in colorectal cancer studies with a focus on Hispanic and Latino participant enrollment.

e13532 Background: Colorectal cancer (CRC) is a leading cause of cancer mortality among Hispanic and Latino groups (Hispanic/Latinx). Despite making up 18.9% of the U.S. population, Hispanic/Latinx representation is only 2.3%-3.9% of subjects in oncology trials, highlighting the need for diversity in CRC research. Freenome is developing a blood test (MyTectCRC) intended to provide a convenient and accessible option for CRC screening. Its clinical validation will be supported by PREEMPT CRC, a prospective multi-center observational study. To ensure a diverse enrollment, Freenome partnered with several sites, including IHS, in communities with a diverse population. This analysis explores strategies used at IHS Health to effectively enroll minority groups. Methods: Initiated in 2020, PREEMPT CRC study (NCT04369053) enrolled participants aged 45-85 at average CRC risk. Eligible and consenting participants underwent a blood draw and a screening colonoscopy (CS), with the blood sample analyzed by Freenome using the investigational blood test. IHS Health, a research institute in Kissimmee, Florida, utilized a variety of methods to maximize the enrollment of diverse populations reflective of its local communities, such as partnering with local organizations to establish community outreach and employing bilingual staff to translate, educate, answer study questions, with cultural sensitivity. Participants were also able to have blood drawn and undergo CS on the same day due to its proximity to a gastroenterology office. Results: The site of IHS Health enrolled 427 participants in the PREEMPT CRC study, including substantial representation of Hispanic/Latinx (78.7%) which exceeded their proportional representation in the U.S. population. The self-reported race of enrolled participants was predominantly White (71.2%), with a significant proportion of Black or African American (24.1%). The age distribution showed higher enrollment for the 65-74 age group, emphasizing inclusivity for older populations characteristic of the catchment area. Participants exhibited healthy lifestyle behavior with the majority of the population abstaining from tobacco (88.8%), alcohol (84.1%) or drug use (99.5%). Participants were very receptive to the blood test/CS with all undergoing blood draw and 96% CS adherence. Conclusions: The results underscore the success of IHS Health's recruitment methods in addressing health disparity by emphasizing the importance of inclusivity in clinical trials, leading to high enrollment of Hispanic/Latinx, reflective of local demographics. Success of PREEMPT CRC study highlights the need for careful site selection, robust recruitment strategies, and practical accessibility for patients to ensure a comprehensive understanding of medical interventions across diverse populations. Clinical trial information: NCT04369053 .

Examining knowledge of cancer-related family history in an urban underserved patient population.

e22550 Background: An accurate assessment of family history of cancer is essential in assigning cancer risk, and in decision making regarding the timing and method of cancer screening. However, obtaining a complete and accurate cancer-related family history, including first- and second-degree relatives, is often challenging in underserved communities. Familial dynamics such as single parent households, kinship care, and estrangement may act as barriers to an individual’s knowledge of their family health history. Presently, Electronic Medical Record systems constrain users to a binary documentation of cancer history as either ‘yes’ or ‘no’. However, patients may be unaware or uncertain of their family’s cancer history. These unknowns are not captured, resulting in poor understanding of patient knowledge regarding their family history of cancer. Objective: To assess knowledge of cancer-related family history for first- and second-degree relatives among an urban underserved patient population. Funding source: The American Cancer Society. Methods: University of Illinois Health patients aged 45-75 years without a history of colorectal cancer, who received an order for colorectal cancer screening through fecal immunochemical testing or screening colonoscopy were eligible to participate. A total of 88 respondents completed a 23-item telephone survey assessing knowledge of their family cancer health history using a 5-point Likert scale. Surveys were administered in both English and Spanish languages. Results: Of the 88 survey participants, 50 (57%) were female, 54 (61%) were of black or African American race, and 31 (36%) were of Hispanic or Latino ethnicity. On a single-item question assessing overall knowledge of their cancer-related family history, 35 (39.7%) responded they know it well or very well, versus 13 (14.8%) with little or no knowledge. On knowledge of maternal cancer related history, 8 participants (9.1%) reported little or no knowledge of their mother’s cancer history, and 29 participants (33%) reported little or no knowledge of their maternal relatives’ cancer history. On knowledge of their father’s cancer history, 35 (39.8%) reported little or no knowledge of their father’s cancer history, and 48 participants (54.5%) reported little or no knowledge of their paternal relatives’ cancer history. Conclusions: This original research study addresses the current gap in understanding patient knowledge regarding familial cancer health history. Survey results demonstrate a striking discrepancy between respondent reported overall knowledge of cancer-related family history, and knowledge of their maternal and paternal cancer histories. Moreover, respondents reported increased knowledge of their mother’s versus father’s cancer history p < 0.0001. Improved recognition of unknown family history in first- and second-degree family members may improve cancer-risk assessment.

Fostering diversity and inclusion in the preempt CRC study through strategic site selection and innovative recruitment tools.

e23025 Background: Diversity in clinical studies is crucial in aligning the study population with the intended patient demographic. Freenome is developing a blood based test (MyTectCRC) intended to offer a convenient and accessible option for colorectal cancer (CRC) screening. Its clinical validation is supported by the PREEMPT CRC study, a prospective, multi-center observational study. PREEMPT CRC was able to achieve a diverse population representing various ethnic, racial, and geographical backgrounds that reflect the United States population. This analysis evaluates the significance of strategic site selection and use of forward-thinking study tools in achieving a diverse and inclusive study population. Methods: Starting in 2020, PREEMPT CRC enrolled participants aged 45-85 at average CRC risk. Eligible and consenting participants underwent a blood draw and a screening colonoscopy, with the blood sample analyzed by MyTectCRC. To ensure diversity, strategic site selection was employed beyond large academic institutions and hospitals to smaller sites and community hospitals. The study also incorporated a decentralized clinical trial (DCT) model to reach broader geographical areas and used electronic consenting and mobile phlebotomy (MP) services to facilitate enrollment. Results: PREEMPT CRC enrolled 48,995 participants and achieved ethnic/racial diversity comparable to 2020 U.S. Census for Blacks (11.2%, vs 13.6%), Asians (6.8%, vs 6.3%) and Hispanic or Hispanic/Latinx (11.2%, vs 19.1%), Native Hawaiian or Other Pacific Islander (0.3% vs 0.4%). The primary site types were community hospitals and regional clinics, accounting for 45.5% of all sites, followed by health systems (12.0%), research institutes (18.5%), and academic centers/teaching hospitals (16.0%). The community clinics and academic centers enrolled the highest proportion of Black participants within their sites (21.4% and 12.1%, respectively). Research institutions had the highest proportion of Asian (24.8%) and Hispanic/Latinx (18.3%) populations. There was no significant difference observed in male versus female distribution between site types. Within traditional sites, 32% used MP service. DCT enrolled 12,137 participants (24.7% of total) from every state in the U.S., including high representation from rural areas (24.5%). Conclusions: PREEMPT CRC integrated multiple methodologies and tools to enhance diversity and inclusivity. This multimodal approach ensured diversified representation through the participation of sites with harder-to-reach populations, which was reflected in ethnic and racial data, as well as the geographical diversity. PREEMPT CRC study underscores the importance of incorporating early diversity planning into study strategy and using multiple methods to broaden the representation of the patient population. Clinical trial information: NCT04369053 .

The annual cost of cancer screening in the U.S.

11051 Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.

Decentralized trial recruitment methods to facilitate broad coverage across urban and rural counties for a blood-based test in early colorectal cancer detection.

1607 Background: Based on the 2022 census, 20% of the U.S. population lives in rural areas. Recent literature suggests that individuals in these areas may encounter health disparities, potentially leading to higher mortality from colorectal cancer (CRC) when compared to their urban counterparts. The PREEMPT CRC is a prospective, multicenter clinical study designed to validate an investigational blood test (MyTectCRC) intended to provide a convenient and accessible option for CRC screening. PREEMPT CRC included a decentralized clinical trial (DCT) site to broaden enrollment from a wider range of geographical areas, including traditionally underrepresented rural regions. This analysis evaluates demographic characteristics of participants from rural and urban areas enrolled in two distinct strategies within the DCT sites. Methods: Eligibility criteria for PREEMPT CRC have been previously described (NCT04369053). All DCT activities occurred under one clinical study ‘Metasite’, enabled by a multichannel recruitment strategy that included 1) Direct-to-Participant (DTP) via digital enrollment and 2) Site-Based (SB) partners who supported the principal investigator by identifying participants scheduled to receive a screening colonoscopy. Participant zip codes were mapped to local counties and aligned with either 1) Metropolitan (Urban) or 2) non-Metropolitan (Rural) counties. Enrolled participants were analyzed for demographics and lifestyle behaviors such as tobacco, alcohol, and drug use. Results: The DCT site enrolled 12,137 participants, where 7,634 used DTP and 4,503 used SB. Of all DCT participants, 24.4% resided in rural areas. DTP's rural population recruitment (27.8%) was double that of the SB (13.5%). The female and male distribution was similar across the groups. A larger percentage of participants from underrepresented races overall were enrolled from urban areas; however, there were some noticeable trends in the rural population. For participants who resided in rural areas and reported their race, 12.5% of DTP participants were Black and 1.2% were Asian, compared to 9.6% and 1.2%, respectively, in SB. For participants in rural areas who reported ethnicity, within DTP, 5.1% identified as Hispanic/Latinx, compared to 14.3% Hispanic/Latinx in SB. Lifestyle behavior factors were similar between DTP and SB participants who resided in rural and urban areas. Conclusions: Through the use of a DCT, the PREEMPT CRC study reached rural areas especially through DTP methodology. Furthermore, the use of SB versus DTP showed certain shifts in demographics, these differences highlight the effectiveness of targeted outreach strategies and reflect the importance for integration of multiple methods and tools to enhance essential population characteristics across geographical locations. Clinical trial information: NCT04369053 .

Virtual reality intervention to improve quality of care during colonoscopy: a hybrid type 1 randomized controlled trial

Background and AimsEffective management of patients’ pain, anxiety, and discomfort during colonoscopy is crucial for successful completion of the procedure, patient adherence to follow-up examinations, and patient satisfaction. Virtual Reality (VR) interventions, as a nonpharmacological and innovative solution, have demonstrated promising results in managing these outcomes. Nevertheless, there is limited evidence on their effectiveness and implementation. This trial aimed to test clinical effectiveness and identify factors to facilitate the implementation of VR during colonoscopy. MethodsA hybrid type 1 effectiveness-implementation, parallel randomized controlled, open-label trial was conducted. Fifty patients were randomized (1:1) to a VR or a control group. The effectiveness (pain, anxiety, discomfort, medication usage, and satisfaction) and implementation (reach, adoption, implementation, and maintenance) outcomes were assessed before, during, and after colonoscopy. ResultsPatients in the VR group reported significantly lower pain (p=0.043) and discomfort (p<0.0001) during colonoscopy, had a higher number of completed colonoscopy without sedation (p=0.003), and showed higher satisfaction (p=0.032). The major barrier to the implementation and maintenance of the VR intervention was inadequate VR content design. Staff were most worried about altered patient communications, unclear responsibilities, increasing workload, and patient safety. Patients expressed willingness to reuse VR glasses and to suggest them to other patients. ConclusionVR can be used as a nonpharmacological method for pain management and for overcoming anxiety and discomfort during colonoscopy. VR can improve patients’ satisfaction and diminish the need for sedative medications; accordingly, it has the potential to promote cooperation and compliance among patients and increase screening colonoscopy rates. Clinicaltrials.gov NCT05723861.

An analysis of factors contributing to low colonoscopy rates at Kline Health Center in comparison to the national average in the USA (according to the internal quality measures of the medical group fiscal year 2023) and a follow-up initiative to improve colon cancer screening participation.

e23244 Background: The UPMC-Kline Health Center (KHC) located in Harrisburg, PA, has a lower colon cancer screening rate compared to the general patient population in the USA (26.03% vs 78%, respectively, according to the Medical Group Fiscal Year 2023 Internal Quality Measures). To understand the reasons behind this disparity, a comprehensive questionnaire was conducted aiming to identify factors contributing to the lower colonoscopy screening rate and to implement targeted interventions to improve the situation. Methods: Surveys were distributed to eligible patients aged 45 to 75 at the clinic, considering linguistic diversity by preparing questionnaires in Spanish, English, and Nepali. Distribution, randomized and conducted by medical assistants, aims to identify and address specific clinic-related issues. Subsequent assessment, after a few months, will determine improvements resulting from interventions targeting the underlying causes of screening gaps. Results: Over a three-month period, a total of 77 questionnaires were completed and collected. We analyzed responses from 33 patients (42%, 14 females, and 19 males; 16 white/Caucasian, 14 black/African American, 2 Asian, 1 other; 8 Hispanic/Latino, 25 non-Hispanic/Latino) who had not undergone a colonoscopy in the past 10 years. Findings revealed that 72% (24/33) of patients reported not receiving paperwork for scheduling, while 72% (24/33) were not contacted to schedule the test. Additionally, 78% (26/33) of patients did not receive a reminder call or message before their scheduled appointments. 51% (17/33) of patients highlighted a lack of insurance coverage for costs, with 63% (21/33) indicating the need for a co-pay. 57% (19/33) of patients reported difficulties in obtaining the screening test. 51% (17/33) of patients mentioned that their healthcare provider discussed the importance of the screening test, and 54% (18/33) of patients noted that their providers explained the purpose of the test. Conclusions: The survey identifies scheduling, communication, and cost-related barriers to colon cancer screening at KHC. Proposed interventions, including the implementation of automated reminders, integrating technology to facilitate communication, and incorporating flyers within the clinic and patient waiting areas. This quality improvement project is ongoing, with data scheduled for recollection in a few months. These measures are anticipated to foster improvements, aiding more patients in preventing delayed cancer diagnoses. KHC aims to create a patient-friendly environment by addressing scheduling inefficiencies, improving communication, and tackling financial concerns for timely and accessible colon cancer screenings.

Risk prediction of advanced colorectal neoplasia varies by race and neighbourhood socioeconomic status

ObjectiveNeighbourhood deprivation increases the risk of colorectal neoplasia and contributes to racial disparities observed in this disease. Developing race-specific advanced colorectal neoplasia (ACN) prediction models that include neighbourhood socioeconomic status...

Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study.

Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.

Adenoma detection rate of screening colonoscopy among age 40–75 years: Implications for lowering the age for colorectal cancer screening

AbstractIncidence of early‐onset colorectal cancer is on the rise, prompting updated international guidelines recommending screening for average‐risk individuals starting at age 45. Adenoma detection rate (ADR) serves as a crucial quality indicator for colonoscopy (CFS), with a current benchmark of 25% for screening CFS starting at age 50. However, the impact of lowering the screening age on ADR remains uncertain. This study aimed to assess the ADR in average‐risk individuals who undergo screening colonoscopy at an age older than 40. Participants who underwent a complete colonoscopy for health examination at a medical center between January 2014 and February 2020 were enrolled in this study. We excluded colonoscopies performed on individuals younger than 40 years of age or older than 75 years of age, as well as those conducted for surveillance purposes. ADR was defined as the percentage of colonoscopies with at least one colorectal adenoma detected. We calculated the ADR for different age groups, including 40–44, 45–49, 50–54, and 55–75, to understand the age‐specific ADR of screening colonoscopy. Additionally, we evaluated the ADR among participants who started screening colonoscopy at ages ≥40, ≥45, and ≥50 to understand the impact of starting age on ADR. A p value &lt;.05, determined by the chi‐square test, was considered significant. Among the 33 073 CFS completed during the study period, 5852 CFS examined in patients aged younger than 40 years, 344 CFS examined in patients aged older than 75, and 6881 CFS with surveillance indication were excluded, leaving 19 996 CFS enrolled for analysis. The mean age of the participants was 53, with 57% being male and 43% being female. The ADR for the age groups of 40–44, 45–49, 50–54, and 55–75 were 28.0% (1058/3778), 31.8% (1191/3741), 35.6% (1387/3891), and 44.2% (3794/8586), respectively, with a statistically significant difference (p &lt; .01). The ADR for age ≥40, ≥45, and ≥50 were 37.2% (7430/19996), 40.1% (6372/15874), and 41.5% (5181/12477), respectively, with a statistically significant difference (p &lt; .01). The findings of our study indicate that there are notable differences in ADR among various age groups. Lowering the screening age might result in a decrease in the overall ADR. However, our results suggest that even if CRC screening begins at age 40 or 45, the current benchmark of 25% ADR for screening colonoscopy may still be maintained. These findings provide valuable insights into the age‐ and gender‐specific prevalence of adenomas in colonoscopy screening and can be used to inform future screening guidelines and recommendations.

Overall Polyp Detection Rate as a Surrogate Measure for Screening Efficacy Independent of Histopathology: Evidence from National Endoscopy Database.

Adenoma detection rate (ADR) is challenging to measure, given its dependency on pathology reporting. Polyp detection rate (PDR) (percentage of screening colonoscopies detecting a polyp) is a proposed alternative to overcome this issue. Overall PDR from all colonoscopies is a relatively novel concept, with no large-scale studies comparing overall PDR with screening-only PDR. The aim of the study was to compare PDR from screening, surveillance, and diagnostic indications with overall PDR and evaluate any correlation between individual endoscopist PDR by indication to determine if overall PDR can be a valuable surrogate for screening PDR. Our study analyzed a prospectively collected national endoscopy database maintained by the National Institute of Health from 2009 to 2014. Out of 354,505 colonoscopies performed between 2009-2014, 298,920 (n = 110,794 average-risk screening, n = 83,556 average-risk surveillance, n = 104,770 diagnostic) met inclusion criteria. The median screening PDR was 25.45 (IQR 13.15-39.60), comparable with the median overall PDR of 24.01 (IQR 11.46-35.86, p = 0.21). Median surveillance PDR was higher at 33.73 (IQR 16.92-47.01), and median diagnostic PDR was lower at 19.35 (IQR 9.66-29.17), compared with median overall PDR 24.01 (IQR 11.46-35.86; p < 0.01). The overall PDR showed excellent concordance with screening, surveillance, and diagnostic PDR (r > 0.85, p < 0.01, 2-tailed). The overall PDR is a reliable and pragmatic surrogate for screening PDR and can be measured in real time, irrespective of colonoscopy indication.

Decentralized Colorectal Cancer Care: Benefit or Burden in the Pandemic? – An International Comparative Study in two Health Care Systems (DCCC Study)

Abstract Background Beneficial effects of centralization could be shown. During SARS-CoV2 pandemic however, the centralization in the UK healthcare system led to cessation of screening colonoscopies and oncological resections. In the decentralized healthcare system of Switzerland, a high frequency of colonoscopies could be maintained. Aims The aim of this international study is to evaluate if a decentralized health care systems can prevent the threatening unmet needs of colorectal cancer patients under pandemic conditions. Methods This observational trial was performed in the south-east of Scotland and in the extended northwest of Switzerland with a catchment area of 1.5 Mio. inhabitants each. Patients with colorectal cancer diagnosed during January 2019 and December 2022 were included. Results Six thousand six hundred and eighty patients were included in this preliminary analysis (4059 in the NHS group and 2621 in the Swiss group). In Scotland the median number of diagnosed patients per quarter was 258 pre-pandemics, 218 during lockdown and 258 after lockdown (p=0.56). There was no significant alteration of the median diagnosed patients per quarter during different phases in Switzerland (165 pre-pandemic vs. 187 during lockdown vs. 162 post-lockdown, p=0.56). In Scotland the median number of all performed tumor treatments per quarter were lower during lockdown (83 pre-pandemic vs. 75 during lockdown vs. 93 post-lockdown, p&amp;lt;0.01). In Switzerland the median treatment numbers per quarter didn´t differ during different phases (56 pre-pandemic vs. 62 during lockdown vs. 60 post-lockdown, p=0.51). The number of patients diagnosed with a T4 tumor during pandemic was higher in Scotland than in Switzerland (28% vs. 19%, p&amp;lt;0.01). The 30-day mortality under pandemic condition was 7.5% (65 of 859) in Scotland compared to 3.7% (14 of 374) in Switzerland (p=0.01). Conclusion SARS-CoV2 pandemic led to a reduction in performed cancer treatments in Scotland. In Switzerland's decentralized healthcare system, cancer treatments were maintained during pandemic.

Duration of risk reduction in colorectal cancer incidence and mortality after a complete colonoscopy in Ontario, Canada: a population-based cohort study

Colorectal cancer guidelines recommend screening colonoscopy every 10 years after a negative procedure. If risk reduction extends past 10 years, the recommended interval could be extended, reducing the burden on the individual and health-care system. We aimed to estimate the duration that patients remain at reduced risk of colorectal cancer incidence and mortality after a complete colonoscopy. We did a population-based cohort study of individuals aged 50-65 years between Jan 1, 1994, to Dec 31, 2017. We excluded individuals with previous exposure to colonoscopy or colorectal surgery, those previously diagnosed with colorectal cancer, or a history of hereditary or other bowel disorders. We followed up participants until Dec 31, 2018, and identified all colonoscopies performed in this time period. We used a 9-level time-varying measure of exposure, capturing time since last complete colonoscopy (no complete colonoscopy, ≤5 years, >5-10 years, >10-15 years, and >15 years) and whether an intervention was performed (biopsy or polypectomy). A Cox proportional hazards regression model adjusting for age, sex, comorbidity, residential income quintile, and immigration status was used to estimate the association between exposure to a complete colonoscopy and colorectal cancer incidence and mortality. 5 298 033 individuals (2 609 060 [49·2%] female and 2 688 973 [50·8%] male; no data on ethnicity were available) were included in the cohort, with a median follow-up of 12·56 years (IQR 6·26-20·13). 90 532 (1·7%) individuals were diagnosed with colorectal cancer and 44 088 (0·8%) died from colorectal cancer. Compared with those who did not have a colonoscopy, the risk of colorectal cancer in those who had a complete negative colonoscopy was reduced at all timepoints, including when the procedure occurred more than 15 years earlier (hazard ratio [HR] 0·62 [95% CI 0·51-0·77] for female individuals and 0·57 [0·46-0·70] for male individuals. A similar finding was observed for colorectal cancer mortality, with lower risk at all timepoints, including when the procedure occurred more than 15 years earlier (HR 0·64 [95% CI 0·49-0·83] for female participants and 0·65 [0·50-0·83] for male participants). Those who had a colonoscopy with intervention had a significantly lower colorectal cancer incidence than those who did not undergo colonoscopy if the procedure occurred within 10 years for females (HR 0·70 [95% CI 0·63-0·77]) and up to 15 years for males (0·62 [(0·53-0·72]). Compared with those who do not receive colonoscopy, individuals who have a negative colonoscopy result remain at lower risk for colorectal cancer incidence and mortality more than 15 years after the procedure. The current recommendation of repeat screening at 10 years in these individuals should be reassessed. Canadian Institutes of Health Research.

The association of cancer-preventive lifestyle with colonoscopy screening use in border Hispanic adults along the Texas-Mexico border.

The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.