Colorectal Cancer Prevention Programs Research Articles

Colorectal cancer screening uptake and adherence by modality at a large tertiary care center in the United States: a retrospective analysis

Objective Real-world data regarding colorectal cancer (CRC) screening adherence and use of various screening modalities is critical to improving efficacy of CRC prevention programs. We assessed overall CRC screening adherence rates and utilization by modality over a three-year period (2017-2019) within a large Primary Care network. Methods A retrospective review of individuals aged 50-75 years at average risk for CRC with at least one clinic visit in the previous 24 months. The primary outcome was CRC screening adherence each calendar year, overall and by modality, among the entire eligible population and among individuals newly completing screening (i.e., newly adherent). The final sample included 107,366 patients and 218,878 records. Results Overall CRC screening adherence increased from 2017 to 2019 (71% to 78%). Colonoscopy was the most utilized modality (up to approximately 74% were “up-to-date” with colonoscopy versus 4% for non-invasive options). However, utilization of various modalities accounting for individuals being “up-to-date” with screening changed over time, with the highest increase for mt-sDNA (10.2-fold increase), followed by FIT (1.6-fold increase) and colonoscopy (1.1-fold increase). Among newly adherent individuals, the proportion screened by colonoscopy and FOBT decreased (89% to 80% and 2.4% to 1.2%, respectively), while uptake of FIT and mt-sDNA increased (7.7% to 11.5% and 0.9% to 6.8%, respectively). Notably, FIT and mt-sDNA increased disproportionately among the age and race-ethnicity groups with the lowest overall screening rates. Conclusions In an opportunistic CRC screening program, adherence increased over time but remained below the national goal of 80%. Although colonoscopy remained the most utilized screening modality, colonoscopy uptake rates decreased, while utilization rates of mt-sDNA and FIT increased. Among minority populations, new uptake increased most with mt-sDNA and FIT. Multiple CRC screening options should be leveraged by patients and Providers to potentially improve the effectiveness and help address disparities in CRC prevention programs.

Colorectal neoplasia surveillance in inflammatory bowel disease

Performing colorectal neoplasia surveillance in persons with inflammatory bowel disease (IBD) that is both clinically effective and cost effective is among the greatest challenges facing endoscopists who care for this population. While heightened colorectal cancer (CRC) risk has long been recognized among persons with IBD, this risk has been declining over time, with recent reports suggesting no more than a 1.5–2-fold higher risk compared to age and sex matched members of the general population. Nonetheless, given that CRC still occurs at a higher rate in this population, current surveillance strategies are inadequate for some persons. Conversely, 80–90% of persons with IBD had no neoplastic lesions identified during colonoscopy surveillance, suggesting that many persons with IBD are unnecessarily exposed to the risks of colonoscopy, with society bearing these excess costs.
 The purpose of colorectal neoplasia surveillance is to reduce the burden of CRC and CRC-related death in the IBD population. Societal guidelines recommend initiating colorectal neoplasia screening with colonoscopy in all persons with colorectal IBD involving at least the rectosigmoid (or at least 1/3 of the colorectum if accompanied by discontinuous inflammation) at 8–10 years following disease diagnosis and continuing lifelong surveillance every 1–5 years. Major factors influencing surveillance frequency include historical disease severity, extent of colorectal inflammation, chronic post-inflammatory changes, family history of CRC, history of colorectal neoplasm, primary sclerosing cholangitis, prior colonoscopy findings, and adequacy of prior surveillance. All guidelines further recommend targeted sampling or resection of suspicious visible abnormalities, and some societies continue to recommend extensive non-targeted biopsies to detect “invisible” neoplasia, particularly if other adjunctive optical modalities, such as dye-spray chromoendoscopy (DCE) or virtual chromoendoscopy (VCE), are not performed, or if the mucosa is poorly visualized, such as in areas of significant inflammation, post-inflammatory polyposis, or poor bowel preparation. Most societies now advocate for DCE or VCE as primary screening tools for IBD neoplasia surveillance or, at a minimum, as alternative modalities to traditional white light colonoscopy with non-targeted biopsies where resources and expertise exists.
 However, there are no prospective studies demonstrating a reduction in the incidence of CRC or of death from CRC with current surveillance strategies in persons with IBD. Furthermore, observations from large retrospective studies are also conflicting. A Cochrane analysis of 3 studies in persons with UC did not find a significant mortality benefit for current surveillance strategies. Considering that IBD afflicts many persons at a young age, is rising in prevalence in Canada and globally, and requires intensive lifelong surveillance , the amount of endoscopy resources directed toward IBD surveillance is potentially enormous. Increasing demands on colonoscopy resources from expansion of population-based CRC screening programs and an aging population are likely to challenge the ability to continue to provide intensive surveillance to all persons with IBD. Optimizing delivery of limited colonoscopy resources will thus be essential to maintain effective CRC prevention programs in this population.
 Current standards for neoplasia surveillance in IBD have been recently updated. Shah and Itzkowitz authored a comprehensive review that includes epidemiology, pathogenesis, and management of colorectal neoplasia, along with a chart that compares surveillance recommendations put forward by multiple societies. The present review will highlight new evidence influencing neoplasia surveillance and provide practical approaches for surveillance and management of neoplastic lesions in the IBD population.

The role of artificial intelligence based systems for cost optimization in colorectal cancer prevention programs.

Colorectal Cancer (CRC) has seen a dramatic increase in incidence globally. In 2019, colorectal cancer accounted for 1.15 million deaths and 24.28 million disability-adjusted life-years (DALYs) worldwide. In India, the annual incidence rates (AARs) for colon cancer was 4.4 per 100,000. There has been a steady rise in the prevalence of CRC in India which may be attributed to urbanization, mass migration of population, westernization of diet and lifestyle practices and a rise of obesity and metabolic risk factors that place the population at a higher risk of CRC. Moreoever, CRC in India differs from that described in the Western countries, with a higher proportion of young patients and more patients presenting with an advanced stage. This may be due to poor access to specialized healthcare and socio-economic factors. Early identification of adenomatous colonic polyps, which are well-recognized pre-cancerous lesions, at the time of screening colonoscopy has been shown to be the most effective measure used for CRC prevention. However, colonic polyps are frequently missed during colonoscopy and moreover, these screening programs necessitate man-power, time and resources for processing resected polyps, that may hamper penetration and efficacy in mid- to low-income countries. In the last decade, there has been significant progress made in the automatic detection of colonic polyps by multiple AI-based systems. With the advent of better AI methodology, the focus has shifted from mere detection to accurate discrimination and diagnosis of colonic polyps. These systems, once validated, could usher in a new era in Colorectal Cancer (CRC) prevention programs which would center around “Leave in-situ” and “Resect and discard” strategies. These new strategies hinge around the specificity and accuracy of AI based systems in correctly identifying the pathological diagnosis of the polyps, thereby providing the endoscopist with real-time information in order to make a clinical decision of either leaving the lesion in-situ (mucosal polyps) or resecting and discarding the polyp (hyperplastic polyps). The major advantage of employing these strategies would be in cost optimization of CRC prevention programs while ensuring good clinical outcomes. The adoption of these AI-based systems in the national cancer prevention program of India in accordance with the mandate to increase technology integration could prove to be cost-effective and enable implementation of CRC prevention programs at the population level. This level of penetration could potentially reduce the incidence of CRC and improve patient survival by enabling early diagnosis and treatment. In this review, we will highlight key advancements made in the field of AI in the identification of polyps during colonoscopy and explore the role of AI based systems in cost optimization during the universal implementation of CRC prevention programs in the context of mid-income countries like India.

Advanced Endoscopic Technologies to Improve the Diagnosis of Colorectal Polyps

AbstractColonoscopy is the gold standard for colorectal cancer (CRC) prevention. The main quality indicator of colonoscopy is the adenoma detection rate, which is inversely associated with the risk of interval CRC and the risk of death from this neoplasia. In the setting of CRC prevention, diagnostic colonoscopy has undergone a remarkable evolution in the past 20 years. Hand in hand with the implementation of CRC prevention programs and technological advances, we are now able to identify tiny and subtle neoplastic lesions and predict their histology with great efficiency. In this article, we briefly review the endoscopy technologies that can be used to improve the detection and characterization of colorectal polyps.

Artificial intelligence-assisted colonoscopy: A review of current state of practice and research.

Colonoscopy is an effective screening procedure in colorectal cancer prevention programs; however, colonoscopy practice can vary in terms of lesion detection, classification, and removal. Artificial intelligence (AI)-assisted decision support systems for endoscopy is an area of rapid research and development. The systems promise improved detection, classification, screening, and surveillance for colorectal polyps and cancer. Several recently developed applications for AI-assisted colonoscopy have shown promising results for the detection and classification of colorectal polyps and adenomas. However, their value for real-time application in clinical practice has yet to be determined owing to limitations in the design, validation, and testing of AI models under real-life clinical conditions. Despite these current limitations, ambitious attempts to expand the technology further by developing more complex systems capable of assisting and supporting the endoscopist throughout the entire colonoscopy examination, including polypectomy procedures, are at the concept stage. However, further work is required to address the barriers and challenges of AI integration into broader colonoscopy practice, to navigate the approval process from regulatory organizations and societies, and to support physicians and patients on their journey to accepting the technology by providing strong evidence of its accuracy and safety. This article takes a closer look at the current state of AI integration into the field of colonoscopy and offers suggestions for future research.

Diet quality indices and gastrointestinal cancer risk: results from the Lifelines study

ObjectiveTo investigate the long-term association between four dietary quality indices and the risk of gastrointestinal (GI) cancer.MethodsBaseline details of the dietary intake of participants, assessed by a single food frequency questionnaire from the prospective Lifelines population-based cohort were translated to diet quality scores using several dietary and dietary-lifestyle indices. Incident cases of GI cancer were then assessed by linkage to the Dutch nationwide histo-cytopathology registry. The association between GI cancer risk and diet quality (defined as higher quintiles on dietary indices compared to the first quintile) was assessed by multivariable Cox proportional hazard models.ResultsWe included 72,695 participants aged 51.20 ± 8.71 years with a median follow-up to cancer diagnosis of 8 years (interquartile range 2 years). During follow-up, 434 colorectal cancers and 139 upper GI cancers were diagnosed. There was a significant reduction in colorectal cancer risk for high categories in the American Cancer Society (ACS) Index (hazard ratio 0.62; 95% CI 0.46–0.84). However, high dietary index scores were not associated with strong beneficial effects on upper GI cancer risk.ConclusionHigh quintiles on the ACS Index were associated with a significantly reduced risk of colorectal cancer. This index may be of use in a colorectal cancer prevention program.

The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study

Few studies have investigated psychosocial characteristics and lifestyle behaviors of participants at programs for secondary prevention of colorectal cancer (CRC). This study aimed, through a comprehensive psychosomatic assessment based on clinimetric principles, to evaluate psychosocial characteristics and lifestyle behaviors in participants at CRC secondary prevention program, and to investigate the associations between these variables and endoscopic outcomes. In this cross-sectional study, the first 150 consecutive asymptomatic participants at the CRC prevention program who resulted positive to fecal occult blood test (FOBT) and were thus referred to colonoscopy, underwent a psychosomatic assessment including psychiatric diagnoses (DSM-5), psychosomatic syndromes (DCPR-R), psychological distress, psychological well-being and lifestyle behaviors. Whereas only 5.3% of the sample showed at least one DSM-5 diagnosis, 51.3% showed at least one DCPR syndrome, such as allostatic overload, alexithymia, Type A behavior, and demoralization. Patients affected by psychosomatic syndromes presented with significantly higher psychological distress, lower psychological well-being and unhealthy lifestyle behaviors, such as tobacco smoking and unhealthy diet, in comparison with patients without DCPR syndromes. Among endoscopic outcomes, the presence of adenomas was significantly associated with DCPR irritable mood. In a clinical context of secondary prevention addressing asymptomatic patients with positive FOBT, a comprehensive psychosomatic assessment may provide relevant clinical information for those patients who present certain psychosomatic syndromes associated with high psychological distress, impaired psychological well-being, unhealthy lifestyle behaviors and colorectal precancerous lesions. The results of the present study indicate a road to the practice of “preventive” medicine at CRC screening program.

Patients With Chronic Hepatitis C Virus Infection Are at an Increased Risk of Colorectal Cancer: A Nationwide Population-Based Case-Control Study in Taiwan.

AimStudies evaluating colorectal cancer (CRC) risk associated with chronic hepatitis C virus (HCV) infection are limited.MethodsIn this case-control study, we identify 67,670 CRC cases newly diagnosed from 2005 to 2011 and randomly selected 67,670 controls without HCV and CRC from the same database, frequency matched by age and sex of cases.ResultsResults of logistic regression analysis revealed that the adjusted odds ratio (aOR) of CRC was 1.16 (95% confidence interval [CI] = 1.08–1.24, p < 0.001) in association with chronic HCV. The CRC risk was slightly greater for women than for men. The risk decreased with age, with the aOR decreased from 2.26 (95% CI = 1.32–3.87, p = 0.003) in patients under 45 years old to 1.31 (95% CI = 1.10–1.55, p = 0.03) in patients aged 50–59, and 1.10 (95% CI = 1.00–1.22, p = 0.061) in patients aged over 70.ConclusionsOur findings suggested that patients with chronic HCV infection are at an elevated risk of developing CRC. Our data also imply that the CRC prevention programs are needed to target younger HCV patients.

Abstract PO-255: A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system

Abstract Background: Colorectal Cancer (CRC) is often preventable through regular screening. CRC screening is an evidence-based intervention for early detection and prevention of CRC. However, screening rates are low among medically underserved, minority populations. In collaboration with a local safety-net healthcare system and community clinics, we are implementing a comprehensive, multi-modal CRC prevention program. Our CRC screening program includes community outreach, culturally and linguistically targeted educational point-of-care patient education videos, patient navigation services, and provider and staff training. In 2018, a new component was introduced that includes a CRC survivor led provider-targeted assessment intervention leveraging the American Cancer Society National Colorectal Roundtable’s “80% in Every Community” campaign. Methods: As part of the 80% in Every Community campaign, providers and clinical staff are trained by the CRC survivor staff member to employ strategies from the Roundtable’s toolkit to heighten clinic-level commitment to improving screening rates. Specific strategies include providing tips for evidence-based messaging to reach the unscreened, and training providers to consistently give a strong CRC screening recommendation. A baseline survey was administered ahead of the initial training to assess current clinical practices. Results: Survey data indicated 84.3% (N= 297, 14 clinics) of respondents identified patients not completing and returning FIT as a screening barrier (61.7%-Sometimes and 22.7%-Usually). When asked if they had mechanism to ensure patients given a FIT kit have completed and returned them -75.7 % said Yes and 24.3%-No. In the follow-up question, asking if they had a mechanism to ensure FIT were completed and returned, responses showed: 13.9 % said no mechanism, 43.0% reminder call, 8.1% mail reminder, and 28.6% said a chart reminder to return kit at next visit. 73 respondents wrote in various other mechanisms. Discussion: Respondents believed a systematic mechanism already existed to remind patients to complete their FIT and return it to their clinic. Our next steps are to present these findings to health system leadership and investigate the possibility to strengthen screening patient reminders in various forms of communication to increase FIT completion rate. Citation Format: Allison Rosen, Roshanda Chenier, Jane Montealegre, Maria Jibaja-Weiss. A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-255.

Heterogeneity in colorectal cancer incidence among people recommended 3-yearly surveillance post-polypectomy: a validation study.

Background Colonoscopy surveillance is recommended for patients at increased risk of colorectal cancer (CRC) following adenoma removal. Low-, intermediate-, and high-risk groups are defined by baseline adenoma characteristics. We previously examined intermediate-risk patients from hospital data and identified a higher-risk subgroup who benefited from surveillance and a lower-risk subgroup who may not require surveillance. This study explored whether these findings apply in individuals undergoing CRC screening. Methods This retrospective study used data from the UK Flexible Sigmoidoscopy Screening Trial (UKFSST), English CRC screening pilot (ECP), and US Kaiser Permanente CRC prevention program (KPCP). Screening participants (50 – 74 years) classified as intermediate-risk at baseline colonoscopy were included. CRC data were available through 2006 (KPCP) or 2014 (UKFSST, ECP). Lower- and higher-risk subgroups were defined using our previously identified baseline risk factors: higher-risk participants had incomplete colonoscopies, poor bowel preparation, adenomas ≥ 20 mm or with high-grade dysplasia, or proximal polyps. We compared CRC incidence in these subgroups and in the presence vs. absence of surveillance using Cox regression. Results Of 2291 intermediate-risk participants, 45 % were classified as higher risk. Median follow-up was 11.8 years. CRC incidence was higher in the higher-risk than lower-risk subgroup (hazard ratio [HR] 2.08, 95 % confidence interval [CI] 1.07 – 4.06). Surveillance reduced CRC incidence in higher-risk participants (HR 0.35, 95 %CI 0.14 – 0.86) but not statistically significantly so in lower-risk participants (HR 0.41, 95 %CI 0.12 – 1.38). Conclusion As previously demonstrated for hospital patients, screening participants classified as intermediate risk comprised two risk subgroups. Surveillance clearly benefited the higher-risk subgroup.

Diagnosis and Treatment of Diminutive Polyps in the Colon

Colonoscopy and polypectomy reduce the incidence and mortality of colorectal cancer (CRC) by detecting and removing colorectal adenomas. Diminutive polyps (1–5 mm) account for 75% of all polyps found but rarely contain or progress to CRC. Although a high adenoma detection rate (ADR) is associated with improved cancer prevention, the increase in detection of diminutive polyps also increases costs associated with CRC prevention programs. This review provides an update on endoscopic management and considerations related to diminutive colorectal polyps. Recent studies show that only 0–4.3% of diminutive polyps show advanced features and progression into CRC is extremely rare. Advances in endoscopic imaging have improved the ADR for screening colonoscopy, mostly as a result of greater detection of diminutive and hyperplastic polyps. A resect and discard strategy for these low-risk diminutive polyps could reduce the need for pathologic assessment and is included in society guidelines with recommendations on imaging modalities, classification, and endoscopist benchmarks. To ensure complete resection, cold snare polypectomy is emerging as the most efficient and safest method of removal. A recent guideline review showed that fecal immunochemical testing is generally the preferred first-line screening test in average-risk adults. Post-polypectomy surveillance intervals may increase in the future as evidence on the management and outcomes of diminutive polyps which is assimilated. High detection rates of diminutive polyps result in more surveillance colonoscopies and higher healthcare costs, with unclear benefit for CRC prevention. Optical diagnosis and strategies such as resect and discard may help to reduce costs. The performance of high-quality colonoscopies and strict adherence to recommended surveillance intervals will also optimize the effectiveness of screening programs.

Water Exchange (WE) and Quality Improvement—Enhanced Advanced Adenoma Detection

Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

284 Factors That Underpin the Increase in Right Colon Adenoma Detection Rate: A Pooled Analysis of Three Reports Comparing Water Exchange, Water Immersion, and Air Insufflation Colonoscopy

INTRODUCTION: Interval cancers due to missed adenomas tend to cluster in the right colon. Both water immersion (WI) and water exchange (WE) use water infusion to aid insertion. WI, which is easy to adopt at the discretion of the colonoscopist, removes water mainly during withdrawal. WE, which has evolved from WI, removes water mainly during insertion using new skills. WE, but not WI, provides insertion cleansing and improves bowel cleanliness. Reduced cleaning-related multi-tasking distractions from search for polyps, but not improved bowel cleanliness per se, is linked significantly to the improved adenoma detection rate (ADR) with WE (UEGJ Dec 5, 2018). In a pooled data analysis of three reports, WE significantly increased right colon adenoma detection rate (rADR) compared with WI and air insufflation (AI) (DDW 2019). However, the significant and independent factors that account for the increased rADR have not been described. We aim to assess the factors associated with an increase in rADR by multiple logistic regression analysis of the pooled individual patient data in the three aforementioned reports. METHODS: Three reports with data on rADR comparing WE with WI and AI were identified. The demographic and procedural data were extracted, pooled to optimize sample size and analyzed. Multiple logistic regression analysis was conducted using backward likelihood ratio selection procedure. RESULTS: Table 1 shows comparable pooled demographic data. Table 2 shows volume infused and suctioned confirm use of WE, WI and AI. WE has highest cleanliness scores, least use of adjunct maneuvers, and highest willingness to repeat. rADR of WE (22.4%) is significantly higher than those of WI (17.4%) (P = 0.009) and AI (15.7%) (P &lt; 0.001); but WI and AI are similar (reported 2019 DDW). Table 3 shows multiple logistic regression analysis (unreported): older age, shorter insertion time, longer withdrawal time, and WE; but not WI (when compared with AI), are significant and independent factors associated with a higher rADR. CONCLUSION: WE, compared with AI, was significantly associated with a higher rADR, adjusting for other confounding factors. The improved quality adds value to WE colonoscopy, and justifies the call to incorporate WE into colorectal cancer prevention programs. Since WE = WI + suction of water during insertion, the higher rADR of WE provides incentive for transitioning from WI to WE. The impact of WE on right colon interval cancers warrants further assessment.

Family health history of colorectal cancer: a structural equation model of factors influencing Chinese Americans' communication with family members.

BackgroundChinese Americans, the largest subgroup of Asian Americans with a 63% of first-generation immigrants, suffer from high incidence and mortality rates of colorectal cancer (CRC). As an identification marker to classify the CRC risk level, family health history (FHH) of CRC can help physicians provide patients personalized recommendations towards CRC. Yet, Chinese Americans’ communication of FHH of CRC with family members is unknown. The purpose of this first-of-its-kind study is to examine Chinese Americans’ behavior and the associated psychological factors of FHH of CRC communication with family members.MethodsWe developed an integrated theoretical framework based on the Health Belief Model, the Theory of Planned Behavior, and the Social Cognitive Theory to assess Chinese Americans’ FHH of CRC communication with family members and the psychological factors affecting such communication behavior. Using structural equation modeling, the framework was tested with the baseline survey data from 742 Chinese American participants from a FHH-based CRC prevention program in Texas.ResultsThe majority of Chinese American participants (with an average age of 47.7 years) were female (60.0%), married (72.0%), born outside the US (95.4%), did not speak English at home (95.5%), and had some kind of health insurance (75.2%). About half were employed (52.7%) and had college degrees or above (54.5%), some religious beliefs (52.5%), and primary care physicians (45.1%). Most Chinese Americans in our sample had either never or seldom collected and discussed with their family members about their FHH of CRC. The integrated theoretical framework was supported by the survey data. Perceived susceptibility for getting CRC, perceived severity for CRC, and perceived benefits of FHH of CRC communication with family members were significantly and positively associated with Chinese American participants’ attitudes toward FHH communication with family members (β =0.089, P<0.005; β =0.141, P<0.001; and β =0.479, P<0.001, respectively). Attitudes (β =0.324, P<0.001) and self-efficacy (β =0.577, P<0.001) in FHH of CRC communication were positively and significantly associated with the Chinese American sample’s intention in communicating FHH of CRC with their family members. Stronger intention, older age, lack of health insurance, and non-English spoken at home were correlated with participants’ behavior in FHH of CRC communication (β =0.410, P<0.001; β =0.113, P<0.05; β =−0.112, P<0.05; β =0.096, P<0.05, respectively).ConclusionsGiven that most Chinese Americans in our sample lacked FHH of CRC communication with family members, interventions and education for this particular racial/ethnic population are needed. Our integrated theoretical framework may provide a guideline for such interventions and education in the future.

Retrospective study of the results obtained in a colorectal cancer prevention program

Retrospective study of the results obtained in a colorectal cancer prevention program

Community-Based Participatory Research: a Family Health History-Based Colorectal Cancer Prevention Program Among Chinese Americans.

Asian Americans are the fastest growing racial/ethnic group in the USA, as this population increased by 72% between 2000 and 2015. Chinese Americans are the largest Asian subgroup, with a high immigrant proportion (63%), a high poverty rate (14%), and a large percentage of low English competency (41%). Colorectal cancer (CRC) is the second most commonly diagnosed cancer and cause of cancer death among Chinese Americans. As CRC has a genetic predisposition, family health history (FHH) has been proposed as a preventive tool to stratify CRC risk and guide personalized screening and behavioral modifications. The purpose of this study was to adopt a community-based participatory research (CBPR) approach to develop the first culturally and linguistically appropriate FHH-based CRC prevention program for Chinese Americans in Texas. The program development involved five CBPR steps: (1) establishment of partnership and research team, (2) literature review and needs assessment, (3) creation of a theoretical framework of the FHH-based CRC prevention, (4) development a culturally and linguistically appropriate intervention, and (5) program evaluation. Key components of this program included two intervention activities: (1) a culturally and linguistically appropriate FHH-based CRC prevention workshop and (2) a follow-up individualized phone consultation and health insurance enrollment and navigation services (if needed). The pilot study suggested feasibility of the program. This CBPR-grounded, FHH-based CRC prevention project can serve as a model for future cancer prevention programs targeting other types of cancers that also have FHH components.

Patient satisfaction, an indicator to consider in the colorectal cancer process

Colorectal cancer (CRC) is one of the most relevant diseases worldwide because of its incidence, prevalence and mortalitye. It is the third most common tumor in men, after lung and prostate cancer, and the second most common tumor in women, after breast cancer. A recent systematic analysis showed global data referring to age-standardized incidence rates for CRC, which increased by 9.5% from 1990 to 2017, whereas mortality rates decreased by 13.5%. This might be due to the introduction of CRC prevention programs, which facilitate early identification and higher survival chances.

Assessment of Risk Stratification and Genetic Testing of Patients Referred for Polyposis to a High-Risk Colorectal Cancer Prevention Program

Assessment of Risk Stratification and Genetic Testing of Patients Referred for Polyposis to a High-Risk Colorectal Cancer Prevention Program

Structural and dynamic characterization of human Wnt2-Fzd7 complex using computational approaches.

Wnt and Frizzled (Fzd) family members play crucial roles in the self-renewal of tumor-initiating cells. Until now, only a few studies have addressed the distinct mechanism of Wnt-Fzd interactions. In this study, we suggest a possible interaction mode of Wnt2 with the Fzd7 cysteine-rich domain (CRD)-both of which are up-regulated in some types of cancer. A combination of homology modeling, molecular docking and molecular dynamics (MD) simulations was carried out to study this ligand-receptor complex in great detail. The results demonstrated the unique dynamic behavior of Wnt2 upon binding to Fzd7. Interestingly, the β-strand content of the C-terminal binding site of Wnt2 was obviously reduced when bound to Fzd7 CRD. Moreover, the N-terminal and C-terminal binding sites of Wnt2 appeared to interact with the C-terminal and N-terminal binding sites of Fzd7, respectively. Calculation of the binding energies uncovered the pivotal role of electrostatic and hydrophobic interactions in the binding of Wnt2 to Fzd7 CRD. In conclusion, this study provides valuable insights into the mechanism of the Wnt2-Fzd7 CRD interaction for application in colorectal cancer prevention programs. Graphical abstract Flowchart representation of different steps used in this study.

Association between oral health and colorectal adenoma in a screening population.

Although periodontal disease and gastrointestinal tract health are closely associated, few studies have investigated whether periodontitis is a risk factor for colorectal adenoma. The aim of this study was to investigate whether there is an association between periodontitis and the risk of colorectal adenoma in asymptomatic healthy people.From January 2013 to October 2015, we retrospectively enrolled 42,871 patients who underwent health screening at Kangbuk Samsung Hospital in South Korea. Demographic and clinical data were collected before colonoscopy. We calculated the odds ratio (OR) for adenoma in these patients.The median age was 39.3 ± 8.7 years and 70.4% of the patients were men; 32.5% had a body mass index (BMI) 25.0 kg/m2. The frequency of adenoma was 12% (n = 5136). A higher risk of adenoma was associated with the following factors: BMI 25.0 kg/m2 (OR 1.51, 95% confidence interval [CI]: 1.42–1.61), current smoker (OR 1.51, 95% CI: 1.42–1.61), former smoker (OR 1.28, 95% CI: 1.19–1.37), periodontitis (OR 1.95, 95% CI: 1.82–2.0), moderate alcohol intake (OR 1.8, 95% CI: 1.69–1.93), and heavy alcohol intake (OR 2.67, 95% CI: 2.24–3.18).Being male or a former or current smoker, alcohol intake above the moderate level, and periodontitis increase the risk of colorectal adenoma. These findings suggest that controlling oral disease is important to the prevention and management of colorectal adenoma. The findings of this study could be applied to risk stratification and colorectal cancer prevention programs, including screening guidelines.