Colorectal Cancer Screening Program Research Articles

Optimizing allocation of colorectal cancer screening hospitals in Shanghai: a geospatial analysis.

Screening programmes are important for early diagnosis and treatment of colorectal cancer (CRC) but they are not equally efficient in all locations. Depending on which hospital people belong to, they often are not willing to follow up even after a positive result, resulting in a lower-than-expected overall detection rate. Improved allocation of health resources would increase the program's efficiency and assist hospital accessibility. A target population exceeding 70,000 people and 18 local hospitals were included in the investigation of an optimization plan based on a locationallocation model. We calculated the hospital service areas and the accessibility for people in communities to CRC-screening hospitals using the Huff Model and the Two-Step Floating Catchment Area (2SFCA) approach. We found that only 28.2% of the residents with initially a positive screening result had chosen followup with colonoscopy and significant geographical differences in spatial accessibility to healthcare services indeed exist. The lowest accessibility was found in the Southeast, including the Zhangjiang, Jichang and Laogang communities with the best accessibility mainly distributed near the city centre of Lujiazui; the latter also had relatively a high level of what is called "ineffective screening" as it represents wasteful resource allocation. It is recommended that Hudong Hospital should be chosen instead of Punan Hospital as the optimization, which can improve the service population of each hospital and the populations served per colonoscope. Based on our results, changes in hospital configuration in colorectal cancer screening programme are needed to achieve adequate population coverage and equitable facility accessibility. Planning of medical services should be based on the spatial distribution trends of the population served.

Determinants of cancer screenings participation in Queensland: a scoping review.

Introduction Cancer screening programmes for cervical, breast, and colorectal cancer have successfully reduced mortality rates among target groups. However, a large proportion of women and men are unscreened. Aim This review aims to provide an overview of the literature regarding the determinants of cancer screening participation among target groups in Queensland. Methods Electronic databases were searched for studies on determinants of cancer screening participation in Queensland. Retrieved studies were screened, and eligible articles were selected for data extraction. Both peer-reviewed and grey literature studies were included. The determinants of cancer screening participation were classified according to the I-Change model. Results Sixteen out of 75 articles were selected and analysed. Information factors, such as the lack of tailored strategies, determined cancer screening participation. Age, gender, cultural beliefs, fear and past experiences were the most reported predisposing factors to cancer screening participation. Lack of knowledge, misconceptions, low awareness, timely access to service, privacy and confidentiality were mainly reported awareness and motivation factors. Encouragement from health professionals, providing more information and interactions with communities would result in different effects on cancer screening participation among the target groups. Discussion The I-Change model is a valuable tool in mapping the current determinants of cancer screening participation programs. Further research may be needed to fully understand the barriers and facilitators of cancer screening programs.

Identifying the need for a UK colorectal cancer screening programme for patients with cystic fibrosis (CF): 10-year retrospective review of colonoscopy and colorectal cancer outcomes at a single CF centre

ObjectivePatients with cystic fibrosis (pwCF) have a high incidence of early colorectal cancer (CRC). In the absence of a UK CRC screening programme for pwCF, we evaluated the utility and...

Evaluation of the severity of screened colorectal cancer in the context of the health crisis linked to COVID19 in Ile-de-France region

BackgroundAfter the announcement in March 2020 of the COVID-19 pandemic, colorectal cancer (CRC) screening programs were suspended in several countries. Compared to the lesions detected during previous campaigns, this study aims to assess the severity of CRC detected during the 2020 screening campaign in Île-de-France, the French region most affected by the 1st wave of the pandemic. MethodsThe descriptive and etiological study included all faecal immunochemical test (FIT) results carried out between January 2017 and December 2020 on people aged 50–74, living in Île-de-France. First, the proportion of colonoscopies performed within one month (One-month-colo) following FIT; the yield of colonoscopy (proportion of colonoscopies with a neoplasm lesion among those performed) and CRC severity (TNM Classification, Level-0: T0/N0/M0, Level-1: T1/T2/N0/M0, Level-2: T3/T4/N0/M0; Level-3: T3/T4/N1/M0; Level-4: M1) were described in 2020 compared to previous campaigns (2017, 2018, and 2019). Subsequently, the link between the level of CRC severity and the predictive factors, including campaign year and time to colonoscopy, was analysed using polytomous multivariate regression. ResultsThe one-month-colo (2017: 9.1% of 11,529 colonoscopies; 2018: 8.5% of 13,346; 2019: 5.7% of 7,881; 2020: 6.7% of 11,040; p < 0.001), the yield (65.2%, 64.1%, 62.4%, 60.8% respectively, p < 0.001) were significantly different between campaigns. The proportion of CRC level-4 (4.8% in 2017 (653 CRC); 7.6% in 2018 (674 CRC); 4.6% in 2019 (330 CRC) and 4.7% in 2020 (404 CRC); p < 0.29) was not significantly different between campaigns. The probability of having CRC with a high severity level was inversely related to the time to colonoscopy but not to the campaign year. Compared to patients having undergone colonoscopy within 30 days, the odds were significantly reduced by 60% in patients having undergone colonoscopy after 7 months (adjusted Odds-Ratio: 0.4 [0.3; 0.6]; p < 0.0001). ConclusionsThe French indicators were certainly degraded before the first wave of the COVID-19. The delay in access to colonoscopy as well as its extension induced by the COVID-19 crisis had no impact in terms of cancer severity, due to a discriminatory approach prioritizing patients with evident symptoms.

Socioeconomic differences in expected discomfort from colonoscopy and colon capsule endoscopy

Individual income and educational level are associated with participation rates in colorectal cancer screening. We aimed to investigate the expected discomfort from the endoscopic diagnostic modalities of colonoscopy and colon capsule endoscopy in different socioeconomic groups as a potential barrier for participation. In a randomized clinical trial within the Danish colorectal cancer screening program, we distributed questionnaires to 2031 individuals between August 2020 and December 2022 to investigate the expected procedural and overall discomfort from investigations using visual analogue scales. Socioeconomic status was determined by household income and educational level. Multivariate continuous ordinal regressions were performed to estimate the odds of higher expected discomfort. The expected procedural and overall discomfort from both modalities were significantly higher with increasing educational levels and income, except for procedural discomfort from colon capsule endoscopy between income quartiles. The odds ratios for higher expected discomfort increased significantly with increasing educational level, whereas the differences between income groups were less substantial. Bowel preparation contributed most to expected discomfort in colon capsule endoscopy, whereas in colonoscopy, the procedure itself was the largest contributor. Individuals with prior experiences of colonoscopy reported significantly lower expected overall but not procedural discomfort from colonoscopy. The threshold for acceptable discomfort between subgroups is unknown, but the expected discomfort in colon capsule endoscopy and colonoscopy was higher in higher socioeconomic subgroups, suggesting that expected discomfort is not a significant contributor to the inequalities in screening uptake.

Mental disorders, participation, and trajectories in the Danish colorectal cancer screening programme: a population-based cohort study

People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. Danish Cancer Society, Danish Health Foundation.

Combined SEPT9 and BMP3 methylation in plasma for colorectal cancer early detection and screening in a Brazilian population.

Colorectal cancer (CRC) screening can help to reduce its incidence and mortality. Noninvasive strategies, such as plasma analysis of epigenetic alterations, can constitute important biomarkers of CRC detection. This study aimed to evaluate the plasma methylation status of SEPT9 and BMP3 promoters as biomarkers for detection of CRC and its precursor lesions in a Brazilian population. Plasma samples from 262 participants of the CRC screening program of Barretos Cancer Hospital who had a positive fecal occult blood test and underwent colonoscopy and cancer patients were analyzed. Participants were grouped according to the worst lesion detected in the colonoscopy. Cell-free circulating DNA (cfDNA) was bisulfite treated followed by the analysis of SEPT9 and BMP3 methylation status using a droplet digital PCR system (ddPCR). The best methylation cutoff value for group discrimination was calculated by receiver operating characteristic (ROC) curve analysis. Among the 262 participants, 38 were diagnosed with CRC, 46 with advanced adenomas 119 with nonadvanced adenomas, three with sessile serrated lesions, and 13 with hyperplastic polyps. In 43 participants, no lesion was detected in the colonoscopy and were used as controls. The CRC group showed the highest cfDNA concentration (10.4 ng/mL). For the SEPT9 gene, a cutoff of 2.5% (AUC = 0.681) that discriminates between CRC and the control group resulted in CRC sensitivity and specificity of 50% and 90%, respectively. Concerning the BMP3 gene, a cutoff of 2.3% (AUC = 0.576) showed 40% and 90% of sensitivity and specificity for CRC detection, respectively. Combining SEPT9, BMP3 status, and age over 60 years resulted in a better performance for detecting CRC (AUC = 0.845) than the individual gene models, yielding 80% and 81% of sensitivity and specificity, respectively. The present study suggests that a combination of SEPT9 and BMP3 plasma methylation, along with age over 60 years, showed the highest performance in detecting CRC in a Brazilian population. These noninvasive biomarkers can potentially serve as useful tools for CRC screening programs.

Comparison and commutability study among four faecal immunochemical tests (FIT) systems.

Faecal immunochemical tests for haemoglobin (FIT) are used in colorectal cancer screening programs around the world and increasingly for triage of symptomatic patients. FIT results are currently not traceable to a common reference standard and results obtained on various FIT systems may not be equivalent. The size of the bias between the systems is difficult to quantify due to the complex pre-analytical aspects of FIT. This study aimed to quantify the bias and the correlation between four FIT systems by measuring a panel of 38 faecal samples while limiting the effect of the pre-analytical aspects. In addition, the commutability of seven candidate reference materials (RM) was assessed. Pairwise method comparisons based on faecal samples demonstrated Pearson correlation coefficients ranging between 0.944 and 0.970 and an average proportional bias of-30 to-35 % for one FIT system compared to the other three. The relative standard deviation among biases of the individual samples was around 20 %. Due to these sample specific differences, no decisive conclusions could be drawn in the commutability study. However, twocandidate RMs, prepared in the FIT system-specific storage/extraction buffers, had a better commutable profile than the other five. The use of a common threshold for all FIT systems is currently not possible due to the presence of a proportional bias. We have identified potential commutable RMs to take to further studies on the production of a common calibrator, with the aim being to reduce the analytical bias observed on different FIT systems.

Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health.

Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada. We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines. Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations. Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.

A Review of Community Awareness for Colorectal Cancer Screening and Prevention in North and Central Asian Countries.

Colorectal cancer (CRC) incidence and mortality rates are increasing in low- and middle-income countries (LMIC), including North and Central Asian countries (NCAC). Screening and risk factor reduction can aid in the prevention of colorectal cancer, but communities lack awareness of these screening programs. The review assessed community awareness about CRC screening and prevention in NCAC to facilitate cancer control policies. Study type and methods: For this scoping review, we searched PubMed/Medline, Embase, and the Cochrane Library for articles on community awareness about CRC screening and prevention in NCAC according to inclusion and exclusion criteria. Eight of 677 articles from five of the 15 NCAC countries met the criteria. Most of the studies utilized a survey design. The results indicated low awareness of the availability of CRC screening and poor knowledge of CRC symptoms. Knowledge of CRC screening modalities was also inadequate. Some countries also lack CRC screening programs. Community unawareness is a significant barrier to screening program utilization and sustenance. Community health awareness programs (CHAP) are needed to improve the uptake of CRC screening in NCAC. The NCAC should include CHAP as an integral component of the CRC control plan. Long-term cancer control in LMICcould be adapted using the step-ladder pyramidal approach.

Socio-demographic and cultural factors related to non-participation in the Dutch colorectal cancer screening programme

BackgroundHigh participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed. We investigated demographic differences between participants and non-participants in the Dutch faecal immunochemical test-based colorectal cancer (CRC) screening programme. MethodsIn this population-based cohort study, we included all invitees for CRC screening in 2018 and 2019. Participation status, birth year, and sex were extracted from the Dutch national screening information system and linked to demographic characteristics from Statistics Netherlands, including migration background, level of education, socioeconomic category, household composition, and household income. A multivariable logistic regression was used to assess the association between demographic factors and participation. ResultsA total of 4,383,861 individuals were invited for CRC screening in 2018 and 2019, of which 3,170,349 (72.3%) participated. Individuals were less likely to participate when they were single and/or living with others (single with other residents versus couple: odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.31–0.38), had a migration background (e.g. Moroccan migrant versus Dutch background: OR 0.43, 95% CI: 0.42–0.44), or had a low income (lowest versus highest quintile: OR 0.45, 95% CI: 0.44–0.45). Although to a lesser extent, non-participation was also significantly associated with being male, being younger, receiving social welfare benefits and having a low level of education. ConclusionWe found that individuals who were single and/or living with others, immigrants from Morocco or individuals with low income were the least likely to participate in the Dutch CRC screening programme. Targeted interventions are needed to minimise inequities in CRC screening.

Improved stage and survival for patients in the Aotearoa New Zealand colorectal cancer screening program 2012-2019.

Colorectal cancer (CRC) screening was introduced in Aotearoa New Zealand at Waitematā District Health Board (WDHB) in late 2011. This study reviewed patterns of disease, treatment received, and survival of patients with national bowel screening program (NBSP)-detected CRC versus non-NBSP patients at WDHB 2012-2019. Data collected retrospectively for all patients with adenocarcinoma of the colon or rectum at WDHB 2012-2019. Patient records were manually reviewed. Chi-square, Fisher's exact test and the Mann Whitney U-test used as appropriate. Kaplan-Meier and Cox proportional hazards regression modelling for survival analysis. 1667 patients included (360 NBSP and 1307 non-NBSP). 863 (51.8%) were male. Median age at diagnosis 73 years (range 21-100); NBSP patients were younger (median 68 vs. 76 years, P < 0.001). NBSP patients had significantly lower T, N, M and overall TNM stage than non-BSP patients. Median survival estimate on Kaplan-Meier analysis was 94 months for all patients. Statistically significant (P < 0.05) predictors of mortality on multi-variate regression analysis included increasing overall TNM stage compared with stage I (stage II HR 1.63 (95% CI 1.14-2.34), stage III HR 2.86 (95% CI 2.03-4.03), stage IV HR 7.73 (95% CI 5.59-10.68)), diagnosis within NBSP (HR 0.51 (95% CI 0.37-0.71)), increasing age in years (HR 1.03 (95% CI 1.02-1.03)), urgent/emergency surgery (HR 1.66 (95% CI 1.36-2.01)) and formal resection of primary tumour (HR 0.31 (95% CI 0.25-0.38)). Patients diagnosed within the Aotearoa New Zealand NBSP were found to be younger and have earlier stage CRC. Diagnosis within the NBSP is an independent predictor of survival for patients with CRC.

Mutational and DNA fragment analysis may help in the triage of FIT+ patients enrolled in colorectal cancer screening programs.

e15546 * F. Pepe made an equal contribution Background: Mutational and DNA fragment analysis have already been investigated for a possible role in the detection of colorectal cancer. This pilot study, conducted at ASL NA 3 SUD (Naples, Italy) with the University of Naples Federico II, attempts to understand their possible role in the detection of Advanced Adenomas+ (AA+) and their potential ability to triage subjects with a positive FIT test for referral to colonoscopy. Methods: 160 FIT+ subjects of both genders, aged 50-74, participating in a colorectal cancer screening program were enrolled in a clinical trial focusing on a novel biomarker for colorectal cancer diagnostics. Of these, 14 subjects had disease (12 AAs and 2 colorectal cancers, from now on “CRC”). After ethical committee’s approval and release of informed consents, a 20 ml whole-blood sample was collected from each subject. Samples were centrifuged following standard procedures and stored at -80°C. DNA extraction was later performed using a Minielute kit (Qiagen). Mutational and DNA fragment analysis were performed using a qPCR-based technology: the ColoScape™ 2.5 kit (DiaCarta Inc, Pleasanton, CA). A logistic regression was run to determine the probability of disease in subjects showing positivity for predictors. Estimates of sensitivity, specificity, PPV, NPV (with 95% C.I.), PLR, NLR and Youden’s Index were also obtained. Results: The logistic regression showed statistical significance, with a p-value &lt; 0.0001, that is, the logistic regression model with provides a better fit than the model without the independent variable. ColoScape identified 12 subjects with disease out of 14, for a sensitivity of 86% (67%,100%); both CRCs were picked up by ColoScape together with 10 AAs. 2 AAs were missed. Out of 146 healthy subjects, 107 were successfully identified as negatives, for a specificity of 73% (66%, 80%). PPV was 24% (12%, 35%). NPV was 98% (96%, 100%). PLR, NLR and Youden’s Index were 3.21, 0.19 and 0.59 respectively. Conclusions: This pilot study was intended to provide performance indicators to design a larger population study that is currently underway. These preliminary findings suggest that liquid biopsy-based mutational and DNA fragment analysis can play a role in selecting subjects with a higher risk of returning a positive colonoscopy, thus potentially improving the quality of colorectal cancer screening programs and patients’ experience.

Attendance characteristics of the breast and colorectal cancer screening programmes in a highly urbanised region of the Netherlands: a retrospective observational study

ObjectivesThroughout Europe, many countries offer population-based cancer screening programmes (CSPs). In the Netherlands, two implemented CSPs are targeting people of 50 years and older, aiming at breast cancer (BC) and...

Plasma cfDNA role in detecting cardiovascular, metabolic and other diseases in a FIT+ population enrolled for a colorectal cancer screening program.

e15541 * Francesco Pepe made an equal contribution to the study Background: Cell-free DNA (cfDNA) has long been established as a useful tool in a variety of clinical settings, including infectious, auto-immune, cardiovascular and neoplastic diseases. In a study that is conducted at ASL NA 3 SUD (Naples, Italy) with the University of Naples Federico II, cfDNA was used to conduct mutational analysis using a novel biomarker for colorectal cancer. In this study, the observation of cfDNA value has suggested its potential use as a disease detector. This abstract reports findings of a secondary analysis in the study. Methods: 667 FIT+ subjects, aged 50-74, participating in a colorectal cancer screening program enrolled in a clinical trial focusing on the role of a novel biomarker in colorectal cancer diagnosis. The subjects' medical history included cardiovascular diseases (CVD) and diabetes primarily, collectively named as Concomitant Diseases (CD). 398 patients had at least one CD, while 269 had none. A whole blood sample was obtained from each study subjects and total plasma cfDNA was measured using QuantiDNA™ test, manufactured by DiaCarta Inc. ROC curve was run to assess diagnostic efficacy and determine cutoff points of cfDNA for detecting the CD and specifically cardiovascular ones. Logistic regression was used to determine the probability of disease in subjects with an elevated cfDNA concentration. Adjusted estimates were obtained to assess the potential confounding effect of CD vs colorectal neoplasia (CN). Results: The area under the curve (AUC) for cfDNA as a predictor of CD was 0.562 (95% C.I. 0.518, 0.607); the cutoff point was 13.44 ng/ml, with a sensitivity of 50% (95% C.I 45%, 55%) and a specificity of 63% (95% C.I. 57%, 69%). The logistic regression to assess the probability of CD showed an odds ratio (OR) for cfDNA of 1.6279 (95% C.I. 1.19, 2.234; p = 0.0023) that is, one unit increase in cfDNA will increase the odds of disease by ~63%. A specific assessment was made for cfDNA as a detector for CVD. The AUC was 0.567 (95% C.I. 0.523, 0.611), the cutoff point was 12.8 ng/ml, with a sensitivity of 55% (95% C.I. 50%, 60%) and a specificity of 57% (95% C.I. 51%, 63%). The logistic regression indicated an OR of 1.681 (95% C.I. 1.2378, 2.2876; p &lt; 0.001) meaning that a one unit increase in cfDNA will increase the odds of disease by ~68.1%. Lastly, the logistic regression of cfDNA as a predictor of CN adjusted for CD showed a change in slope &gt; 10% from the unadjusted form, suggesting a potential confounding effect. Conclusions: Although the study was not designed to assess the validity of cfDNA as a detector of diseases, these secondary findings suggest that cfDNA can be used as a disease detector for CD including CVD, which encourages further studies. Attention should be directed towards potential confounding effects, such as from CD or CN since cfDNA can be elevated by several different conditions.

Knowledge, attitude, practice, and perceived barriers of colorectal cancer screening among primary care physicians in the Kingdom of Bahrain

Background: Colorectal cancer (CRC) is one of the lethal cancers all over the world. Early detection of colorectal cancer has been shown to reduce incidence and mortality. Primary care physicians have a crucial role in early detection of cancer. This study aims to explore the knowledge, attitude and practice of primary care physicians in Bahrain towards CRC screening and to determine the barriers related to CRC screening. Methods: A cross sectional study was carried out among primary care physicians working at primary health care centers in Bahrain. It included 174 physicians. A self-filled questionnaire that includes demographic information, knowledge scale, attitude scale, practice scale items and barriers of not performing CRC screening was used as the study tool. Results: The overall knowledge score revealed that 51.7% had poor knowledge score and 48.3% had adequate knowledge score. Majority of the participants (93.7%) agreed to have a structured screening program for colorectal cancer rather than an opportunistic one. Most of the physicians (60%) reported that less than 25% of those eligible patients truly receive a screening. Physician’s lack of time was the top barrier of not performing CRC screening. Conclusions: This study showed that most primary care physicians have poor knowledge regarding CRC screening and the majority do not screen their eligible patients for CRC.

Screening for colorectal cancer : Arecommendation statement of the Austrian National Committee for Cancer Screening.

Colorectal cancer is the fourth most common cancer in Austria. To date, colorectal cancer screening in Austria remains opportunistic and includes colonoscopy or stool-based blood tests. The Austrian National Committee for Cancer Screening developed evidence-based recommendations for anationwide organized colorectal cancer screening program. The methodological framework followed the approach of the United States Preventive Services Task Force. The evidence base underlying the newly developed recommendations comprised areview of the existing published evidence and adecision analytic model tailored to the Austrian context. Using astructured process, committee members considered 1)the magnitude of the net benefit of each screening strategy, 2)the certainty of evidence, and 3)the level of acceptance of the interventions among the target population. The Austrian National Committee for Cancer Screening recommends the implementation of anationwide organized colorectal cancer screening program for all adults aged 45-75years. For persons 65years or older, screening decisions should occur on an individual basis in accordance with aperson's overall health, prior screening history, and preferences. Specifically, the committee recommends either a10-year screening colonoscopy or biennial fecal immunochemical tests with colonoscopy following apositive result, with both screening strategies considered equivalent. Each citizen should be able to make an informed decision about their preferred screening method. Switching between the two screening strategies should be possible. Following an unremarkable colonoscopy, screening by fecal immunochemical test (FIT) is only required after 10years. Screening recommendations apply only to asymptomatic persons at average risk for colorectal cancer. The screening program must be pilot tested, and accompanied by apublic information campaign, formative evaluation, quality assurance, and data collection.

Hot Mail: Temperature Exposure during Mail Return of an Immunochemical Fecal Occult Blood Test.

Fecal immunochemical tests (FITs) are widely used for colorectal cancer (CRC) screening; however, high ambient temperatures were found to reduce test accuracy. More recently, proprietary globin stabilizers were added to FIT sample buffers to prevent temperature-associated hemoglobin (Hb) degradation, but their effectiveness remains uncertain. We aimed to determine the impact of high temperature (>30°C) on OC-Sensor FIT Hb concentration with current FITs, characterize FIT temperatures during mail transit, and determine impact of ambient temperature on FIT Hb concentration using data from a CRC screening program. FITs were analyzed for Hb concentration after in vitro incubation at different temperatures. Data loggers packaged alongside FITs measured temperatures during mail transit. Separately, screening program participants completed and mailed FITs to the laboratory for Hb analysis. Regression analyses compared the impact of environmental variables on FIT temperatures and separately on FIT sample Hb concentration. In vitro incubation at 30 to 35°C reduced FIT Hb concentration after >4 days. During mail transit, maximum FIT temperature averaged 6.4°C above maximum ambient temperature, but exposure to temperature above 30°C was for less than 24 hours. Screening program data showed no association between FIT Hb concentration and maximum ambient temperatures. Although FIT samples are exposed to elevated temperatures during mail transit, this is brief and does not significantly reduce FIT Hb concentration. These data support continuation of CRC screening during warm weather with modern FITs with a stabilizing agent when mail delivery is ≤4 days.

Implementation of artificial intelligence in speech (voice input) in the conditions of a high-flow endoscopy

Artificial intelligence (AI) and digitalization are used in all spheres of life, including medicine: in making diagnoses, in working with patients, in creating and using an Electronic Medical Record (EMC) for fast and accessible document management. Attempts have been made repeatedly to facilitate work with medical protocols. Technologies related to speech recognition are a promising direction in this area. The purpose of the research work was to optimize the time of writing the protocol using voice input. The object of the study was a template protocol of endoscopic examination. This work was carried out on the basis of 2 large endoscopic centers in Moscow, created as part of the pilot project of the DM within the framework of the colorectal cancer screening program in the Russian Federation in 2021. The software of the Voice2Med Speech Technology Center (MDG) was used to fill out the research protocol. Using mathematical calculations, 4 metrics were created to evaluate the work of the software: the time of protocol formation; the proportion of protocol formation time from the study; the level of speech recognition accuracy; satisfaction of doctors when working with technology. Standardized protocol templates for various nosologies related to voice commands have been developed; medical thesaurus. In the course of the work, the accuracy of speech recognition was investigated and improved. Control measurements of the time of writing the protocol were carried out. The results of the evaluation of the use of the technology by endoscopists were obtained - the time of protocol formation decreased by 29%, the evaluation of the work by endoscopists was positive. Thus, the use of speech technologies related to the formation of a doctor’s protocol “from the voice” is a promising direction for the further development of the IT sphere in practical medicine.

Implementation of a novel program to support colorectal cancer screening in a community health center consortium before and after the onset of COVID-19: a qualitative study of stakeholders’ perspectives

BackgroundIn 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program’s Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic.MethodsSemi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis.ResultsTwenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities.ConclusionsImplementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.