Positive Fitness Research Articles

Modelling the Development of Precancerous Polyps: Utility of Social History, Comorbidities, FOBT/FIT Testing, and NSAID Use

Introduction: Studies have attempted to ascertain the risk factors (RF) for developing colorectal cancer (CRC), but few have attempted to elucidate the causes of precancerous (PC) polyposis. Early detection of PC polyps is essential to prevent progression to CRC. Evaluation of RF such as family history (FH), tobacco and alcohol abuse, and glycemic control may be useful in determining which patients may be more likely to have PC polyps. Methods: Data were collected on 4200 patients at the Robley Rex VAMC in Louisville, Ky. 2758 were excluded based on exclusion criteria: diagnosis of IBD and pre-existing malignancies, birth prior to 1948, poor bowel preparation, and lack of pathologic/histologic data from first colonoscopy. Of the 1442 patients included in the study, a subset had: FOBT or FIT testing, positive family history of CRC, positive smoking history, COPD, history of NSAID use, and hemoglobin A1c within 6 months of colonoscopy. A Poisson regression was used for analysis of relative risk (RR). P<0.05, was deemed statistically significant. Results: Delaying colonoscopy had a RR of 1.03 (P<0.001) per year and males had an increased RR of 1.32 (P=0.011) when compared to females. Family history of CRC (first degree relative) had a RR of 1.179 (P=0.016). Hemoglobin A1c >6.5% had a RR of 1.147 (P=0.031). A positive FOBT/FIT also demonstrated an increase in RR of 1.677 (P<0.001). Current smokers had a RR of 1.215 (P=0.003) when compared to those who never smoked. Patients with COPD had a RR of 1.348 (P<0.001). NSAID users had a decreased RR of 0.688 (P<0.001), if NSAIDs were used within 6 months preceding initial colonoscopy. Conclusion: Development of PC polyps is multifactorial. Increased risk occurs in those with a positive family history, smoking, history of COPD and suboptimal glycemic control. Results indicate that positive FOBT and FIT are also associated with an increased relative risk for PC polyps. This may illustrate a greater ability of these testing modalities to detect PC polyps. Interestingly, the use of NSAIDs appears to have a protective effect, thereby decreasing the RR. The major limitation of this study is the primarily male VA population. In the future, utilization of the factors identified in this study may allow for further risk stratification, resulting in specific target years for initial screening colonoscopies.Table: Table. Model for precancerous colonic polyp risk

Effects of Descending Stair Walking on Health and Fitness of Elderly Obese Women.

Eccentric exercise training produces positive fitness and health outcomes, but whether this is also the case for descending stair walking (DSW) is unknown. This study investigated the hypothesis that DSW would improve insulin sensitivity, lipid profiles and physical fitness better than ascending stair walking (ASW). Elderly (≥60 yr) obese women were placed to either DSW or ASW group (n = 15 per group). An elevator was used to eliminate ascending stairs for DSW, and descending stairs for ASW. Descending stair walking and ASW were performed twice a week for 12 wk by increasing the repetitions gradually. Overnight fasting blood samples were taken 3 d before the first training session and 4 d after the last training session, and analyzed for insulin sensitivity and lipid profile markers. Resting HR, systolic blood pressure, and diastolic blood pressure, bone mineral density, knee extensor maximal voluntary isometric contraction strength and several functional physical fitness measures were taken before and after the intervention. Average HR during DSW (88.6 ± 7.8 bpm) was lower (P < 0.05) than that of ASW (113.7 ± 10.9 bpm). Resting HR (-10%) and systolic blood pressure (-9%) decreased greater after DSW than ASW (-4% for both), and bone mineral density increased (6%) only for DSW (P < 0.05). Decreases in serum triacylglycerols, total and low-density lipoprotein cholesterols, glucose, insulin, homeostasis model assessment and whole blood glycosylated hemoglobin, and increases in high-density lipoprotein cholesterols were greater (P < 0.05) after DSW than ASW. Maximal voluntary isometric contraction strength increased greater for DSW (34%) than ASW (15%), and many of functional physical fitness measures showed greater (P < 0.05) improvement for DSW than ASW. These results supported the hypothesis and suggest that DSW is an effective exercise intervention for elderly obese women to improve their health and fitness.

The fitness costs and benefits of antibiotic resistance in drug-free microenvironments encountered in the human body.

The relationship between bacterial drug resistance and growth fitness is a contentious topic, but some antibiotic resistance mutations clearly have a fitness cost in the laboratory. Whether these costs translate into deleterious effects in natural habitats is less certain however. Previously, fitness effects of resistance mutations were mostly characterized in nutrient-rich, fast-growth conditions, which bacteria rarely encounter in natural habitats. Carbon, phosphate, iron or oxygen limitations are conditions met by bacterial pathogens in various compartments of the human body. Here, we measured the fitness of four different rpoB mutations commonly found in rifampicin-resistant bacterial isolates. The fitness properties and the emergence of these and other alleles were studied in Escherichia coli populations growing under nutrient excess and in four different nutrient-limited states. Consistent with previous findings, all four mutations exhibited deleterious fitness effects under nutrient-rich conditions. In stark contrast, wefound positive or neutral fitness effects under nutrient-limited conditions. Two particular rpoB alleles had a remarkable fitness increase under phosphate limitation and these alleles arose to high frequencies specifically under phosphate limitation. These findings suggest that it is not meaningful to draw general conclusions on fitness costs without considering bacterial microenvironments in humans and other animals.

The Effect of Parasitism and Interpopulation Hybridization on Aedes albopictus (Diptera: Culicidae) Fitness.

Recent research in mosquito population genetics suggests that interpopulation hybridization has likely contributed to the rapid spread of the container-breeding mosquitoes. Here, I used laboratory experiments to investigate whether interpopulation Aedes (Stegomyia) albopictus (Skuse) F1 and F2 hybrids exhibit higher fitness than parental populations, and whether hybrid mosquito performance is related to infection by the coevolved protozoan parasite Ascogregarina taiwanensis (Lien and Levine). Overall, there were significant differences in development time, wing length, and survival between the two parental mosquito populations, but no difference in per capita growth rate r. Hybrid mosquitoes were generally intermediate in phenotype to the parentals, except that F2 females were significantly larger than the midparent average. In addition, As. taiwanensis parasites produced fewest oocysts when they were reared in hosts of hybrid origin. These data suggest that hybridization between previously isolated mosquito populations can result in slight increases in potential mosquito reproductive success, via increased hybrid body size, and via the temporary escape from coevolved parasites. These findings are significant because studies have shown that even slight hybrid vigor can have positive fitness consequences for population persistence. Although this was a laboratory experiment extending only to the F2 generation, many other invasive insects also carry coevolved parasites, and thus the patterns seen in this mosquito system may be broadly relevant.

Su1730 - Time to Diagnostic Colonoscopy and Colonoscopic Findings after Positive fit in an Ethnically Diverse Cohort of U.S. Veterans

Su1730 - Time to Diagnostic Colonoscopy and Colonoscopic Findings after Positive fit in an Ethnically Diverse Cohort of U.S. Veterans

Su1721 - Differences in Colonoscopy Associated Costs Between Primary Colonoscopy and Colonoscopy After Positive fit in Colorectal Cancer Screening

Su1721 - Differences in Colonoscopy Associated Costs Between Primary Colonoscopy and Colonoscopy After Positive fit in Colorectal Cancer Screening

Sa1004 - Adenoma Detection Rate among Colonoscopy for Positive Screening Fit is Higher than for Direct Screening Colonoscopy: A Call for Differential ADR Targets

Sa1004 - Adenoma Detection Rate among Colonoscopy for Positive Screening Fit is Higher than for Direct Screening Colonoscopy: A Call for Differential ADR Targets

The reality of human capital in the Algerian economic enterprise in the current economic transformations field study Sonelgaz Company - Unit Tlemcen - from 2000 to 2013

Most of the management systems currently use the concept of flexibility and organizational effectiveness aims to optimize the use of resources especially human resources to ensure a positive fit. For this, the company needs to make changes in terms of strategies and policies appropriate to its human capital. Thus, the subject of this work is to bring some answers to the inability of the company to develop the skills and human resource investment performance despite endless efforts in management.

Analysis and specification of the crash behaviour of plastics/metal-hybrid composites by experimental and numerical methods

Plastics materials are nowadays used in many structural applications for the substitution of metals with respect to weight reduction. In order to utilize the high freedom of design and the light-weight potential of plastics materials in crash-relevant structural parts, so-called hybrid composites which combine the high rigidity and strength of steel with the advantages of plastics materials are investigated in the outlined research. Thereby, the joining of both materials as well as the design by means of numerical methods such as the finite element analysis (FEA) are challenges which have to be met. A new approach in joining is based on the modified arc welding process where metal pin structures are formed in one working step and subsequently welded onto the surface. The pins are formed with ball-shaped, cylindrical or spiky ends and produced directly from the welding wire without requiring additional pre-fabricated components such as studs or similar. This allows the small-scale surface structuring of metal components that can be adapted optimally for a form fit on the respective plastics structure. Subsequently, injection molding is used for the application of the plastics material onto the pin-structured metal part in order to generate a positive fit between metal and plastics in an intrinsic joining process. An additional joining process, which is carried out after injection molding, is not required. Within the framework of the research presented, comprehensive mechanical tests are presented to illustrate the suitability of pin-structured metal-hybrid composites in crash applications. In comparison to structures which are in particular exposed to static loads and therefore designed to exhibit maximum component strength, crash applications are designed to fail in a continuous process to achieve maximum energy consumption. The outlined research illustrates the enhanced failure behavior of pin-structured plastics/metal-hybrid composites and the increased energy consumption under impact loading. Moreover, a comparison between pin structuring and laser structuring with regard to the obtainable mechanical properties under impact loading is given. Concluding, the current potential and weak points in the simulation of plastics/metal-hybrid structures using FEA is presented and discussed.

Trade-offs in an ant-plant-fungus mutualism.

Species engaged in multiple, simultaneous mutualisms are subject to trade-offs in their mutualistic investment if the traits involved in each interaction are overlapping, which can lead to conflicts and affect the longevity of these associations. We investigate this issue via a tripartite mutualism involving an ant plant, two competing ant species and a fungus the ants cultivate to build galleries under the stems of their host plant to capture insect prey. The use of the galleries represents an innovative prey capture strategy compared with the more typical strategy of foraging on leaves. However, because of a limited worker force in their colonies, the prey capture behaviour of the ants results in a trade-off between plant protection (i.e. the ants patrol the foliage and attack intruders including herbivores) and ambushing prey in the galleries, which has a cascading effect on the fitness of all of the partners. The quantification of partners' traits and effects showed that the two ant species differed in their mutualistic investment. Less investment in the galleries (i.e. in fungal cultivation) translated into more benefits for the plant in terms of less herbivory and higher growth rates and vice versa. However, the greater vegetative growth of the plants did not produce a positive fitness effect for the better mutualistic ant species in terms of colony size and production of sexuals nor was the mutualist compensated by the wider dispersal of its queens. As a consequence, although the better ant mutualist is the one that provides more benefits to its host plant, its lower host-plant exploitation does not give this ant species a competitive advantage. The local coexistence of the ant species is thus fleeting and should eventually lead to the exclusion of the less competitive species.

The ‘strength of weak ties’ among female baboons: fitness-related benefits of social bonds

Studies across a range of species have shown that sociability has positive fitness consequences. Among baboons, both increased infant survival and adult longevity have been associated with the maintenance of strong, equitable and durable social bonds. However, not all baboon populations show these patterns of bonding. South African chacma baboons, Papio ursinus, in the Drakensberg Mountains and De Hoop Nature Reserve show cyclical variation in social relations across time, with strong bonds formed only during certain times of the year. Using long-term data from the De Hoop baboons, we tested whether social relations influence female reproductive success in our study group in a manner similar to other baboon populations. Our results show that the number of strong bonds a female maintained predicted birth rate, and that the number of weak bonds a female possessed predicted infant 12-month survival and infant longevity. Fitness-related benefits of sociability were, however, independent of female dominance rank, and there was no relationship between the number of weak and strong bonds a female maintained. One possible explanation for the influence of weak as well as strong bonds in our study group may be that variation in demographic and ecological conditions across populations may favour the use of different social strategies by females. In our sample, weak bonds as well as strong bonds appear to be instrumental to achieving fitness-related benefits.

Abstract C67: Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project

Abstract The prevalence of colorectal cancer screening among people living in Texas-Mexico, rural/frontier Border communities and colonias is not well characterized. While colorectal cancer screening in the Border region is 30%, among Hispanics, FOBT screening in the prior 2 years is 9.4%, and 59% of screening eligible adults have never had endoscopy (Texas BRFSS 2010). The FluFIT on the Frontera project, a colorectal cancer screening project for average risk people, was adapted from the evidence based FluFIT curriculum and implemented in a rural/frontier community setting to increase colorectal cancer screening. The project provides education, screening, early detection and treatment through community and regional partnerships. It targets Hispanic and underserved men and women aged 50-75 years of age who reside in the rural/frontier communities of Del Rio Texas and the surrounding colonias. Methods Clinic based providers and certified male and female promotores from Val Verde Regional Medical Center and QUAD Counties Promotoras Program, respectively, received formal didactic and implementation training for the FluFIT intervention. Participants received colorectal cancer screening education and FluFIT test process instruction from trained staff in the clinical setting and promotores in the community setting. Clinic and community based navigators provided participant navigation to insure timely receipt of specimens for analysis and follow-up. Participants who did not have a primary care provider were assigned to a provider in the Val Verde Regional Medical Center primary care clinic. All test results were provided to participants by either their assigned or private primary care providers. An integrated clinic and community based provider, navigator and project partnership assured referral for appropriate services as needed for positive tests. Results In the first 7 months of community programming 3743 community members were educated in either group or individual settings. Of these, 1959 adults (789 males, 40%; 1170 females) aged 50-75 years were evaluated for screening. Seventy five percent self-identified as white Hispanic and 25% as non-Hispanic. 753 met the screening eligibility criteria and 1206 did not. Of 753 (38.4%) who were screening eligible, 563 (74.8%) received FIT kits. Among 342 kits (60.7%) that were returned, 14 (12.57%) were positive. Colonoscopy was completed in 79% of patients with a positive FIT test and polyps were identified in 7. No cancers were diagnosed. Average and high risk participants accounted for 58.8% and 41.2% of people who were ineligible for screening. Among ineligible average risk participants 659 (80.3%) had prior screening. Among 575 high risk patients, 199 (34.6%) reported no prior screening. Prior screening accounted for 74.1% of participant ineligibility overall irrespective of risk stratification. Conclusions The FluFIT intervention is being successfully implemented in a rural/frontier community. The high proportion of males recruited to this study suggests that male promotores positively impact male recruitment. Colorectal cancer screening in this rural/frontier population is higher than previously reported in BRFSS and approaches that of the Border region (30%). The increased prevalence of participants who are high risk for colorectal cancer is a surprising finding that merits further investigation to better understand the population risk. Citation Format: Thelma C. Hurd, Ceci Lozano, Simon Sotelo, Samantha Adame, Raquel Rodriguez, Hector Guerra, Thankam Sunil. Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C67.

Do group dynamics affect colour morph clines during a range shift?

Species exhibiting colour polymorphism are thought to have an ecological advantage at the landscape scale, because spatial segregation of alternatively adapted ecotypes into diverse habitats can increase the species' niche breadth and thus confer greater geographic range size. However, morph frequencies are also influenced by intrapopulational processes such as frequency- or density-dependent social interactions. To identify how social feedback may affect clinal variation in morph frequencies, we investigated reciprocal interactions between morph-specific thermal tolerance, local climatic conditions and social environments, in the context of a colour-morph frequency cline associated with a recent range expansion in blue-tailed damselflies (Ischnura elegans) in Sweden. Cold tolerances of gynochromes (female-like female morph) were positively correlated with local gynochrome frequencies, suggesting a positive frequency-dependent fitness benefit. In contrast, androchrome (male-mimic female morph) cold tolerances were improved following recent exposure to cold weather, suggesting a beneficial environmental acclimation effect. Thus, according to an environment-matching hypothesis for clinal variation, androchrome frequencies should therefore increase towards the (cooler) range limit. In contrast to this prediction, gynochrome frequencies increased at the expanding range limit, consistent with a positive frequency-dependent social feedback that is beneficial when invading novel climates. Our results suggest that when phenotypes or fitnesses are affected by interactions with conspecifics, beneficial social effects on environmental tolerances may (i) facilitate range shifts, and (ii) reverse or counteract typical patterns of intraspecific interactions and environment-matching clines observed in stable populations observed over broader geographic scales.

Behavioral thermal tolerances of free-ranging rattlesnakes (Crotalus oreganus) during the summer foraging season

Increasing temperature due to climate change is one of the greatest challenges for wildlife worldwide. Behavioral data on free-ranging individuals is necessary to determine at what temperatures animals modify activity as this would determine their capacity to continue to move, forage, and mate under altered thermal regimes. In particular, high temperatures could limit available surface activity time and time spent on fitness-related activities. Conversely, performance, such as feeding rate, can increase with temperature potentially having positive fitness effects. Here, we examine how the hunting behaviors of free-ranging Northern Pacific Rattlesnakes (Crotalus oreganus) associate with air temperature and body temperature. We continuously recorded snakes in the field using videography, capturing behaviors rarely considered in past studies such as movements in and out of refuge and strikes on prey. We found that as mean daily air temperature increased, hunting activity and the likelihood of hunting at night decreased, while the number of movements and distance moved per day increased. Snakes typically retreated to refuge before body temperatures reached 31°C. Body temperatures of snakes hunting on the surface were lower compared to temperatures of non-hunting snakes in refuge in the morning, while this relationship was inverted in the afternoon. Snake body size influenced the disparity of these temperatures. Finally, strike initiation and success occurred across a wide range of body temperatures, indicating hunting performance may not be strongly constrained by temperature. These results on the temperatures at which free-ranging rattlesnakes exhibit fitness-related behaviors could be valuable for understanding their vulnerabilities to future climates.

Are hemoglobin levels really lower in faecal immunochemical test positive patients with colorectal cancer?

IntroductionFaecal immunochemical test (FIT) is advocated in many colorectal cancer-screening programs. A positive FIT translates to the need for a colonoscopy. However, waiting times for diagnostic colonoscopy is long. The aim of our study is to determine the correlation of hemoglobin levels in patients with a positive FIT who were subsequently diagnosed with colorectal cancer, and to compare them with patients with only colonic adenomas and those with normal colonoscopy with the intention of determining if hemoglobin levels could be used to stratify the urgency of colonoscopy. MethodologyThis is a matched case–control study of patients who were FIT positive and subsequently underwent colonoscopy at the National University Hospital, Singapore. Newly diagnosed colorectal cancers formed the case group. The patients with colorectal cancers were then matched for age, gender and ethnicity at a 1:1 ratio to patients with colonic adenomas and then those in whom colonoscopy was normal. ResultsFifteen patients met the inclusion criteria and formed the case group. The differences between the groups were not statistically significant in terms of age, gender and ethnicity. The median hemoglobin level for the patients in the case group compared to the control group was (12.4 vs 14.5, p = 0.002) for the group with adenomas and (12.4 vs 14.4, p = 0.007) for the group with normal colonoscopy. ConclusionColorectal cancer patients presenting with a positive FIT are more likely to be anemic. A test to identify those patients who have a positive FIT that are anemic could enable earlier colonoscopic evaluation.

Dependency and Response of Apuleia leiocarpa to Inoculation with Different Species of Arbuscular Mycorrhizal Fungi

Inoculation with arbuscular mycorrhizal fungi (AMF) is a strategy to improve the efficiency of forest plantations, reducing costs and increasing the survival of plant species. The objective of this study was to assess the response and mycorrhizal dependency of seedlings of the forest species Apuleia leiocarpa (Vogel) J.F. Macbr to inoculation with AMF. The experiment was conducted in a completely randomized design using a 5 × 5 factorial arrangement with six replications. The treatments consisted of combinations of five P rates (0, 24, 71, 213, and 650 mg kg-1) with five types of inoculations with AMF (inoculation with the fungi Rhizophagus clarus, Gigaspora margarita, Dentiscutata heterogama, inoculation with an AMF mix of these three species, and a treatment without inoculation). The A. leiocarpa showed the highest biomass accumulations in inoculation with D. hetorogama combined with the P rates of 213 and 650 mg kg-1, and in the AMF mix combined with the P rates of 71, 213, and 650 kg-1. Biomass accumulation showed a linear, positive response to inoculation with D. heterogama combined with the different P rates, and a positive square root fit to inoculation with the AMF mix. The plants inoculated with G. margarita had no significant biomass accumulation. The plant species had a positive response to inoculation with R. clarus combined with the lowest P rates; however, it had a negative response to combination with the highest P rate (650 mg kg-1). The relative benefit of inoculation with these fungi was more than 100 % in most treatments, showing the high mycorrhizal dependency of A. leiocarpa and the nutritional benefit of AMF inoculation for this species. However, this response is dependent on the fungus species that colonize the plant roots. The best combination between fungus and P rate was inoculation with the AMF mix combined with the P rate of 71 mg kg-1.

Fitness Effects of 10-Month Frequent Low-Volume Ball Game Training or Interval Running for 8-10-Year-Old School Children.

We investigated the exercise intensity and fitness effects of frequent school-based low-volume high-intensity training for 10 months in 8–10-year-old children. 239 Danish 3rd-grade school children from four schools were cluster-randomised into a control group (CON, n = 116) or two training groups performing either 5 × 12 min/wk small-sided football plus other ball games (SSG, n = 62) or interval running (IR, n = 61). Whole-body DXA scans, flamingo balance, standing long-jump, 20 m sprint, and Yo-Yo IR1 children's tests (YYIR1C) were performed before and after the intervention. Mean running velocity was higher (p < 0.05) in SSG than in IR (0.88 ± 0.14 versus 0.63 ± 0.20 m/s), while more time (p < 0.05) was spent in the highest player load zone (>2; 5.6 ± 3.4 versus 3.7 ± 3.4%) and highest HR zone (>90% HRmax; 12.4 ± 8.9 versus 8.4 ± 8.0%) in IR compared to SSG. After 10 months, no significant between-group differences were observed for YYIR1C performance and HR after 2 min of YYIR1C (HRsubmax), but median-split analyses showed that HRsubmax was reduced (p < 0.05) in both training groups compared to CON for those with the lowest aerobic fitness (SSG versus CON: 3.2% HRmax [95% CI: 0.8–5.5]; IR versus CON: 2.6% HRmax [95% CI: 1.1–5.2]). After 10 months, IR had improved (p < 0.05) 20 m sprint performance (IR versus CON: 154 ms [95% CI: 61–241]). No between-group differences (p > 0.05) were observed for whole-body or leg aBMD, lean mass, postural balance, or jump length. In conclusion, frequent low-volume ball games and interval running can be conducted over a full school year with high intensity rate but has limited positive fitness effects in 8–10-year-old children.

Introducing the Questionnaire of Commitment to Exercise

The present study aimed to make and establish psychometric features of an exercise commitment questionnaire. The primary 35 questions were administered to 210 staffs working in Isfahan Steel Company, 120 males and 90 females. Subjects had 10 years of work experience in the company and were randomly selected using stratified sampling method. Principle component analysis and Varimax rotation were used to measure its construct validity. Finally, 25 questions were extracted with more than 0.5 loading factor indicating the validity of the instrument. Accordingly, a four-factor construct was made, being capable of explaining 58.4 percent of total variance by the use of principle component method. Results of the confirmatory factor analysis yielded features indicating positive fitness of the confirmatory analytic model of the commitment to exercise questionnaire. Also by using internal consistency reliability was calculated with Cronbach’s alpha and the coefficient was 0.873 showing strong reliability. Overall, based on the satisfactory reliability and validity, this study shows that commitment to exercise questionnaire serves as a suitable measuring tool for the future research.

Defining Benchmarks for Adenoma Detection Rate and Adenomas Per Colonoscopy in Patients Undergoing Colonoscopy Due to a Positive Fecal Immunochemical Test.

Although there is an accepted benchmark for adenoma detection rate (ADR) in average risk screening colonoscopy, a benchmark for ADR or the associated quality indicator, adenomas per colonoscopy (APC), for colonoscopies performed for a positive fecal immunochemical test (FIT+) has not been established. The purpose of this study was to propose methods for establishing a benchmark ADR and APC for FIT+ patients. In this historical cohort study, we included 15,329 patients aged 50-74 years who underwent a colonoscopy at Alberta Health Services' Colon Cancer Screening Centre, Calgary, Canada, from 1 January 2014 to 30 June 2015 for either investigation of a positive FIT or average risk screening. Using meta-regression, we estimated for FIT+ patients the ADR and APC that corresponded to (Method #1: minimally acceptable) an ADR of 25% in average risk individuals, (Method #2: standard of care) the average ADR or APC in all FIT+ patients, and (Method #3: aspirational) the average FIT+ ADR or APC in colonoscopies performed by endoscopists with an ADR of ≥35% in average risk patients. At least one adenoma was detected in 30% of average risk patients and 58% of FIT+ patients. The calculated benchmark FIT+ ADRs for the three methods were 55, 60, and 65%, respectively. The calculated benchmarks for FIT+ APC were 1.2, 1.4, and 1.7, respectively. To account for expected random variation in individual endoscopists' ADR or APC, we propose using the upper bound of the 95% confidence interval of an endoscopist's ADR or APC to determine if they fall below a given benchmark. We have proposed methods of defining benchmarks for ADR and APC in FIT+ patients that go beyond the current "minimally acceptable" threshold currently recommended in average risk patients. These new thresholds represent results obtained by all peers and by a group of expert adenoma detectors defined in an independent patient cohort (average risk). Because the true adenoma burden in FIT+ patients could vary based on factors such as the threshold used to define a positive FIT, screening programs or endoscopy units may need to calculate their own benchmarks using local data.

Extending Colorectal Cancer Screening to Persons Aged 40 to 49 Years With Immunochemical Fecal Occult Blood Test

To assess the association between the initial immunochemical fecal occult blood tests (FIT) and subsequent colorectal cancer, and to explore the ability of FIT to identify individuals age 40 to 49 years with a higher cancer risk. The number of cancer cases in this age group is increasing globally and the cancers found in younger age tend to be more advanced than in older age. A total of 513,283 individuals had FIT as part of their self-paying medical screening program between 1994 and 2008. The initial FIT test was used. When matched with the Taiwan cancer registry, the cohort identified 2138 colorectal cancer cases. The number needed to screen (NNS) to identify 1 cancer was calculated from the reciprocal of cancer incidence cases during the study period. One in 7 colorectal cancers above age 40 years occurred in the age group of 40 to 49 years. Individuals 40 to 49 years old with positive FIT (≥100 ng/mL) had a 3 times larger cancer risk than those 50 to 59 years old and without FIT, or double the cancer risk as those 50 to 69 years old and without FIT, with NNS at 42, 135, and 95, respectively. A similar relationship existed for the cancer incidence rate. The HR for ages 40 to 44 years or 45 to 49 years with a positive FIT was 2.3 or 5.7 times larger than the HR for ages 50 to 54 years. There was a dose-response relationship between increasing FIT values and the cancer risk for each age group, including ages 40 to 49 years. Offering FIT to individuals 40 to 49 years of age could identify higher-risk individuals earlier for follow-up colonoscopy, and could, in turn, reduce cancer mortality.