Fecal Occult Blood Test Screening Research Articles

A computer-aided polyp detection system in screening and surveillance colonoscopy: an international, multicentre, randomised, tandem trial

Studies on the effect of computer-aided detection (CAD) in a daily clinical screening and surveillance colonoscopy population practice are scarce. The aim of this study was to evaluate a novel CAD system in a screening and surveillance colonoscopy population. This multicentre, randomised, controlled trial was done in ten hospitals in Europe, the USA, and Israel by 31 endoscopists. Patients referred for non-immunochemical faecal occult blood test (iFOBT) screening or surveillance colonoscopy were included. Patients were randomomly assigned to CAD-assisted colonoscopy or conventional colonoscopy; a subset was further randomly assigned to undergo tandem colonoscopy: CAD followed by conventional colonoscopy or conventional colonoscopy followed by CAD. Primary objectives included adenoma per colonoscopy (APC) and adenoma per extraction (APE). Secondary objectives included adenoma miss rate (AMR) in the tandem colonoscopies. The study was registered at ClinicalTrials.gov, NCT04640792. A total of 916 patients were included in the modified intention-to-treat analysis: 449 in the CAD group and 467 in the conventional colonoscopy group. APC was higher with CAD compared with conventional colonoscopy (0·70 vs 0·51, p=0·015; 314 adenomas per 449 colonoscopies vs 238 adenomas per 467 colonoscopies; poisson effect ratio 1·372 [95% CI 1·068-1·769]), while showing non-inferiority of APE compared with conventional colonoscopy (0·59 vs 0·66; p<0·001 for non-inferiority; 314 of 536 extractions vs 238 of 360 extractions). AMR in the 127 (61 with CAD first, 66 with conventional colonoscopy first) patients completing tandem colonoscopy was 19% (11 of 59 detected during the second pass) in the CAD first group and 36% (16 of 45 detected during the second pass) in the conventional colonoscopy first group (p=0·024). CAD increased adenoma detection in non-iFOBT screening and surveillance colonoscopies and reduced adenoma miss rates compared with conventional colonoscopy, without an increase in the resection of non-adenomatous lesions. Magentiq Eye.

Výsledky z evaluace screeningu kolorektálního karcinomu v České republice

Introduction: Colorectal cancer screening, which was introduced in the Czech Republic in 2000, plays an important role in reducing the population burden. It is necessary to continuously evaluate the organised population-based program and introduce necessary adjustments to ensure its high effectiveness, which in the long term leads to a reduction in the incidence and mortality of the disease. The aim of this article is to summarise and discuss the key results of the evaluation of the National Colorectal Cancer Screening Program based on available national data. Material and methods: The evaluation used the registries of the National Health Information System, the Registry of Preventive Colonoscopies, and data on population demographics managed by the Czech Statistical Office. The analysis was carried out on available data up to 2021. Basic indicators were calculated in accordance with international recommendations, which were adapted for the Czech environment. Results: A number of performance indicators for colorectal screening demonstrate the negative impact of the COVID-19 pandemic in 2020 and 2021. Coverage of the target population by screening has stabilised at around 30% before the pandemic. Considering a three-year interval, the full coverage of the target population by screening reaches around 50%. Participation rates for follow-up colonoscopy after a positive faecal occult blood test (FOBT) screening ranged between 60 and 70% over time. FOBT screening positivity increased in the recent years up to 10%, which is reflected in the increase in the average waiting time for follow-up FOBT+ colonoscopy. Despite the identified limitations of the screening program, there has been a clear long-term decline in colorectal cancer incidence and mortality. Conclusion: The comprehensive screening information system enables the evaluation of colorectal screening. The evaluated indicators show that despite the positive impact of the screening program on the population burden, it still has its opportunities for improvement, and therefore it is essential to continue its monitoring in order to improve the quality of the whole program. Keywords colonoscopy, colorectal neoplasms, mass screening, occult blood, program evaluation, performance indicators, registries

Colonoscopy indications and findings in older adults

Aims: The share of older population is increasing globally. Colonoscopy is a frequently used diagnostic/therapeutic procedure, no study to our knowledge comprehensively examines the indications and findings of colonoscopy in geriatric population. We aimed to reveal these in older adults.&#x0D; Methods: Colonoscopy procedures performed in older adults (≥65 years), which covered a 5-year period (2017-2022), were analyzed retrospectively. Indications and findings of colonoscopies were assessed. The relationship between the indications and the associated findings was also evaluated on an indication basis.&#x0D; Results: In the study, 2370 colonoscopy procedures were examined. 27.8% were performed in very old (≥75 years) patients. Colonoscopy was completed in 84.3%. Colon cleansing was not optimal in approximately one-fourth. The frequency of completion of colonoscopies and optimal cleaning were similar in the very old. Iron deficiency anemia (IDA) or fecal occult blood test (FOBT) positivity and screening colonoscopy were the common indications. Regarding indications, IDA-FOBT positivity and bleeding were more frequent, screening colonoscopy, IBD and polyp control were less frequent in the very old group. Colonoscopy was reported as normal in 42.4% of the patients, while polyps (28.3%) and diverticula (17.5%) were the common findings. Among findings tumor, diverticula and solitary rectal ulcer were higher in the very old. IDA -FOBT positivity, bleeding, and colonoscopy performed due to findings of other imaging modalities were related to diagnosis of a tumor.&#x0D; Conclusion: In this study, we presented the indications and results of colonoscopy in a large number of older patients. The main indications for colonoscopy can be listed as IDA-FOBT positivity, screening colonoscopy and control of previous polyp-tumor. Near one of two colonoscopies were found to be normal, polyps and diverticula were the major pathologies in the rest. It should be emphasized that IDA -FOBT positivity, bleeding, and findings of other imaging modalities were related to tumor in colonoscopy.

Estimated Lifetime Gained With Cancer Screening Tests

Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests. To estimate lifetime gained with cancer screening. A systematic review and meta-analysis was conducted of randomized clinical trials with more than 9 years of follow-up reporting all-cause mortality and estimated lifetime gained for 6 commonly used cancer screening tests, comparing screening with no screening. The analysis included the general population. MEDLINE and the Cochrane library databases were searched, and the last search was performed October 12, 2022. Mammography screening for breast cancer; colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) for colorectal cancer; computed tomography screening for lung cancer in smokers and former smokers; or prostate-specific antigen testing for prostate cancer. Searches and selection criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were independently extracted by a single observer, and pooled analysis of clinical trials was used for analyses. Life-years gained by screening was calculated as the difference in observed lifetime in the screening vs the no screening groups and computed absolute lifetime gained in days with 95% CIs for each screening test from meta-analyses or single randomized clinical trials. In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, -190 to 237 days), prostate cancer screening (37 days; 95% CI, -37 to 73 days), colonoscopy (37 days; 95% CI, -146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, -70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, -286 days to 430 days). The findings of this meta-analysis suggest that current evidence does not substantiate the claim that common cancer screening tests save lives by extending lifetime, except possibly for colorectal cancer screening with sigmoidoscopy.

Knowledge and belief of fecal occult blood screening: A systematic review.

Colorectal cancer (CRC) is associated with a high incidence and mortality rate. Fecal occult blood test (FOBT) is effective in the prevention of CRC. This study aimed to assess knowledge and beliefs regarding FOBT-based screening. This study used PubMed, Cochrane Library, MEDLINE Complete, and Web of Science to search for articles. Original full-text studies in English language focusing on knowledge and beliefs of FOBT screening were included. A total of 32 articles were included. This study indicated that the population in most studies had inadequate knowledge and lacked beliefs toward FOBT-based screening. Most of the extracted studies showed that less than half of the participants had heard of FOBT-based screening. Six studies showed that less than 50% of participants had knowledge of FOBT age. Three studies found that less than 40% of participants were aware of the screening interval. Some participants perceived the benefits of FOBT-based screening, while others perceived many barriers to the test. Participants' knowledge and belief in FOBT-based screening were insufficient. This review highlights the importance of educational programs to increase knowledge and beliefs regarding FOBT-based screening. It is important to include FOBT-based screening in the health care system to promote the secondary prevention of CRC.

Coverage by examinations associated with early detection of colorectal neoplasia in the Czech Republic.

Coverage by examinations is a crucial indicator of the future impact on the burden of colorectal cancer (CRC). The study aimed to evaluate coverage by examinations associated with CRC screening and early cancer detection of CRC in the Czech Republic. The burden of CRC was also assessed. The novel nationwide administrative registry with individual data (period 2010-19) was used to evaluate coverage by examinations for screening faecal occult blood test and colonoscopy. In the second step, additional examinations for early CRC detection were included in the coverage calculation (complete coverage). Age-specific trends in CRC incidence (period 1977-2018) were investigated using Joinpoint regression. Coverage by screening examinations within recommended interval was around 30%. Complete coverage reached >37% and >50% at the 3-year interval. The coverage by examinations for the non-screening population aged 40-49 years was almost 4% and 5% (most of them were colonoscopies) at the 3-year interval. In age groups aged ≥50 years, we observed a significant annual decline, especially in the 50-69 age group, with recent annual decreases reaching up to 5-7%. The change in trend and the recent decline were also observed in the age group 40-49. More than half of the target screening population was covered by examinations potentially associated with early detection and subsequent treatment of colorectal neoplasms. The substantial coverage by potentially prophylactic examinations might be an explanation for the considerable decrease in CRC incidence.

Social determinants and participation in fecal occult blood test based colorectal cancer screening: A qualitative systematic review and meta-synthesis.

Colorectal cancer (CRC) screening through fecal occult blood testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations. PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to 22 June 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories. A total of 8,501 publications were identified and screened. A total of 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. SO WHAT?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers address the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions.

Colorectal Cancer Chemoprevention: A Dream Coming True?

Colorectal cancer (CRC) is one of the deadliest forms of cancer worldwide. CRC development occurs mainly through the adenoma-carcinoma sequence, which can last decades, giving the opportunity for primary prevention and early detection. CRC prevention involves different approaches, ranging from fecal occult blood testing and colonoscopy screening to chemoprevention. In this review, we discuss the main findings gathered in the field of CRC chemoprevention, focusing on different target populations and on various precancerous lesions that can be used as efficacy evaluation endpoints for chemoprevention. The ideal chemopreventive agent should be well tolerated and easy to administer, with low side effects. Moreover, it should be readily available at a low cost. These properties are crucial because these compounds are meant to be used for a long time in populations with different CRC risk profiles. Several agents have been investigated so far, some of which are currently used in clinical practice. However, further investigation is needed to devise a comprehensive and effective chemoprevention strategy for CRC.

Immunochemical Fecal Occult Blood Test Screening Results prior to Colorectal Cancer Diagnosis

Abstract Introduction/Objective Immunochemical fecal occult blood testing (iFOBT) is one of the options outlined by the standard of care guidelines from the U.S. Preventive Services Task Force (USPSTF) for screening for colorectal cancer in adults. The iFOBT assay is a convenient and reasonably accurate screening assay. It has been shown in the literature, through a metanalysis of iFOBT tests, that the overall sensitivity of iFOBT in the general population for detecting colorectal cancer within 2 years of follow-up across different medical settings is 0.79 (95% confidence interval 0.69-0.86). However, similar investigation in the veteran population is sparse, but would be important given the significant differences between the Veteran population and the general population including increased medical comorbidities. Methods/Case Report A search of all iFOBT testing performed at a regional Veteran Affairs Medical Center (VAMC) from 10/1/2018 to 6/4/2022 was performed to identify patients with both diagnosed colorectal cancer by pathology examination and iFOBT testing within 2 years prior to this diagnosis. The iFOBT result (at least one positive prior to diagnosis or always negative) prior to diagnosis with colorectal cancer was recorded once per patient. iFOBT results collected after the day the positive colorectal pathology specimen was obtained were excluded. Demographic information was also recorded. iFOBT testing was performed using the Polymedco assay product (Cortlandt Manor, NY). Results (if a Case Study enter NA) There were a total of 26 patients (25 males and 1 female) with diagnosed colorectal cancer. The patient age range was 37 to 88 years (average 70) with an ethnic composition of 12 of 26 (46%) African Americans, 13 of 26 (50%) Caucasian American, and 1 of 26 (4%) Native Hawaiian or other Pacific Islander American. 20 of the 26 patients (77%) of the patients had at least one positive iFOBT test result prior to their colorectal cancer diagnosis, which is within the published observation for the accepted sensitivity in the general population. Conclusion While there are differences between the general population and the veteran population in terms of medical comorbidities, the iFOBT test assay performed similarly to the general population in terms of sensitivity for colorectal cancer diagnosed within 2 years of the iFOBT assay and remains an important part of the standard of care for colorectal screening for both populations.

Perceived barriers and benefits in the participation in faecal occult blood test colorectal cancer screening programme

BackgroundColorectal cancer is the second cancer-related cause of death in the world. Tumour stage at diagnosis is the principal prognosis factor of survival. However, the participation in the programme is around 50%. The aim of the study was to identify the benefits and barriers perceived by the population when participating in a colorectal cancer screening programme with faecal occult blood test. MethodsWe carried out a cases–controls study with 408 participants. We analyzed epidemiological and social variables associated with lifestyle and behavioural factors based in the Health Belief Model. We conducted a descriptive analysis, and identified variables associated to adherence by a logistic regression. ResultsVariables independently associated with the participation in a colorectal cancer screening programme were age (OR 1.06; 95% CI: 1.01–1.11), having a stable partner (OR 1.96; 95% CI: 1.20–3.18), the level of education (OR 1.59; 95% CI: 1.02–2.47) and two of the barriers to participate in the faecal occult blood test screening: “you don’t know how to do one” (OR=0.46; 95% CI: 0.23–0.93) and “it is not that important right now” (OR=0.43; 95% CI: 0.24–0.78). ConclusionThe existing barriers for screening with faecal occult blood test are the best factor predicting. This is relevant when designing the intervention programmes, as they should focus on reducing perceived barriers to increase the participation in colorectal cancer screening, thereby reducing colorectal cancer mortality.

Benefit of Biennial Fecal Occult Blood Screening on Colorectal Cancer in England: A Population-Based Case-Control Study.

BackgroundThe English national bowel cancer screening program offering a guaiac fecal occult blood test began in July 2006. In randomized controlled trials of guaiac fecal occult blood test screening, reductions in mortality were accompanied by reductions in advanced stage colorectal cancer (CRC). We aimed to evaluate the effect of participation in the national bowel cancer screening program on stage-specific CRC incidence as a likely precursor of a mortality effect.MethodsIn this population-based case-control study, cases were individuals diagnosed with CRC aged 60-79 years between January 1, 2012, and December 31, 2013. Two controls per case were matched on geographic region, gender, date of birth, and year of first screening invitation. Screening histories were extracted from the screening database. Conditional logistic regression with correction for self-selection bias was used to estimate odds ratios (odds ratios corrected for self-selection bias [cOR]) and 95% confidence intervals (CIs) by Duke stage, sex, and age.Results14 636 individuals with CRC and 29 036 without were eligible for analysis. The odds of CRC (any stage) were increased within 30 days of a screening test and decreased thereafter. No reduction in CRC (any stage) among screened individuals compared with those not screened was observed (cOR = 1.00, 95% CI = 0.89 to 1.15). However, screened individuals had lower odds of Duke stage D CRC (cOR = 0.68, 95% CI = 0.50 to 0.93). We estimate 435 fewer Duke D CRC by age 80 years in 100 000 people screened biennially between ages 60 and 74 years compared with an unscreened cohort.ConclusionThe impact of colorectal screening on advanced CRC incidence suggests that the program will meet its aim of reducing mortality.

Ten-year changes in colorectal cancer screening in Switzerland: The Swiss Health Interview Survey 2007, 2012 and 2017

Recent recommendations for colorectal cancer (CRC) screening suggest fecal occult blood test (FOBT) or colonoscopy. Since 2013, mandatory health insurance in Switzerland reimburse CRC screening. We set out to determine if CRC testing rate and type of CRC screening changed in Switzerland from 2007 to 2017 and between the three main language regions. We extracted data on 50–75-year-olds from the Swiss Health Interview Survey (SHIS) 2007, 2012 and 2017 to determine rates of self-reported testing with FOBT within last 2 years and colonoscopy within last 10 years. We estimated prevalence ratio (PR) in multivariate-adjusted logistic regression models and compared rates in German-, French- and Italian-speaking regions, adjusting for sociodemographic, self-rated health and insurance variables. Overall testing rates (FOBT or colonoscopy) increased in all regions from 2007 to 2017 (German-speaking 33.6% to 48.3%; French-speaking 30.8% to 48.8%; Italian-speaking 37.9% to 46.8%), mainly because of an increase in colonoscopy rate for screening reasons (p < 0.001 in all regions). Rates of FOBT testing fell significantly in the German-speaking region (11.9% to 4.4%, p < 0.001), but not in the Italian- (13.9% to 8.5%, p = 0.052) and French-speaking regions (7.6% to 7.4%, p = 0.138). Overall CRC testing rate rose from 33.2% in 2007 to 48.4% in 2017, mainly because of an increase of colonoscopy rate for screening reasons. Coverage remains below the 65% target of European guidelines. Organized screening programs encouraging FOBT screening could contribute to further increasing the CRC testing rate.

A health action process approach for developing invitee endorsed interventions to increase mail‐out bowel cancer screening

Theory‐based, user‐informed interventions are needed to increase the low participation rates of population‐based faecal occult blood test (FOBT) bowel cancer screening. This study investigated the theoretical fit of the health action process approach (HAPA) for home FOBT screening and measured screening invitees' attitudes towards different intervention strategies. A cross‐sectional sample (n = 377), aged 50–74 years, participated in this study. Two scales were created for this study. The process approach to mail‐out screening (PAMS) scale measured HAPA constructs, and the user ratings of mail‐out screening interventions (UR‐MSI) scale measured attitudes towards different intervention strategies. Structural equation modelling was used to assess the fit of PAMS scale responses to the HAPA model, and descriptive statistics were calculated for UR‐MSI responses. PAMS results showed acceptable model fit, CFI = .968, RMSEA = .050 and explained 49.9% of the variation in FOBT screening participation. Positive ratings of interventions ranged from 20.47%, an intervention prompting planning to complete the FOBT kit, to 72.25%, an intervention promoting the positive health outcome associated with FOBT screening. Intervention strategies should be combined such that they target all factors specified within the HAPA model. User‐informed intervention design should be used to effectively facilitate FOBT uptake in the community.

The yield of fecal occult blood testing as a screening tool for colon cancer in a primary care setting.

The most common cancer among men and the third most common among women in Saudi Arabia is colon cancer. This study aimed to evaluate the yield of the fecal occult blood test (FOBT) used as a screening tool for colon cancer. Medical records of all patients above the age of 50 years who had visited the Family Medicine clinic at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia and who had undergone the FOBT screening between January 2002 and March 2017 were retrospectively reviewed. We collected patients' demographic data, FOBT results, and colonoscopy pathology reports results. Data were analyzed using the Statistical Package for Social Science Version 25 (IBM Corp., Armonk, NY, USA). We included 2179 patients in this study. The mean age was 59.8 ± 8 years. As a result of the FOBT screening, 19.7% of the patients had a positive FOBT. Colon cancer accounted for 3.5% of all abnormal colonoscopy pathology reports. The Saudi age-standardized incidence rate (ASIR) in our study was 26.56 per 100,000 persons. FOBT is a feasible tool that can be used for colon cancer screening in primary care settings. The Saudi ASIR in our study was higher than the Saudi Cancer Registry, but it was still lower in comparison to other countries. We recommend the establishment of a national community-based colon cancer screening program.

Factors associated with organized and non-organized colorectal cancer screening

Abstract Background Data on non-organized colorectal cancer screening using fecal occult blood tests (FOBTs) is currently lacking. We identified factors associated with organized and non-organized FOBT screening. Methods Data of 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017 were analyzed. Logistic regression with generalized estimating equations was used to assess associations between municipal characteristics and organized and non-organized screening coverages. Results Median organized screening coverage increased (36.4% to 40.1%) while non-organized screening coverage decreased (4.8% to 3.3%) in 2015-2017. Organized screening coverage was negatively associated with average income (OR = 0.97, 95%CI: 0.96-0.98) and percentage of people with a non-Belgian/Dutch nationality (OR = 0.962, 95%CI: 0.957-0.967). More older people (70-74) in the target screening population were related to lower coverages by both organized (OR = 0.98, 95%CI: 0.97-0.99) and non-organized screening (OR = 0.98, 95%CI: 0.96-0.999). Education level was positively associated with organized screening coverage (OR = 1.010, 95%CI: 1.008-1.011). While GP visit was positively associated with both organized and non-organized screening coverages, average number of patients per GP and having a global medical dossier handled by preferred GP showed more pronounced associations with non-organized screening (OR = 1.021, 95%CI: 1.016-1.026 and OR = 1.025, 95%CI: 1.018-1.031, respectively) compared to organized screening coverage. Conclusions Higher average income, lower average education level, more older people and people with foreign nationality were associated with lower organized screening coverage. GP involvement showed a positive association with non-organized screening. It seems that some GPs and screening-invited individuals are still not fully aware of the benefits of organized screening. Available instruments in screening programs should be optimized to fill this gap in knowledge. Key messages We identified factors associated with both organized and non-organized colorectal cancer screening using fecal occult blood tests (FOBTs). Based on this knowledge, strategies can be developed to promote screening among non-participants and encourage non-organized participants to switch to organized screening.

Sociodemographic features and patterns of non-participation in colorectal cancer screening in Finland

Colorectal cancer (CRC) screening was run as a randomized health services programme in Finland between 2004 and 2016. This study evaluates sociodemographic features and patterns of non-participation among men and women invited to be screened. The study population in this register-based study includes 233 211 men and women invited to guaiac faecal occult blood test screening on consecutive screening rounds (n = 708 621 invitations). A generalized estimating equation (GEE) was used to estimate incidence rate ratios (IRR) between sociodemographic features and non-participation. The overall proportion of non-participation was 31.6% and was higher in men (38.8%) than in women (24.6%). Birth cohort, education, marital status and country of birth were associated with non-participation. The birth cohort of 1950-54 was less likely to participate than the birth cohort of 1940-44. Men and women with primary education were more likely non-participants (IRR 1.26, CI 1.23-1.29 and IRR 1.22, CI 1.18-1.26, respectively) than men or women with tertiary education. Further, unmarried persons and immigrants had an increased risk of non-participation. Initial non-participation predicted subsequent behaviour, since, e.g. ∼80% of first-round non-participants also remained non-participants in the second round. Education, gender and marital status had a significant effect on non-participation in the CRC screening programme. As high and comprehensive participation is essential for a successful screening programme, attention should be paid in ensuring participation of all sociodemographic groups. Special efforts should be invested in those not participating in the first invitational round, since initial non-participation predicts non-participation to subsequent invitations.

Issue Highlights

Anti-tumor necrosis factor (TNF) biologics are an important class of treatment in patients with inflammatory bowel disease.1Singh S. Murad M.H. Fumery M. et al.First- and second-line pharmacotherapies for patients with moderate to severely active ulcerative colitis: an updated network meta-analysis.Clin Gastroenterol Hepatol. 2020; 18: 2179-2191Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Because of population aging and improved therapeutics, clinicians are seeing more elderly patients with indications for anti-TNF therapy. It is thus important to evaluate the safety and efficacy of these agents in the elderly population.2Beaugerie L. Rahier J.F. Kirchgesner J. Predicting, preventing, and managing treatment-related complications in patients with inflammatory bowel diseases.Clin Gastroenterol Hepatol. 2020; 18: 1324-1335Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar In this issue of Clinical Gastroenterology and Hepatology, Cheng and colleagues3Cheng D. Cushing K.C. Cai T. et al.Safety and efficacy of tumor necrosis factor antagonists in older patients with ulcerative colitis: patient-level pooled analysis of data from randomized trials.Clin Gastroenterol Hepatol. 2021; 19: 939-946Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar combined patient-level data from 4 clinical trials on the use of anti-TNF therapy in patients with ulcerative colitis. Among 2257 patients, 231 were 60 years or older. Although older patients receiving anti-TNF therapy were more likely to have severe adverse events or require hospitalizations than younger patients, there was no difference in infective complications. After induction therapy for 6 to 8 weeks, 20.3% of older patients and 25.1% of younger patients achieved clinical remission with anti-TNF therapy. There was a trend that anti-TNF therapy was less effective in maintaining clinical remission in the older population upon longer follow up, but the difference was not statistically significant. These data suggest that it is reasonable to start older patients with inflammatory bowel disease on anti-TNF therapy. The long-term remission rate in this population deserves further studies. See page 939. Current guidelines recommend regular colorectal cancer (CRC) screening in average-risk individuals starting at 45 or 50 years of age.4Melson J.E. Imperiale T.F. Itzkowitz S.H. et al.AGA White Paper: Roadmap for the future of colorectal cancer screening in the United States.Clin Gastroenterol Hepatol. 2020; 18: 2667-2678Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Among the screening modalities, fecal occult blood test is relatively simple and has been shown to reduce CRC mortality in randomized controlled trials. The benefits of fecal occult blood test screening in different patient groups are incompletely understood. Shaukat and colleagues5Shaukat A. Kaalby L. Baatrup G. et al.Effects of screening compliance on long-term reductions in all-cause and colorectal cancer mortality.Clin Gastroenterol Hepatol. 2021; 19: 967-975Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar combined data from the Minnesota Colon Cancer Control Study in the USA and the Funen Fecal Occult Blood Trial in Denmark. During a follow-up of 30 years, people who remained adherent to fecal occult blood test screening had a 16% and 2% relative risk reduction in CRC mortality and all-cause mortality, respectively. Overall, among those adherent to screening, the reduction in CRC mortality was more pronounced in men than women. The greatest reduction in CRC mortality was observed in men aged 60 to 69 years and women aged 70 years or older. This study highlights the importance of adherence when one chooses fecal occult blood test for CRC screening, and provides long-term data on the clinical benefits in various subgroups. This article is highlighted by an editorial by Emma C. Robbins and Amanda J. Cross.6Robbins E.C. Cross A.J. Guaiac fecal occult blood tests and mortality: A 30-year follow-up of two pooled trials.Clin Gastroenterol Hepatol. 2021; 19: 892-894Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar See pages 892 and 967. In colorectal cancer screening, the adenoma detection rate during colonoscopy is an important quality metric that correlates with missed lesions and interval cancers.7Forbes N. Boyne D.J. Mazurek M.S. et al.Association between endoscopist annual procedure volume and colonoscopy quality: systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2020; 18: 2192-2208Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,8Mangas-Sanjuan C. Santana E. Cubiella J. Rodríguez-Camacho E. et al.Variation in colonoscopy performance measures according to procedure indication.Clin Gastroenterol Hepatol. 2020; 18: 1216-1223Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Likewise, the neoplasia detection rate, defined as the percentage of patients found to have high-grade dysplasia or esophageal adenocarcinomas during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with Barrett’s esophagus as these lesions are easily missed. Dhaliwal and colleagues9Dhaliwal L. Codipilly D.C. Gandhi P. et al.Neoplasia detection rate in Barrett’s Esophagus and its impact on missed dysplasia: results from a large population-based database.Clin Gastroenterol Hepatol. 2021; 19: 922-929Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar examined data from the Rochester Epidemiology Project that included patients from 11 counties of southeastern Minnesota. Among 1066 patients with Barrett’s esophagus confirmed by endoscopy and histology, the neoplasia detection rate was 4.9%. Older age, male sex, smoking, longer length of Barrett’s esophagus, and endoscopies performed by gastroenterologists were factors associated with the detection of neoplasia. From 1996 to 2018, the percentage of patients having low-grade and high-grade dysplasia increased over time. Three hundred ninety patients with no high-grade dysplasia or esophageal adenocarcinoma at baseline underwent a follow-up endoscopy within 12 months, among whom 8 had neoplasia at the second endoscopy suggestive of missed lesions during the index assessment, yielding a missed rate of 13%. The real-world data suggest a lower neoplasia detection rate than previously reported in tertiary centers. Future studies should examine the neoplasia detection rate at the endoscopist level and define its use as a quality metric. This article is highlighted by an editorial by Swathi Eluri and Nicholas J. Shaheen.10Eluri S. Shaheen N.J. Measuring quality in Barrett’s endoscopy.Clin Gastroenterol Hepatol. 2021; 19: 889-891Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar See pages 889 and 922. Nonalcoholic fatty liver disease (NAFLD) is a common condition that predisposes to cirrhosis of the liver, hepatocellular cancer, as well as suboptimal cardiovascular outcomes.11Geier A. Rinella M. Balp M.-M. McKenna S.J. Brass C.A. Przybysz R. Cai J. Knight A. Gavaghan M. Howe T. Rosen D. Ratziu V. Real-World Burden of Nonalcoholic Steatohepatitis.Clin Gastroenterol Hepatol. 2021; 19: 1020-1029Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 12Younossi Z. Stepanova M. Ong J.P. et al.global nonalcoholic steatohepatitis council. nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates.Clin Gastroenterol Hepatol. 2019; 17: 748-755Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar, 13Baratta F. Pastori D. Angelico F. et al.Nonalcoholic fatty liver disease and fibrosis associated with increased risk of cardiovascular events in a prospective study.Clin Gastroenterol Hepatol. 2020; 18: 2324-2331Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar In Asia, a significant proportion of patients with NAFLD are lean with normal body mass index (BMI). Although a few studies suggest the same may be true in North America, data are scarce. Besides, there are conflicting data on the severity of NAFLD and clinical outcomes in the lean population. Weinberg and colleagues analyzed the TARGET NASH cohort, a multicenter study of real-world 3386 patients with NAFLD.14Weinberg E.M. Trinh H.N. Firpi R.J. et al.Lean Americans with nonalcoholic fatty liver disease have lower rates of cirrhosis and comorbid diseases.Clin Gastroenterol Hepatol. 2021; 19: 996-1008Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Although the majority of patients were obese, 12.8% were lean and 27.1% were overweight. Overall, lean patients had milder liver and metabolic diseases. Compared with overweight and obese patients, lean patients with NAFLD were less likely to have cirrhosis, diabetes, hypertension, dyslipidemia, and history of cardiovascular disease. Regardless of BMI, Asian patients were also less likely to have cirrhosis and the metabolic conditions. Clinicians should be aware of NAFLD in lean patients, particularly if they have concomitant risk factors. However, on the whole, they are less likely to have cirrhosis and metabolic comorbidities. See page 996. Lean Americans With Nonalcoholic Fatty Liver Disease Have Lower Rates of Cirrhosis and Comorbid DiseasesClinical Gastroenterology and HepatologyVol. 19Issue 5PreviewNonalcoholic fatty liver disease (NAFLD) is typically associated with obesity. Little is known about the prevalence of cirrhosis in patients with NAFLD and a normal body mass index (BMI). Full-Text PDF Neoplasia Detection Rate in Barrett’s Esophagus and Its Impact on Missed Dysplasia: Results from a Large Population-Based DatabaseClinical Gastroenterology and HepatologyVol. 19Issue 5PreviewIt is a challenge to detect dysplasia in Barrett’s esophagus (BE) and esophageal adenocarcinomas (EACs) are missed in 25%–33% of cases. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or EAC detection during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with BE. However, current estimates are from referral center cohorts, which might overestimate NDR. Effects on rates of missed dysplasia are also unknown. Full-Text PDF Effects of Screening Compliance on Long-term Reductions in All-Cause and Colorectal Cancer MortalityClinical Gastroenterology and HepatologyVol. 19Issue 5PreviewRandomized trials have shown that biennial fecal occult blood test (FOBT) screening reduces mortality from colorectal cancer (CRC), but not overall mortality. Differences in benefit for men vs women, and by age, are unknown. We sought to evaluate long-term reduction in all-cause and CRC-specific mortality in men and women who comply with offered screening, and in different age groups, using individual participant data from 2 large randomized trials of biennial FOBT screening, compared with an intention to treat analysis. Full-Text PDF Safety and Efficacy of Tumor Necrosis Factor Antagonists in Older Patients With Ulcerative Colitis: Patient-Level Pooled Analysis of Data From Randomized TrialsClinical Gastroenterology and HepatologyVol. 19Issue 5PreviewTreatment of older patients (more than 60 years) with ulcerative colitis (UC) can be a challenge, because they might be more vulnerable to adverse events (AEs). We determined the effects of age on the safety and efficacy of anti-tumor necrosis factor (TNF) therapy in a pooled analysis of data from randomized trials. Full-Text PDF

Estimation of overdiagnosis in colorectal cancer screening with sigmoidoscopy and faecal occult blood testing: comparison of simulation models

ObjectiveTo estimate overdiagnosis of colorectal cancer (CRC) for screening with sigmoidoscopy and faecal occult blood testing (FOBT).DesignSimulation study using data from randomised trials.SettingPrimary screening, UK, NorwayParticipants152 850 individuals from the...

Colorectal Cancer Screening: Knowledge and Practice among Private General Practitioners in Northeast Peninsular Malaysia

Colorectal cancer screening is an important screening to detect colorectal cancer. Thus, the aim of this study is to determine the knowledge, practice and its associated factors of colorectal cancer screening among private general practitioners (PGPs) in Northeast Peninsular Malaysia. Crosssectional study was conducted involving 127 PGPs in Kelantan. The study used a validated selfadministrated questionnaire that contained three domains. The domains were sociodemographic, knowledge and practice of colorectal cancer screening. The inclusion criterion was doctors working in a private clinic for more than six months, while the exclusion criteria were non-residential doctors and doctors practicing in private specialised clinics. Only 21.3% of PGPs had good knowledge and 3.9% had good practice on colorectal cancer screening. The duration of practice as a PGP was significantly associated with good practice for colorectal cancer screening. Only 58.3% were aware of the current recommendation on colorectal cancer screening. Most PGPs would refer patients for a colonoscopy, but screening with faecal occult blood test (FOBT) in average-risk patients was low. Only 4% of PGPs followed the recommended guidelines for colorectal cancer screening. The main reasons for not offering FOBT screening were patients’ refusal, patients were not regular patients of the doctor and the referral system for colonoscopy was found to be difficult. This study noted that knowledge and practice of colorectal cancer screening among PGPs were inadequate. Overcoming barriers for screening is important to promote colorectal cancer screening.

Microbiome Analysis of More Than 2,000 NHS Bowel Cancer Screening Programme Samples Shows the Potential to Improve Screening Accuracy.

There is potential for fecal microbiome profiling to improve colorectal cancer screening. This has been demonstrated by research studies, but it has not been quantified at scale using samples collected and processed routinely by a national screening program. Between 2016 and 2019, the largest of the NHS Bowel Cancer Screening Programme hubs prospectively collected processed guaiac fecal occult blood test (gFOBT) samples with subsequent colonoscopy outcomes: blood-negative [n = 491 (22%)]; colorectal cancer [n = 430 (19%)]; adenoma [n = 665 (30%)]; colonoscopy-normal [n = 300 (13%)]; nonneoplastic [n = 366 (16%)]. Samples were transported and stored at room temperature. DNA underwent 16S rRNA gene V4 amplicon sequencing. Taxonomic profiling was performed to provide features for classification via random forests (RF). Samples provided 16S amplicon-based microbial profiles, which confirmed previously described colorectal cancer-microbiome associations. Microbiome-based RF models showed potential as a first-tier screen, distinguishing colorectal cancer or neoplasm (colorectal cancer or adenoma) from blood-negative with AUC 0.86 (0.82-0.89) and AUC 0.78 (0.74-0.82), respectively. Microbiome-based models also showed potential as a second-tier screen, distinguishing from among gFOBT blood-positive samples, colorectal cancer or neoplasm from colonoscopy-normal with AUC 0.79 (0.74-0.83) and AUC 0.73 (0.68-0.77), respectively. Models remained robust when restricted to 15 taxa, and performed similarly during external validation with metagenomic datasets. Microbiome features can be assessed using gFOBT samples collected and processed routinely by a national colorectal cancer screening program to improve accuracy as a first- or second-tier screen. The models required as few as 15 taxa, raising the potential of an inexpensive qPCR test. This could reduce the number of colonoscopies in countries that use fecal occult blood test screening.