Colorectal Cancer Screening Methods Research Articles

Fecal blood tests-screening methods for identification of pre-tumor changes and tumors at the early stage

Mortality due to cancer of the rectal colon is currently increasing in all groups of the adult population. Various screening methods are used to identify the pre-tumor and early stages of the development of tumor pathology of the colon: occult blood tests in feces, computer colonography (virtual colonoscopy), colonoscopy, DNA testing, tumor marker M2-PK (tumor fractional pyruvate kinase fraction M2). All of these colorectal cancer screening methods give good results, but there is no consensus among experts regarding the choice of the most optimal method. One of the first tests to detect hidden blood in the stool was biochemical tests: guaiac test (gFOBT guaiac fecal occult-blood test ), in which hemoglobin in the stool was detected by a biochemical method that exploited the pseudoperoxidase activity of hemoglobin and the Gregersen reaction, which is a benzidine test in which benzidi was used instead of guaiac resin And instead of a hydrogen peroxide barium peroxide. Enzyme-linked immunosorbent assays, in contrast to biochemical ones, use antibodies specific only to human hemoglobin, which excludes false-positive results obtained using the biochemical method. The FIT test (Fecal Immunochemical Test or Immunochemical Fecal occult blood test) specifically determines human hemoglobin in feces at lower threshold values (40300 g HB/1 g feces) compared to g-FOBT. Due to its high accuracy, Enzyme-linked immunosorbent assays are successfully used to detect occult blood in inflammatory bowel diseases, allergic enteropathies, acute intestinal infections, and erosive gastritis.

Colorectal cancer in patients under age 50: a five-year experience.

to evaluate the clinical characteristics of patients with colorectal cancer under the age of 50 treated at a public hospital in Brasilia over 5 years. we conducted a longitudinal, retrospective study, with 184 patients undergoing surgical procedures at the Asa Norte Regional Hospital (HRAN), including those who underwent only biopsy, between January 2013 and January 2018. We divided the patients into two groups: under the age of 50 (n=39) and age equal to or greater than 50 years (n=145). We compared the groups as to age, sex, symptoms, time between symptom onset and diagnosis, family and personal history, tumor location, histopathological characteristics, applied surgical management, staging and mortality. the group of patients under the age of 50 had more individuals with stage III and IV (p=0.041), more frequent poorly differentiated tumors (10.25% versus 3.52%; p=0.153), and higher incidences of compromised surgical margins (p=0.368), angiolymphatic (p=0.07) and perineural (p=0.007) invasion, which denotes more advanced disease in this group of patients. the study showed the low effectiveness of population screening methods for colorectal cancer currently used in this population, given the high incidence of the disease and late diagnosis in both groups.

Colorectal Cancer Screening Methods and Molecular Markers for Early Detection.

Colorectal cancer (CRC) is one of the most common malignant tumors in the digestive tract in humans. The development of colorectal cancer is composed of multiple stages, starting with benign adenomatous polyps in the inner wall of the large intestine and rectum, and then gradually developing. Then it developed into advanced adenomas carcinoma in situ and invasive carcinoma. Represents the distant metastasis of the most advanced development. The purpose of this review is to novel routine screening and diagnostic methods (e.g., Endoscopy and CT colonoscopy, SEPT9 methylation assay, Fecal test) and find reliable molecular markers for early diagnosis of CRC.

Short Term Outcomes of Using Fecal Immunochemical Test for a Pilot Colorectal Cancer Screening Program. A Single Center Study on 3024 Consecutive Patients.

Background: In Romania, colorectal cancer does not benefit yet from a national screening program. In order to decrease the harm and burden of colorectal cancer (CRC), opportunistic programs relying on endoscopy has been adopted by each centre according to its capacity. A colorectal cancer (CRC) screening programme based on faecal immunochemical test (FIT) was launched at Ponderas Academic Hospital (PAH) in 2019. Aim: The present study analyses the outcomes after the first 1500 tests in the PAH-FIT-CRC Screening Program. We have also aimed to compare the efficiency of the FIT testing program with the screening colonoscopies performed in our Center, withing the same time interval (2019). Methods: The test was recommended in asymptomatic patients over 45 years, and it was followed by a colonoscopy when the test results were positive. Furthermore, we performed a retrospective observational study gathering data from all the consecutive patients prospectively included in the respective databases of our hospital, comparing the efficacy of the two colorectal cancer screening methods (FIT versus colonoscopy). Results: Between 01.01.2019 and 01.01.2020, 1524 screening colonoscopies were performed, and the resulting data were compared with those obtained in the FIT group (1500 FIT tests freely distributed). In the screening colonoscopy group, the polyp detection rate was 38.98% and 22 (1.44%) adenocarcinomas were identified. In the FIT group, the FIT uptake rate was 71% with a positivity rate of 21.7%. The colonoscopy compliance rate for positive FIT patients was 29.4%, with only 2 adenocarcinomas detected. Conclusions: Following data analysis, the need for improvement of uptake rate and colonoscopy compliance rate was suggested, due to the lower acceptance of FIT tests and colonoscopies, especially among men. Moreover, special efforts should be made in order to improve quality indicators for screening colonoscopies (especially adenoma detection rate) with the purpose of decreasing interval CRC.

Use of enteroscope without the overtube in incomplete colonoscopies

Objectives: Colonoscopy is the gold standard diagnostic method for colorectal cancer (CRC) screening. Despite the progress in the endoscopy technology field, a small percentage of colonoscopies is still incomplete. The reasons for that are mostly associated with anatomic features, such as fixed, angulated, long and loopy colon, intra-abdominal adherences and female gender. To overcome such difficulties, the usefulness of scopes different from conventional adult colonoscope (CF), such as paediatric colonoscope (PCF), gastroscope (GIF), single and double balloon enteroscope (SBE and DBE, respectively), has been shown in literature. Our retrospective study aims to evaluate the caecal intubation rate using a SBE without the overtube in patients who previously underwent an incomplete procedure with a different scope.Methods: Patients with a previous incomplete colonoscopy with CF, PCF or GIF were retrospectively enrolled through the analysis of a dedicated database. The enteroscope used was the Olympus Enteropro Single Balloon SiF-Q180 with no overtube. Complete colonoscopy was defined as successful caecal intubation.Results: SBE was used to scope 47 adult patients, mostly female, and it led to a complete procedure in 91% of them. The most frequent reason for an incomplete procedure even with the use of SBE was a fixed and angulated colon.Conclusions: Colonoscopy performed with SBE was safe and no adverse events during and/or after the procedure occurred. Our results suggest that SBE with no overtube is a useful and valid alternative to other type of scopes in difficult cases, especially those related to fixed/angulated colon and in female gender.

Recognition and Participation of Colorectal Cancer Screening in Turkey: Meta-analysis of Literature

Abstract Background The aim of the study was to perform a systematic review and meta-analysis of studies about the proportion of recognition of fecal occult blood test (FOBT) and colonoscopy (CS) methods and participation to them in any period of life for colorectal cancer (CRC) screening in Turkey. Methods PubMed, Web of Science, Google Scholar, Turkey Citation Index and YOK Thesis Center databases were screened both in Turkish and English language to identify relevant studies and key words ’colorectal cancer’, ’colon cancer’, ’cancer screening’, ’information’, ’attitude’, ’behavior’, ’awareness’ and ’Turkey’ were. Criteria for inclusion in the analysis were; conducted in Turkey, original and cross-sectional, conducted CRC risky groups (having CRC in the first degree patients and 50 and above age), studies that give the number of participants and number of taking FOBT and CS screening in any period of their lives and/or the number of knowing them. The studies that met the criteria were read as double blind. The data were entered into the Open Meta Analyst demo program. Because of p < 0.001 in the heterogeneity test, random effects model was used in group analysis of the articles. The proportion and 95% confidence interval of knowing and taking FOBT and CS were calculated from the total number of cases. Results A total of 1176 articles were reached in first review. Duplications and inappropriated studies were eliminated, and 52 studies were selected. Eight studies about recognition FOBT, 16 about participation FOBT, 9 about recognition CS and 17 about participation CS were taken in analysis. After analysis it was found that 1315 of 4334 individuals (19.3%, 95%CI:6.6-32.1) recognized to FOBT, 1174 of 6825 individuals (13.2%, 8.0-18.5) participated to FOBT, 2197 of 5728 individuals (31.7%, 18.2-45.2) recognized to CS and 913 of 8860 individuals (10.0%, 8.1-12.0) participated to CS. Conclusions The proportion of recognition and participation to FOBT and CS were found less than expected. Key messages The proportion of recognition and participation CRC screening methods is low in risky groups. Awareness and participation of screening should be increased in risky groups.

301 Improving Colorectal Cancer (CRC) Screening by Offering Less Invasive Testing When Patients Refuse Colonoscopy: A Quality Improvement (QI) Project

INTRODUCTION: CRC is the third leading cause of cancer death, and therefore early detection by screening is beneficial. Residents in primary care clinics offer screening modalities for CRC starting at the age of 50. At a clinic in New Jersey, the primary method offered for screening has always been colonoscopy every 10 years starting at the age of 50. However, when patients refused colonoscopy, other less invasive tests were not being offered. A QI project was undertaken to assess the % of residents not offering less invasive tests, before and 6 months after education about CRC screening modalities. METHODS: 63 residents were surveyed about their preferred and alternate method of CRC screening. The questionnaire was anonymous. When colonoscopy was refused, results were obtained to assess the % of residents offering less invasive tests before and 6 months after being educated about CRC screening options. RESULTS: At this institution, results revealed that 73% of residents offered colonoscopy as a first test, 19% FOBT and 8% other methods. 64% of residents offered less invasive tests when colonoscopy was refused; this increased to 95% at 6 months post education, accounting for a 31% increase. CONCLUSION: Most cases of CRC develop from adenomatous polyps. Therefore, early detection and removal by colonoscopy reduces the risk of CRC development. Colonoscopy is the gold standard for CRC screening. However, other modalities are also approved such as yearly FOBT. It is important to offer these modalities when colonoscopy is declined. This QI project demonstrated that an educational intervention about CRC screening modalities given to residents in primary care clinics enhanced the number of patients being screened, especially in the group of patients who refused colonoscopy. In conclusion, offering more CRC screening methods yields to better medical care to our patients.

Physicians' view on sigmoidoscopy as an additionally offered method for colorectal cancer screening.

In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians' experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection. At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10-15 minutes were conducted. Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative. The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.

Screening Refusal Associated with Choice of Colorectal Cancer Screening Methods. A Cross-sectional Study Among Swiss Primary Care Physicians.

Screening Refusal Associated with Choice of Colorectal Cancer Screening Methods. A Cross-sectional Study Among Swiss Primary Care Physicians.

Circulating miR-141-3p, miR-143-3p and miR-200c-3p are differentially expressed in colorectal cancer and advanced adenomas.

Colorectal cancer (CRC) is one of the prominent causes of cancer related deaths because, in part, there is not an early, non-invasive, effective detection strategy. Circulating microRNAs (miRNAs) have been proposed as potential non-invasive biomarkers for CRC. In this study, we evaluated the miRNA profile in sixteen CRC tissues by Next-Generation-Sequencing and compared the circulating expression levels of 22 miRNAs among 45 CRC, 14 hyperplastic polyps, 11 advanced adenoma patients and 45 control subjects, by reverse transcription-quantitative PCR, to search for miRNAs which could be potential biomarkers. In total, nine of them represented 70% of total read counts (miR-10a-5p, miR-192-5p, miR-10b-5p, miR-22-3p, miR-26a-5p, miR-148a-3p, miR-181a-5p, miR-92a-3p and miR-143-5p). In silico analysis found eight candidates to mature miRNAs. With respect to circulating miRNA, we found higher serum expression levels of miR-143-3p, miR-141-3p and miR-200c-3p in the CRC and adenoma groups compared with controls (P<0.002), and we also found significant higher levels of miR-141-3p and miR-200c-3p in serum of adenoma patients compared with the CRC group. In conclusion, the measurement of miRNAs in the blood could complement current screening methods for CRC and might provide new insights into mechanisms of tumorigenesis. miR-143-3p, miR-141-3p and miR-200c-3p could be interesting miRNAs to study as potential biomarkers for CRC.

Application and prospect of fecal DNA test in colorectal cancer screening

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Tu1647 – State-Level Health Insurance Status is Associated with Method of Colorectal Cancer Screening

Tu1647 – State-Level Health Insurance Status is Associated with Method of Colorectal Cancer Screening

Current Trends in Colorectal Cancer Screening

The following review is to assess the current methods, both non-invasive and invasive, in colorectal cancer screening and discuss novel screening techniques. Colorectal cancer continues to affect millions of people across the world. Through increased and widespread adoption of various screening methods, the rates of colon cancer-related deaths are decreasing. However, this decline has not been observed worldwide, possibly due to the lack of widespread screening adoption. Although there are many methods for screening colorectal cancer, colonoscopy remains the gold standard, due to high sensitivity and specificity as well as the ability to immediately sample or remove concerning tissue. Blood-based molecular testing is the most recent advancement in colorectal cancer screening; however, it has a significantly lower sensitivity and specificity when compared to other methods. However, with continued investigation, blood-based molecular testing may change how we screen for colorectal cancer in the near future. Several options for colorectal cancer screening exist today. Colorectal cancer screening methods and techniques have improved over the last several decades. These improvements have helped to decrease the rates of colorectal cancer-related deaths, most notably in the USA. Various organizations have provided a list of recommendations and suggested screening agendas, which will be reviewed in this discussion.

Likelihood of a fecal occult blood test uptake among older adults: comparisons between health professionals and healthcare volunteers based on the health belief model

BackgroundHealth professionals and healthcare volunteers play a critical role in promoting uptake of the fecal occult blood test (FOBT), which is an effective screening method for colorectal cancer. However, previous studies paid less attention to investigating both groups regarding their intention to undergo the test. This study used the Health Belief Model (HBM) to explore the likelihood of an FOBT uptake among health professionals and healthcare volunteers aged 50 years or older.MethodsA cross-sectional survey was conducted at public health centers in a county in northern Taiwan. Health professionals and healthcare volunteers were invited to complete the questionnaires. Overall, 391 valid questionnaires were obtained (response rate = 93.10%). Structural equation modeling was used to examine the associations among the variables based on the HBM.ResultsThe HBM explained 45, 44, and 50% of the variance in the likelihood of undergoing an FOBT in all participants, health professionals, and healthcare volunteers, respectively. The explained variance in healthcare volunteers outweighed that of professionals by 6%. Perceived benefits and self-efficacy significantly affected the likelihood of undergoing an FOBT. Self-efficacy significantly mediated the effects of perceived severity, benefits, and barriers on the likelihood of an FOBT uptake. A borderline significant difference in structural coefficients was found across groups.ConclusionsThe HBM model was used to examine the likelihood of an FOBT uptake among health professionals and healthcare volunteers, and the results showed that self-efficacy was the optimal predictor of the likelihood of an FOBT uptake, followed by perceived benefits. Future multifactorial interventions to promote FOBT uptake among health professionals and healthcare volunteers aged 50–75 years could include these significant factors.

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial.

BackgroundFecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation.ObjectiveThe objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result.MethodsThis randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude.ResultsOverall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001).ConclusionsA text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests.Trial RegistrationClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl)

An analysis of the sensitivity and stability of patients’ preferences can lead to more appropriate medical decisions

Patients are faced with multiple alternatives when selecting the preferred method for colorectal cancer screening, and there are multiple criteria to be considered in the decision-making process. We model patients’ choices using a multicriteria decision model, specifically an Analytic Hierarchy Process-based model, and propose a new approach for characterizing the idiosyncratic preference regions for individual patients. The new approach involves the development of a personalized sensitivity and stability analysis of preferences that provides pertinent insights about the changes that occur in a patient’s preferences, as he/she learns additional relevant medical information. We show how the insights derived from the sensitivity and stability of patients’ preferences could be used by a healthcare provider within the medical decision-making process.

Colorectal cancer screening guidelines for Nigeria in 2019

Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.

DNA methylation biomarkers in stool for early screening of colorectal cancer.

Objective: Detection of aberrant methylated genes in feces has been developed as an early screening method for colorectal cancer. The aim of this study was to probe the methylation status of SEPT9, BMP3, NDRG4, and SDC2 in stool and study whether methylation of these genes is associated with colorectal cancer.Materials and Methods: DNAs were isolated and purified from cancerous and non-cancerous stool samples and colorectal cancer tissue. Gene methylation levels were quantified by methylation-specific PCR on SEPT9, BMP3, NDRG4, and SDC2 and analyzed by a diagnostic model.Results: DNA methylation of SEPT9, NDRG4 and SDC2, but not BMP3, had diagnostic potential for detecting colorectal cancer. Moreover, integration of SEPT9, NDRG4, and SDC2 methylation demonstrated high feasibility for detecting colorectal cancer and adenoma, with better performance on colorectal cancer than adenoma.Conclusion: The methylation of SEPT9, NDRG4, and SDC2 in stool may be a potential biomarker for early screening of colorectal cancer.

Assessing knowledge on preventive colorectal cancer screening in Saudi Arabia: A cross-sectional study.

Context:According to the Saudi Cancer Registry's 2014 Cancer Incidence Report, colorectal cancer (CRC) is the leading form of malignant cancer among Saudi men and ranks third among women. Raising awareness about CRC risk factors could lead to a significant decline in incidence of disease.Aims:To assess CRC awareness and evaluate the main barriers that might prevent individuals’ participation in screening.Settings and Design:A self-administered survey was conducted over two days as part of a CRC awareness campaign in Jeddah, Saudi Arabia in March, 2018.Methods and Materials:The survey addressed issues regarding knowledge of CRC and available screening methods. The survey also examined barriers that might make one reluctant to undergo preventative screening. Stata/SE 15.0 was used for all statistical analyses.Statistical Analyses:Continuous variables were described with frequencies and percentages. Stepwise linear regression models were constructed to predict CRC knowledge and barriers.Results:Out of 422 participants, 50.2% were men. Most respondents were between 15–35 years old (65.8%). Multivariate analysis revealed that gender was a significant predictor of CRC knowledge. Furthermore, the variables of education and family history of CRC significantly predicted subjects’ awareness of colonoscopic screenings. The most common barriers for seeking screening included fear of the procedure, absence of clinical symptoms, and fear of the results.Conclusions:Our results highlight deficits in public CRC knowledge and their awareness of preventative measures. These shortcomings were found to be mainly related to education level. Specific barriers affecting screening decisions were also identified; intensive efforts on awareness to overcome these obstacles will be required.

Is Awareness Enough to Bring Patients to Colorectal Screening?

BackgroundThe aim of the study was to assess the awareness of colorectal cancer (CRC) patients about CRC screening methods and to investigate the relationship between awareness, socio-demographic characteristics and the stage in which patients with CRC are diagnosed.MethodsThe observational cross-sectional study included 275 CRC patients admitted between 2014 and 2016 to two surgical clinics from Tîrgu Mureş, Romania. Study variables were collected via face-to-face interview and from patients’ observation sheets.ResultsOnly 41.5% of the patients heard about cancer screening and 6.5% about specific CRC screening methods. Mass-media was the major source of information (85.1%) followed to a much lesser extent (14.9%) by family, friends, and colleagues. Health professionals did not contribute at all to informing patients about screening methods. Awareness about screening methods was statistically associated with the patients’ residence, age, and educational achievement, but not with the stage of CRC.ConclusionThe level of awareness of CRC screening methods was very low among the CRC patients included in the study but it could not predict the stage in which malignancy was diagnosed, suggesting that awareness alone is not enough to bring patients to undergo early CDC screening procedures.