Colorectal Cancer Screening Methods Research Articles

Knowledge and practice of colorectal screening in a suburban group of Iraqi American women.

Colorectal cancer (CRC) was the second most common cancer among women in 2008, accounting for 571,000 cases, and 9.4% of all cancer cases afflicting women worldwide. According to the World Health Organization (WHO) and the Iraqi National Cancer Registry (INCR), Iraq has seen a steady rise in CRC rates among its general population over the past several decades. Despite Iraq's increasing national incidence of CRC and the growth of the US' Iraqi immigrant population over the last 10 years, little remains known about the prevalence of CRC among the latter population, their knowledge of CRC and associated risk factors, or their behavioral intent and practices regarding CRC screening. The aims of this study were to (1) examine the knowledge of and adherence to National Cancer Institute screening recommendations for CRC among a population of Iraqi women living in the Washington D.C. Metropolitan Area and (2) test the efficacy of a one-time educational intervention conducted using linguistically and culturally appropriate materials to raise awareness of, and promote future adherence to, CRC screening methods. This descriptive study used a pre/post design with a 12-month follow-up. Following extensive dissemination of information regarding the study in the Iraqi American community in the study location, 50 women were initially recruited, of whom 32 participated in the study. The study's findings revealed that the participants generally had low baseline levels of CRC screening adherence and preventive knowledge that significantly improved after the intervention as demonstrated by pre- and post-assessments of knowledge and behavior. These findings could be used to raise awareness (1) among clinicians regarding the need for early detection and screening of and referral for CRC treatment among Iraqi American women and (2) among Iraqi American women about risk factors for this disease and the importance of early detection and screening. The study also highlights the need for a larger study of knowledge, attitudes, and perceptions among both this population and the clinicians who serve them.

Detection of miRNA as non-invasive biomarkers of colorectal cancer.

Colorectal Cancer (CRC) is one of the deadliest cancers—ranking as the fourth most common cause of cancer-related deaths in the world. It is such a deadly disease because it is largely asymptomatic until the latter stages—oftentimes when the cancer has metastasized. Thus, a huge emphasis of cancer treatment is placed on early detection. Currently, there is a lack of a noninvasive, reliable, and cost-effective screening method for CRC. In recent years, microRNA (miRNA) diagnostic markers have been suggested as a viable new screening method for CRC. miRNAs play an important role in carcinogenesis, and has been observed to be dysregulated in many cancers including CRC. This review examines the diagnostic potential of circulatory and fecal miRNA markers in relation to CRC, as well as current techniques to detect them.

Colorectal cancer screening and prevention in women.

Colorectal cancer (CRC) is one of the leading cancers and cause of cancer deaths in American women and men. Females and males share a similar lifetime cumulative risk of CRC however, substantial differences in risk factors, tumor biology, and effectiveness of cancer prevention services have been observed between them. This review distills the evidence documenting the unique variation observed between the genders relating to CRC risk factors, screening and prevention. Consistent evidence throughout the world demonstrates that women reach equivalent levels of adenomas and CRC as men but it occurs nearly a decade later in life than in their male counterparts. Women have a higher proportion of tumors which are hypermethylated, have microsatellite instability and located in the proximal colon suggesting the serrated pathway may be of greater consequence in them than in men. Other CRC risk factors such as smoking, diet and obesity have been shown to have disparate effects on women which may related to interactions between estrogen exposure, body fat distribution, and the biologic underpinnings of their tumors. There is data showing the uptake, choice, and efficacy of different CRC screening methods in women is dissimilar to that in men. The mortality benefit from FOBT, sigmoidoscopy, and protection from interval CRC by colonoscopy appears to be lower in women than men. A greater understanding of these gender idiosyncrasies will facilitate an personalized approach to CRC prevention and should ultimately lead to a reduced burden of disease.

The evolving role of nonsteroidal anti-inflammatory drugs in colon cancer prevention: a cause for optimism.

Colorectal cancer (CRC) is a serious yet preventable disease. The low acceptance and cost of colonoscopy as a screening method or CRC make chemoprevention an important option. Nonsteroidal anti-inflammatory drugs (NSAIDs), not currently recommended for CRC prevention, have the potential to evolve into the agents of choice for this indication. Here, we discuss the promise and challenge of NSAIDs for this chemopreventive application.Multiple epidemiologic studies, randomized clinical trials (RCTs) of sporadic colorectal polyp recurrence, RCTs in patients with hereditary colorectal cancer syndromes, and pooled analyses of cardiovascular-prevention RCTs linked to cancer outcomes have firmly established the ability of conventional NSAIDs to prevent CRC. NSAIDs, however, are seriously limited by their toxicity,which can become cumulative with their long-term administration for chemoprevention, whereas drug interactions in vulnerable elderly patients compound their safety. Newer, chemically modified NSAIDs offer the hope of enhanced efficacy and safety.Recent work also indicates that targeting earlier stages of colorectal carcinogenesis, such as the lower complexity aberrant crypt foci, is a promising approach that may only require relatively short use of chemopreventive agents. Drug combination approaches exemplified by sulindac plus difluoromethylornithine appear very efficacious. Identification of those at risk or most likely to benefit from a given intervention using predictive biomarkers may usher in personalized chemoprevention. Agents that offer simultaneous chemoprevention of diseases in addition to CRC, e.g., cardiovascular and/or neurodegenerative diseases,may have a much greater potential for a broad clinical application.

MicroRNAs as non-invasive screening biomarkers of colorectal cancer.

Colorectal cancer is a major cause of cancer-associated deaths in the world. Early detection would be greatly enhanced if accurate and cost-effective diagnostic biomarkers for this disease were accessible. The development of such a blood test will evidently lower the screening costs in regards of colorectal cancer detection. Lately, it has been suggested that microRNA diagnostic biomarkers are feasible new screening methods for colorectal cancer. This review summarizes the diagnostic potential of circulating microRNA biomarkers in relation with colorectal cancer, as well as current methods to detect them.

Methylation pattern of ALX4 gene promoter as a potential biomarker for blood-based early detection of colorectal cancer.

Background:To develop a non-invasive screening method for colorectal cancer, we evaluated the methylation of ALX4 gene promoter in serum samples from patients with colorectal cancer (CRC) and equal number of healthy individuals.Materials and Methods:In serum samples from 25 patients with colorectal cancer and 25 healthy control subjects, isolated serum free-floating DNA was treated with sodium bisulfite and analyzed by methylation-specific polymerase chain reaction (MSP) with primers specific for methylated or unmethylated promoter CpG island sequences of the ALX4 gene.Results:Methylation of the ALX4 gene promoter was present in the serum DNA of patients with adenoma and colorectal cancer. A sensitivity of 68% and specificity of 88% were achieved in the detection of promoter methylation in colorectal neoplasia samples. The difference in methylation status of the ALX4 promoter between the patients with colorectal neoplasia and the control group was statistically highly significant (P < 0.001).Conclusions:The results indicate that this serum free DNA test of methylation of the ALX4 gene promoter is a sensitive and specific method. Therefore in combination with other useful markers it seems ALX4 has the potential of a clinically useful test for the early detection of colorectal cancer.

Motivating factors associated with receipt of asymptomatic colonoscopy screening.

Background:Colonoscopy is the preferred screening method for colorectal cancer (CRC). This study aimed to identify factors motivating a beneficial health behavior, that is, the decision to complete a colonoscopy.Methods:We surveyed 91 primarily urban minority health care workers who were ineligible for a large randomized controlled trial due to self-reported asymptomatic colonoscopy screening. Participants were asked an open-ended question about what made them get screened. Responses were classified as external or internal motivations.Results:The most commonly reported external motivation was a primary care physician's recommendation (n = 60, 65.9%). Other external motivations were familiarity with CRC or polyps through family or work (n = 16, 17.6%) and pressure from relatives or friends (n = 8, 8.8%). Seventeen respondents were deemed self-motivated; these individuals were more likely have income over $50K/year (P < 0.05) and to be US born (P = 0.05); they were more likely to mention being age-appropriate for screening (P < 0.05); knew more people who had colonoscopies (P < 0.001); they were less likely to believe that most of the age-appropriate population in New York City has been screened (P < 0.01) and less likely to be deterred from colonoscopy by work schedule (P < 0.001) or by having to take a powerful laxative (P < 0.001).Conclusions:A primary care physician's recommendation may be the most prevalent motivating factor in patients’ decisions to receive a colonoscopy, but a subgroup seeks CRC screening on their own. Analysis of the motivations of individuals who have sought colonoscopy screening may offer useful insights into motivating those who have not.

Recent advances to improve the endoscopic detection and differentiation of early colorectal neoplasia.

One of the primary aims of colonoscopy is to detect andresect pre-cancerous lesions, thereby preventing cancerdevelopment and early colorectal cancers, avoiding thegrowth of advanced and deep-infiltrating malignanttumours. Failure to find and remove polyps and early can-cers results in a delayed cancer diagnosis and treatment,with the potential for poor patient outcomes and the riskof litigation [1]. In recent years, industry has made manyefforts to improve the technology to enhance the perfor-mance of endoscopic examination: many of these innova-tions are included under the term ‘augmentedendoscopy’. Augmented endoscopy includes topical dyes[2,3], optical filtering [4,5], zoom-magnification [6,7]and allows for various analyses of gastro-intestinal lesions,such as minute structure of crypts on the mucosal surfaceand superficial micro-vessels. This kind of enhancedendoscopy provides new tools for identifying the abnor-malities in the size, density, and shape of crypts andvessels in either the normal colon or a tumour lesion.Today, colonoscopy is a universally accepted methodfor colorectal cancer screening and diagnosis [8]. En-doscopists may, however, miss up to 6% of advancedadenomas (≥10 mm in size) or cancer and as many as26–30% of all adenomas when using standard white-light colonoscopy [9], probably because of the locationof the lesion, the skill of the endoscopist [10] and theimage contrast of the endoscopic picture. Augmentedendoscopy, enhancing the endoscopic appearances ofcolon lesions, has the potential to improve detectionand differentiation of colon neoplasms from otherlesions [11]. Clinical trials testing the usefulness ofaugmented endoscopy for the diagnosis of colonneoplasia show conflicting results [12]. This may berelated to the limitations of each technology and varia-tion in the diagnostic skill of the participants. There-fore, as reported by Fujiya and Kohgo, ‘...two factorsrelated to the usefulness of these novel technologiesneed to be evaluated: at which step(s) is that technologyapplicable for the diagnosis of colon neoplasms (detec-tion, differentiation, or staging) and by what level(s) ofendoscopists (experts or less experienced endoscopists)can the technology be used ...’ [13].Technology alone, however, is not enough to ensureoptimal results and to achieve the best outcome. Allvariables affecting rates of detection by the endoscopistand the endoscopic method used are important. Theseinclude the operator’s experience, bowel preparation,examination technique and the use of instruments ordevices able to increase visual identification.

Abstract PC01-01: Colorectal cancer screening for African Americans: Should we be screening at an earlier age? The Pro side

Abstract Colorectal cancer is the second leading cause of cancer mortality in the United States, and there are seven tests recommended for its screening to help detect cancer and/or its precursors at an early stage. Major risk factors for colorectal cancer are age, family history, and race. Surveillance, Epidemiology, and End Results (SEER) data consistently show that in the United States that Blacks have the highest incidence of and highest mortality from colorectal cancer, compared to Whites, Native Americans, Hispanic Americans, and Asian Americans. Blacks, when compared to Whites, tend to present at advance stages of colorectal cancer, and have poorer survival at all stages. There are a number of theories and potentially contributing factors to cause this disparity, including socio-economic, insurance, and education differences, access to medical care, the use of colorectal cancer screening methods, types of diet, obesity and physical activity, use of tobacco products, use of NSAIDs and hormone replacement therapy, but it is not clear if one or all factors are contributing and/or are relevant. Some studies point towards health care utilization as the major contributing factor for disparity. Additionally, there is strong evidence that Blacks have an anatomical shift of polyps and cancer to the right colon when compared to Whites. This is important as colonoscopic screening does not reduce mortality to the same degree when cancers are in the right side of the colon when compared to left-sided colon cancers. The proportion of Blacks presenting with colorectal cancer below the age of 50 when screening is recommended is 10.6%, compared to 5.5% for Whites. This rate approximates 5.5% for Blacks at age 45 years. The American College of Gastroenterology, the American College of Physicians, and the Institute for Clinical Systems Improvement have all recommended earlier ages (40 or 45 years) to begin screening Blacks for colorectal cancer in the United States, although other organizations have yet to make this recommendation. A general approach to any cancer screening involves (a) a sensitive and specific test, (b) acceptable to asymptomatic persons, (c) reduce morbidity and mortality, and (d) be cost-effective and affordable to society. Most of the seven tests recommended for colorectal cancer screening meet these general criteria. There are modifications to colorectal cancer screening based on higher risk populations, such as those with potential familial inheritance of cancer and those with a history of inflammatory bowel disease. The rationale is that these populations develop colorectal cancer earlier, and that by screening them earlier will find cancers or their precursors at early stages. Based on objective data, colonoscopic screening should be the preferred approach for Blacks due to the higher right-sided colon prevalence for polyps and cancers. And, as for inflammatory bowel disease and potential hereditary predisposition or based on family history, the time for screening Blacks should be at an earlier age due to higher prevalence and mortality from colorectal cancer. Indeed, the cost-effectiveness for screening Blacks with colonoscopy is much greater than Whites due to the higher rates of the disease. Citation Format: John M. Carethers. Colorectal cancer screening for African Americans: Should we be screening at an earlier age? The Pro side. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr PC01-01. doi:10.1158/1538-7755.DISP13-PC01-01

Ineffective Use of Fecal Blood Testing as a Lone Method for Colorectal Cancer Screening: Cancer Screening Is Only Useful When in Compliance With Recommendations

Introduction: In a culture which leans towards procedural screening for colorectal cancer, it is easy to disregard less invasive methods. There is a subset of patients who defer endoscopic exam either due to embarrassment, fear, or they are deemed medically inappropriate for routine screening. Use of fecal blood testing as a screen for colorectal cancer is recommended annually as an alternative to endoscopic examination. Gastroenterologists have limited interaction with the general patient population as compared with primary care physicians, thus the task of most cancer screening falls to primary care. To ensure that this subset of patients is being screened appropriately, we undertook the task of investigating compliance of fecal blood testing as a lone cancer screening within our healthcare system. Methods: On a retrospective review of 8,187 patient medical records from January 1, 2002 through December 31, 2012, selected from the primary care cohort as being average risk of colorectal cancer based on the American Gastrointestinal Association 2012 guidelines. The entry point for the study was an adult of age 50 or older within the study period, and who were using fecal blood testing as their primary screening method for colorectal cancer. Patients undergoing other means of screening by endoscopic examination, barium enema, or computerized tomography (CT) colonography were excluded. Patient records were reviewed over this period for annual compliance. Results: The mean age of patients included was 67.1 years; 55% of these were females. Out of 8,187 patients undergoing fecal blood testing, only 672 (8.2%) were appropriately undergoing annual testing as a sole method for colorectal cancer screening over the 10-year study period; 7,147 (87.3%) patients did not undergo a consecutive fecal blood test on an annual basis and underwent no alterative means of screening. Surprisingly, 368 (4.5%) patients were undergoing both annual fecal blood testing and endoscopic examination by colonoscopy. Conclusion: We have found that compliance with annual fecal blood testing as a colorectal cancer screen is quite low throughout our healthcare system. It is unclear where the care gap lies; on the side of the physician not requesting appropriate testing, or with the patient not completing the requested testing. Interestingly, a subgroup of patients had an overutilization of screening by both concomitant colonoscopy and annual fecal blood testing. Despite the use of electronic medical records with proven care benchmarks and quality care alerts, there still exists a care gap and in some cases a redundancy of care which requires further review. Implementation of care standards within the electronic medical record may assist in closing this care gap.

Committee opinion no 609: colorectal cancer screening strategies.

Each year, more than 24,000 women die from colorectal cancer, which makes it the third leading cause of cancer death in women after lung cancer and breast cancer. However, screening tests are underused for many segments of the population and are ordered in a manner inconsistent with guidelines. The primary goal of colorectal cancer screening is to reduce mortality through the reduction of advanced disease. The American College of Obstetricians and Gynecologists recommends colonoscopy for colorectal cancer screening every 10 years for average-risk women beginning at age 50 years and at age 45 years for African American women.The American College of Obstetricians and Gynecologists recommends colonoscopy every 10 years as the most effective screening modality. Every screening method has advantages and limitations, which ultimately depend on the quality of the screening test, patient adherence, screening guidelines, and access to timely and appropriate follow-up. Colorectal cancer screening methods should be discussed with patients to identify the method they are most likely to accept and complete.

Abstract 299: Circulating microRNAs in association with colorectal neoplasia

Abstract Purpose: MicroRNAs (miRNAs) are non-coding regulatory RNAs that are stable in circulation and implicated in the etiology of many cancers including colorectal cancer (CRC). In this study we investigated whether candidate miRNAs could serve as blood-based biomarkers of colorectal adenoma. Methods: We conducted a colonoscopy-based case-control study of men and women ages 50-79; this report includes data from 48 polyp-free controls, 43 advanced adenoma, 73 non-advanced adenomas, and 8 CRC cases. We selected 12 miRNA candidates that are highly expressed in adenoma tissue and have low expression in blood cells, in addition to miRNAs previously reported as biomarkers of adenoma. miRNAs were extracted from stored plasma samples, and copy number assessed with qRT-PCR. Odds ratios (ORs) and area-under-the-curve (AUC) from receiver-operator characteristic curves were estimated to quantify the association between plasma copy-number of these candidate miRNAs and each case group. Results: No miRNA transcripts were associated with risk of adenoma or advanced adenomas, or with an AUC significantly above 0.5 that would indicate usefulness in discriminating either category of adenoma cases from controls. In contrast, statistically significant and strong associations (ORs&amp;gt;5) with CRC were observed for 6 miRNA candidates, with corresponding AUCs significantly greater than 0.5. Conclusions: Our results suggest that these candidate miRNAs, assayed with qRT-PCR, are unlikely to have clinical utility as blood-based screening biomarkers of adenomas. However, strong associations were observed with CRC. Circulating miRNAs may therefore have promise as potential early detection biomarkers to augment current CRC screening methods, but an optimal screening biomarker would detect pre-malignant colorectal adenomas as well as frank CRC. Citation Format: Scott V. Adams, Polly A. Newcomb, Andrea N. Burnett-Hartman, Melissa P. Upton, Lee-Ching Zhu, Margaret Mandelson, John D. Potter, Karen W. Makar. Circulating microRNAs in association with colorectal neoplasia. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 299. doi:10.1158/1538-7445.AM2014-299

90 Use of the Health Belief Model in screening methods for colorectal cancer

Introduction: Breast and cervical cancer are the most common types of cancer in women worldwide. Previous studies have shown that breast and cervical cancer awareness is lower among female university students. The goal of this study is to assess breast and cervical cancer awareness among female university students at two different cultures. Material and Methods: This study was conducted a cross-sectional survey of female university students using a questionnaire to investigate awareness of breast and cervical cancer of students. A total of 350 nursing students participate in this study from Turkey and Poland. In data analysis, descriptive statistics and chi square tests were used. Results and Discussion: In this study, the mean age of participants were 21.3+2.0 years in Turkish and 19.9+1.6 in Polish. Regarding family history, 87.4% of the Turkish students and 81.3% of the Polish had no known familial history of breast cancer. Students 97.9% of Turkish, 84.4% of Polish had knowledge about breast self examination and 72.1% of Turkish students, 48.1% of Polish students had performed breast self examination. 78.9% of Turkish students and 68.8% Polish students had knowledge about prevention of cervical cancer. It was determined that knowing and performing breast self examination ratio is higher in Turkish students (c = 20.892, p = 0.000; c = =21.023, p = 0.000); having clinical breast examination ratio is higher in Polish students (c = 5.996, p = 0.02). Conclusion: Results of this study showed that breast and cervix cancer awareness is similar among university students in both countries. It has been concluded that although awareness of students on breast and cervix cancer are at a good level, this isn’t enough when importance of early diagnosis in breast and cervix cancer are taken into consideration, which are among common cancers in women. Effects on Nursing Practices: Public health nurses and oncology nurses can use this research while increase breast and cervical cancer awareness of young people and be able to make health education about this issue. No conflict of interest.

Awareness of colonoscopy as a screening method for colorectal cancer and its uptake in Spain

The objective of this study was to describe awareness levels of colonoscopy as a screening procedure for colorectal cancer (CRC), to study its uptake and analyze possible associated factors in Spain. This was a cross-sectional study using data from the Oncobarómetro survey, carried out by face-to-face interviews with a representative national sample of the Spanish population aged 18 years and older. Awareness was assessed using the following questions: 'Do you know of any examination procedures or medical technique used to detect cancer?' and 'I'm going to list some screening procedures (including colonoscopy) to see if you know of them as a cancer screening test or whether this is the first time you have heard of them'. To evaluate colonoscopy uptake, participants were asked whether they had undergone a colonoscopy in the past 2 years. The independent variables included sociodemographic, socioeconomic, and health-related factors. 65.7% of the study population was aware of colonoscopy as a screening tool. Individuals from lower socioeconomic groups or those who only had primary education showed a lower level of awareness. 12.8% of participants had undergone a colonoscopy in the past 2 years. This number increased to 45% in the Spanish Autonomous Communities, where screening programs are in place. Colonoscopy screening rates are 10.28 times higher among those who had fecal occult blood testing during the previous 2 years. There is an inverse relationship between social inequality and both awareness and uptake of colonoscopy. Consequently, for screening to be more effective, interventions that reduce barriers to access for target populations should be implemented.

DNA methylation analysis of SFRP2, GATA4/5, NDRG4 and VIM for the detection of colorectal cancer in fecal DNA.

Aberrantly methylated genes are increasingly being established as biomarkers for the detection of colorectal cancer (CRC). In the present study, the methylation levels of the secreted frizzled-related protein gene 2 (SFRP2), GATA binding protein 4/5 (GATA4/5), N-Myc downstream-regulated gene 4 (NDRG4) and vimentin (VIM) promoters were evaluated for their use as markers in the noninvasive detection of CRC. Methylation-specific polymerase chain reaction was performed to analyze promoter CpG methylation of SFRP2, GATA4/5, NDRG4 and VIM in the fecal DNA of 56 patients with CRC and 40 individuals exhibiting normal colonoscopy results. Promoter methylation levels of SFRP2, GATA4/5, NDRG4 and VIM in CRC patients were 57.1% (32/56), 42.9% (24/56), 83.9% (47/56), 28.6% (16/56) and 41.1% (23/56), respectively. Furthermore, the specificity of the genes were 90.0% (4/40), 95.0% (2/40), 82.5% (7/40), 97.5% (4/40) and 85.0% (6/40), respectively. The overall sensitivity of detection for fecal DNA with at least one methylated gene was 96.4% (54/56) in CRC patients. By contrast, only 14 of the 40 normal individuals exhibited methylated DNA in the aforementioned promoter regions. Methylation of the SFRP2, GATA4/5, NDRG4 and VIM promoters in fecal DNA is associated with the presence of colorectal tumors. Therefore, the detection of aberrantly methylated DNA in fecal samples may present a promising, noninvasive screening method for CRC.

"BeneFITs" to increase colorectal cancer screening in priority populations.

"BeneFITs" to increase colorectal cancer screening in priority populations.

Combined faecal quantitative calprotectin and immunochemical faecal occult blood tests for the detection of colorectal carcinoma and significant adenomas

Introduction: Testing for faecal occult blood is a widely accepted non-invasive screening method for colorectal cancer (CRC) and significant adenomas, but lack of sensitivity remains a critical problem. The aim of this study was to analyze the combined sensitivity and specificity of faecal quantitative calprotectin and immunochemical faecal occult blood tests in patients with colorectal cancer and colonic polyps.

Mo1077 Clinical Efficacy of Same Day CT Colonography Following Incomplete Colonoscopy

Background: Colonoscopy is the preferred screening method for colorectal cancer (CRC) but may be incomplete in 4% to 25% of cases. CT colonography (CTC) is an adjunct to evaluate the colon after an incomplete colonoscopy (IC). No study has focused on same day CTC after an IC. Our primary aim was to determine the yield of same day CTC after IC. Methods: Our institution has the capability to perform same day CTC in patients with an incomplete colonoscopy. This was a retrospective review of all CTC done immediately following IC from January 2008 to December 2012. 198 CTC met inclusion criteria. Descriptive statistics were used. Results: Of 198 patients with IC and CTC 50 patients had 61 intracolonic findings. 23/50 (46%) were screening procedures, 1/50 (2%) high risk screening, 17/50 (34%) had a diagnostic colonoscopy and 9/50 (18%) surveillance colonoscopy. 10/50 patients had 12 findings on CTC on areas that were not reached by incomplete colonoscopy. 6 of these 10 patients had a follow up intervention: 2 had retrograde double balloon enteroscopy and 4 had colonoscopies. 3 findings correlated with CTC (1 ascending colon adenocarcinoma and 2 polyps) and 3 did not ( normal colonoscopy/DBE). 40 patients had 49 colonic findings on CTC on areas reached but not described during IC. 19/49 (39%) findings were not described during the initial colonoscopy. Only 6 of these 40 pts had a repeat colonoscopy. 9 findings did not correlate with subsequent complete colonoscopy. Only 1 CTC finding correlated with repeat colonoscopy. There were 30 colonic findings on CTC in areas that were reached and described during the incomplete colonoscopy. Nineteen were sigmoid diverticular strictures with no additional findings in the rest of the colon, 10 were diverticulosis of the sigmoid and 1 ascending colon adenocarcinoma with no synchronous lesions. Conclusions: Same day CTC can be of added value in patients with incomplete colonoscopy. Potential benefits include no need to repeat bowel cleansing and no extra day lost from work. Our data showed that correlation of findings by CTC in areas not visualized by incomplete colonoscopy was poor as 50% of patients had CTC abnormalities which did not correlate with a repeat colonoscopy. When CTC described an abnormality in an area already reached but not described during IC correlation was also poor as only one patient had correlation between CTC and repeat colonoscopy. When CTC reported the same findings described during IC correlation was 100%. More data on the efficacy and cost-effectiveness of same day CTC compared to repeating a colonoscopy or maybe performing a retrograde overtube assisted enteroscopy is needed to determine which effort is worthwhile.

Sa1420 Can the Use of Endoscopy Report Writers Improve the Quality of Colonoscopy?

Colorectal cancer (CRC) is the 2nd leading cause of cancer related death in the U.S. [1]. Colonoscopy is the preferred screening method for CRC. The effectiveness and safety of colonoscopy depends on the quality of the exam, which can vary among endoscopists [2]. The American Society of Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) task force in 2006 proposed 14 quality indicators for colonoscopy to define areas for quality improvement [2]. Reporting on those measures can promote improvement in quality and outcomes and reduce healthcare cost.

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62%) participating FPs. Most (77%) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52% pre; 88% post; p < 0.001), correct management recommendations for patients with CRC FH (51% pre; 84% post; p < 0.001), and improvement in total mean scores on outcome measures for all vignettes. Most (90%) agreed the tool would improve practice. Receipt of the CRC Risk Triage/Management Tool was associated with improvement in FPs' CRC risk assessment, screening, and genetics referral recommendations for clinical vignettes. This demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.