Colonoscopy For Colorectal Cancer Screening Research Articles

Screening Colonoscopy to Reduce the Incidence and Mortality of Colorectal Cancer.

Colorectal cancer (CRC) is a major concern because of its increasing incidence and mortality worldwide. Therefore, effective screening strategies are necessary to reduce its incidence. In addition to fecal immunochemical tests and computed tomography colonography, screening colonoscopy is expected to significantly contribute to the reduction of CRC. However, the timing of colonoscopy for CRC screening is not well-defined because of the lack of sufficient data. Additionally, the effectiveness of colonoscopy is affected by various factors known as quality indicators (QIs), such as the performance of the endoscopist; therefore, there are concerns regarding quality assurance. The adenoma detection rate (ADR) is a well-known QI of colonoscopy. Substantial evidence has suggested that improving the ADR could reduce the incidence and mortality of postcolonoscopy CRC. Recent technological advancements have led to the development of image-enhanced endoscopy and the incorporation of artificial intelligence, and their ability to improve the ADR has been assessed. This review focused on screening colonoscopies and QIs and their ability to improve the ADR and incidence and mortality of CRC.

Risk factors of cholangiocarcinoma in areas not endemic for liver fluke infection.

Thailand has the world's highest prevalence of cholangiocarcinoma (CCA), especially in the endemic area of liver fluke Opisthorchis viverrini infection. However, other regions of Thailand still have relatively high CCA prevalence. We aimed to determine CCA risk factors in areas not endemic for OV infection. A case--control study was performed at a referral center during December 2016-December 2017. We collected blood samples and information from CCA patients and identified them as cases. The control group comprised patients who visited a gastrointestinal clinic for colorectal cancer screening colonoscopy. Logistic regression analysis was used to determine risk factors for CCA. Of 138 participants, O. viverrini infection rate was higher in the case than in the control group (57.1% vs. 36.1%, P = 0.023). Male, O. viverrini infection, smoking, alcohol consumption, and biliary tract diseases were independent risk factors, whereas diabetes, obesity, and cirrhosis were not associated with CCA. By age and sex-adjusted analysis, chronic biliary tract diseases, especially choledochal cysts and smoking, were risk factors for CCA, with adjusted odds ratio (aOR) of 12.7 (95% confidence interval [CI]: 1.4-116.9) and 3.8 (95% CI: 1.3-11.8), respectively, while O. viverrini infection became insignificant risk for CCA (aOR 1.8, 95% CI: 0.8-4.1). In contrast with endemic areas for O. viverrini infection, chronic biliary tract diseases and smoking are major risk factors, whereas O. viverrini infection has trivial contribution to the development of CCA.

Overview of a national endoscopy database: The Trans.IT database and its impact on data registration quality.

The Trans.IT database is a national gastrointestinal (GI) endoscopy database developed in 2012. It automatically collects anonymous data from GI endoscopy procedures in a centralized database. All endoscopists use a structured reporting tool for uniform data collection. In this study, we aim to provide an overview of the database and to evaluate its impact on data registration quality. We used all ERCPs, colonoscopies and colorectal cancer (CRC)-screening colonoscopies performed between 2016 and 2020. We excluded centers joining after 2016 and patients below age 18. Data registration quality for ERCPs included completeness of data for: intention of ERCP, Schutz score, ASA classification, papillary status (virgin or previous sphincterotomy), cannulation (success or failure to cannulate the desired duct) and procedural success. For colonoscopies: indication, ASA-classification, Boston Bowel Preparation Score (BBPS), cecal intubation, polyp detection rate (PDR). For CRC-screening colonoscopies, ASA-classification, BBPS, cecal intubation, PDR and adenoma detection rate (ADR). A total of 14,156 ERCPs, 150,962 colonoscopies and 37,199 colorectal cancer screening colonoscopies were included in our analysis. For ERCPs, registration of procedural intention, Schutz score, ASA classification, papillary status, cannulation and procedural success improved from 34.9%, 32.7%, 72.6%, 36.5%, 34.6%, 27.2% in 2016, to 86.4%, 84.6%, 97.4%, 86.4%, 82.1%, 84.0%, respectively, in 2020. For non-screening colonoscopies, registration of indication, ASA classification, BBPS, cecal intubation and PDR improved from 40.4%, 60.5%, 47.6%, 69.8% and 32.3% in 2016 to 90.3%, 88.9%, 59.8%, 79.1% and 39.1%, respectively, in 2020. For CRC-cancer screening colonoscopy registration equaled outcome, PDR and ADR changed from 74.7% to 63.6% in 2016 to 66.3% and 53.8% in 2020, respectively. The quality of endoscopy data registration has consistently improved over the years by using the Trans.IT database. This is most likely the result of feedback to performing endoscopists to review performance in real-time online and progressive awareness of quality of data registration.

Differential Outcomes in Colorectal Cancer Detection: A Comparative Study of Swedish Nationwide Screening and Fast-Track Diagnostic Pathways.

In 2021, a nation-wide screening program for colorectal cancer (CRC) was step-wise implemented in Region Örebro County (RÖC) for patients aged 60 to 74 years, utilizing the fecal immunochemical test (FIT) to refer patients for colonoscopy. Concurrently, the standardized care course for colorectal cancer (SCC-CRC), initiated in 2016, employs a fast-track pathway for patients with alarm symptoms to undergo colonoscopy. This study compares CRC screening colonoscopies with SCC-CRC colonoscopies in RÖC among patients aged 60 to 67 years. An initial analysis of the Swedish colorectal screening cohort was combined with a retrospective cohort study, analyzing data from 307 CRC screening patients and 441 age-matched SCC-CRC patients in RÖC. Data included demographics, colonoscopy participation rates, and pathology findings. Statistical analyses compared outcomes between the 2 groups. Among the screening group, 2% tested positive for FIT, with an 86% colonoscopy participation rate (N=9296). In RÖC, 266 screening patients underwent colonoscopy, with 10% diagnosed with CRC, compared with 20% in the SCC-CRC group. In addition, 39% of the screening group in RÖC were diagnosed with advanced adenomas, versus 15% in the SCC-CRC group. Screening participation was high, with effectiveness aligning with international counterparts. The SCC-CRC pathway excels in diagnosing CRC among symptomatic patients, while the nationwide screening program is effective in early detection of CRC and advanced adenomas. underscoring the importance of integrating and optimizing both approaches within the Swedish health care system to optimize CRC prevention and management.

Mortality from upper gastrointestinal tumors in colorectal cancer screening patients.

Background and study aims Currently, gastric cancer screening is only cost-effective in countries with high incidence. Integrated screening, in which gastroscopy is performed in conjunction with colonoscopy, could help reduce the gastric cancer screening procedure burden in countries with low or intermediate incidence. However, there is a lack of population-based studies to identify high-risk groups. Methods In this retrospective analysis of a colorectal cancer (CRC) screening program database, we used Cox proportional hazards model to identify an association of high- and low-risk finding (polyps ≥ 10 mm or with high-grade dysplasia) with time to death from upper gastrointestinal cancer (esophageal and gastric). We estimated the 10-year mortality of upper gastrointestinal tumors in different 10-year age groups, stratified by sex and polyp finding at colonoscopy. Results We included 349,856 CRC screening colonoscopies in our study. The median follow-up time was 5.22 years (95% confidence interval [CI] 5.21-5.24 years). Of the participants, 4.5% had polyps ≥ 10 mm or with high-grade dysplasia (HGD). At the end of the study period, 384 deaths from upper gastrointestinal cancer had occurred. Aside from age and sex, we found the presence of high-risk polyps to be significantly associated with upper gastrointestinal cancer death (hazard ratio 1.54, 95% CI 1.06-2.25, P = 0.025). Conclusions CRC screening participants with polyps < 10 mm and no HGD have a lower risk for mortality from upper gastrointestinal cancers compared with participants with polyps > 10 mm and HGD. Future studies will demonstrate whether integrated screening with additional gastroscopy is effective in CRC screening participants with large or highly dysplastic polyps.

The Old: Is There Any Role for Screening Colonoscopy after the Age of 75? The Surgeon's Perspective

AbstractGuidelines recommend individualized decision making for screening colonoscopy for colorectal cancer (CRC) in patients after the age of 75 years due to low additional benefits. That should be taken with a grain of salt, as these recommendations are based on expert opinion and simulation models which do not consider (1) the differences in pathogenesis and cancer biology of CRC in elderly; (2) the risks of colonoscopy in this patient population; (3) and the impact of new surgical and nonsurgical therapies for CRC. In this review, our goal is to bring a surgeon's perspective to understand the role of screening colonoscopy in patients older than 75 years.

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

Abstract 4787: Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities

Abstract Background: The Alaska Tribal Health System is working on increasing colorectal cancer (CRC) screening rates among Alaska Native people, who have the highest CRC rates in the world. Most remote Alaska Native communities are not connected to the road system, which severely limits access to screening colonoscopy. As part of a clinical trial, Alaska Native patients were offered either colonoscopy or the at-home multi-target stool DNA test (mt-sDNA; Cologuard®). Patients had never been offered mt-sDNA before and it was unknown what they would think about the new test option. Both tests were provided at no cost to patients. Methods: From April 2022 to July 2023, 194 patients who chose mt-sDNA for screening received a follow-up phone survey asking whether they were aware that they could have had colonoscopy instead, their reasons for choosing mt-sDNA, and the factors influencing their choice of mt-sDNA over colonoscopy. Patients answered the survey before receiving results of their mt-sDNA test in order to capture initial screening test preferences. Results: A total of 115 (59%) Alaska Native patients participated in the survey; 56% men and 44% women. About 70% were ages 45 to 60 years while the remaining 30% were 61 to 75 years old. The majority (80%) were aware that they had the option to undergo colonoscopy for CRC screening instead of mt-sDNA. Key themes for mt-sDNA preference included not having to travel, less time commitment, and greater convenience. Many patients expressed financial concerns arising from the costs of air travel and accommodation required to access screening colonoscopy even though the procedure itself was covered. Additionally, patients highlighted existing obligations such as childcare and work responsibilities which made the use of mt-sDNA at home more appealing. Many respondents also shared negative perceptions of colonoscopy procedure including fear, embarrassment, and discomfort as reasons why they preferred mt-sDNA instead. Conclusions: These findings demonstrate the multifaceted factors influencing the preference for at-home mt-sDNA CRC screening among Alaska Native individuals. Challenges such as limited access to medical facilities, financial burdens, and personal commitments have significant bearing on the screening decision-making process. Moreover, the emotional aspect of fear and discomfort associated with colonoscopy plays a role in shaping these preferences. CRC screening programs need to be aware of patient needs and preferences when deciding which screening methods to offer to increase screening rates and result in improved colorectal health outcomes. Citation Format: Diana Redwood. Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4787.

The Efficacy of Real-time Computer-aided Detection of Colonic Neoplasia in Community Practice: A Pragmatic Randomized Controlled Trial

BackgroundThe use of computer-aided detection (CADe) has increased the adenoma detection rates (ADR) during colorectal cancer (CRC) screening/surveillance in randomized controlled trials (RCT) but has not shown benefit in real-world implementation studies. We performed a single-center pragmatic RCT to evaluate the impact of real-time CADe on ADR in colonoscopy performed by community gastroenterologists. MethodsWe enrolled 1100 patients undergoing colonoscopy for CRC screening, surveillance, positive fecal-immunohistochemical tests, and diagnostic indications at one community-based center from 09/2022 to 03/2023. Patients were randomly assigned (1:1) to traditional-colonoscopy or real-time CADe Blinded pathologists analyzed histopathologic findings. The primary outcome was adenoma detection rate (ADR, the percentage of patients with at least 1 histologically proven adenoma or carcinoma). Secondary outcomes were adenomas detected per colonoscopy (APC), sessile-serrated lesion detection rate (SSLDR), and non-neoplastic resection rate. ResultsThe median age was 55.5 (IQR 50-62), 61% were female, 72.7% were Hispanic ethnicity, and 9.1% had inadequate bowel preparation. The ADR for the CADe group was significantly higher than the traditional-colonoscopy group (42.5% vs. 34.4%, p=0.005). The mean APC was significantly higher in the CADe group compared to the traditional-colonoscopy group (0.89±1.46 vs. 0.60±1.12, p<0.001). The improvement in adenoma detection was driven by increased detection of <5 mm adenomas. CADe had a higher SSLDR than traditional-colonoscopy (4.7% vs. 2.0%, p=0.01) The improvement in ADR with CADe was significantly higher in the first half of the study (47.2% vs. 33.7%, p=0.002) compared to the second half (38.7% vs. 34.9%, p=0.33). ConclusionsIn a single-center pragmatic randomized controlled trial, real-time CADe modestly improved ADR and APC in average-detector community endoscopists. (ClinicalTrials.gov number, NCT05963724).

Uptake and detection rate of colorectal cancer screening with colonoscopy in China: A population-based, prospective cohort study

BackgroundColorectal cancer is the leading cause of cancer-related death worldwide. Colonoscopy is widely used as a screening test for detecting colorectal cancer in many countries. However, there is little evidence regarding the uptake and diagnostic yields of colonoscopy in population-based screening programs in countries with limited medical resources. ObjectiveWe reported the uptake of colonoscopy and the detection of colorectal lesions and explored related factors based on a colorectal cancer screening program in China. DesignIndividuals aged 45–74 years who were asymptomatic for colorectal cancer and had no history of colorectal cancer were recruited. An established risk score system was used to identify individuals at high risk for colorectal cancer, and they were subsequently recommended for colonoscopy. SettingA population-based, prospective cohort study was implemented in 169 communities, 14 districts of Chongqing, Southwest China. ParticipantsA total of 288,150 eligible participants were recruited from November 2013 to June 2021, and 41,315 participants were identified to be at high risk of colorectal cancer. MethodsGeneralized linear mixed model was used to explore the individual and community structural characteristics associated with uptake of colonoscopy. Additionally, the detection rate of colorectal lesions under colonoscopy screening was also reported, and their associated factors were explored. Results7859 subjects underwent colonoscopy, with an uptake rate of 19.02 % (95 % CI 18.64 %–19.40 %). Lower uptake rates were associated with older age, lower education, more physical activity, and structural characteristics, including residing in developing areas (OR 0.73, 95 % CI 0.69–0.78), residing more than 5 km from screening hospital (5–10 km: OR 0.85, 95 % CI 0.79–0.91; >10 km: OR 0.85, 95 % CI 0.80–0.91), and not being exposed to social media publicity (OR 0.63, 95 % CI 0.53–0.75). Overall, 8 colorectal cancers (0.10 %), 423 advanced adenomas (5.38 %), 820 nonadvanced adenomas (10.43 %), and 684 hyperplastic polyps (8.70 %) were detected, with an adenoma detection rate of 15.92 %. Several factors, including older age, male, current smoking and a family history of colorectal cancer, were positively related to colorectal neoplasms. ConclusionsThe uptake of colonoscopy for colorectal cancer screening was not optimal among a socioeconomically diverse high-risk population. The screening strategy should attempt to ensure equitable access to screening according to regional characteristics, and enhance the uptake of colonoscopy by recommended multifaceted interventions, which focus on individuals with poor compliance, select a closer screening hospital, and strengthen social media publicity at the structural level.

Management of colorectal cancer screening backlog due to the COVID-19 pandemic: A retrospective analysis of the use of a colorectal cancer screening clinical-decision support tool in Argentina

BackgroundThe COVID-19 pandemic created a backlog in colorectal cancer (CRC) screening and surveillance colonoscopies. The real impact in Argentina is not fully known. GoalTo estimate the impact of the COVID-19 pandemic on CRC prevention by comparing the number of CRC screening and surveillance consults in a clinical decision support-tool used in Argentina before, during and after pandemic lockdown. MethodsWe analyzed data from May 2019 to December 2021 from CaPtyVa, a clinical decision support tool for CRC screening and surveillance. Queries were divided in pre-pandemic (May 2019 to March 2020), lockdown (April 2020 to December 2020), and post-lockdown (January 2021 to December 2021). The number of CRC monthly screening and surveillance visits were compared among the three periods and stratified according to CRC risk. ResultsOverall, 27,563 consults were analyzed of which 9035 were screening and 18,528 were surveillance. Pre-pandemic, the median number of screening consults was 346 per month (IQR25–75 280–410). There was a decrease to 156 (80–210)/month (p<0.005) during lockdown that partially recovered during post-lockdown to 230 (170–290)/month (p=0.05). Pre-pandemic, the median number of surveillance consults was 716 (560–880)/month. They decreased to 354 (190–470)/month during lockdown (p<.05) and unlike screening, completely recovered during post-lockdown to 581 (450–790)/month. ConclusionsThere was a >50% decrease in the number of CRC screening and surveillance consults registered in CaPtyVa during lockdown in Argentina. Post-lockdown, surveillance consults recovered to pre-pandemic levels, but screening consults remained at 66% of pre-pandemic levels. This has implications for delays in CRC diagnoses and patient outcomes.

Colonoscopy screening for colorectal cancer in Egypt: a nationwide cross-sectional study

BackgroundCurrent guidelines advocate for colorectal cancer (CRC) screening in adults who are at risk by using direct visualization methods such as colonoscopy. However, in Egypt, there is a paucity of data regarding the current practice of colonoscopy screening. Moreover, more information is needed about the knowledge and attitudes of potential participants regarding the procedure and possible barriers that can limit their participation.MethodsWe conducted a nationwide cross-sectional study using an interview-based survey of patients aged 45 years or above who presented to outpatient clinics of nine university hospitals throughout Egypt. Participants were surveyed to assess their compliance with CRC colonoscopy screening guidelines, their knowledge of and attitude towards colonoscopy screening, and their perspective on potential barriers to colonoscopy screening.ResultsA total of 1,453 participants responded to our survey in the nine study centers. Only a minority of participants (2.3%) were referred for CRC screening. Referral rates were higher among those who knew someone with a history of CRC (5.3% vs 1.5%, p < 0.001) or had a discussion with their physician about CRC (25.8% vs 0.7%, p < 0.001). Few responders (3.2%) had good knowledge regarding CRC screening. After introducing the concept of CRC screening to all participants, most patients (66.7%) showed a positive attitude towards having the procedure. Financial burden and fear of results were the two most frequently cited barriers to undergoing CRC screening (81.1%; and 60.1%, respecteively).ConclusionsDespite the positive attitude, there is insufficient knowledge about CRC screening among eligible participants in Egypt. This has probably contributed to low compliance with current CRC screening guidelines and needs to be addressed at the national level.

Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design.

Previous studies demonstrate that self-reports of mammography screening for breast cancer and colonoscopy screening for colorectal cancer demonstrate concordance, based on adherence to screening guidelines, with electronic medical records (EMRs) in over 90% of those interviewed, as well as high sensitivity and specificity, and can be used for monitoring our Healthy People goals. However, for screening tests for cervical and lung cancers, and for various sub-populations, concordance between self-report and EMRs has been noticeably lower with poor sensitivity or specificity. This study aims to test the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey (NHIS). We present the protocol for a study designed to measure the validity and reliability of the NHIS cancer screening questions compared to EMRs from four US-based healthcare systems. We planned a randomized trial of a phone- vs web-based survey with NHIS questions that were previously revised based on extensive cognitive interviewing. Our planned sample size will be 1576 validity interviews, and 1260 interviews randomly assigned at 1 or 3 months after the initial interview. We are enrolling people eligible for cancer screening based on age, sex, and smoking history per US Preventive Services Task Force recommendations. We will evaluate question validity using concordance, sensitivity, specificity, positive predictive value, negative predictive value, and report-to-records ratio. We further are randomizing participants to complete a second survey 1 vs 3 months later to assess question reliability. We suggest that typical measures of concordance may need to be reconsidered in evaluating cancer screening questions.

A survey among Flemish gastroenterologists about endoscopic sedation practices in colorectal cancer screening.

The sedation levels and methods used for colonoscopy in colorectal cancer screening programs vary from country to country and from continent to continent. Little is known in the literature about how frequently the different sedation levels are used in colorectal cancer screening colonoscopies. We made a survey among all Flemish gastroenterologists (GI) to determine how frequently they use the different sedation modalities in this target population and to determine the motives of the GI to opt for one or another sedation modality. An online survey was sent to all 329 Flemish GI by e-mail. A reminder e-mail was sent one month later. Participants could indicate how frequently (by percentage) they used the different sedation methods (no sedation, minimal sedation, conscious sedation, deep sedation) and which sedative medication they administered. In addition, they were asked to indicate their main motives for choosing a specific sedation method. Descriptive statistics were used. 112 out of 329 GI answered the questionnaire (response rate 34%). Anesthesia monitored care is the most frequently used sedation modality, followed by conscious sedation. Patient preference is the main motive for most GI to use each sedation modality. Anesthesia monitored care is currently the most frequently used sedation regimen to perform a colonoscopy in the FIT positive population or in the colorectal cancer screening program in Flanders. The motives given by the GI for choosing one or another sedation modality are not always congruent with current scientific evidence or guidelines.

P11 Real-World Evidence of Total Colonoscopy for Colorectal Cancer Screening Based on Test Performance RCTs

P11 Real-World Evidence of Total Colonoscopy for Colorectal Cancer Screening Based on Test Performance RCTs

Abstract C116: Provider input following implementation trial to address overdue colorectal cancer screening

Abstract Implementing Fit Kit Colorectal Cancer (CRC) Screening in At-Risk Populations Study was a trial of 4 evidence-based strategies to increase colorectal cancer (CRC) screening in the primary care setting. The focus of this report is the factors that impacted implementation of these interventions in a safety net setting. Using the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework, we evaluated providers’ assessments of the impact of the intervention on the 2 main outcomes: 1) CRC screening ordered; 2) CRC screening completed in a diverse population with more than 3,000 individuals overdue for screening. Methods: We conducted a Qualtrics evaluation survey among 51 staff members identified as individuals involved in cancer screening in a safety net primary care setting that serves over 38,000 individuals in New Haven, CT. The staff surveys are part of the evaluation of the program at one-year post-intervention. Invited staff were provided links through group emails from the provider partners requesting participation in a 2–5-minute Qualtrics survey. Questions on job title, role in CRC screening, and whether and how the interventions (referred to as “the study”) impacted CRC screening in this facility, understanding of the procedures in place to facilitate scheduling and completion of CRC screening, and the barriers and facilitators that impact CRC screening completion were queried. Descriptive results will be mapped to relevant aspects of the RE-AIM framework. Results: Twenty (39%) staff members completed the survey including 9 (45.0%) registered nurses/advanced practice registered nurses, 6 (30.0%) physicians, 2 (10.0%) physician assistants, and 3 (15.0%) individuals in other roles, e.g., schedulers. 87.5% (n=14) were authorized to order colorectal cancer (CRC) screening tests, either colonoscopy or stool-based testing, for their patients. By self-report, effectiveness of the intervention on provider behavior was limited with only 22.2% reporting that the study impacted decisions to order CRC screening. Yet 41% of providers in the study placed a “blanket order” for all individuals who were due for CRC screening even if they were not seen for an appointment during the study period. Barriers to completion of CRC screening were “patient factors” (37%) and insufficient consultation time during appointments (27.3%). Most health care providers cited COVID-19 as a significant factor in delivering an effective CRC screening program. Provider suggestions to improve CRC screening uptake included posted information in exam rooms, use of clinical decision-making tools in the electronic medical record to determine if colonoscopy or FIT (stool-based) testing is the best option, nurse visits to teach use of stool-based testing and making in-home test kits available over the counter in pharmacies. Discussion: Although the results from this small sample of providers has limited generalizability, the findings will be useful in designing scalable interventions in similar high volume primary care settings. Citation Format: Beth A. Jones, Denise L. Stevens, Sakinah Suttiratana, Sarah A. DeGiovanni, Laney Zhang, Margarita Vargas-Torres, Michael Couturie, Levita Robinson. Provider input following implementation trial to address overdue colorectal cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C116.

Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.

The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.

The risk of bleeding and perforation from sigmoidoscopy or colonoscopy in colorectal cancer screening: A systematic review and meta-analyses.

Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening programs have found more frequent and severe physical harm from screening procedures, e.g., bleeding and perforation, than reported in previous trials. Therefore, the objectives of the study were to systematically review the evidence on the risk of bleeding and perforation in Colorectal Cancer Screening. Systematic review with descriptive statistics and random-effects meta-analyses. We systematically searched five databases for studies investigating physical harms related to Colorectal Cancer Screening. We assessed the internal and the external validity using the ROBINS-I tool and the GRADE approach. Harm estimates was calculated using mixed Poisson regression models in random-effect meta-analyses. We included 89 studies. Reporting and measurement of harms was inadequate in most studies. In effect, the risk of bias was critical in 97.3% and serious in 98.3% of studies. All GRADE ratings were very low. Based on severe findings with not-critical risk of bias and 30 days follow-up, the risk of bleedings per 100,000 people screened were 8 [2;24] for sigmoidoscopy, 229 [129;408] for colonoscopy following fecal immunochemical test, 68 [39;118] for once-only colonoscopy, and 698 [443;1045] for colonoscopy following any screening tests. The risk of perforations was 88 [56;138] for colonoscopy following fecal immunochemical test and 53 [25;112] for once-only colonoscopy. There were no findings within the subcategory severe perforation with long-term follow-up for colonoscopy following any screening tests and sigmoidoscopy. Harm estimates varied widely across studies, reporting and measurement of harms was mostly inadequate, and the risk of bias and GRADE ratings were very poor, collectively leading to underestimation of harm. In effect, we consider our estimates of perforation and bleeding as conservative, highlighting the need for better reporting and measurement in future studies. PROSPERO registration number: CRD42017058844.

Application of artificial intelligence in colorectal cancer screening by colonoscopy: Future prospects (Review).

Colorectal cancer (CRC) has become a severe global health concern, with the third‑high incidence and second‑high mortality rate of all cancers. The burden of CRC is expected to surge to 60% by 2030. Fortunately, effective early evidence‑based screening could significantly reduce the incidence and mortality of CRC. Colonoscopy is the core screening method for CRC with high popularity and accuracy. Yet, the accuracy of colonoscopy in CRC screening is related to the experience and state of operating physicians. It is challenging to maintain the high CRC diagnostic rate of colonoscopy. Artificial intelligence (AI)‑assisted colonoscopy will compensate for the above shortcomings and improve the accuracy, efficiency, and quality of colonoscopy screening. The unique advantages of AI, such as the continuous advancement of high‑performance computing capabilities and innovative deep‑learning architectures, which hugely impact the control of colorectal cancer morbidity and mortality expectancy, highlight its role in colonoscopy screening.

Veterans Health Administration enrollees' choice of care setting relates to the expansion of care options: Evidence from screening colonoscopies before and after the MISSION Act.

To estimate whether those enrolled in the Veterans Health Administration (VHA) were less likely to use VHA-delivered colorectal cancer screening colonoscopies after the MISSION Act. Secondary data were collected on VHA-enrolled Veterans from FY2017-FY2021. This retrospective cross-sectional study measured the volume and share of screening colonoscopies that were VHA-delivered over time and by drive time eligibility-defined as living more than 60 min away from the nearest VHA specialty-care clinic. We used a multivariable logistic regression to adjust for patient and facility factors. Data were extracted for VHA enrollees (n = 773,766) who underwent a screening colonoscopy either performed or purchased by the VHA from FY2017-FY2021. In the 9 months after the implementation of the MISSION Act, and before the onset of the Covid-19 pandemic, the average monthly VHA-share of screening colonoscopies decreased by 3 percentage points (pp; 95% confidence interval [CI] = [-4 to -2 pp]) for the non-drive time eligible group and it decreased by 16 pp (95% CI = [-22 to -9 pp]) for the drive time eligible group. The total number of screening colonoscopies did not significantly change in either group during this time period. After adjusting for patient characteristics, a linear time trend, and parent facility fixed effects, implementation of the MISSION Act was associated with a reduction in the probability of a VHA-delivered screening colonoscopy (average marginal effect [AME]: -2.5 pp; 95% CI = [-5.1 to 0.0 pp]) for the non-drive time eligible group. The drive time eligible group (AME: -9.4 pp; 95% CI = [-13.2 to -5.5 pp]) experienced a larger change. The VHA-share of screening colonoscopies among VHA enrollees fell in the 9 months immediately after the passage of the MISSION Act. This decline was larger for VHA enrollees who were targeted for eligibility due to a longer drive time. These results suggest that the MISSION Act led to more VHA-purchased care among targeted VHA enrollees, though it is unclear whether total utilization increased.