Reduce Colorectal Cancer Mortality Research Articles

Abstract 895: NFκB and IκBKB polymorphisms and colorectal cancer survival in the Seattle Colon Cancer Family Registry

Abstract Introduction: IκBKB and NFκB are regulatory enzymes that interact with the prostaglandin synthesis pathway, which plays a key role in inflammation and colorectal carcinogenesis. Transcriptional targets of the nuclear factor NFκB have been linked to cellular proliferation, angiogenesis, and metastasis. IκBKB binds NFκB within the cytoplasm and can prevent its nuclear localization. The role of variability in these genes in relation to colorectal cancer (CRC) survival has not been investigated; we therefore examined polymorphisms in both IκBKB and NFκB in relation to CRC survival. Methods: CRC cases were ascertained from 1997-2002 from the Seattle Colon Cancer Family Registry and were matched through linkages to the National Death Index records to obtain date and cause of death. A subgroup of CRC cases was genotyped for selected tagSNPs (9 in IκBKB; 44 in NFκB), including non-synonymous candidate polymorphisms (IκBKB: rs17875749, rs2272736; NFκB: rs4648072, rs4648099). Cox proportional hazards regression models were used to estimate hazard ratios investigating the relationship between polymorphisms in IκBKB and NFκB and CRC-specific mortality. Results: We observed statistically significant inverse associations between four SNPs in IκBKB (rs11986055, rs2272733, rs6474387, and rs9694958) and the risk of CRC mortality after diagnosis. The observed survival benefit ranged from 86% reduced CRC mortality risk for rs11986055 (HR AA vs. AC or CC: 0.14, 95% CI 0.02-1.03) to 59% reduced CRC mortality risk for rs2272733 (HR GG vs. GA or AA: 0.41, 95% CI 0.20-0.82). The functional significance of these SNPs is unknown; none of these SNPs were in high linkage disequilibrium, with all r2 values < 0.7. No SNPs investigated in NFκB were significantly associated with colorectal cancer survival. Conclusion: These data suggest that certain polymorphisms in IκBKB may be associated with mortality from colorectal cancer after diagnosis.Associations between IκBKB polymorphisms and CRC survival Hazard Ratio95% CIp-valueAliveDeaadrs11986055 A>C AA1.00Ref. 20279AC or CC0.140.02-1.030.05241rs2272733 G>A GG1.00Ref. 17571GA or AA0.410.20-0.820.01519rs6474387 C>T CC1.00Ref. 18875CT or TT0.400.16-1.000.05365rs9694958 A>G AA1.00Ref. 18874AG or GG0.370.16-0.860.02386All models reported above adjusted for age, sex, and stage of disease at diagnosis Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 895.

National Institutes of Health State-of-the-Science Conference Statement: Enhancing Use and Quality of Colorectal Cancer Screening

Each year, nearly 150 000 persons receive a diagnosis of colorectal cancer (CRC) and 50 000 die of the disease. Screening reduces CRC mortality, but many eligible patients do not receive screening....

Progress and Challenges in Colorectal Cancer Screening and Surveillance

Colorectal cancer is a leading cause of cancer death throughout the world. There is evidence that screening of average-risk individuals can result in mortality reduction with early cancer detection and cancer prevention by detection and removal of cancer precursor lesions. The optimal form of screening is not clear. Fecal screening tests can be performed at home at low initial cost, but current versions lack high sensitivity for cancer precursor lesions, and tests need to be repeated at regular intervals. Adherence to repeat testing for negative tests and referral for colonoscopy for positive tests are important elements of program effectiveness. Structural examinations of the colon are more invasive and may result in detection of both early cancer and cancer precursor lesions. Every screening program has advantages and limitations, but each program ultimately depends on quality and patient adherence.

Abstract CN14-06: Screening for colorectal cancer: 2009

Abstract CN14-06: Screening for colorectal cancer: 2009

Improving Fecal Occult Blood Testing Compliance Using a Mailed Educational Reminder

BACKGROUNDColorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low.OBJECTIVETo determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance.DESIGNBlinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California.PATIENTSSeven hundred and seventy-five consecutive patients ≥50 years of age referred by their primary care physicians for FOBT.INTERVENTIONPatients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only.MEASUREMENTSThe primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis.RESULTSAt 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P < 0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48–2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29–2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13–0.50).CONCLUSIONA simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-009-1087-5) contains supplementary material, which is available to authorized users.

What determines individuals’ preferences for colorectal cancer screening programmes? A discrete choice experiment

Introduction In many countries uptake of colorectal cancer (CRC) screening remains low. Aim To assess how procedural characteristics of CRC screening programmes determine preferences for participation and how individuals weigh these against the perceived benefits from participation in CRC screening. Methods A discrete choice experiment was conducted among subjects in the age group of 50–75 years, including both screening-naïve subjects and participants of a CRC screening programme. Subjects were asked on their preferences for aspects of CRC screening programmes using scenarios based on pain, risk of complications, screening location, preparation, duration of procedure, screening interval and risk reduction of CRC-related death. Results The response was 31% (156/500) for screening-naïve and 57% (124/210) for CRC screening participants. All aspects proved to significantly influence the respondents’ preferences. For both groups combined, respondents required an additional relative risk reduction of CRC-related death by a screening programme of 1% for every additional 10 min of duration, 5% in order to expose themselves to a small risk of complications, 10% to accept mild pain, 10% to undergo preparation with an enema, 12% to use 0.75 l of oral preparation combined with 12 h fasting and 32% to use an extensive bowel preparation. Screening intervals shorter than 10 years were significantly preferred to a 10-year screening interval. Conclusion This study shows that especially type of bowel preparation, risk reduction of CRC related death and length of screening interval influence CRC screening preferences. Furthermore, improving awareness on CRC mortality reduction by CRC screening may increase uptake.

Modeling the Cost-Effectiveness of Colorectal Cancer Screening: Policy Guidance Based on Patient Preferences and Compliance

Obtaining regular screening exams can significantly reduce colorectal cancer (CRC) mortality. Most CRC models to date have assumed "ideal conditions" such as 100% compliance, and the effects of CRC screening tests have been assessed only under these conditions. In this study, we assess cost-effectiveness incorporating real-world patient preferences and compliance. We built an agent-based simulation model to assess the effect of compliance and patient preferences. Baseline values were derived from the 2003 and 2005 National Health Interview Survey, and effectiveness and cost parameters were obtained through literature review. Initial screening compliance was 45%, and compliance with follow-up diagnostic tests was 75%. The current level of screening reduces CRC mortality by 44.1% when compared with no screening. Increasing diagnostic follow-up compliance to 95% can lead to an additional 9.3% reduction in CRC mortality, whereas increasing initial screening compliance to 95% can result in an additional 50.4% reduction. These increases can be achieved at a cost of about $7,500 ($1,309-$32,864) per life year saved and $14,000 ($3,620-$35,855) per life year saved for diagnostic follow-up and initial screening tests, respectively. Increasing compliance with both initial screening test recommendation and diagnostic testing are cost-effective approaches. The most cost-effective approach under limited funding is to increase compliance with diagnostic testing for those already being screened. Targeted interventions, which are necessary to increase compliance, are generally cost-effective under the base case scenarios presented in this model, but additional studies are required to identify the most cost-effective approach.

T2018 Risk of Colorectal Neoplasia in Patients with Renal Transplantation: Case-Control Study

Guaiac based fecal occult blood test (gFOBT) is the only screening tool with high-quality evidence obtained from randomised controlled trials (RCTs) demonstrating its efficacy to reduce colorectal cancer (CRC) mortality. However, it has some drawbacks, one is the requirement for frequent testing, which may limit compliance and thereby effectiveness. Aim: to assess the short term outcomes of the 2nd round of a biennial gFOBT CRC screening program. Methods: Comparison of the outcomes of the 1st and 2nd rounds (R1 and R2) of the organized CRC screening program with Hemoccult II implemented in the Haut-Rhin, a French administrative area, since 2003 (Denis B et al Gut 2007;56:1579-84). Results: Main outcomes are presented in the table. The crude participation rate decreased from 49.0% to 45.0%. 57.0% of excluded people had a recent < 5 years colonoscopy and 37.5% were at increased CRC risk. 28.4% of people who had participated in R1 did not participate in R2 and conversely, 25.4% of people who participated in R2 had not participated in R1. 83.9% of the completed gFOBTs were provided by general practitioners (GPs) and 12.1% by direct mailing in R2 and respectively 78.6% and 15.5% in R1 (p<0.001). 93.7% of people who received a gFOBT from their GP actually completed it in R2 vs. 81.6% in R1 (p<0.001). The rate of ≥ 10 mm adenomas did not differ between R1 (32.9%) and R2 (30.5%). The positive predictive value for advanced neoplasia was significantly lower in R2 (28.3%, p= 0.04) and in people who had a previous negative gFOBT result (27.2%, p=0.01) than in R1 (31.1%). The rate of invasive cancers limited to the colorectal wall was not different between R2 (59.3%) and R1 (69.4%). Conclusion: Participation and diagnostic yield deteriorated with time in our organized population-based gFOBT CRC screening program. Despite an increasing involvement of GPs, more than a quarter of eligible people did not repeat screening in the 2nd round. This deterioration was not observed in previous RCTs on gFOBT screening and may question the reproducibility of their effectiveness on the reduction of CRC mortality in the real world.

T2020 Frequency and Predictors of Colorectal Cancer Screening Among Average Risk American Indians/Alaskan Natives Utilizing the Indian Health Services from 1996 to 2004

Guaiac based fecal occult blood test (gFOBT) is the only screening tool with high-quality evidence obtained from randomised controlled trials (RCTs) demonstrating its efficacy to reduce colorectal cancer (CRC) mortality. However, it has some drawbacks, one is the requirement for frequent testing, which may limit compliance and thereby effectiveness. Aim: to assess the short term outcomes of the 2nd round of a biennial gFOBT CRC screening program. Methods: Comparison of the outcomes of the 1st and 2nd rounds (R1 and R2) of the organized CRC screening program with Hemoccult II implemented in the Haut-Rhin, a French administrative area, since 2003 (Denis B et al Gut 2007;56:1579-84). Results: Main outcomes are presented in the table. The crude participation rate decreased from 49.0% to 45.0%. 57.0% of excluded people had a recent < 5 years colonoscopy and 37.5% were at increased CRC risk. 28.4% of people who had participated in R1 did not participate in R2 and conversely, 25.4% of people who participated in R2 had not participated in R1. 83.9% of the completed gFOBTs were provided by general practitioners (GPs) and 12.1% by direct mailing in R2 and respectively 78.6% and 15.5% in R1 (p<0.001). 93.7% of people who received a gFOBT from their GP actually completed it in R2 vs. 81.6% in R1 (p<0.001). The rate of ≥ 10 mm adenomas did not differ between R1 (32.9%) and R2 (30.5%). The positive predictive value for advanced neoplasia was significantly lower in R2 (28.3%, p= 0.04) and in people who had a previous negative gFOBT result (27.2%, p=0.01) than in R1 (31.1%). The rate of invasive cancers limited to the colorectal wall was not different between R2 (59.3%) and R1 (69.4%). Conclusion: Participation and diagnostic yield deteriorated with time in our organized population-based gFOBT CRC screening program. Despite an increasing involvement of GPs, more than a quarter of eligible people did not repeat screening in the 2nd round. This deterioration was not observed in previous RCTs on gFOBT screening and may question the reproducibility of their effectiveness on the reduction of CRC mortality in the real world.

Implementation of population screening for colorectal cancer by repeated fecal occult blood test in the Netherlands

BackgroundColorectal cancer (CRC) is the third most prevalent type of cancer in the world. Its prognosis is closely related to the disease stage at the time of diagnosis. Early detection of symptomless CRC or precursor lesions through population screening could reduce CRC mortality. However, screening programs are only effective if enough people are willing to participate. This study aims to asses the uptake of a second round of fecal occult blood test (FOBt) based screening and to explore factors that could potentially increase this uptake.Methods and designTwo years after the first screening round, 10.000 average risk persons, aged 50 to 75, will again receive an invitation to participate in immunohistochemical FOBt (iFOBt) based screening. Eligible persons will be recruited through a city population database. Invitees will be randomized to receive either an iFOBt with a faeces collection paper or an iFOBt without a collection paper. The iFOBts will be analyzed in a specialized laboratory at the Academic Medical Centre. Positive iFOBts will be followed by a consultation at our outpatient clinic and, in the absence of contra-indications and after informed consent, by a colonoscopy. The primary outcome measure is the participation rate. Secondary outcome measures are the effect of the addition of a collection paper on the participation rate, reasons for participation and non-participation, measures of informed choice and psychological consequences of screening and measures of psychological and physical burden associated with the iFOBt and the colonoscopy. Another secondary outcome measure is the diagnostic yield of the program.DiscussionIn order to implement population screening for colorectal cancer in the Netherlands, information is needed on the uptake of repeated rounds of FOBt-based screening and on factors that could potentially increase this uptake in the future since effectiveness of such a program depends on the willingness of persons to participate. This study will provide information on the actual uptake and perception of a second round of iFOBt-based screening. The results of this study will contribute to the future implementation of a national colorectal screening program in the Netherlands.Trial registrationDutch Trial register: NTR1327

Should computed tomographic colonography replace optical colonoscopy in screening for colorectal cancer?

Clinical evidence amassed over the last several decades indicates that routine colorectal cancer (CRC) screening, compared to no screening, detects CRC at an earlier stage, reduces the incidence of CRC or the progression early CRC through polypectomy, and reduces CRC mortality. Computed tomographic colonography (CTC) is a minimally invasive, structural evaluation of the entire colorectum that has recently been advocated by multiple American professional medical societies as an effective alternative for CRC screening. The potential advantages of CTC, including rapid image acquisition and processing, non-invasiveness, and decreased procedural risks of perforation, bleeding, and sedation complications may serve to improve the low rates of colorectal cancer screening that are currently observed in our society. Several large studies of CTC as a CRC screening test have reported excellent results but have been criticized because of the expertise of CTC interpreters participating in those trials. As a response to these criticisms, the long-awaited results of the American College of Radiology Imaging Network (ACRIN) National CT Colonography Trial were recently published. The purpose of this study was to assess the accuracy of CTC in a "community based" environment to determine if previous results obtained at expert sites could be replicated. All CTC were confirmed and compared to conventional colonoscopy, the gold-standard colorectal cancer screening test. For polyps >10 mm, the results obtained in the ACRIN trial were comparable to previous studies with a mean CTC sensitivity of 90% and a mean CTC specificity of 86%. The sensitivity of CTC fell to 78% for lesions >6 mm, a value that some studies have suggested is comparable to the detection rate of conventional colonoscopy. This study adds to the body of literature regarding the efficacy of CTC and will likely be cited by many as evidence supporting CTC as an acceptable CRC screening test, in the same league as colonoscopy. Issues remain, however, regarding the extension and reproducibility of these results in the true community setting. There are concerns regarding thresholds for referrals, appropriate intervals between studies, the optimal management of extracolonic findings, and radiation exposure with CTC that remain unanswered by these data.

Colorectal Cancer Mortality in Two Areas of Tuscany With Different Screening Exposures

Several randomized trials have demonstrated the efficacy of colorectal cancer screening by the fecal occult blood test in reducing colorectal cancer mortality, but an evaluation of population-based screening programs is still lacking. We compared the colorectal cancer mortality rates (both adjusted rates and 3-year moving average rates) during 1985-2006 for two geographic areas in the provinces of Florence and Prato in the Tuscany region of Italy that began active population-based screening for colorectal cancer at different times: the Empolese-Mugello district, in the early 1980s, and the rest of the Florence and Prato provinces, in early 2000. A log-linear Poisson model was used to estimate the annual percent change in mortality and to examine whether geographic area modified the effect of calendar year on it. The Empolese-Mugello district had a greater decrease in colorectal cancer mortality than the rest of the Florence and Prato provinces (estimated annual percent change in age-adjusted colorectal cancer mortality rate, 2.7% decrease per year [95% confidence interval {CI} = 1.7% to 3.7%] vs 1.3% decrease per year [95% CI = 0.8% to 1.7%], respectively). The interaction between calendar period and area was statistically significant (P < .001). Our results support the hypothesis that the implementation of colorectal cancer screening in the early 1980s in the Empolese-Mugello district, where approximately 17 500 people were tested each year with the fecal occult blood test, was associated with a larger reduction in colorectal cancer mortality than that observed in the rest of Florence and Prato provinces, where screening started 15-20 years later and where approximately 38 000 people were screened each year beginning in 2000.

Diagnosis and management of dysplasia in patients with ulcerative colitis and Crohn's disease of the colon.

To minimize the possibility of developing lethal colorectal cancer (CRC) in ulcerative colitis (UC) and Crohn's colitis, patients are usually enrolled in a program of dysplasia surveillance. The success of a surveillance program depends on the identification of patients with dysplasia and timely referral for colectomy. While a number of issues might stand in the way of a surveillance system achieving its maximal effect (less than ideal agreement in the interpretation of biopsy specimens, sampling error by endoscopists, delays in referral to surgery, and patient drop-out among others), circumstantial evidence supports the concept that colonoscopic dysplasia surveillance is an effective means of reducing CRC mortality and morbidity while minimizing the application of colectomy for cancer prevention. This review critically appraises key issues in the diagnosis and management of dysplasia in UC and Crohn's disease as well as adjunct efforts to prevent CRC in inflammatory bowel disease.

Colorectal Cancer in Inflammatory Bowel Disease

Patients with long-standing inflammatory bowel disease have an increased risk of developing colorectal cancer (CRC). CRC risk increases with longer duration of colitis, greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and severity of inflammation of the colon. Chemoprevention includes aminosalicylates, ursodeoxycholic acid, and possibly folic acid. To reduce CRC mortality in IBD, colonoscopic surveillance remains the major way to detect early mucosal dysplasia. When dysplasia is confirmed, proctocolectomy is considered for these patients. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal-anastomosis have a rather low risk of dysplasia in the ileal pouch, but the anal transition zone should be monitored periodically. New endoscopic and molecular screening approaches may further refine our current surveillance guidelines and our understanding of the natural history of dysplasia.

Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer

Early detection of colorectal cancer could reduce cancer-specific mortality. The aim of this trial was to evaluate the effect of faecal occult blood test (FOBT) screening on colorectal cancer mortality in a Swedish population. All 68,308 citizens in Göteborg born between 1918 and 1931 were randomized to a screening or a control group at the age of 60-64 years. All were screened two to three times with rehydrated Hemoccult-II. Compliance was 70.0 per cent (23,916 individuals). Those with a positive test result were offered sigmoidoscopy and a double-contrast enema. The primary endpoint was death from colorectal cancer. After a mean of 9 years from the last screening, there was a significant reduction in colorectal cancer mortality in the screening group compared with the control group. The overall risk ratio of death from colorectal cancer was 0.84 (95 per cent confidence interval 0.71 to 0.99). The groups did not differ in incidence of colorectal cancer or in overall mortality. FOBT screening significantly reduces colorectal cancer mortality.

Cochrane Systematic Review of Colorectal Cancer Screening Using the Fecal Occult Blood Test (Hemoccult): An Update

Reducing mortality from colorectal cancer (CRC) may be achieved by the introduction of population-based screening programs. The aim of the systematic review was to update previous research to determine whether screening for CRC using the fecal occult blood test (FOBT) reduces CRC mortality and to consider the benefits, harms, and potential consequences of screening. We searched eight electronic databases (Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, SIGLE, and HMIC). We identified nine articles describing four randomized controlled trials (RCTs) involving over 320,000 participants with follow-up ranging from 8 to 18 yr. The primary analyses used intention to screen and a secondary analysis adjusted for nonattendance. We calculated the relative risks and risk differences for each trial, and then overall, using fixed and random effects models. Combined results from the four eligible RCTs indicated that screening had a 16% reduction in the relative risk (RR) of CRC mortality (RR 0.84, 95% confidence interval [CI] 0.78-0.90). There was a 15% RR reduction (RR 0.85, 95% CI 0.78-0.92) in CRC mortality for studies that used biennial screening. When adjusted for screening attendance in the individual studies, there was a 25% RR reduction (RR 0.75, 95% CI 0.66-0.84) for those attending at least one round of screening using the FOBT. There was no difference in all-cause mortality (RR 1.00, 95% CI 0.99-1.02) or all-cause mortality excluding CRC (RR 1.01, 95% CI 1.00-1.03). The present review includes seven new publications and unpublished data concerning CRC screening using FOBT. This review confirms previous research demonstrating that FOBT screening reduces the risk of CRC mortality. The results also indicate that there is no difference in all-cause mortality between the screened and nonscreened populations.

Colorectal Cancer Screening in Scotland

In the United Kingdom the National Screening Committee advised the Health Departments to carry out a demonstration pilot of colorectal cancer screening based on the results of the previous randomised trials. These trials all employed the guaiac based faecal occult blood test and a meta analysis indicated that this approach could produce an overall reduction in colorectal cancer mortality of around 16 % [1]. The largest of these trials was the Nottingham study [2] and as this had been carried out in a United Kingdom context it was used as the bench mark for the demonstration pilot. The pilot sites were chosen on the basis of competitive bids and one was located in Grampian, Tayside and Fife in Scotland and one in Coventry and Warwickshire in England. It was agreed that the pilot sites should invite all men and women aged between 50 and 69 to perform a guaiac faecal occult blood test. The tests were mailed out to the potential participants along with an invitation letter, information about screening and instructions as to how to complete the test. The test was then sent back in the mail to the Central Laboratories where they were analysed. Each test involved supplying two samples from each of three separate stools on to six ovals. If five or six ovals were positive the invitee was contacted by a specialist nurse who organised colonoscopy. If one to four ovals were positive then a repeat test with dietary restriction was offered. If any oval was positive in this repeat test colonoscopy was organised and if all ovals were negative a further repeat test was offered. Again colonoscopy was only offered if any of the ovals on the second repeat test were positive.

The Importance of Quality-Assurance Methods for Competent Execution, Handling and Structuring of Colon Cancer Screening Programs - the Case of Programs Based on Stool Tests

Screening for colorectal cancer aims at the early detection of early cancer stages in individuals in a defined, otherwise healthy population. In randomized controlled trials it was possible to achieve a clinically and statistically significant reduction of colorectal cancer mortality for those citizens who participated in a quality assured screening program. It is one of the most pertinent goals of quality assurance measures to attain this success in routine settings. As Sir Muir Gray pointed out: All screening programs do harm, some do good as well [1]. Since screening of colorectal cancer is not just the test such as a test for occult blood, quality assurance has to cover all relevant steps of the program (”screening chain”).

Cancer in inflammatory bowel disease

Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Many of the molecular alterations responsible for sporadic colorectal cancer, namely chromosomal instability, microsatellite instability, and hypermethylation, also play a role in colitis-associated colon carcinogenesis. Colon cancer risk in inflammatory bowel disease increases with longer duration of colitis, greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and degree of inflammation of the bowel. Chemoprevention includes aminosalicylates, ursodeoxycholic acid, and possibly folic acid and statins. To reduce CRC mortality in IBD, colonoscopic surveillance with random biopsies remains the major way to detect early mucosal dysplasia. When dysplasia is confirmed, proctocolectomy is considered for these patients. Patients with small intestinal Crohn's disease are at increased risk of small bowel adenocarcinoma. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal-anastomosis have a rather low risk of dysplasia in the ileal pouch, but the anal transition zone should be monitored periodically. Other extra intestinal cancers, such as hepatobiliary and hematopoietic cancer, have shown variable incidence rates. New endoscopic and molecular screening approaches may further refine our current surveillance guidelines and our understanding of the natural history of dysplasia.

Colorectal cancer screening perceptions and practices: Results from a national survey of gastroenterology, surgery and radiology trainees

Colorectal cancer (CRC) screening in the United States is suboptimal. We conducted a national survey to learn about CRC screening perceptions and practices among trainees who perform CRC screening tests including those enrolled in Gastroenterology and Hepatology (GIH), General and Colorectal Surgery, and Diagnostic and Abdominal Radiology training programs. Program directors/administrators (PDs/PAs) from 642 programs were contacted by e-mail with an invitation to forward our survey to trainees in their programs. Participating trainees then completed an anonymous, Web-based questionnaire. A total of 130/642 (20%) PDs/PAs forwarded our survey to their trainees, with responses received from 476 trainees (80 GIH, 261 surgery, 135 radiology). Colonoscopy was felt to be the best CRC screening test at reducing CRC mortality, with patient-related factors perceived as greater barriers than system-related factors. No single guideline was deemed very influential on CRC screening practices by most trainees. A total of 2 of 5 above-average risk patient profiles were not recognized by most trainees. Colonoscopy was selected as the preferred follow-up test for a positive CRC screening test by most trainees. However, 34% of respondents chose an option other than colonoscopy alone for follow-up of a positive fecal occult blood test. Based on data from this national survey of gastroenterology, surgery, and radiology trainees, opportunities exist for curricular changes that may help enhance current perceptions and practices of trainees who perform CRC screening tests.