Colorectal Cancer Mortality Research Articles

Colorectal cancer mortality trend analysis in Montenegro from 1990 to 2018.

Colorectal cancer (CRC) is the second leading cause of cancer-related death in Europe. This study aimed to investigate CRC mortality trends in Montenegro from 1990 to 2018 and critically review the impact of preventive activities on cancer suppression in this country. We used the national CRC mortality data categorized by sex and age. Mortality rates were age-standardized according to the World Standard Population. The trends were described using regression techniques. In the period from 1990 to 2018, there was a significant increase in CRC mortality (P < .05). The death rates and the number of deaths from CRC were constantly increasing for both the overall level and gender, with the mean annual percentage change for the rates respectively average annual percent change (95% confidence interval-CI): 2.6% (1.9-3.2), 2.6% (1.8-3.5); 2.3% (1.3-3.3), and for the number of cases, respectively: 4.2% (3.5-4.9), 4.3% (3.3-5.3), 4.3% (3.2-5.5). The most affected age groups were 65 to 74 years (33%), followed by those aged 75 to 84 years (25%) and the age group 55 to 64 (22%). In Montenegro, CRC mortality trends are increasing among both men and women over the age of 45. Additional research on the risk factors and mechanisms that contribute to the unfavorable trends in CRC mortality in Montenegro is necessary.

Association Between Time to Colonoscopy After Abnormal Fecal Immunochemical Test and Risk of Adenoma, Advanced Colorectal Neoplasia and Colorectal Cancer Incidence

Objective: Colorectal cancer (CRC) is a significant health concern in Thailand, with high incidence and late-stage diagnosis rates. This study investigates the timing of colonoscopy following a positive fecal immunochemical test (FIT) and identifies risk factors for colorectal neoplasms. Material and Methods: A retrospective analysis included Thai patients aged 50-75 with a positive FIT who underwent colonoscopy. Exclusions were made for prior colonoscopy, colorectal surgery history, hereditary syndromes, inflammatory bowel disease, and incomplete pathology reports. Data from January 2018 to December 2021 were assessed for demographics, colonoscopy findings, and pathology outcomes. Results: The study encompassed 2,717 participants with balanced age and gender distributions. Preliminary risk factors associated with the development of adenoma and advanced colorectal neoplasia (ACRN) included age [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.02-1.05, p-value&lt;0.001], gender (OR for males: 1.60 for adenoma, 1.69 for ACRN, p-value&lt;0.001), and smoking (OR: 1.92, p-value=0.001). The timing of colonoscopy within one-year post-FIT did not exhibit statistically significant associations with adenoma, ACRN, or CRC. Conclusion: This study provides valuable insights into CRC screening in Thailand. It suggests that timing within a year of colonoscopy might not be the sole determinant of improved outcomes post-FIT. Preliminary risk factors encompassed age, gender, and smoking. Future studies should focus on larger cohorts to investigate adverse outcomes, such as late-stage CRC and CRC-related mortality.

Risk-stratified screening and colorectal cancer incidence and mortality: A retrospective study from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

ObjectiveTo determine whether risk stratification can optimize the benefits of flexible sigmoidoscopy (FSG) screening. MethodsThe Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial was conducted from 1993 to 2001 in the United States. A colorectal cancer (CRC) risk stratification tool was developed in the control arm (n = 64,207) from the PLCO cohort and validated in the UK Biobank (n = 270,726). PLCO participants (n = 130,021) were classified into low-, medium-, and high-risk groups. Cumulative incidence and mortality were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between screening and CRC incidence and mortality. ResultsThe CRC risk stratification tool was based on age, gender, body mass index, smoking status, family history of CRC, diabetes, regular use of aspirin, and CRC screening history. Compared with the control arm, FSG screening was significantly associated with a reduction in mortality in both the medium-risk (HR = 0.76, 95% CI = 0.63–0.92) and high-risk groups (0.58, 0.46–0.73), but not in the low-risk group (0.85, 0.61–1.19). FSG screening also reduced distal CRC incidence and mortality in the medium-risk and high-risk groups. Furthermore, it was associated with a reduction in incidence (0.74, 0.59–0.92) and mortality (0.59, 0.40–0.87) of proximal colon cancer in the high-risk group. ConclusionsFSG screening yielded more benefits for the high-risk group than for the low-risk and medium-risk groups, supporting the development of a risk-stratified CRC screening strategy.

Delayed diagnosis, disease and secondary prevention, especially in young patients with colorectal cancer.

&lt;b&gt;Introduction:&lt;/b&gt; Colorectal cancer (CRC) is the third most common cancer worldwide and the second cause of death. Its incidence rate decreased by about 3% per year between 2011 and 2015, and mortality by 35% between 1990 and 2007. This improvement is a result of cancer prevention and early detection strategies through screening. The decline in cancer rates may have been due to a growing awareness of colorectal cancer in the Polish population. There was a discernible improvement in the quality of surgical treatment with time.&lt;b&gt;Aim:&lt;/b&gt; The aim of the study was to determine the relationship between colonoscopy and the incidence of CRC, the incidence and family history of cancer and other intestinal diseases, as well as between the stage and time from first symptoms to the start of treatment.&lt;b&gt;Materials and methods:&lt;/b&gt; A retrospective analysis of the records of patients with CRC treated surgically between 1995 and 2005 at the Department of General, Oncological, and Gastroenterological Surgery in Krakow and a diagnostic survey method were used.&lt;b&gt;Results:&lt;/b&gt; There was a statistically significant relationship between the performance of colonoscopy and the incidence of CRC (P&lt;0.001). There was no correlation between CRC and the incidence of cancer and other bowel diseases in the family, or between the stage and the time from first symptoms to the start of treatment. The length of time was long, usually up to 6 months, 1-3 years, and in some cases longer than 6 years.&lt;b&gt;Discussion:&lt;/b&gt; Unfortunately, the incidence of CRC in young people under 50 years (EOCRC) has increased. Screening is of proven importance in reducing the incidence and mortality of CRC and every effort should be made to carry out as many of these screenings as possible. The time between diagnosis and treatment should also be kept as short as possible. Recommendations for the timeframe from diagnosis to treatment of cancer exist in many countries. In Australia, guidelines for an optimal care pathway suggest a timeframe of up to 7-9 weeks, similar to the National Health Service UK guidelines in the UK. Timeliness of treatment is an important factor in cancer care, to assess the consequences of delays and disruptions in oncology care.&lt;b&gt;Conclusions:&lt;/b&gt; The incidence of CRC was lowest among those who had prophylactic examinations - colonoscopies. Studies on secondary prevention have confirmed that there was poor diagnosis in this area, even though there were cases of CRC in the immediate family, so it is worth educating the public and encouraging them to have colonoscopies and take care of their health. The long time between the appearance of the first clinical symptoms and the start of treatment, which was presented in the study, is unfortunately associated with a worse prognosis, as any delay in starting treatment for oncology patients is unfavorable.&lt;b&gt;Significance of the research for the development of the field:&lt;/b&gt; The role of secondary prevention in the prevention of CRC and the need to educate the public to catch the first worrying signs of cancer and to consult a doctor are emphasized.

Umbrella Review on the Relationship between Vitamin D Levels and Cancer.

Cancer is a growing public health problem and cancer is linked to vitamin D via several mechanisms. Recent umbrella reviews on the extra-skeletal effects of vitamin D did not turn their attention to cancer. Accordingly, an overview of the current state of research is needed. An umbrella review was conducted to provide an overview of systematic reviews on the association between vitamin D and incidence or mortality of breast cancer, colorectal cancer, lung cancer, pancreatic cancer, and prostate cancer. Inverse correlations were found between the vitamin D level (measured by circulating 25(OH)D) and mortality for all five types of cancer. For breast cancer, colorectal cancer, lung cancer, and pancreatic cancer, there are also hints of a lower incidence due to higher 25(OH)D levels. As most reviews include observational studies, conclusions on causality cannot be made. Methodological differences between the included reviews and different study designs in the individual studies lead to methodological problems. Despite these problems, the review shows inverse correlations between 25(OH)D levels and mortality, and mostly inverse correlations between 25(OH)D levels and incidence.

Polyp detection with colonoscopy assisted by the GI Genius artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice (COLO-DETECT): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial

Increased polyp detection during colonoscopy is associated with decreased post-colonoscopy colorectal cancer incidence and mortality. The COLO-DETECT trial aimed to assess the clinical effectiveness of the GI Genius intelligent endoscopy module for polyp detection, comparing colonoscopy assisted by GI Genius (computer-aided detection [CADe]-assisted colonoscopy) with standard colonoscopy in routine practice. We did a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial in 12 National Health Service (NHS) hospitals (ten NHS Trusts) in England, among adults (aged ≥18 years) undergoing planned colonoscopy for gastrointestinal symptoms or for surveillance due to personal or family history (ie, symptomatic indications), or colorectal cancer screening. Randomisation (1:1) to CADe-assisted colonoscopy or standard colonoscopy was done with a web-based dynamic adaptive algorithm, immediately before colonoscopy, with stratification by age group, sex, colonoscopy indication (screening or symptomatic), and NHS Trust. Recruiting staff, participants, and colonoscopists were unmasked to trial allocation; histopathologists, co-chief investigators, and trial statisticians were masked. CADe-assisted colonoscopy consisted of standard colonoscopy plus the GI Genius module active for at least the entire inspection phase of colonoscope withdrawal. The primary outcome was mean adenomas per procedure (total number of adenomas detected divided by total number of procedures); the key secondary outcome was adenoma detection rate (proportion of colonoscopies with at least one adenoma). Analysis was by intention to treat (ITT), with outcomes compared between groups by mixed-effects regression modelling, in which effect estimates were adjusted for randomisation stratification variables. Data were imputed for outcome measures with more than 5% missing values. All participants who underwent colonoscopy were assessed for safety. The trial is registered on ISRCTN (ISRCTN10451355) and ClinicalTrials.gov (NCT04723758), and is complete. Between March 29, 2021, and April 6, 2023, 2032 participants (1132 [55·7%] male, 900 [44·3%] female; mean age 62·4 years [SD 10·8]) were recruited and randomly assigned: 1015 to CADe-assisted colonoscopy and 1017 to standard colonoscopy. 1231 (60·6%) participants were undergoing screening and 801 (39·4%) had symptomatic indications. Mean adenomas per procedure was 1·56 (SD 2·82; n=1001 participants with available data) in the CADe-assisted colonoscopy group versus 1·21 (1·91; n=1009) in the standard colonoscopy group, representing an adjusted mean difference of 0·36 (95% CI 0·14-0·57; adjusted incidence rate ratio 1·30 [95% CI 1·15-1·47], p<0·0001). Adenomas were detected in 555 (56·6%) of 980 participants in the CADe-assisted colonoscopy group versus 477 (48·4%) of 986 in the standard colonoscopy group, representing a proportion difference of 8·3% (95% CI 3·9-12·7; adjusted odds ratio 1·47 [95% CI 1·21-1·78], p<0·0001). Numbers of adverse events were similar between the CADe-assisted colonoscopy and standard colonoscopy groups (adverse events: 25 vs 19; serious adverse events: four vs six), and no adverse events in the CADe-assisted colonoscopy group were deemed to be related to GI Genius use on independent review. Results of the COLO-DETECT trial support the use of GI Genius to increase detection of premalignant colorectal polyps in routine colonoscopy practice. Medtronic.

Novel monastrol/melatonin hybrids as a new approach for colorectal cancer intervention: design, synthesis, biological activity, and drug-likeness modeling studies

Considering the important increase in the incidence and mortality of colorectal cancer, it is necessary to develop new strategies in the search for new alternatives against this disease. Hence, we designed and synthesized a new series of monastrol/melatonin hybrids and evaluated them in vitro and in silico to determine the potential of these new chemical entities on this type of cancer. To achieve this goal, the different compounds were evaluated in human colorectal adenocarcinoma cells SW480, while establishing the selective potential of the hybrids through the nonmalignant human colon mucosal epithelial cell line (NCM460). According to the results, hybrids 6a, 6c, 6i, and 6j displayed the best response, with IC50 values in the range of 5.2 and 6.3 μM, inducing important changes depending on concentration and time. In addition, these compounds were extremely active in comparison to the single molecules, and they were slightly more selective than the reference drug (5 fluorouracil, 5-FU). Besides, an optimal pharmacokinetic and toxicological profile was also estimated for hybrids 6a, 6c, 6i, and 6j. Altogether, novel hybrids of monastrol-MLT, in particular, 6a (-H), 6c (3-OMe), 6i (3,4-OMe), and 6j (3,5-OMe) could be addressed as starting points for further pharmacological studies concerning to combat colorectal cancer.

Association of US county-level social vulnerability index with breast, colorectal, and lung cancer screening, incidence, and mortality rates across US counties.

Despite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Using county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median. Our study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates. In conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.

Will computer-aided detection of polyps decrease colorectal cancer incidence and mortality?

Will computer-aided detection of polyps decrease colorectal cancer incidence and mortality?

Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer.

The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

Sustaining Improvements in Colorectal Cancer Across Delaware:: A Look at Racial Disparities a Decade Later.

A previously initiated statewide effort in Delaware improved outcomes in colorectal cancer (CRC) racial disparities. Objective. To examine whether improvements in racial disparities for CRC have been sustained a decade later and the status of Delaware's current cancer burden. Methods. Cancer incidence data from the Delaware Cancer Registry, mortality data from the Centers for Disease and Control and Prevention (CDC)'s National Center for Health Statistics, and cancer screening data from CDC's Behavioral Risk Factor Surveillance System were analyzed. Five-year age-adjusted incidence and mortality rates were calculated, and comparisons were made between non-Hispanic Black and non-Hispanic White groups using rate ratios. Distributions by cancer stage were compared between time periods by race/ethnicity utilizing chi-square statistical tests. The prevalence of Delawareans meeting recommendations for CRC screening was compared between time points for each race/ethnicity group using the Rao-Scott Modified chi-square test. Results. Comparing 2006-2010 and 2015-2019, CRC incidence rates decreased for non-Hispanic Black Delawareans from 51.0 to 39.6 per 100,000 population and decreased for non-Hispanic White Delawareans from 46.6 to 37.6 per 100,000 population. Between 2006-2010 and 2015-2019, CRC mortality rates decreased for non-Hispanic Black Delawareans from 16.8 to 15.1 per 100,000 population and decreased for non-Hispanic White Delawareans from 16.8 to 13.3 per 100,000 population. There were no significant differences in CRC incidence or mortality rates by race/ethnicity in either period. The distribution of cases by stage comparing 2006-2010 and 2015-2019 were not significantly different for either race/ethnicity group. There were no significant differences in meeting CRC screening recommendations comparing 2010 and 2018 by race/ethnicity or directly comparing race/ethnicity groups in either year. Conclusions. Delaware has sustained improvements in CRC incidence, mortality rates, and disparities between non-Hispanic Black and non-Hispanic White groups but will continue to monitor CRC trends and outcomes to ensure early diagnosis and that disparities are eliminated.

Screening and Surveillance of Colorectal Cancer: A Review of the Literature.

Colorectal cancer (CRC) has the highest mortality rate among men and is the second highest among women under fifty, with incidence and mortality rates rising in younger populations. Studies indicate that up to one-third of patients diagnosed before fifty have a family history or genetic factors, highlighting the need for earlier screening. Contrariwise, diagnosis in healthy subjects through screening strategies enables early-stage detection of the tumor and better clinical outcomes. In recent years, mortality rates of CRC in Western countries have been on a steady decline, which is largely attributed to widespread screening programs and advancements in treatment modalities. Indeed, early detection through screening significantly improves prognosis, with stark differences in survival rates between localized and metastatic disease. This article aims to provide a comprehensive review of the existing literature, delving into the performance and efficacy of various CRC screening strategies. It navigates through available screening tools, evaluating their efficacy and cost-effectiveness. The discussion extends to delineating target populations for screening, emphasizing the importance of tailored approaches for individuals at heightened risk.

MiRNA-mediated regulation of clock gene expression in men and women with colorectal cancer and possible consequences for disease management

BackgroundThe incidence and mortality of colorectal cancer (CRC) are persistently higher in men than in women. CRC malignancy is strongly influenced by small non-coding RNAs (miRNAs). Moreover, deregulation of the circadian molecular oscillator has been associated with CRC facilitation. To analyse possible cumulative effects of the above-mentioned factors on CRC progression, we focused on functions of sex-biased miRNAs associated with the clock genes per2 and/or cry2, which are involved in the cell cycle control and DNA damage response. Major findingsWe identified miR-24, miR-92a, miR-181a, and miR-21 associated with per2 that are up-regulated in transformed colon tissue of men. miR-93, miR-17, miR-20a, and miR-24 with higher expression in males compared to females were linked to cry2. All these miRNAs possess oncogenic potential and exert their effects mainly via inhibition of the tumour suppressors phosphatase and tensin homolog (PTEN) and/or p53. Down-regulation of PTEN and p53 in men was further strengthened by inhibition of tumour suppressor per2. Oncogenic up-regulated miRNAs associated with per2 or cry2 in the transformed colon tissue of women were not detected. ConclusionWe conclude that the cancer-promoting, sex-biased miRNAs miR-24, miR-92a, miR-181a, miR-93, miR-17, miR-20a, and miR-21 associated with clock genes per2 and/or cry2 can contribute to the sex-dependent development of CRC via inhibition of the PTEN and p53 pathways.

Body Mass Index and Risk of Colorectal Cancer Incidence and Mortality in Asia

The global burden of obesity is increasing, as are colorectal cancer (CRC) incidence and mortality. To assess the association between body mass index (BMI) and risks of incident CRC and CRC-related death in the Asian population. This cohort study includes data pooled from 17 prospective cohort studies included in The Asia Cohort Consortium. Cohort enrollment was conducted from January 1, 1984, to December 31, 2002. Median follow-up time was 15.2 years (IQR, 12.1-19.2 years). Data were analyzed from January 15, 2023, through January 15, 2024. Body mass index, calculated as weight in kilograms divided by height in meters squared. The primary outcomes were CRC incidence and CRC-related mortality. The risk of events is reported as adjusted hazard ratios (AHRs) and 95% CIs for incident CRC and death from CRC using the Cox proportional hazards regression model. To assess the risk of incident CRC, 619 981 participants (mean [SD] age, 53.8 [10.1] years; 52.0% female; 11 900 diagnosed incident CRC cases) were included in the study, and to assess CRC-related mortality, 650 195 participants (mean [SD] age, 53.5 [10.2] years; 51.9% female; 4550 identified CRC deaths) were included in the study. A positive association between BMI and risk of CRC was observed among participants with a BMI greater than 25.0 to 27.5 (AHR, 1.09 [95% CI, 1.03-1.16]), greater than 27.5 to 30.0 (AHR, 1.19 [95% CI, 1.11-1.29]), and greater than 30.0 (AHR, 1.32 [95% CI, 1.19-1.46]) compared with those with a BMI greater than 23.0 to 25.0 (P < .001 for trend), and BMI was associated with a greater increase in risk for colon cancer than for rectal cancer. A similar association between BMI and CRC-related death risk was observed among participants with a BMI greater than 27.5 (BMI >27.5-30.0: AHR, 1.18 [95% CI, 1.04-1.34]; BMI >30.0: AHR, 1.38 [95% CI, 1.18-1.62]; P < .001 for trend) and was present among men with a BMI greater than 30.0 (AHR, 1.87 [95% CI, 1.49-2.34]; P < .001 for trend) but not among women (P = .15 for trend) (P = .02 for heterogeneity). In this cohort study that included a pooled analysis of 17 cohort studies comprising participants across Asia, a positive association between BMI and CRC incidence and related mortality was found. The risk was greater among men and participants with colon cancer. These findings may have implications to better understand the burden of obesity on CRC incidence and related deaths in the Asian population.

Evolution of Colorectal Cancer Trends and Treatment Outcomes: A Comprehensive Retrospective Analysis (2019-2023) in West Kazakhstan.

To determine the demographic and clinical characteristics of individuals diagnosed with colorectal cancer. A retrospective study was conducted on 650 patients diagnosed with colorectal cancer in West Kazakhstan from 2019 to 2023. Statistical analysis was performed to explore the relationships between various factors and outcomes, using significance tests and regression techniques. The study included 650 colorectal cancer patients, with 59.7% males and 40.3% females. Age distribution showed 63.1% between 24-65 years and 36.9% over 65, with no gender-based age differences. Nationality significantly influenced patient composition (63.8% Kazakh, 36.2% Russian, P=0.03). KRAS mutations (76.0% negative) and tumor morphology (40% adenocarcinoma, P=0.02) displayed varied associations. Univariate logistic regression revealed links between demographic/clinical factors and cancer outcomes. Multivariate analysis emphasized age, stage of cancer, expansion, involvement of lymphatic and metastasis in cancer progression. Nomogram predictive modeling incorporated gender, tumor form, stage, and infiltration. Evaluation in a validation cohort showed good differentiation (AUC=0.6293) and calibration. The findings provide insights into colorectal cancer demographics, progression, treatment, and mortality, aiding personalized interventions. this study reveals critical insights into demographics, treatment, and prognosis. Emphasizing the complexity of CRC, the study highlights age, gender, and tumor characteristics' impact on progression and mortality. A developed nomogram model offers clinicians a practical tool for personalized treatment decisions, enhancing prognosis discussions with patients.

Colonoscopy quality measures and adherence to follow-up guidelines among endoscopists participating in a U.S. endoscopy registry

Colonoscopy screening can substantially reduce colorectal cancer incidence and mortality. Colonoscopies may achieve maximum benefit when they are performed with high quality and accompanied by follow-up recommendations that adhere to clinical guidelines. This study aimed to determine to what extent endoscopists met targets for colonoscopy quality from 2016 through 2019 (the most recent years prior to the COVID-19 pandemic). We examined measures of colonoscopy quality and recommended follow-up intervals in the GI Quality Improvement Consortium, a large nationwide endoscopy registry. The analysis included over 2.5 million outpatient screening colonoscopies in average risk adults aged 50-75 years. At least 90% of endoscopists met performance targets for adequate bowel preparation, cecal intubation rate, and adenoma detection rate. However, nonadherence to guidelines for follow-up intervals was common. For patients with no colonoscopy findings, 12.0% received a follow-up interval recommendation of ≤5 years instead of the guideline-recommended 10 years. For patients with 1-2 small tubular adenomas, 13.5% received a follow-up interval recommendation of ≤3 years instead of the guideline-recommended 5-10 years. For patients with small sessile serrated polyps, 30.7% received a follow-up interval recommendation of ≤3 years instead of the guideline-recommended 5 years. Some patients with higher risk findings received a follow-up interval recommendation of ≥5 years instead of the guideline-recommended 3 years, including 18.2% of patients with advanced serrated lesions. Additional attention may be needed to achieve more consistent adherence to guidelines for colonoscopy follow-up recommendations.

Barriers and proposed solutions to at-home colorectal cancer screening tests in medically underserved health centers across three US regions to inform a randomized trial.

At-home colorectal cancer (CRC) screening is an effective way to reduce CRC mortality, but screening rates in medically underserved groups are low. To plan the implementation of a pragmatic randomized trial comparing two population-based outreach approaches, we conducted qualitative research on current processes and barriers to at-home CRC screening in 10 community health centers (CHCs) that serve medically underserved groups, four each in Massachusetts and California, and two tribal facilities in South Dakota. We conducted 53 semi-structured interviews with clinical and administrative staff at the participating CHCs. Participants were asked about CRC screening processes, categorized into eight domains: patient identification, outreach, risk assessment, fecal immunochemical test (FIT) workflows, FIT-DNA (i.e., Cologuard) workflows, referral for a follow-up colonoscopy, patient navigation, and educational materials. Transcripts were analyzed using a Rapid Qualitative Analysis approach. A matrix was used to organize and summarize the data into four sub-themes: current process, barriers, facilitators, and solutions to adapt materials for the intervention. Each site's process for stool-based CRC screening varied slightly. Interviewees identified the importance of offering educational materials in English and Spanish, using text messages to remind patients to return kits, adapting materials to address health literacy needs so patients can access instructions in writing, pictures, or video, creating mailed workflows integrated with a tracking system, and offering patient navigation to colonoscopy for patients with an abnormal result. Proposed solutions across the three regions will inform a multilevel intervention in a pragmatic trial to increase CRC screening uptake in CHCs.

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.

This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.

A novel dual-target Septin9 methylation assay for improved detection of early-stage colorectal cancer and high-grade intraepithelial neoplasia

BackgroundColorectal cancer (CRC) ranks as the third most common malignancies in the world, and periodic examination of the patient is advantageous in reducing the mortality of CRC. The first blood-based Septin9 gene methylation assay which recognized by the US FDA for CRC examination was Epi proColon. However, this assay was not broadly applied in the current clinical guideline because of its relatively lower sensitivity in the detection of early-stage CRC.MethodsThis study aimed at developing a new multiplex Septin9 methylation assay (ColonUSK) which simultaneously evaluates two CpG-rich subregions in the promoter of the Septin9 gene and an internal control in a single reaction. ColonUSK proved increased sensitivity, with a detection limit as low as 12pg of the positive DNA compared with the Septin9 assay targeting one CpG-rich subregion. 1366 subjects were prospectively recruited from four comprehensive hospitals in China in an opportunistic screening study for assessing its value in CRC detection. Blind testing was developed to evaluate ColonUSK in comparison with clinical examination using clinical gold standard such as colonoscopy.ResultsThe assay demonstrates clinical sensitivity for diagnosing colorectal cancer (CRC) and advanced adenoma at rates of 77.34% and 25.26%, respectively. Furthermore, ColonUSK exhibits a high degree of specificity for non-CRC cases (95.95%) clinically. Significantly, the detection rate of cases in high-grade intraepithelial neoplasia increased to 54.29%. The value for the assay in the Kappa test was 0.76, showing a high degree of consistency between ColonUSK and clinical gold standard.ConclusionsColonUSK indicated moderate diagnostic value and could become a non-invasive detection way for CRC. The implementation of the ColonUSK assay has the capacity to markedly enhance CRC screening practices.

Geographical Disparities in Colorectal Cancer in Canada: A Review.

Colorectal cancer (CRC) is a prominent contributor to cancer-related mortality in Canada. This review paper sheds light on the research conducted in Canada to scrutinize the influence of economicfactors. The review seeks to uncover notable disparities in Colorectal cancer incidence and mortality rate across diverse Canadian populations, including Indigenous communities, rural dwellers, and individuals with lower socioeconomic status (SES). Recent investigations reveal significant disparities in CRC incidence, mortality, and treatment outcomes among various demographic groups in Canada. Indigenous peoples, rural populations, and those with lower SES are particularly vulnerable to these disparities. Access to screening and specialized cancer care is notably limited for these marginalized populations, exacerbating existing health inequities. Furthermore, emerging evidence underscores the potential influence of dietary factors on CRC risk, highlighting the importance of tailored prevention and treatment strategies. The findings underscore the urgent need for targeted interventions aimed at enhancing access to CRC screening and specialized cancer care for disadvantaged populations in Canada. By addressing these disparities, more individuals can undergo timely screening and receive early-stage diagnoses, thereby improving prognosis and ultimately saving lives. However, to effectively bridge these gaps, further research is imperative to elucidate the underlying mechanisms driving these disparities and to identify and implement effective interventions.