Role In Colorectal Cancer Screening Research Articles

Abstract C116: Provider input following implementation trial to address overdue colorectal cancer screening

Abstract Implementing Fit Kit Colorectal Cancer (CRC) Screening in At-Risk Populations Study was a trial of 4 evidence-based strategies to increase colorectal cancer (CRC) screening in the primary care setting. The focus of this report is the factors that impacted implementation of these interventions in a safety net setting. Using the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework, we evaluated providers’ assessments of the impact of the intervention on the 2 main outcomes: 1) CRC screening ordered; 2) CRC screening completed in a diverse population with more than 3,000 individuals overdue for screening. Methods: We conducted a Qualtrics evaluation survey among 51 staff members identified as individuals involved in cancer screening in a safety net primary care setting that serves over 38,000 individuals in New Haven, CT. The staff surveys are part of the evaluation of the program at one-year post-intervention. Invited staff were provided links through group emails from the provider partners requesting participation in a 2–5-minute Qualtrics survey. Questions on job title, role in CRC screening, and whether and how the interventions (referred to as “the study”) impacted CRC screening in this facility, understanding of the procedures in place to facilitate scheduling and completion of CRC screening, and the barriers and facilitators that impact CRC screening completion were queried. Descriptive results will be mapped to relevant aspects of the RE-AIM framework. Results: Twenty (39%) staff members completed the survey including 9 (45.0%) registered nurses/advanced practice registered nurses, 6 (30.0%) physicians, 2 (10.0%) physician assistants, and 3 (15.0%) individuals in other roles, e.g., schedulers. 87.5% (n=14) were authorized to order colorectal cancer (CRC) screening tests, either colonoscopy or stool-based testing, for their patients. By self-report, effectiveness of the intervention on provider behavior was limited with only 22.2% reporting that the study impacted decisions to order CRC screening. Yet 41% of providers in the study placed a “blanket order” for all individuals who were due for CRC screening even if they were not seen for an appointment during the study period. Barriers to completion of CRC screening were “patient factors” (37%) and insufficient consultation time during appointments (27.3%). Most health care providers cited COVID-19 as a significant factor in delivering an effective CRC screening program. Provider suggestions to improve CRC screening uptake included posted information in exam rooms, use of clinical decision-making tools in the electronic medical record to determine if colonoscopy or FIT (stool-based) testing is the best option, nurse visits to teach use of stool-based testing and making in-home test kits available over the counter in pharmacies. Discussion: Although the results from this small sample of providers has limited generalizability, the findings will be useful in designing scalable interventions in similar high volume primary care settings. Citation Format: Beth A. Jones, Denise L. Stevens, Sakinah Suttiratana, Sarah A. DeGiovanni, Laney Zhang, Margarita Vargas-Torres, Michael Couturie, Levita Robinson. Provider input following implementation trial to address overdue colorectal cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C116.

Effect of Patient-Directed Messaging on Colorectal Cancer Screening

Colorectal cancer (CRC) screening is underused in the US. Tailored message interventions have shown benefit for increasing screening uptake of mammography and Papanicolaou testing, but their role in CRC screening is less clear. To evaluate the effectiveness of a tailored message telephone intervention prior to scheduling of a screening or surveillance colonoscopy and its effect on CRC screening completion rates. This randomized clinical trial was conducted from July 2017 through August 2018 at the University of Pennsylvania Health System (UPHS), an urban academic medical center. Participants were asymptomatic patients aged 50 to 75 years who were eligible for CRC screening or surveillance, had been referred for colonoscopy, and did not have a scheduled colonoscopy appointment. Data analysis was conducted from January to September 2019. Patients underwent block randomization in a 1:1:1 ratio to 1 of 3 study arms. Participants in the usual care group were contacted via a mailed letter and instructed to call to schedule a colonoscopy. In the generic message group, participants were contacted by telephone, completed an assessment, and received a uniform, nontailored message encouraging colonoscopy scheduling. Participants in the tailored message group were contacted by telephone, completed an assessment, and received a tailored message encouraging colonoscopy scheduling based on their identified assessment cohort. The primary outcome was colonoscopy completion rate within 120 days of enrollment. The secondary outcome was colonoscopy scheduling rate appointment within 120 days of enrollment. A total of 600 participants (median [IQR] age, 56 [51-63] years; 373 women [62.2%]) were enrolled, including 200 participants randomized to usual care, 200 participants randomized to the generic message, and 200 participants randomized to the tailored message. The total sample included 12 Asian participants (2.0%), 324 Black participants (54.0%), and 227 White participants (37.8%), and 9 participants (1.5%) were of Latino or Hispanic ethnicity. Colonoscopy completion was significantly higher for both the tailored message group (69 participants [34.5%]) and the generic message group (64 participants [32.0%]) compared with the usual care group (37 participants [18.5%]) (P < .001 and P = .002, respectively). Scheduling rates were also significantly higher in both groups, with 106 participants (53.0%) in the tailored message group and 105 participants (52.5%) in the generic message group scheduling appointments, compared with 54 participants (27.0%) in the usual care arm (P < .001 for both). In this randomized clinical trial among individuals whose CRC screening was not up to date, both a tailored message intervention and a generic message intervention were significantly more effective at increasing colonoscopy scheduling and completion rates compared with usual care. These findings suggest that individualized health communications can increase individual motivation to obtain CRC screening. ClinicalTrials.gov Identifier: NCT03310892.

Justice beliefs buffer against perceived barriers to colorectal cancer screening among African Americans

Objectives African Americans develop and die from colorectal cancer (CRC) more than any other racial group in the United States. Perceived barriers to screening (e.g. embarrassment and financial costs) likely exacerbate these disparities. Identifying psychological factors that can reduce the impact of perceived barriers and encourage CRC screening is therefore critical. This study explored whether believing the world is fairer for oneself than in general (personal justice ascendancy) would moderate the impact that perceived barriers have on receptivity to CRC screening. Method Four-hundred fifty-seven screening eligible African Americans completed measures of beliefs about justice for self and others, as well as perceived barriers to CRC screening. Participants also completed theory of planned behaviour (TPB) measures of screening receptivity (attitudes, norms, perceived behavioural control and intentions). Results Perceived barriers and justice beliefs interacted to predict perceived behavioural control over screening. Perceived barriers were associated with less perceived behavioural control only when personal justice beliefs were low. In turn, perceived behavioural control predicted stronger intentions to obtain CRC screening. Conclusions Interactive effects with perceived barriers highlight that strong personal justice beliefs play an important role in CRC screening and could aid in addressing CRC screening disparities among African Americans.

ID: 3526093 THE VALUE OF QUANTITATIVE FAECAL IMMUNOCHEMICAL TEST (QFIT) AS A PRIORITISATION TOOL FOR PATIENTS WITH IRON DEFICIENCY REQUIRING URGENT OUTPATIENT INVESTIGATION

Difficulty in providing endoscopy for patients with iron deficiency anaemia (IDA) during the COVID-19 pandemic has highlighted the requirement for a prioritisation tool. Currently qFIT has a role in colorectal cancer screening and in identifying patient cohorts with colorectal symptoms who may benefit from more urgent endoscopy. We aimed to test the validity of qFIT as a prioritisation tool in patients with iron deficiency and its ability to identify patients with neoplasia, defined as upper GI cancer, colonic adenoma over 1cm or colorectal cancer. Data collected from patients referred with biochemically proven iron deficiency and synchronous qFIT who underwent full gastrointestinal investigation within NHS Greater Glasgow and Clyde was analysed retrospectively. Biochemically proven iron deficiency was defined as a ferritin ≤ 15 micrograms/L. Patients who did not undergo full investigation, defined as gastroscopy and colonoscopy or CT colonography, were excluded. Outcomes from these investigations were linked to qFIT results. Area under the curve (AUC) analysis was performed on qFIT results and outcome, defined as the presence of neoplasia. Sensitivity and specificity from AUC analysis guided cut-off scores for qFIT. Patients with a qFIT of <9, 10-200, >200, were allocated a score of 1, 2 and 3 respectively. A total of 575 patient met criteria for inclusion into the study. Within the patient cohort, 50 patients had a confirmed neoplasm. Overall, qFIT results strongly predicted the presence of GI neoplasms (AUC 0.866, 0.812-0.921; P <0.001). The prevalence of neoplasm in patients with scores 1 to 3 was 1.2%, 13.5% and 38.9% respectfully. When controlled for other significant variables, patients with a higher qFIT score were statistically more likely to have a GI neoplasm (qFIT score = 2; OR 12.8; P<0.001, qFIT score = 3, OR 50.0; P<0.001). qFIT was highly sensitive for the presence of neoplasia (92.0% (84.4%-99.5%), with moderate specificity (63.2% (59.1%-67.4%)). A negative qFIT had a high negative predictive value for the presence of neoplasia (98.5% 97.5%-100.0%). These results strongly suggest that qFIT has validity as a prognostic tool in patients with iron deficiency; both allowing for a more informed decision of investigation of patients with very low risk of malignancy, and in identifying higher risk patients who may benefit from more urgent endoscopy.

Occult Blood in Feces Is Associated With an Increased Risk of Ischemic Stroke and Myocardial Infarction: A Nationwide Population Study.

BackgroundAlthough occult hemoglobin in feces is universally valued as a screening tool for colorectal cancer (CRC), only few studies investigated the clinical meaning of fecal immunochemical test (FIT) in other diseases. We evaluated the clinical utility of FIT in patients with cardiovascular diseases (namely, ischemic stroke and myocardial infarction [MI]).Methods and ResultsUsing the National Health Insurance database, participants (aged >50 years) with CRC screening records from 2009 to 2012 were screened and followed up. Subjects with a history of cardiovascular diseases and CRC were excluded. Ischemic stroke, MI, and other comorbidities were defined by International Classification of Diseases, Tenth Revision (ICD‐10), codes. Age, sex, smoking, alcohol consumption, regular exercise, diabetes mellitus, hypertension, dyslipidemia, and body mass index were adjusted in a multivariate analysis. A total of 6 277 446 subjects were eligible for analysis. During the mean 6.79 years of follow‐up, 168 570 participants developed ischemic stroke, 105 983 developed MI, and 11 253 deaths were observed. A multivariate‐adjusted model revealed that the risk of ischemic stroke was higher in the FIT‐positive population (adjusted hazard ratio [HR], 1.09; 95% CI, 1.07–1.11). Similarly, FIT‐positive subjects were at an increased risk of MI (adjusted HR, 1.09; 95% CI, 1.06–1.12). Moreover, increased all‐cause mortality was observed in the FIT‐positive population (adjusted HR, 1.15; 95% CI, 1.07–1.23). The increased risk remained consistent in the stratified analysis on anemia and CRC status.ConclusionsPositive FIT findings were associated with ischemic stroke, MI, and mortality. Occult blood in feces may offer more clinical information than its well‐known conventional role in CRC screening.

Disparities in Utilization of Medical Specialists for Colonoscopy

Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist.Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested.Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant.Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.

Colorectal cancer tumour markers and biomarkers: Recent therapeutic advances.

Colorectal cancer (CRC) is the second most commonly diagnosed cancer among females and third among males worldwide. It also contributes significantly to cancer-related deaths, despite the continuous progress in diagnostic and therapeutic methods. Biomarkers currently play an important role in the detection and treatment of patients with colorectal cancer. Risk stratification for screening might be augmented by finding new biomarkers which alone or as a complement of existing tests might recognize either the predisposition or early stage of the disease. Biomarkers have also the potential to change diagnostic and treatment algorithms by selecting the proper chemotherapeutic drugs across a broad spectrum of patients. There are attempts to personalise chemotherapy based on presence or absence of specific biomarkers. In this review, we update review published last year and describe our understanding of tumour markers and biomarkers role in CRC screening, diagnosis, treatment and follow-up. Goal of future research is to identify those biomarkers that could allow a non-invasive and cost-effective diagnosis, as well as to recognise the best prognostic panel and define the predictive biomarkers for available treatments.

Advanced Studies in Clinical and Experimental Research in Gastroenterology.

Current research in gastroenterology and hepatology (both clinical and experimental) made great and rapid progress in new methods, in biomedical technology, and last but not least in practical application of basic scientific achievements during the last decade. Original research articles focusing on new, advanced studies in clinical and experimental research in gastroenterology and hepatology that have a potential to influence our daily practice and further clinical and experimental research were sent to this journal to be published by many leading gastroenterology specialists. We bring ten articles in this special issue focused on the most interesting topics in gastroenterology and hepatology research. One of the leading areas of advanced studies in gastroenterology is cancer research. Colorectal cancer is one of the most common malignancies worldwide in terms of incidence and mortality. Although clear progress in both diagnosis and treatment has been achieved, efficacy of surgery and chemotherapy remains unsatisfactory due to late diagnosis. A possible new prognostic marker and therapeutic target in this disease is discussed in the article “ATAD2 Overexpression Identifies Colorectal Cancer Patients with Poor Prognosis and Drives Proliferation of Cancer Cells.” The aim of another article dealing with the colorectal cancer “Molecular Features and Methylation Status in Early Onset (≤40 Years) Colorectal Cancer: A Population Based, Case-Control Study” was to define the frequency of known hereditary colorectal syndromes and to characterise genetic and epigenetic features of early nonhereditary tumours in order to elucidate possible pathogenetic mechanisms. Colonoscopy plays an important role in colorectal cancer screening in many countries worldwide. Quality of colonic cleansing achieved is crucial for good quality of colonoscopy screening. Possible improvements in the field of low volume colonoscopy cleansing were described in the article “A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.” Second malignancy, which is discussed in a special issue in more detail, is the third most common cause of cancer-related death in the world: the gastric cancer. In the article “The Prevalence of Gastric Intestinal Metaplasia and Distribution of Helicobacter pylori Infection, Atrophy, Dysplasia, and Cancer in Its Subtypes,” the prevalence of the precancerous gastric lesions (intestinal metaplasia especially) in a large cohort of patients within the region with a high risk of gastric cancer was described. The metastatic involvement of the posterior lymph nodes along the common hepatic artery (the extra-regional lymph nodes called No.8p) was identified as a prognostic factor in the retrospective study: “Prognostic Value of Metastatic No.8p LNs in Patients with Gastric Cancer.” The research based on the use of experimental animals still plays an important role in gastroenterology and the rat is one of the most extensively used experimental animal models. The study “Surgical Anatomy of the Gastrointestinal Tract and Its Vasculature in the Laboratory Rat” investigated the functional anatomy and vasculature of the stomach, liver, and intestine in the laboratory rat and compared it with human morphology. Nonsteroidal anti-inflammatory drug-induced gastropathy and ulcers represent an important complication related to one of the most commonly used drugs worldwide. Possible mucosal protective effect of Syzygium cumini (L.) Skeels aqueous extract in experimental mice model of indomethacin-induced gastric damage was proven in article “Anti-Inflammation Property of Syzygium cumini (L.) Skeels on Indomethacin-Induced Acute Gastric Ulceration.” Research in hepatology is represented in three articles: “Assessing the Effect of Leptin on Liver Damage in Case of Hepatic Injury Associated with Paracetamol Poisoning,” “Lower Viral Response to Pegylated Interferon Alpha 2a Treatment of Chronic Hepatitis B in Roma People in Eastern Slovakia,” and “Serum Liver Fibrosis Markers for Predicting the Presence of Gastroesophageal Varices in Liver Cirrhosis: A Retrospective Cross-Sectional Study.” The special issue cannot be a complete overview of research in the field of gastroenterology and hepatology. However, we believe that it is an interesting look at this area and provides a preview with an important impact on clinical medicine. Ilja Tacheci Jithinraj Edakkanambeth Varayil Zuzana Zelinkova Marcela Kopacova Miroslav Zavoral

Capsule endoscopy: current practice and future directions.

Capsule endoscopy (CE) has transformed investigation of the small bowel providing a non-invasive, well tolerated means of accurately visualising the distal duodenum, jejunum and ileum. Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications, diagnostic yields and safety profile has been presented. Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel. Most commonly, small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn's disease (CD) (in patients with or without a prior history of CD). Typically, CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis. Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures (such as patients known to have CD or presenting with obstructive symptoms) to reduce the risk of capsule retention. CE also has a role in patients with coeliac disease, suspected small bowel tumours and other small bowel disorders. Since the advent of small bowel CE, dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders. Oesophageal CE may be used to diagnose oesophagitis, Barrett's oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability. Colon CE provides an alternative to conventional colonoscopy for symptomatic patients, while a possible role in colorectal cancer screening is a fascinating prospect. Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.

Psychological barriers and facilitators of colorectal cancer screening: a French qualitative study

The aim of this qualitative study was to explore the psychological barriers to and facilitators of undergoing the Hemoccult-II&amp;reg; colorectal cancer screening test in France. Sixty-nine French people aged 50 to 74 years were divided into seven qualitative focus groups. Three issues were discussed with participants: &lt;em&gt;knowledge and beliefs about colorectal cancer screening; facilitators of colorectal cancer screening by Hemoccult-II&amp;reg;; barriers to colorectal cancer screening by Hemoccult-II&amp;reg;&lt;/em&gt;. All the discussions were led by two psychologists and were recorded, transcribed verbatim and analyzed using qualitative data analysis software. Correspondence factor analyses identified three dimensions for each topic. The main psychological facilitators of colorectal cancer screening were: &lt;em&gt;information about colorectal cancer screening&lt;/em&gt;, &lt;em&gt;perceived simplicity of using Hemoccult-II&amp;reg;&lt;/em&gt;, and &lt;em&gt;perception of risk&lt;/em&gt;. &lt;em&gt;Uncertainty about the reliability of Hemoccult-II&amp;reg;&lt;/em&gt;, &lt;em&gt;health anxiety&lt;/em&gt;, and &lt;em&gt;embarrassment&lt;/em&gt; emerged as the main barriers to colorectal cancer screening. Cross-sectional analyses identified the differences between the views expressed by women and men. Women appeared more embarrassed about Hemoccult-II&amp;reg; and men seemed to be more worried about colorectal cancer. This preliminary study suggests that psychological factors play an important role in colorectal cancer screening by Hemoccult-II&amp;reg;. This finding may help health organizations to conceive better awareness campaigns to promote colorectal cancer screening in order to reduce the related mortality rate by taking into account psychological determinants.

Psychological Barriers and Facilitators of Colorectal Cancer Screening: A French Qualitative Study.

The aim of this qualitative study was to explore the psychological barriers to and facilitators of undergoing the Hemoccult-II® colorectal cancer screening test in France. Sixty-nine French people aged 50 to 74 years were divided into seven qualitative focus groups. Three issues were discussed with participants: knowledge and beliefs about colorectal cancer screening; facilitators of colorectal cancer screening by Hemoccult-II®; barriers to colorectal cancer screening by Hemoccult-II®. All the discussions were led by two psychologists and were recorded, transcribed verbatim and analyzed using qualitative data analysis software. Correspondence factor analyses identified three dimensions for each topic. The main psychological facilitators of colorectal cancer screening were: information about colorectal cancer screening, perceived simplicity of using Hemoccult-II®, and perception of risk. Uncertainty about the reliability of Hemoccult-II®, health anxiety, and embarrassment emerged as the main barriers to colorectal cancer screening. Cross-sectional analyses identified the differences between the views expressed by women and men. Women appeared more embarrassed about Hemoccult-II® and men seemed to be more worried about colorectal cancer. This preliminary study suggests that psychological factors play an important role in colorectal cancer screening by Hemoccult-II®. This finding may help health organizations to conceive better awareness campaigns to promote colorectal cancer screening in order to reduce the related mortality rate by taking into account psychological determinants.

Screening Colonoscopy in the US: Attitudes and Practices of Primary Care Physicians

Rising colorectal cancer (CRC) screening rates in the last decade are attributable almost entirely to increased colonoscopy use. Little is known about factors driving the increase, but primary care physicians (PCPs) play a central role in CRC screening delivery. Explore PCP attitudes toward screening colonoscopy and their associations with CRC screening practice patterns. Cross-sectional analysis of data from a nationally representative survey conducted in 2006-2007. 1,266 family physicians, general practitioners, general internists, and obstetrician-gynecologists. Physician-reported changes in the volume of screening tests ordered, performed or supervised in the past 3 years, attitudes toward colonoscopy, the influence of evidence and perceived norms on their recommendations, challenges to screening, and practice characteristics. The cooperation rate (excludes physicians without valid contact information) was 75%; 28% reported their volume of FOBT ordering had increased substantially or somewhat, and the majority (53%) reported their sigmoidoscopy volume decreased either substantially or somewhat. A majority (73%) reported that colonoscopy volume increased somewhat or substantially. The majority (86%) strongly agreed that colonoscopy was the best of the available CRC screening tests; 69% thought it was readily available for their patients; 59% strongly or somewhat agreed that they might be sued if they did not offer colonoscopy to their patients. All three attitudes were significantly related to substantial increases in colonoscopy ordering. PCPs report greatly increased colonoscopy recommendation relative to other screening tests, and highly favorable attitudes about colonoscopy. Greater emphasis is needed on informed decision-making with patients about preferences for test options.

Role of CT colonography in symptomatic assessment, surveillance and screening

When 'whole colonic imaging' is indicated, clinicians must decide between optical colonoscopy, barium enema and CT colonography (CTC). CTC is a relatively new technique which has become increasingly accessible in the UK over the past 5years. As radiologists have gained experience and scanning parameters have standardised, there have been substantial improvements in both the accuracy and safety of CTC. We review evidence from observational studies and randomised trials, and draw on expert opinion, to provide a comprehensive discussion of the current role of CTC in both symptomatic and asymptomatic individuals. The emergence of CTC could soon entirely obviate the need for barium enema. CTC now has a complementary role alongside colonoscopy in symptomatic patients and a possible future role in colorectal cancer screening in the UK.

Organized colorectal cancer screening programmes

Colorectal cancer (CRC) is an important public health issue in France, justifying a screening policy adapted to individual risk. The general practitioner (GP) is most commonly the initiator of CRC screening. The EDIFICE 2 survey, carried out in 2008 among 600 GPs, showed that 83% of GPs were convinced of the importance of screening, but that only 30% of GPs systematically recommended the procedure. The main underlying reasons were that only 50% of GPs declared themselves sufficiently trained, GPs needed clear guidelines and information supports for patients and a better implication in the programme's overall organization. This important role was confirmed by patients as the second most important reason for not undergoing screening: the absence of recommendation from their treating physician. The optimization of the screening procedure thus requires a stronger implication of GPs, by confirming their pivotal role in CRC screening and by relying on clear reference documentation guaranteeing quality assurance of a national organized screening programme.

Progesterone Receptor Upregulation is an Early Event in Colon Carcinogenesis: Potential Modulator of Neoplastic Risk in Women

Purpose: While colorectal cancer (CRC) impacts upon the genders equally, there are profound differences in biology and epidemiology (e.g., women tend to have proximal lesions, MSI high tumors etc). However, clinical practice largely treats CRC as gender-neutral. Our group has shown that CRC biomarkers are different in women thus having significant implications for screening (JAMA 2009, Can Prev Res 2010). The gender differences are generally attributed to sex steroids although precise hormones remain unclear. For instance, WHI data indicates estrogen/progesterone reduced CRC by 38% (Chlebowski et al., NEJM 2004) although estrogen alone had no effect (OR:1.08, Anderson et al., JAMA 2004) suggesting that the progesterone receptor (PR) was important. However, the role of PR in CRC remains unexplored. Methods: For these studies we employed the azoxymethane (AOM)-treated rat which is the best-accepted model of experimental colon carcinogenesis requiring 20 and 40 weeks for adenomas and CRCs to develop, respectively. PR expression from colonic mucosa was assessed by real time RT-PCR using high capacity cDNA synthesis kit and PR-specific taqman probe. In order to further assess PR's role, we employed a well-established chemopreventive agent, celecoxib in the human CRC cell line HCT 116. (Bertagnolli et al., NEJM 2006). We evaluated protein levels using quantitative immunoblot analysis. Results: In the AOM-treated rat, PR was markedly (319.6±12.2%) increased in the tumor when compared to colonic mucosal scrapings from age-matched saline-treated controls. Moreover, a comparable (392±4.2%, p<0.001) increase was noted in the microscopically-normal mucosa of these AOM-treated rats implicating field carcinogenesis. Typically, we examined the 10 week (premalignant) time-point since it best replicates human field carcinogenesis and noted a comparable induction of PR in the premalignant mucosa (313±4.2%, p<0.001). From a diagnostic perspective, the AUROC at the 10 week timepoint for discriminating AOM versus control rats was an impressive 0.97. Finally, we noticed that PR was markedly altered with celecoxib treatment (50μm) in HCT116 by 37.4% (p<0.01). Conclusion: We report, herein, for the first time that PR induction is an early event in colorectal carcinogenesis. Moreover, its reversal by chemoprevention underscores PR's biological significance. Importantly, the performance of PR expression was outstandingly supporting a possible role in CRC screening, potentially coupled with our recently developed ability to perform real time PCR on mucus layer fecal colonocytes (to detect field carcinogenesis). Furthermore, PR status may finally explain some of the gender-related differences in colon carcinogenesis.

A new way for improving the quality of colonoscopy?

Colonoscopy is currently regarded as the “gold standard” for diagnosing diseases of colon and rectum; it also plays a key role in colorectal cancer screening, as either a primary approach in average-risk subjects or a second level test in asymptomatic individuals with positive faecal occult test or abnormal findings at CT colonography.

The Primary Care Physician May Have a More Critical Role in Colorectal Cancer Screening in African Americans When Compared to Non-African Americans

The Primary Care Physician May Have a More Critical Role in Colorectal Cancer Screening in African Americans When Compared to Non-African Americans

Performance value of high risk factors in colorectal cancerscreening in China

To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

Will Virtual Colonoscopy Replace Optical Colonoscopy for Colorectal Cancer Screening?

Will Virtual Colonoscopy Replace Optical Colonoscopy for Colorectal Cancer Screening?

Mutated DNA in the stool—does it have a role in colorectal cancer screening?

This Viewpoint discusses the role of stool DNA testing as a new diagnostic tool for detecting colorectal cancer. Preliminary data show it to have better performance characteristics than fecal occult blood testing, however, in its current form sensitivity remains low. Stool DNA testing needs to be studied in larger cohorts of asymptomatic patients, and new markers need to be developed before its role in colorectal cancer screening can be fully established.