Gastrointestinal Cancer Screening Research Articles

Racial, Ethnic, and Sex Differences in Incidence-Based Mortality of Aggregate Upper Gastrointestinal Cancers.

Current strategies for upper gastrointestinal (UGI) cancer screening primarily target cancer-specific risk, with the strongest focus on esophageal adenocarcinoma (EAC). However, all UGI cancers are amendable to screening and early detection with an upper endoscopic examination. This study assesses and explores incidence-based mortality (IBM) for cumulative UGI cancers, aiming to identify race-based or sex-based disparities. We used Surveillance, Epidemiology, and End Results Research data to analyze patients diagnosed with EAC, esophageal squamous cell carcinoma, cardia gastric cancer, noncardia gastric cancer, or colorectal adenocarcinoma from 2000 to 2019. Age-adjusted IBM was calculated as a rate per 100,000 population and stratified by sex and race/ethnicity. We also compared UGI cancer IBM with that of colorectal cancer, a cancer with established population-wide endoscopic screening guidelines. Cumulative IBM for UGI cancers was 8.40 (95% confidence interval [CI] 8.34-8.46). The highest cancer-specific IBM rates were for EAC (2.26, 95% CI 2.23-2.29), followed by noncardia gastric cancer (2.07, 95% CI 2.04-2.10), cardia gastric cancer (1.60, 95% CI 1.57-1.62), esophageal squamous cell carcinoma (1.21, 95% CI 1.19-1.23), and miscellaneous UGI cancer (1.27, 95% CI 1.13-1.40). UGI cancer IBM was highest among Black men (16.43, 95% CI 15.97-16.89), American Indian/Alaska Native men (15.23, 95% CI 13.75-16.82), and Hispanic men (13.76, 95% CI 13.42-14.11). These rates are significantly greater than among White men (12.81, 95% CI 12.68-12.95). UGI cancers impose a significantly higher mortality burden on non-White population subgroups that are not currently targeted by any systematic screening approach.

The use of micronuclei DNA from erythrocytes for the detection of early-stage gastrointestinal cancers.

4085 Background: Gastrointestinal (GI) cancers account for over a third of cancer deaths. However, their early detection remains a challenge. Micronuclei (MN) are extranuclear bodies containing damaged chromosome segments indicative of genomic instability. Increased MN frequency in hematopoietic cells is observed in patients with solid tumors. We have developed a method (WO2021/228246 A1) for purifying and characterizing micronuclei DNA (MN-DNA) in erythrocytes from peripheral blood. By comparing MN-DNA from healthy donors (HDs) and GI cancer patients, we identified significant changes in read densities at specific genomic locations in patients, which were termed as tumor-associated MN-DNA (taMN-DNA) signatures. Here, we evaluated the potential of these signatures for early-stage GI cancer detection, including colorectal (CC), gastric (GC) and esophageal (EC) cancers. Methods: Peripheral blood (1-2 ml) was collected from healthy donors (HD) and cancer patients MN-DNA isolation and purification from erythrocytes. Participants were randomly divided into training, validation and independent test cohorts in a 7:2:1 ratio, maintaining similar cancer types, CC/GC/EC/HD ratio, gender and age distribution. Distinct MN-DNA features between cancer patients and HDs were identified using sequencing data. Logistic regression algorithms were applied using these features for cancer detection. Results: The study enrolled 1753 participants, including 987 HDs, 420 CC, 282 GC and 64 EC cases. Of these, over half were diagnosed with early-stage diseases; TNM stage 0-I accounted for 40.57%, stage II for 23.32%, stage III for 29.25% and stage IV for 6.87%. The cancer detection model with MN-DNA features yielded an overall accuracy of 87.43%, with a sensitivity of 83.66% and specificity of 90.36%. For individual caner types, sensitivity was 85.37% for CC, 79.31% for GC and 92.31% for EC. For early-stage (stage 0-II) CC, GC and EC, the model demonstrated sensitivities of 95.12%, 86.05% and 100.00%, respectively, at 90.36% specificity. Conclusions: Unlike cell-free DNA, MN-DNA are chromosomal fragments in the cytoplasm. The abundance of erythrocytes in peripheral blood provides an easily accessible source for MN-DNA enrichment. This pilot study illustrates the potential of MN-DNA as a tool for early GI cancer detection, contributing to large-scale efforts towards developing an effective GI cancer screening test.

Comparison of Fecal MicroRNA Isolation Using Various Total RNA Isolation Kits.

Fecal specimens have long been regarded as promising sources for gastrointestinal cancer screening and have, thus, been extensively investigated in biomarker research. MicroRNAs (miRNAs) are small, non-coding RNA molecules involved in regulating various biological processes. They are commonly dysregulated during tumor development and exhibit differential expression in feces. To assess the preanalytical feasibility of fecal miRNA analysis, we systematically compared the performance of commonly used total RNA extraction methods. Fecal samples from healthy subjects were utilized for this evaluation. Various methods, including miRNeasy, Universal, Trizol, RNeasy, and mirVana kits, were employed to isolate total RNA. MiRNA expression analyses were conducted using TaqMan or SYBR Green qRT-PCR for a subset of miRNAs, with externally spiked-in cel-miR-39 used for normalization. Most methods demonstrated similar performance in terms of the total RNA concentration and purity. Externally spiked cel-miR-39 and endogenous miRNAs (RNU6b, miR-16, and miR-21) exhibited comparable concentrations across the different RNA isolation methods, whereas the RNeasy mini kit consistently yielded lower values. Our findings suggest that various isolation methods produce reproducible and comparable miRNA expression results, supporting the potential comparability and translational applicability of miRNA-based biomarker research in the future.

Knowledge and awareness of early gastrointestinal cancer screening in Sunan Yugur Autonomous County in Gansu, China.

We aimed to assess the level of knowledge and awareness regarding the need for screening of early gastrointestinal cancer among residents of Sunan Yugur Autonomous County in China. In this cross-sectional study, we conducted a survey among permanent residents of Sunan Yugur Autonomous County from January 2020 to January 2023 using a questionnaire to obtain data on knowledge regarding early gastrointestinal cancer screening. The survey included 12,000 residents. Among participants, 62.30% (7476/12,000) were aware of the need for early gastrointestinal cancer screening. Awareness about the need for early gastrointestinal cancer screening differed significantly based on participants' sex, age, level of education, area of residence, and ethnicity. The level of awareness regarding the need for early gastrointestinal cancer screening was relatively low in our study population. The government and medical institutions should provide information and promote early gastrointestinal cancer screening in the region to improve the health status and quality of life among the Yugur people.

Detection of early-stage gastrointestinal cancers by micronuclei DNA from erythrocytes.

382 Background: Gastrointestinal (GI) cancers account for over a third of cancer deaths. However, their early detection remains a challenge. Micronuclei (MN) are extranuclear bodies containing damaged chromosome segments indicative of genomic instability. Increased MN frequency in hematopoietic cells is observed in patients with solid tumors. We have developed a method (WO2021/228246 A1) for purifying and characterizing micronuclei DNA (mnDNA) in erythrocytes from peripheral blood. Here, we evaluated the potential of mnDNA for early-stage GI cancer detection, including colorectal (CC) and gastric (GC) cancers. Methods: Peripheral blood (1 ml) was collected from healthy donors (HD) and cancer patients mnDNA isolation and purification from erythrocytes. Participants were randomly divided into training, validation and independent test cohorts in a 7:2:1 ratio, maintaining similar cancer types, CC/GC/HD ratio, gender and age distribution. Distinct mnDNA features between cancer patients and HDs were identified using sequencing data. Logistic regression algorithms were applied using these features for cancer detection. Results: The study enrolled 1046 participants, including 419 HDs, 366 CC and 261 GC cases. Of these, over half were diagnosed with early-stage diseases; TNM stage I accounted for 38.7%, stage II for 22.8%, stage III for 30.5% and stage IV for 8.0%. The cancer detection model with mnDNA features yielded an overall accuracy of 84.8%, with a sensitivity of 84.1% and specificity of 85.7%. For individual caner types, sensitivity was 89.2% for CC and 76.9% for GC. For early-stage (stage I-II) CC and GC, the model demonstrated sensitivities of 88.9% and 76.5%, respectively, at 85.7% specificity. Conclusions: Unlike cell-free DNA, mnDNA are chromosomal fragments in the cytoplasm. The abundance of erythrocytes in peripheral blood provides an easily accessible source for mnDNA enrichment. This pilot study illustrates the potential of mnDNA as a tool for early GI cancer detection, contributing to large-scale efforts towards developing an effective GI cancer screening test.

The impact of endoscopy in upper gastrointestinal tract cancer screening programs

The impact of endoscopy in upper gastrointestinal tract cancer screening programs

Current status and perspectives of genetic testing in gastrointestinal cancer (Review).

Genetic testing has become widespread in daily medical care for gastrointestinal (GI) cancers. However, unlike breast cancer and non-small cell lung cancer, in which personalized medicine targeting various driver genes is standardized, the incidence of targeted gene abnormalities in GI cancers is low. Nevertheless, such abnormalities may be linked to therapeutic agents and the further development of therapeutic agents for personalized medicine for GI cancers is desired. A liquid biopsy is of great benefit in offering clinical decision support, in applications such as GI cancer screening, surgical interventions, monitoring disease status and enhancing patient survival outcomes, all of which would contribute to personalized medicine. Germline genetic testing is required for several types of GI cancer, which shows clinical indications of hereditary predisposition. The increasing use of multigene panel testing has redefined gene-cancer associations, and consequently the estimate of cancer risk that vary from low to high penetrance. Comprehensive genetic testing can enable the detection of novel treatment targets and the discovery of undefined multiple diagnostic/predictive markers, which may enhance the molecular-level understanding of GI cancers. Genetic testing can also aid the design of more appropriate and adequate genomic-driven therapies for patients who may benefit from other standardized therapeutic methods.

Limitation of PET/CT for screening of synchronous upper gastrointestinal cancer in oral cancer patients

ObjectivePatients with squamous cell carcinoma (SCC) of the head and neck including the oral cavity have a high risk of upper gastrointestinal cancer, especially esophageal cancer. Synchronous upper gastrointestinal cancers affect the field of radiation or surgery, and undetected double cancer can cause poor prognosis. The purpose of this retrospective study was to evaluate the diagnostic performance of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting synchronous upper gastrointestinal cancer at the initial staging of oral cancer patients. MethodsBetween September 2006 and August 2021, 804 newly diagnosed oral squamous cell carcinoma patients who undergo esophagogastroduodenoscopy (EGD) and FDG-PET/CT at the initial staging were enrolled in this study. The incidence of synchronous upper gastrointestinal cancer in EGD screening at the initial staging of oral cancer was retrospectively calculated. Furthermore, we evaluated the diagnostic performance of FDG-PET/CT for screening of synchronous upper gastrointestinal cancer in oral cancer patients. ResultsThe incidence of synchronous upper gastrointestinal cancer in EGD screening at the initial staging of oral cancer was 4.2% (34/804 patients). Of 34 oral cancer patients with synchronous upper gastrointestinal cancer, 26 (76.5%) had both smoking and drinking habits. The sensitivity, specificity, accuracy, false-negative rate, false-positive rate, positive predictive value, and negative predictive value of FDG-PET/CT for synchronous upper gastrointestinal cancer were 44.1%, 99.6%, 97.3%, 55.9%, 0.4%, 83.3%, and 97.6%, respectively. ConclusionsBecause PET/CT cannot sufficiently detect synchronous upper gastrointestinal cancer in oral SCC patients, EGD screening before the treatment may be suitable for the high-risk oral SCC patients.

Public Preference Heterogeneity and Predicted Uptake Rate of Upper Gastrointestinal Cancer Screening Programs in Rural China: Discrete Choice Experiments and Latent Class Analysis

Background Rapid increases in the morbidity and mortality of patients with upper gastrointestinal cancer (UGC) in high-incidence countries in Asia have raised public health concerns. Screening can effectively reduce the incidence and mortality of patients with UGC, but the low population uptake rate seriously affects the screening effect. Objective We aimed to determine the characteristics that influence residents’ preference heterogeneity for a UGC-screening program and the extent to which these characteristics predict residents’ uptake rates. Methods A discrete choice experiment was conducted in 1000 residents aged 40-69 years who were randomly selected from 3 counties (Feicheng, Linqu, and Dongchangfu) in Shandong Province, China. Each respondent was repeatedly asked to choose from 9 discrete choice questions of 2 hypothetical screening programs comprising 5 attributes: screening interval, screening technique, regular follow-up for precancerous lesions, mortality reduction, and out-of-pocket costs. The latent class logit model was used to estimate residents’ preference heterogeneity for each attribute level, their willingness to pay, and the expected uptake rates. Results Of the 1000 residents invited, 926 (92.6%) were included in the final analyses. The mean age was 57.32 (SD 7.22) years. The best model contained 4 classes of respondents (Akaike information criterion=7140.989, Bayesian information criterion=7485.373) defined by different preferences for the 5 attributes. In the 4-class model, out of 926 residents, 88 (9.5%) were assigned to class 1, named as the negative latent type; 216 (3.3%) were assigned to class 2, named as the positive integrated type; 434 (46.9%) were assigned to class 3, named as the positive comfortable type; and 188 (20.3%) were assigned to class 4, named as the neutral quality type. For these 4 latent classes, “out-of-pocket cost” is the most preferred attribute in negative latent type and positive integrated type residents (45.04% vs 66.04% importance weights), whereas “screening technique” is the most preferred factor in positive comfortable type residents (62.56% importance weight) and “screening interval” is the most valued attribute in neutral quality type residents (47.05% importance weight). Besides, residents in different classes had common preference for painless endoscopy, and their willingness to pay were CNY ¥385.369 (US $59.747), CNY ¥93.44 (US $14.486), CNY ¥1946.48 (US $301.810), and CNY ¥3566.60 (US $552.961), respectively. Residents’ participation rate could increase by more than 89% (except for the 60.98% in class 2) if the optimal UGC screening option with free, follow-up for precancerous lesions, 45% mortality reduction, screening every year, and painless endoscopy was implemented. Conclusions Public preference heterogeneity for UGC screening does exist. Most residents have a positive attitude toward UGC screening, but their preferences vary in selected attributes and levels, except for painless endoscopy. Policy makers should consider these heterogeneities to formulate UGC-screening programs that incorporate the public’s needs and preferences to improve participation rates.

Detection and localization of gastrointestinal cancers based on multi-dimentional signatures from a single cfDNA targeted sequencing assay.

4169 Background: Five major gastrointestinal (GI) cancers - colorectal (CRC), gastric (GC), liver (LC), esophageal (EC), and pancreatic cancer (PC) - are responsible for hundreds of thousands of mortalities annually worldwide. Unfortunately, there is a lack of cost-effective, blood-based screening method for their early detection. To address this issue, we aimed to develop GutSeer, a noninvasive, targeted methylation sequencing-based test by leveraging methylation and fragmentomic signatures carried by cell-free DNA (cfDNA). Methods: The panel of GutSeer consists of 1656 target regions which were either differentially methylated between healthy and cancer samples, or distinctively methylated in a specific GI cancer. Cancer and healthy participants were recruited and randomly divided into a training and a validation cohort. Their plasma DNA samples were analyzed to generate DNA methylation and fragmentomic features. These multi-dimensional features were integrated to build ensemble stacked machine learning models to differentiate cancer against healthy, and to determine the tissue-of-origin (TOO) of the cancer. Results: A total of 1844 cases (787 healthy, 342 LC, 239 GC, 209 EC, 180 CRC, and 87 PC cases) were recruited for this study. A cancer- vs-healthy model achieved an AUC of 0.94 and 0.95 (sensitivity of 77.7% and 77.1% under the specificity around 96%) using either methylation or fragmentomic features only, respectively. Combining both methylation and fragmentomic features further improved performances, achieving an AUC of 0.96 (sensitivity = 86.2% at a specificity of 96.7%). For individual type of cancer, GutSeer has a sensitivity of 93.3% for CRC, 81.1% for EC, 70.3% for GC, 96.5% for LC, and 86.4% for PC. An independent test using 629 benign cases as controls achieved a specificity of 87.1%. A separate TOO model was built using all features and achieved an overall accuracy of 82% for all cancer cases (66.7% for CRC, 87.0% for GC and EC combined, 89.0% for LC, and 63.2% for PC). Same as the cancer detection model, using multi-dimensional features in TOO prediction yielded higher accuracy than when models using only methylation or fragmentomics features (accuracy = 75.6% or 75.4%, respectively). When compared with whole-genome sequencing (WGS) based approaches, GutSeer showed a comparable performance in cancer detection but a higher accuracy in TOO identification, further confirming its effectiveness for detection of GI cancers. Conclusions: GutSeer, a non-invasive test integrating multi-dimensional features, was demonstrated to detect and localize the 5 main types of GI cancer with high accuracy. Our results further showed that a reasonably sized panel can perform comparably or even better than WGS-based methods in cancer detection and TOO localization, indicating GutSeer may be a low-cost solution for blood-based early screening for GI cancers.

Circulating metabolites as potential biomarkers for the early detection and prognosis surveillance of gastrointestinal cancers

Background and aimsTwo of the most lethal gastrointestinal (GI) cancers, gastric cancer (GC) and colon cancer (CC), are ranked in the top five cancers that cause deaths worldwide. Most GI cancer deaths can be reduced by earlier detection and more appropriate medical treatment. Unlike the current “gold standard” techniques, non-invasive and highly sensitive screening tests are required for GI cancer diagnosis. Here, we explored the potential of metabolomics for GI cancer detection and the classification of tissue-of-origin, and even the prognosis management.MethodsPlasma samples from 37 gastric cancer (GC), 17 colon cancer (CC), and 27 non-cancer (NC) patients were prepared for metabolomics and lipidomics analysis by three MS-based platforms. Univariate, multivariate, and clustering analyses were used for selecting significant metabolic features. ROC curve analysis was based on a series of different binary classifications as well as the true-positive rate (sensitivity) and the false-positive rate (1-specificity).ResultsGI cancers exhibited obvious metabolic perturbation compared with benign diseases. The differentiated metabolites of gastric cancer (GC) and colon cancer (CC) were targeted to same pathways but with different degrees of cellular metabolism reprogramming. The cancer-specific metabolites distinguished the malignant and benign, and classified the cancer types. We also applied this test to before- and after-surgery samples, wherein surgical resection significantly altered the blood-metabolic patterns. There were 15 metabolites significantly altered in GC and CC patients who underwent surgical treatment, and partly returned to normal conditions.ConclusionBlood-based metabolomics analysis is an efficient strategy for GI cancer screening, especially for malignant and benign diagnoses. The cancer-specific metabolic patterns process the potential for classifying tissue-of-origin in multi-cancer screening. Besides, the circulating metabolites for prognosis management of GI cancer is a promising area of research.

Clinical profile and treatment outcome in gastrointestinal cancer patients: a single-center experience in Kashmir valley, India

Background: Gastrointestinal (GI) cancers are one of the common cancers and are associated with significant morbidity and mortality. The present study was conducted to evaluate the treatment outcome of GI cancer patients undergoing follow-up in the oncology OPD of a tertiary care hospital. Methods: Cases previously treated for any GI cancer at one center and coming for follow-up to the hospital were enrolled. Treatment outcome was ascertained in these patients and its relationship with clinical and demographic characteristics of patients at diagnosis were analysed. Results: A total of 68 cases of GI cancers were enrolled with a mean age of 57.44±8.3 years and of 39 (57.35%) were males. The most common site for cancers was oesophagus, stomach, Colo-rectal with 22,20 and 17 cases respectively. Stage II was the most common stage at presentation in 50% cases followed by Stage III in 32.35% of cases. There was significant association between stage at diagnosis with stage I disease at diagnosis significantly related to complete cure. Site of cancer, age and smoking history had no significant correlation with treatment outcome. Conclusions: Diagnosis of GI cancers at early stage was associated with complete cure at follow up. This finding demonstrates the importance of early screening for GI cancers and the need to have robust screening guidelines and improving access to screening with highly valid tests particularly for individuals with high risk features.

Evaluation of Raman spectroscopy combined with the gated recurrent unit serum detection method in early screening of gastrointestinal cancer.

Gastric and colorectal cancers are significant causes of human mortality. Conventionally, the diagnosis of gastrointestinal tumors has been accomplished through image-based techniques, including endoscopic and biopsy procedures coupled with tissue staining. Most of these methods are invasive. In contrast, Raman spectroscopy has the advantages of being non-invasive and label-free and requiring no additional reagents, making it a potential tool for the detection of serum components. In this study, we collected Raman spectra of serum samples from patients with gastric cancer (n = 93) and colorectal cancer (n = 92) and from healthy individuals (n = 100). Analysis of Raman peak areas revealed that cancer patients had significantly higher peak areas at around 2923 cm-1 compared to normal individuals, which corresponded to the presence of lipids and proteins. We successfully achieved the early screening of gastrointestinal tumors using the improved gated recurrent unit (GRU) algorithm and traditional machine learning methods. The accuracy of identifying digestive tract tumors using different recognition models exceeds 84.72%, with support vector machine (SVM) and GRU achieving 100% accuracy. The use of GRU further demonstrated its ability to differentiate subtypes of gastric and colorectal cancers based on the degree of differentiation and stage, with a recognition accuracy exceeding 95%, which is challenging using traditional machine learning methods. Furthermore, our study revealed that principal component analysis (PCA) dimensionality reduction has a limited impact on the recognition results obtained using different recognition models.

Exploring GI Diseases Across the Lifespan.

Exploring GI Diseases Across the Lifespan.

Acute Pancreatitis Increases the Risk of Gastrointestinal Cancer in Type 2 Diabetic Patients: A Korean Nationwide Cohort Study.

The association between acute pancreatitis (AP) and gastrointestinal cancers in diabetic patients is currently not well understood. The study aim was to investigate the association between AP and gastrointestinal cancers in diabetic patients. Data from the Korean National Health Insurance Service database were analyzed. Participants with diabetes who underwent a health examination between 2009 and 2012 were followed up till December 2018. The primary outcome was the occurrence of gastrointestinal cancer. A total of 2,263,184 patients were included in the final analysis. Patients with a history of AP (n = 2390) were found to have a significantly higher risk of gastrointestinal cancer, except for esophageal cancer, as follows: gastric cancer (aHR = 1.637, 95% CI: 1.323-2.025), colorectal cancer (aHR = 2.183, 95% CI: 1.899-2.51), liver cancer (aHR = 2.216, 95% CI: 1.874-2.621), pancreatic cancer (aHR = 4.558, 95% CI: 4.078-5.095), bile duct cancer (aHR = 3.996, 95% CI: 3.091-5.269), and gallbladder cancer (aHR = 2.445, 95% CI: 1.459-4.099). The history of AP is associated with the increased risk of gastrointestinal cancer in diabetic patients. It is necessary to investigate the history of AP and more actively recommend screening for gastrointestinal cancers in such patients.

Metabolic syndrome and gastrointestinal cancer screening

Cancer has become a leading cause of death among patients with metabolic syndrome (MetS). The more components of MetS a patient has, the higher his cancer risk is. MetS is causally associated with colorectal, pancreatic, gallbladder, biliary, hepatocellular, gastric and esophageal adenocarcinomas. MetS increases cancer mortality up to 2.4-fold. Intentional long-term weight loss reduces the excess cancer risk of obese MetS-patients. Preventing and treating the MetS together with GI cancer screening is effective and decreases the burden of GI cancer mortality significantly.

S284 Family Matters: Impact of a Dot Phrase on Complete Family History Documentation During Initial Colorectal Cancer Screening Visits

Introduction: Obtaining a complete family history (FH) informs gastrointestinal (GI) cancer screening and referrals for genetic testing, but this is inconsistently done during colorectal cancer (CRC) screening visits. Previously, we improved the rate of complete FHs obtained to 28.4% from 5.2% after implementing education and a FH screening form in clinic. In this study, we assessed the impact of sharing a FH dot phrase on the rate of complete FHs obtained and genetics referrals made during outpatient CRC screening visits. Methods: We shared a dot phrase that prompts obtaining a complete FH to our gastroenterology division on February 9, 2022. A complete FH was defined as addressing history of cancer in first- and second-degree relatives, colon polyps in first-degree relatives, and GI disease. We reviewed outpatient GI CRC screening visits from February 10, 2022 to March 9, 2022, and compared them to a one-month period of pre-intervention visits. Patient characteristics, rates of complete FH and genetic referrals were extracted. Patients with prior colonoscopies or indications for diagnostic colonoscopy were excluded. Rates of complete FH and genetic referrals were compared between the pre- and post-intervention groups with unpaired T-tests. Results: A total of 188 patient visits were included; 93 post-intervention and 81 pre-intervention. The pre-and post-intervention groups were overall similar, but there were more white patients in the post-intervention group (Table). Complete FHs were obtained in 46/93 (49.5%) of post-intervention visits compared to 23/81 (28.4%) of visits in the pre-intervention group (p = 0.004). Genetic referrals were placed in 1/93 (1.1%) of post-intervention visits compared to 3/81 (3.7%) of pre-intervention visits (p=0.270). Conclusion: In our study, the rate of complete FHs obtained increased significantly to 49.5% from 28.4% after introduction of a FH dot phrase . The rate of genetic referrals was unchanged, though a larger sample size may be required to detect any potential difference. Given there were more white patients in the post-intervention group, further observation of complete FH rates in patients based on race is warranted. When upper GI problems were addressed along with CRC screening, FHs were often incomplete, suggesting a target for further intervention. Overall, further efforts are warranted to increase the rate of complete FHs obtained during CRC screening visits. Table 1. - Baseline characteristics and statistical analyses Patient Characteristics Whole CohortN=174 Pre-interventionN= 81 Post-interventionN= 93 p value Average age at screening, standard deviation [years] 51 51 50 Gender, n (%) Male 75 (43%) 33 (41%) 42 (45%) 0.1416 Female 99 (57%) 48 (59%) 51 (55%) 0.6672 Race/Ethnicity, n (%) AA 85 (49%) 44 (54%) 41 (44%) 0.6455 Asian 9 (5%) 3 (3.7%) 6 (6.5%) 0.1585* Hawaiian or Pacific Islander 0 (0%) 0 (0.0%) 0 (0%) - Hispanic 12 (6.9%) 5 (6.2%) 7 (7.5%) 0.4122 Other 8 (4.6%) 5 (6.2%) 3 (3.2%) 0.3173* Unknown 11 (6.3%) 7 (8.6%) 4 (4.3%) 0.2005* White 49 (28%) 17 (21%) 32 (34%) 0.0024 Complete family history 69 (40%) 23 (28.4%) 46 (49.5%) 0.004 Genetic referral 3 (1.7%) 3 (3.7%) 1 (1.1%) 0.2695 *High estimated error, category with value less than 5.

Pitfalls of Advanced Endoscopy Technologies in Gastrointestinal Cancer Screening.

Pitfalls of Advanced Endoscopy Technologies in Gastrointestinal Cancer Screening.

Satisfaction and its determinants of rural upper gastrointestinal cancer screening in China: a preliminary cross-sectional study

ObjectivesTo assess participants’ satisfaction with and predictors of upper gastrointestinal cancer screening in rural areas.DesignCross-sectional study.SettingTen screening centres in seven cities across five provinces in China.ParticipantsOf the 452 participants screened...

Preference for endoscopic screening of upper gastrointestinal cancer among Chinese rural residents: a discrete choice experiment.

BackgroundThe low uptake rate of upper gastrointestinal cancer (UGC) screening substantially reduces the benefits of endoscopic screening. This study aimed to obtain residents’ UGC screening preferences to optimize screening strategies and increase the participation rate.MethodsA discrete choice experiment (DCE) was conducted to assess UGC screening preferences of 1,000 rural residents aged 40 to 70 years from three countries (Linqu, Feicheng, and Dongchangfu) of Shandong province in China. The DCE questionnaire was developed from five attributes: out-of-pocket costs, screening interval, regular follow-up for precancerous lesions, mortality reduction, and screening technique. The data from the DCE were analyzed within the framework of random utility theory using a mixed logit model.ResultsIn total, 926 of 959 residents who responded were analyzed. The mean (SD) age was 57.32 (7.22) years. The five attributes all significantly affected residents’ preferences, and the painless endoscopy had the most important impact (β=2.927, P<0.01), followed by screening interval of every year (β = 1.184, P<0.01). Policy analyses indicated that switching the screening technique to painless endoscopy would increase the participation rate up to 89.84% (95%CI: 87.04%-92.63%). Residents aged 40–49, with a history of cancer, with a family income of more than ¥30,000 were more likely to participate in a screening.ConclusionsUGC screening implementation should consider residents’ preferences to maximize the screening participation rate. Resources permitting, we can carry out the optimal screening program with shorter screening intervals, lower out-of-pocket costs, less pain, follow-up, and higher UGC mortality reduction.