Incidence Of CRC Research Articles

Abstract 2783: Increased tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) expression in normal colonic mucosa with imipridone ONC201/TIC10 treatment: A potential biomarker for chemoprevention studies

Abstract Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States and currently the most effective method at reducing risk of death is through screening. Although these strategies have reduced the incidence of CRC, they are invasive, costly, and have low rates of compliance. Chemoprevention aims to prevent or delay the onset of CRC through eradication or prevention of precursor colonic adenomas, ideally with affordable and nontoxic drugs. The imipridone ONC201, which induces apoptosis, in part, through upregulation of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), is currently undergoing preclinical evaluation as a potential chemopreventive agent. In preclinical models, we found that treatment with ONC201 is capable of increasing TRAIL expression in normal cells and can improve tumor suppression through immune surveillance by the innate immune system. To further assess potential biomarkers of response to ONC201, we evaluated expression of TRAIL and death receptor 5 (DR5), as well as markers related to cellular stemness such as LGR5 in colonic mucosa obtained from mice treated with ONC201 and vehicle controls. In this study, 16-week-old female C57BL/6 mice were administered vehicle or ONC201 50mg/kg (n=11) body weight by oral gavage twice a week for a total of five doses. Both immunohistochemistry and western blotting were used to evaluate differential expression of various potential biomarkers in both fresh frozen and FFPE colonic tissue. Using western blotting we found a significant increase in TRAIL expression in normal colonic mucosa obtained from mice treated with ONC201 as compared to vehicle controls. This finding was further validated using immunohistochemistry. Other markers, such as DR5 appeared unaffected with treatment. As efforts are currently underway to develop a CRC chemoprevention trial using ONC201, TRAIL may represent a biomarker of interest. Further analysis of stemness markers, as well as serum analyses are currently in process and may reveal other potential biomarkers for use in chemoprevention trial development. Citation Format: Alexander G. Raufi, Arielle De La Cruz, Andrew George, Sean Hacking, Venkateshwar Madka, Varun Prabhu, Howard Safran, Lanlan Zhou, Dean Brenner, Chinthalapally V. Rao, Wafik S. El-Deiry. Increased tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) expression in normal colonic mucosa with imipridone ONC201/TIC10 treatment: A potential biomarker for chemoprevention studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2783.

Early-Onset Colorectal Cancer Incidence, Staging, and Mortality in Canada: Implications for Population-Based Screening.

The incidence of early-onset colorectal cancer (eoCRC) has been increasing in North America. Debate remains as to whether the trends by topography, histology, stage, or mortality in this population are amenable to intervention from screening. CRC incidence (2000-2017) and mortality (2000-2018) data were obtained from the Canadian Cancer Registry and Vital Statistics. Annual percentage changes (APC) in the incidence (topography and histology) and mortality of eoCRC were estimated using joinpoint regression. Incidence of late-stage CRC (III or IV) versus early-stage CRC (I or II) was compared between the eoCRC (age 20-49 years) and eligible screening (age 50-74 years) groups with Poisson regression. Among women aged 20-49 years, the incidence of CRC significantly increased from 2000 to 2017 in both the distal colon (APC = 1.40) and rectum (APC = 3.00), whereas for men aged 20-49 years, the CRC incidence increased in the proximal colon (APC = 1.10), distal colon (APC = 3.00), and rectum (APC = 3.70). Among both men and women aged 20-49 years, the incidence of nonmucinous adenocarcinomas significantly increased (APC: 1.90 and 2.30, respectively), whereas mucinous adenocarcinomas decreased for women (APC = -1.60) and remained stable for men. Adults aged 30 to 49 years, when diagnosed with CRC, had a significantly higher risk of being diagnosed with a late-stage CRC compared with those in the age group of 50-74 years. Rectal cancer mortality increased from 2000 to 2018 in the eoCRC group (APC for women and men 3.80 and 3.40, respectively). Emerging data support future modifications to guidelines on screening for eoCRC in Canada. Further research is required on the effect, cost-effectiveness, and risk prediction for targeted screening within this group.

Early-Age-Onset Colorectal Cancer in Canada: Evidence, Issues and Calls to Action.

The inaugural Early-Age-Onset Colorectal Cancer Symposium was convened in June 2021 to discuss the implications of rapidly rising rates of early-age-onset colorectal cancer (EAO-CRC) in Canadians under the age of 50 and the impactful outcomes associated with this disease. While the incidence of CRC is declining in people over the age of 50 in Canada and other developed countries worldwide, it is significantly rising in younger people. Canadians born after 1980 are 2 to 2.5 times more likely to be diagnosed with CRC before the age of 50 than previous generations at the same age. While the etiology of EAO-CRC is largely unknown, its characteristics differ in many key ways from CRC diagnosed in older people and warrant a specific approach to risk factor identification, early detection and treatment. Participants of the symposium offered directions for research and clinical practice, and developed actionable recommendations to address the unique needs of these individuals diagnosed with EAO-CRC. Calls for action emerging from the symposium included: increased awareness of EAO-CRC among public and primary care practitioners; promotion of early detection programs in younger populations; and the continuation of research to identify unique risk factor profiles, tumour characteristics and treatment models that can inform tailored approaches to the management of EAO-CRC.

The global, regional, and national burden and quality of care index (QCI) of colorectal cancer; a global burden of disease systematic analysis 1990-2019.

BackgroundColorectal cancer (CRC) is among the five most incident and lethal cancers in world and its burden varies between countries and sexes. We aimed to present a comprehensive measure called the quality of care index (QCI) to evaluate the inequity and healthcare quality of care regarding CRC by sex and location.MethodsData on the burden of CRC were extracted from the Global Burden of Disease study 2019. It was transformed to four ratios, including mortality-to-incidence, disability-adjusted life years (DALYs)-to-prevalence, prevalence-to-incidence, and years of life lost (YLLs)-to-years lived with disability (YLDs). Principal component analysis was implemented on the four ratios and the most influential component was considered as QCI with a score ranging from zero to 100, for which higher scores represented better quality of care. Gender Disparity Ratio (GDR) was calculated by dividing QCI for females by males.ResultsThe global incidence and death numbers of CRC were 2,166,168 (95% uncertainty interval: 1,996,298–2,342,842) and 1,085,797 (1,002,795–1,149,679) in 2019, respectively. Globally, QCI and GDR values were 77.6 and 1.0 respectively in 2019. There was a positive association between the level of quality of care and socio-demographic index (SDI) quintiles. Region of the Americas and African Region had the highest and lowest QCI values, respectively (84.4 vs. 23.6). The QCI values started decreasing beyond the age of 75 in 2019 worldwide.ConclusionThere is heterogeneity in QCI between SDI quintiles. More attention should be paid to people aged more than 75 years old because of the lower quality of care in this group.

The Mayo Endoscopic Score Is a Novel Predictive Indicator for Malignant Transformation in Ulcerative Colitis: A Long-Term Follow-Up Multicenter Study

BackgroundData on the relative risk of malignant transformation in ulcerative colitis (UC) are insufficient. We investigated the potential value of the Mayo endoscopic score (MES) for predicting malignant transformation in patients with UC.MethodsData of patients with UC evaluated at our institute from June 1986 to December 2019 were retrospectively analyzed. The MES used in the study indicated the results of the first colonoscopy after hospitalization. We defined MES of 0–1 as low and MES of 2–3 as high. Univariable and multivariate logistic regression models were used for statistical analysis.ResultsAmong the 280 eligible patients with UC with a median follow-up time of 14 (interquartile range, 10.0–18.0) years, those with a high MES were more likely to develop malignant transformation. High MES positively correlated with the degree of malignancy and was an independent risk factor for UC-associated dysplasia and colorectal cancer (CRC, odds ratio [OR], 9.223; 95% confidence interval [CI], 1.160–73.323; p = 0.036). Disease duration >5 years (OR, 2.05; 95% CI, 1.177–3.572; p = 0.011), immunomodulator use (OR, 4.314; 95% CI, 1.725–10.785; p = 0.002), biologics nonuse (OR, 3.901; 95%CI, 2.213–6.876; p < 0.001), and Hb <90 g/L (OR, 2.691; 95% CI, 1.251–5.785; p = 0.011) were contributing factors for high MES.ConclusionHigh MES could be a novel predictor of malignant transformation in UC. Clinicians should optimize the use of biologics and immunomodulators early and should actively correct anemia to improve the MES and then reduce the incidence of UC-associated dysplasia and CRC.

Association between tumor mutation profile and clinical outcomes among Hispanic-Latino patients with metastatic colorectal cancer.

17 Background: According to the World Health Organization GLOBOCAN database, in 2019, approximately 1.8 million new colorectal cancer cases were diagnosed, and almost 861,000 deaths were reported. In the United States, CRC is the third most frequent type of cancer and the second leading cause of cancer-related death. Although the overall incidence of CRC among the Hispanic population has been declining over the last decades, recently, a dramatic increase in CRC incidents among Hispanics younger than 50 years of age (early-onset CRC) has been reported. The increase in the incidence of early-onset CRC is markedly more significant in Hispanic-Latino (HL) patients population (45%) than in non-Hispanic Whites (NHW) (27%) and African-Americans (AA) (15%). Additionally, in contrast to NHW, Hispanics have a worse survival rate. The exact reason for these racial disparities and the biology of CRC in the HL population are not well understood. Therefore, we performed this study to better understand the biology of the disease in HL patients, which might help to identify new directions for targeted therapy. Methods: For the study, 52 formalin-fixed paraffin-embedded (FFPE) tumor tissue samples were collected and analyzed. We compared the results with individual patient clinical histories and outcomes. Of 52 patients with mCRC, 52 (100%) were identified as HL. We identified several commonly altered genes in HL patients ( APC, TP53, KRAS, GNAS, PICK3CA, and NOTCH). Compared to those in other studies. Results: Mutation frequencies in the APC gene were significantly higher among HL patients with mCRC. Moreover, the prevalence of the APC mutation was significantly higher among male HL patients compared to female patients. The combination of mutations in the APC, NOTCH, and KRAS genes in the same tumors was associated with a higher risk of progression after the first-line of chemotherapy and worse overall survival. In addition, mutations in the combination of GNAS and AURKA genes were associated with a significantly higher risk of progression after the first-line of chemotherapy. Conclusions: The data support the notion that the molecular drivers of colon cancer might be different in HL patients compared to other racial/ethnic groups.

Colorectal cancer incidence in Texas border versus non-border counties.

21 Background: There are 32 counties and 2.8 million people in the Texas border region. The population is 88.4% Hispanic with estimates that 47% lack health insurance - not including non-US citizens, who are more likely to lack health insurance than US citizens. In 2014, 7 of the 20 US counties with the lowest CRC screening rates were in Texas, 6 of which were Texas border counties. It is unknown how the incidence of CRC in Texas border counties has changed over time compared to non-border counties. In this study, we investigate changes in the incidence of CRC in Texas border counties between 2000 and 2017. Methods: Data were obtained from the Texas Department of State Health Service’s Texas Cancer Registry. Cases of patients aged 18 or older between 2000 and 2017 were included in our analysis. Cases were excluded if they contained incomplete information regarding age, sex, year of diagnosis, site of diagnosis or poverty level. Simple descriptive statistics were calculated for all covariates. Chi-square tests of independence were created to examine the association between each categorical variable and border county status. Age-adjusted incidence rates (AAIR) were created for the state overall and by border status. SAS v9.4 was used for all data analysis. Results: In border counties from 2000 to 2017, the overall AAIR decreased from 65.9 (per 100,000) to 56.7. In those 50-64 years old and 65 years and older residing in border counties, the AAIR increased from 63.3 to 78.1 and decreased from 244 to 176.1, respectively. In non-border counties from 2000 to 2017, the overall AAIR decreased from 85.2 (per 100,000) to 57.3. In those 50-64 years old and 65 years and older residing in non-border counties, the AAIR decreased from 94.9 to 78.0 and from 303 to 168.5, respectively. Conclusions: The overall AAIR of CRC was lower in Texas border counties compared to non-border counties, which is likely a consequence of lower screening rates in border counties. The overall AAIR decreased at a slower rate in Texas border counties compared to non-border counties, which may represent lower rates of utilization of CRC screening over time in border counties. The increase in the AAIR among those 50-64 years old in Texas border counties warrants further investigation.

Association Between Tumor Mutation Profile and Clinical Outcomes Among Hispanic-Latino Patients With Metastatic Colorectal Cancer.

In the United States, CRC is the third most common type of cancer and the second leading cause of cancer-related death. Although the incidence of CRC among the Hispanic population has been declining, recently, a dramatic increase in CRC incidents among HL younger than 50 years of age has been reported. The incidence of early-onset CRC is more significant in HL population (45%) than in non-Hispanic Whites (27%) and African-Americans (15%). The reason for these racial disparities and the biology of CRC in the HL are not well understood. We performed this study to understand the biology of the disease in HL patients. We analyzed formalin-fixed paraffin-embedded tumor tissue samples from 52 HL patients with mCRC. We compared the results with individual patient clinical histories and outcomes. We identified commonly altered genes in HL patients (APC, TP53, KRAS, GNAS, and NOTCH). Importantly, mutation frequencies in the APC gene were significantly higher among HL patients. The combination of mutations in the APC, NOTCH, and KRAS genes in the same tumors was associated with a higher risk of progression after first-line of chemotherapy and overall survival. Our data support the notion that the molecular drivers of CRC might be different in HL patients.

Age-standardised incidence rate and epidemiology of colorectal cancer in Africa: a systematic review and meta-analysis

ObjectivesColorectal cancer (CRC) is the second-leading cause of cancer deaths globally, with low-income and middle-income countries (LMICs) disproportionately affected. Estimates of CRC rates in LMIC are scarce. We aimed to...

Abstract PO-247: Is colorectal cancer screening in West Africa worthwhile? A prospective multi-institutional study of 2,330 average-risk Nigerians using fecal immunochemical testing (FIT)

Abstract Objective: The estimated incidence of CRC is rising in many African countries. In Nigeria, it is the fourth most common cause of cancer death. More than half of CRC patients in Nigeria present with metastatic disease. Early detection and screening for CRC is a goal of the Nigerian National Cancer Control Plan. This study assessed the performance of the fecal immunochemical test (FIT) as a CRC screening modality in an average-risk population in Nigeria. Methods: A population-based, cross-sectional study of FIT-based CRC screening was undertaken. Asymptomatic average-risk participants aged 45-75 years in three states in Southwest Nigeria were screened using a qualitative (50ng/mL) FIT test. Participants were invited to enroll using age- and sex-stratified convenience sampling following community outreach. Participants with positive test results underwent colonoscopy and the positive predictive value (PPV) of FIT-based CRC screening for CRC and advanced adenomas (tubulovillous, villous or high grade dysplasia) was calculated. Information on demographics, cancer knowledge, and acceptability of the FIT test and colonoscopy were also collected. Results: Between January-April 2021, 2330 participants in 3 states (Osun, Kwara, Lagos) were enrolled in the study. The median age was 57 years. 68% had at least secondary level education. Participants were evenly spread across wealth quintiles. Baseline knowledge of CRC symptoms among participants was low, especially outside of Lagos. The test return rate was 90.6%, and FIT positivity rate was 20.5% overall (n=432); 11.2% in Lagos, 20.4% in Osun, and 27.8% in Kwara states. Among the FIT positive patients who completed colonoscopy (n=285; 66.0%), the positive predictive value (PPV) for invasive adenocarcinoma was 1.1%, and for advanced adenoma was 1.8%.[KTP1] [AD2] The acceptability of fecal-based CRC screening among participants was very high. Conclusions: CRC screening with qualitative FIT testing in Southwest Nigeria is feasible and acceptable to average-risk asymptomatic participants. The high false-positive rates and low PPV for advanced neoplasia, however, suggest it is not an optimal screening tool in this environment, particularly given the health resources required for endoscopic evaluation. Citation Format: Olusegun I. Alatise, Anna J. Dare, Patrick A. Akinyemi, Fatima B. Abdulkareem, Samuel A. Olatoke, Gregg C. Knapp, Peter T. Kingham. Is colorectal cancer screening in West Africa worthwhile? A prospective multi-institutional study of 2,330 average-risk Nigerians using fecal immunochemical testing (FIT) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-247.

Colorectal cancer screening by fecal immunochemical test or colonoscopy in France: how many people are actually covered? Focus on the Provence-Alpes-Côte d'Azur region.

BackgroundColorectal cancer (CRC) screening with fecal immunochemical test (FIT) remains low in France, particularly in the Provence-Alpes-Côte-d’Azur (PACA) region. The aim of this study was to compare insured persons (50–74 years) who had FIT and/or colonoscopy in PACA with the general French population.MethodsFIT and colonoscopy rates were calculated according to SP-France and National Health Data System data.ResultsThe rate of FIT in 2016–2017 was lower in PACA than in France (25.6 vs. 29.1%, P < 0.001). Conversely, in 2013–2017, the rate of colonoscopy in the past 5 years was higher in PACA than in France (23.1 vs. 20.1%, P < 0.001). Total rate for FIT within 2 years and/or colonoscopy within 5 years was 46.0% in PACA vs. 46.5% in France (P < 0.001). Overuse was higher for diagnostic (1.21) than therapeutic colonoscopies (1.05). Therapeutic colonoscopy occurred more with FIT than without (47.88 vs. 38.7%, P < 0.001). According to USA criteria, persons with FIT within 2 years and/or sigmoidoscopy and/or colonoscopy within 10 years was 59.4% in PACA vs. 54.7% in France (P < 0.001).ConclusionLow participation in FIT in France must be improved to increase the rate of therapeutic colonoscopies and reduce the incidence of CRC. The higher colonoscopy rate in PACA could explain the lower CRC mortality. Efforts should be focused on the more than 40% of French insured who are not screened by either FIT or colonoscopy.

Bioinformatically Prediction of the miRNAs Targeting BCL9,FRMD6 Genes in Colorectal Cancer

CRC is a malignancy with no significant symptoms such as bleeding or abdominal pain, and the condition is usually diagnosed when the tumor growth makes the treatment difficult. The survival of CRC patients depends on the disease progression. Most of the CRCs begin with an unbalanced and noncancerous growth of a polyp. CRC may be prevented if the polyps are removed from the colon. Screening reduces the incidence and mortality of CRC. As the miRNAs play a significant role in the regulation of the cellular procedures, this study aims to predict the miRNAs, targeting the BCL9,FRMD6 genes , using bioinformatics tools. After getting the BCL9,FRMD6 protein chain from the NCBI database, the miRNAs targeting the genes were predicted using TargetScan, miRDB, DIANA and miRWalk databases using different algorithms. Based on the scoring system of the bioinformatics software and considering the best targeting scores, (hsa-miR-30e-5p , hsa-miR-30d-5p) and (hsa-miR-106b-5p , hsa-miR-106a-5p) are suggested as the potential miRNAs, targeting the BCL9,FRMD6 genes for future researches. Considering the significant role of the BCL9,FRMD6 genes on Colorectal cancer, the predicted miRNAs can be used as the molecular biomarkers for the early detection of Colorectal cancer patients.

Impact on invitation and participation in the CRC screening in the Basque Country due to Covid19

Abstract Background The colorectal cancer screening programme (BCSP) obtains excellent participation rate, reflected in early detection and treatment of pre &amp; malignant lesions, objectifying a downward trend in incidence &amp; mortality rates Objectives To compare invitation coverage and impact on participation with faecal immunochemical test (FIT) pre&amp;post pandemic. To compare the participation rate in Primary Care Units (UAP) in which the invitation and FIT pickup was interrupted with those that were not, in order to design prioritization strategies in the face of another lockdown Methods Retrospective cohort study of invitations from 2018-2020. Indicators of coverage and participation rate to COVID 19, during the interruption due to lockdown, and subsequent invitations sent out without interruption afterwards. Data analysis R version 4.0.1 stats and MKinfer Results 40% of the planned invitations were taken up (81,097/200,000) showing a decrease in participation rate (71.9/68.8%) P ≤ 0.05 95% CI(2.79-3.52), with significant differences in all groups by age and sex. In the comparative analysis between UAPs that interrupted test collection in March resumed in June or when the invitation was made without interruption (September to December), higher participation rates were observed in the group that did not interrupt the screening (68.1/69.8%) P ≤ 0.05 95%CI (1.18-2.23), with differences in all groups of age and sex. In order to reorganize the activity, agreements were made:1)prioritization of screening colonoscopies, 2)reduce the burden of follow-up colonoscopies based on the evidence. Advanced lesions, has passed from 1 to 3ys, and only the resection in piecemeal ≥20mm sessile is done in under 1y Conclusions The Covid-19 pandemic has affected the BCSP with a decrease in scheduled invitations, but only a slight decrease in the participation rate. The impact is lower if the collection of FIT samples is not interrupted. If a new lockdown is needed, we will not stop the collection of FITs Key messages The Covid-19 pandemic has affected the BCSP adn will impact in incidence and mortality of CRC. The impact is lower if the collection of FIT samples is not interrupted.

Association between metabolic syndrome and incident colorectal cancer in young adults: analysis of a nationwide epidemiological database

Abstract Background Colorectal cancer (CRC) is still increasing in young adults. Metabolic syndrome is reported to be associated with CRC incidence in middle-aged and elderly subjects. However, whether this association exists in young adults remains unclear. We sought to clarify whether metabolic syndrome was associated with incident CRC in young adults (aged&amp;lt;50 years). Methods We studied 902,599 participants (Median age=41 [37–45] years; 55.4% men) enrolled in the JMDC Claims Database during 2005 and 2018. Participants who had a history of CRC, colorectal polyps, Crohn's disease, or ulcerative colitis were excluded. Study participants were categorized into two groups according to the presence of metabolic syndrome based on the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). Results Metabolic syndrome was seen in 58,561 individuals (6.5%). Over a median follow-up of 1,008 (429–1,833) days, there were 1,884 CRC diagnoses. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI]=1.07–1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR=1.35, 95% CI=1.17–1.56), and metabolic syndrome was associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR=1.33, 95% CI=1.10–1.60). This association was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR=1.30, 95% CI=1.09–1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR=1.39, 95% CI=1.12–1.72). Conclusions Metabolic syndrome was associated with a higher incidence of CRC among individuals aged &amp;lt;50 years. These results could be informative for risk stratification of subsequent CRC among young adults. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141)

Colorectal Cancer screening in ambulatory healthcare service clinics in Abu Dhabi, United Arab Emirates in 2015\u20132016

BackgroundColorectal cancer (CRC) is a major public health issue due to high morbidity and mortality. Different screening programs were implemented to reduce its burden.ObjectivesTo estimate the prevalence of CRC screening uptake using fecal immunochemical test (FIT) or guaiac fecal occult blood testing (gFOBT) in Emirati nationals. Other objectives were to measure the incidence of CRC in the screened population, to measure the outcomes of follow-up screening colonoscopy after positive FIT/gFOBT and to identify the causes of not performing follow-up screening colonoscopy after positive FIT/gFOBT.MethodologyAdult Emirati nationals aged 40–75 years who visited Ambulatory healthcare services clinics, Abu Dhabi in 2015–2016 were included in the study. The electronic medical records of the eligible individuals were reviewed retrospectively. The prevalence of CRC screening was measured among the eligible population using the FIT/gFOBT. The IBM SPSS Statistics program, version 21.0.0, was used for analysis.Result45,147 unique individuals were eligible for screening, and only 23.5% were screened using FIT/gFOBT. Of the screened individuals, 13.5% had positive FIT/ gFOBT, and 30.5% of those underwent follow-up screening colonoscopy. CRC was diagnosed in 11 individuals. Colonic polyp were found in 30.5% of individuals who had undergone a follow-up colonoscopy. Collectively 933 individuals did not undergo follow-up screening colonoscopy after having a positive FIT/gFOBT, and about 36.3% had collected the result and referred to a gastroenterologist but did not attend the appointment.ConclusionCRC screening uptake using FIT/gFOBT is low among the adult Emirati nationals.

Colorectal cancer prevention: strategies for promoting literacy

Abstract Background Colorectal cancer (CRC) is the most frequent and deadly cancer in Portugal, prevention and early detection with screening are key factors for decreasing the incidence of CRC and improving survival rates. CRC screenings allow the detection of benign situations and their remotion, preventing the development of a malignant condition. Thus, this study aimed to identify strategies that could promote CRC literacy in order to also increase the number of screenings. Methods A systematic review (SR) was performed using PICOS methodology to define study goals and then PRISMA methodology to collect data for the review, including intervention studies published from 2010. Results A final number of 11 articles were included in this SR, which used several strategies to promote literacy. These studies included patients mostly within the age range of 50–75 years. The different strategies identified contained delivering pamphlets, seminars, using technological solutions, among others. All of these educational strategies led to the breaking down of some barriers that might exist about screening and bowel preparation, which conduced to an increase in adherence to CRC screening. Since most of the studies were performed in populations presenting low health literacy or belonging to ethnic minorities, strategies such as verbal information sessions showed better results. Conclusions Several strategies seems to be effective, since the results of different interventions have translated into increased CCR literacy and also the number of screenings. Portuguese pharmacy professionals, given easy access and user confidence can contribute directly, as a future perspective, in the education of patients with CCR.

PCN5 EARLY-Onset Colorectal Cancer in the United States: A Narrative Review of the Evidence

The incidence and mortality of early-onset (<50 years of age) colorectal cancer (EOCRC) in comparison to colorectal cancer in patients greater than 50 years of age is steadily rising. Due to a delay in screening, younger populations are susceptible to later staged diagnoses, more aggressive treatment strategies, adverse histologic features, and increased mortality. This study summarizes the evidence on early-onset CRC screening, diagnosis, treatment, and survival in the United States MEDLINE, the Cochrane Library, and Google Scholar were searched for English language publications describing studies on early-onset CRC. A study was eligible for inclusion if it reported information on CRC or EOCRC incidence, screening, survival, risk factors, pathophysiology, clinical characteristics, genetic features, diagnostic criteria, treatment strategy or evaluation, racial, geographic, and socioeconomic disparities, and was published in English between January 2000 and October 2020. Patients diagnosed with EOCRC tend to have a distinct histological type including poorly differentiated tumors and signet cells, making diagnosis and treatment more difficult. Genetic features such as hereditary syndromes can contribute to EOCRC, but do not account for the majority of cases. Over-treatment patterns of young adults with EOCRC were observed. EOCRC patients that were over-treated were not shown to have greater survival rates. Ethnic minorities and low socioeconomic classes, especially African-Americans (AA), had greater mortality rates and under-treatment patterns. EOCRC incidence and mortality rates are rising rapidly, and many young adults are not being treated appropriately. Young patients have a greater likelihood of being over-treated and/or misdiagnosed, leading to long-term toxicity effects and decreased quality of life. Special attention needs to be addressed to young AA adults, to counter the observed trend, as they have the highest incidence of CRC among young population groups by race/ethnicity.

Associations of mutation profiles with clinical outcomes among metastatic colorectal cancer patients at the United States-Mexico border.

e15519 Background: The incidence of CRC among Hispanics living in the USA varies according to their country of origin, supports the idea that differences in ancestry may contribute to the differences in the incidence of CRC. Moreover, Hispanics-Latino(HL) patients usually present with a more advanced stage and have a higher mortality rate compared to other ethnic cohorts. Although it is unknown, the incidence of CRC has been substantially increasing among younger Hispanics. We sought to characterize the tumor mutation profile of mCRC patients and associate with clinical outcomes among Hispanic population. Methods: We retrospectively collected the data from next generation sequencing of 49 patients with metastatic CRC (treated at TTUHSC from 2012 to 2020. We identified the most frequent alterations in our study sample and associated with the clinical outcomes. Association analyses were performed using chi square test, unpaired t-test, log rank test and the Cox proportional hazards regressions. Results: Of 49 patients with mCRC, the average age of patients at the time of diagnosis was 57 years with 98% Hispanic, and 32(65%) male. Most of the patients had stage IV disease (98%) and left side CRC (31, 67%). In our study cohort, the most commonly mutated genes identified as APC (37/11, 77.08%), TP53 (29/19, 60.42%), KRAS (23/25, 47.92%), NOTCH 12/36 (25.00%), BRCA 1&amp;2 11/37 (22.92%) and FLT1 11/37 (22.92%). None of the identified mutations were found to be associated with overall survival. However, the presence of the FLT1 mutation was associated with a reduced risk of progression to additional chemotherapy (P=0.031). Compared to the left side CRC, the BRCA mutation appeared slightly higher on the right side of the CRC (p=0.057). In compare to data from larger national and international colon cancer databases ( COSMIC and METABRICS); HL patients showed a significantly higher proportion of frequent mutations. Compared to other ethnic cohorts, HL patients were relatively younger (57 vs. 63 years) and the male to female ratio was observed to be remarkably higher as well (1.77:1 vs. 1.32:1). In our study, the combination of mutations (TP53, APC, and KRAS) was associated with worse clinical outcomes. Our study demonstrated that worse clinical outcomes were correlated with. Conclusions: Our study is the first to characterize the most common genetic alterations among HL patients with mCRC. The most frequent identified mutations including TP53, APC, KRAS, NOTCH, and BRCA were even higher in HL cohort than the national and international databases ( COSMIC and METABRICS). Our data support the motion that molecular drivers of colon cancer might be different in HL patients.

Detailed incidence and mortality trends of early-onset colorectal cancer in Canada.

e15539 Background: There has been a consistent increase in the incidence of early-onset colorectal cancer (eoCRC), under the age of 50, in Canada since the late 1990s. Questions remain surrounding how these trends vary by topography, histology, and stage, and related trends with CRC-specific mortality. Methods: CRC incidence data were obtained from the Canadian Cancer Registry and CRC-specific mortality data from the Canadian Vital Statistics – Death Database for the years 2000 to 2017. Age-specific average annual percent changes (AAPC) in the incidence (by topography and histology) and mortality rates of CRC were estimated using the National Cancer Institute’s Joinpoint Regression Program. To determine age-specific differences (5-year age groups) in CRC diagnosis at late stage (III and IV) for years 2011 to 2017 combined, a logistic regression model adjusting for sex with the 50-54 age group as the referent was conducted. Results: AAPCs and 95% confidence intervals in the rates of incidence (topography and histology) and mortality of eoCRC from 2000 to 2017 in Canada are presented in Table. Different trends in topography were observed across sexes with the largest increases in the distal colon (splenic flexure, descending, and sigmoid) and rectum among males and rectum only among females. Significant increases were observed for non-mucinous adenocarcinomas, while significant decreases were observed for mucinous adenocarcinomas among the 40-49 age group. Compared to the 50-54 age group, only the 45-49 group had a significantly higher odds of developing late-stage colon cancer, while men and adults 25-49 had a higher odds of developing late stage rectal cancer. Despite increases in the incidence of eoCRC there has only been a significant increase in mortality for men aged 20-39. Trends in mortality vary by site, with significant decreases observed for colon cancer-specific mortality among the 40-49 age group and increases in rectal cancer-specific mortality for adults aged 20-49. Conclusions: These results indicate that the largest increases in incidence and mortality for eoCRC have occurred in the rectum and trends have varied by sex. Further research on the etiology and treatment outcomes of eoCRC patients are warranted for this patient population.[Table: see text]

The relationship of tumor necrosis factor alpha levels in plasma toward the stage and differentiation degree in colorectal cancer

IntroductionColorectal cancer (CRC) is one of the most common malignancies in western countries. Furthermore, the morbidity and mortality are increasing around the world including Indonesia. One indicator used to conduct an examination is TNF-α. Therefore, this research aims to study the correlation between TNF-α level in blood plasma with the incidence of CRC. MethodThis was a cross-sectional analytic observational research. The purpose was to determine the differences in TNF-α level in the plasma of CRC patients. These observations were in July-November 2018 at Wahidin Sudirohusodo Hospital. ResultsData analysis indicate that there was a significant relationship between the stages in CRC patients and TNF-α level in blood plasma with a p-value of 0.000. Other variables without significant relationship were age p=0.681, sex p=0.822 and differentiation p=0.141. ConclusionExamination of TNF-α level in plasma can be used as a diagnostic factor in assessing the development and prognosis of CRC patients, and as preliminary information in the high-risk CRC group before other more invasive tests (CT-Scan, endoscopy, and biopsy).