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INTRODUCTION: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January-June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. METHODS: Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020-2022, to five-year, pre-COVID-19 pandemic averages (2015-2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. RESULTS: By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (-8.8% BC and -4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (-37.3% BC and -26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (-41.4% CVC). CONCLUSION: For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume.
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Neoplasias da Mama , COVID-19 , Detecção Precoce de Câncer , Neoplasias do Colo do Útero , Humanos , COVID-19/epidemiologia , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Estados Unidos/epidemiologia , Adulto , Pessoa de Meia-Idade , Programas de Rastreamento/estatística & dados numéricos , Pandemias , SARS-CoV-2RESUMO
Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Implementation of evidence-based interventions (EBIs) increases CRC screening. The purpose of this analysis is to determine which combinations of EBIs or strategies led to increases in clinic-level screening rates among clinics participating in CDC's Colorectal Cancer Control Program (CRCCP). Data were collected from CRCCP clinics between 2015 and 2018 and the analysis was conducted in 2020. The outcome variable was the annual change in clinic level CRC screening rate in percentage points. We used first difference (FD) estimator of linear panel data regression model to estimate the associations of outcome with independent variables, which include different combinations of EBIs and intervention strategies. The study sample included 486 unique clinics with 1156 clinic years of total observations. The average baseline screening rate was 41 % with average annual increase of 4.6 percentage points. Only two out of six combinations of any two EBIs were associated with increases in screening rate (largest was 6.5 percentage points, P < 0.001). Any combinations involving three EBIs or all four EBIs were significantly associated with the outcome with largest increase of 7.2 percentage points (P < 0.001). All interventions involving 2-3 strategies led to increases in rate with largest increase associated with the combination of increasing community demand and access (6.1 percentage points, P < 0.001). Clinics implementing combinations of these EBIs, particularly those including three or more EBIs, often were more likely to have impact on screening rate change than those implementing none.
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Evidence-based interventions, including provider assessment and feedback, provider reminders, patient reminders, and reduction of structural barriers, improve colorectal cancer screening rates. Assessing primary care clinics' readiness to implement these interventions can help clinics use strengths, identify barriers, and plan for success. However, clinics may lack tools to assess readiness and use findings to plan for successful implementation. To address this need, we developed the Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions (Field Guide) for the Centers for Disease Control and Prevention's (CDC's) Colorectal Cancer Control Program (CRCCP). We conducted a literature review of evidence and existing tools to measure implementation readiness, reviewed readiness tools from selected CRCCP award recipients (n = 35), and conducted semi-structured interviews with key informants (n = 8). We sought feedback from CDC staff and recipients to inform the final document. The Field Guide, which is publicly available online, outlines 4 assessment phases: 1) convene team members and determine assessment activities, 2) design and administer the readiness assessment, 3) evaluate assessment data, and 4) develop an implementation plan. Assessment activities and tools are included to facilitate completion of each phase. The Field Guide integrates implementation science and practical experience into a relevant tool to bolster clinic capacity for implementation, increase potential for intervention sustainability, and improve colorectal cancer screening rates, with a focus on patients served in safety net clinic settings. Although this tool was developed for use in primary care clinics for cancer screening, the Field Guide may have broader application for clinics and their partners for other chronic diseases.
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Neoplasias Colorretais , Detecção Precoce de Câncer , Centers for Disease Control and Prevention, U.S. , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Humanos , Atenção Primária à Saúde , Provedores de Redes de Segurança , Estados UnidosRESUMO
INTRODUCTION: The US Preventive Services Task Force (USPSTF) recommends select preventive clinical services, including cancer screening. However, screening for cancers remains underutilized in the United States. The Centers for Disease Control and Prevention leads initiatives to increase breast, cervical, and colorectal cancer (CRC) screening. We assessed the number of avoidable deaths from increased screening, according to USPSTF recommendations, for CRC and female breast and cervical cancers. METHODS: We used model-based estimates of avoidable deaths for the lifetime of single-year age cohorts under the current and increased use of screening scenarios (data year 2016; analysis, 2018). We calculated prevented cancer deaths for each 1% increase in screening uptake and extrapolated to current level of screening (2016), current level plus 10 percentage points, and increasing screening to 90% and 100% of the eligible population. RESULTS: Increased use of screening from current levels to 100% would prevent an additional 2,821 deaths from breast cancer, 6,834 deaths from cervical cancer, and 35,530 deaths from CRC over a lifetime of the respective single-year cohort. Increasing use of CRC screening would prevent approximately 8.5 times as many deaths as the equivalent increase in use of breast cancer screening (women only), although twice as many people (men and women) would have to be screened for CRC. CONCLUSIONS: A large number of deaths could be avoided by increasing breast, cervical, and CRC screening. Public health programs incorporating strategies shown to be effective can help increase screening rates.
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Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias da Mama/mortalidade , Neoplasias Colorretais/mortalidade , Estudos Transversais , Feminino , Humanos , Masculino , Modelos Estatísticos , Serviços Preventivos de Saúde/organização & administração , Neoplasias do Colo do Útero/mortalidadeRESUMO
With funding from the Centers for Disease Control and Prevention's Colorectal Cancer Control Program, The University of Chicago Center for Asian Health Equity partnered with a federally qualified health center (FQHC) to implement multiple evidence-based interventions (EBIs) in order to improve colorectal cancer (CRC) screening uptake. The purpose of this study is to determine the effectiveness and cost of implementing a provider reminder system entered manually and supplemented with patient reminders and provider assessment and feedback. The FQHC collected demographic characteristics of the FQHC and outcome data from January 2015 through December 2015 (preimplementation period) and cost from January 2016 through September 2017 (implementation period). Cost data were collected for the implementation period. We report on the demographics of the eligible population, CRC screening order, completion rates by sociodemographic characteristics, and, overall, the effectiveness and cost of implementation. From the preimplementation phase to the implementation phase, there was a 21.2 percentage point increase in CRC screens completed. The total cost of implementing EBIs was $40908.97. We estimated that an additional 283 screens were completed because of the interventions, and the implementation cost of the interventions was $144.65 per additional screen. With the interventions, CRC screening uptake in Chicago increased for all race/ethnicity and demographic backgrounds at the FQHC, particularly for patients aged 50 to 64 years and for Asian, Hispanic, and uninsured patients.
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Neoplasias Colorretais , Detecção Precoce de Câncer , Chicago , Neoplasias Colorretais/diagnóstico , Medicina Baseada em Evidências , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Populações VulneráveisRESUMO
The Centers for Disease Control and Prevention (CDC) has a long-standing commitment to increase colorectal cancer (CRC) screening for vulnerable populations. In 2005, the CDC began a demonstration in five states and, with lessons learned, launched a national program, the Colorectal Cancer Control Program (CRCCP), in 2009. The CRCCP continues today and its current emphasis is the implementation of evidence-based interventions to promote CRC screening. The purpose of this article is to provide an overview of four CRCCP awardees and their federally qualified health center partners as an introduction to the accompanying series of research briefs where we present individual findings on impacts of evidence-based interventions on CRC screening uptake for each awardee. We also include in this article the conceptual framework used to guide our research. Our findings contribute to the evidence base and guide future program implementation to improve sustainability, increase CRC screening, and address disparities in screening uptake.
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Neoplasias Colorretais , Detecção Precoce de Câncer , Centers for Disease Control and Prevention, U.S. , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Humanos , Programas de Rastreamento , Estados UnidosRESUMO
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States of cancers that affect both men and women. Despite strong evidence that screening for CRC reduces incidence and mortality, CRC screening prevalence is below the national target. This report describes current CRC screening prevalence by age, various demographic factors, and state. METHODS: Data from the 2018 Behavioral Risk Factor Surveillance System survey were analyzed to estimate the percentages of adults aged 50-75 years who reported CRC screening consistent with the United States Preventive Services Task Force recommendation. RESULTS: In 2018, 68.8% of adults were up to date with CRC screening. The percentage up to date was 79.2% among respondents aged 65-75 years and 63.3% among those aged 50-64 years. CRC screening prevalence was lowest among persons aged 50-54 years (50.0%) and increased with age. Among respondents aged 50-64 years, CRC screening prevalence was lowest among persons without health insurance (32.6%) and highest among those with reported annual household income of ≥$75,000 (70.8%). Among respondents aged 65-75 years, CRC screening prevalence was lowest among those without a regular health care provider (45.6%), and highest among those with reported annual household income ≥$75,000 (87.1%). Among states, CRC screening prevalence was highest in Massachusetts (76.5%) and lowest in Wyoming (57.8%). DISCUSSION: CRC screening prevalence is lower among adults aged 50-64 years, although most reported having a health care provider and health insurance. Concerted efforts are needed to inform persons aged <50 years about the benefit of screening so that screening can start at age 50 years.
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Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosAssuntos
Centers for Disease Control and Prevention, U.S. , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Programas de Rastreamento , Idoso , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados UnidosRESUMO
INTRODUCTION: Screening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention's Colorectal Cancer Control Program from July 2009 through June 2015. METHODS: We collected data from the program's 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists' recommendations for the next test. RESULTS: Overall, 82.9% (range among grantees, 50.0%-97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%-99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%-84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%-56.6%) in 5 or more years, and 18.6% (range, 0%-47.2%) in less than 3 years. CONCLUSION: Although overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.
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Centers for Disease Control and Prevention, U.S./estatística & dados numéricos , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Colonoscopia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Estados UnidosRESUMO
INTRODUCTION: The Centers for Disease Control and Prevention (CDC) established the Colorectal Cancer Control Program (CRCCP) in 2009 to reduce disparities in colorectal cancer screening and increase screening and follow-up as recommended. We estimate the cost for evidence-based intervention and non-evidence-based intervention screening promotion activities and examine expenditures on screening promotion activities. We also identify factors associated with the costs of these activities. METHODS: By using cost and resource use data collected from 25 state grantees over multiple years (July 2009 to June 2014), we analyzed the total cost for each screening promotion activity. Multivariate analysis was used to assess the factors associated with screening promotion costs reported by grantees. RESULTS: The promotion activities with the largest allocation of funding across the years and grantees were mass media, patient navigation, outreach and education, and small media. Across all years of the program and across grantees, the amount spent on specific promotion activities varied widely. The factor significantly associated with promotion costs was region in which the grantee was located. CONCLUSION: CDC's CRCCP grantees spent the largest amount of the screening promotion funds on mass media, which is not recommended by the Community Preventive Services Task Force. Given the large variation across grantees in the use of and expenditures on screening promotion interventions, a systematic assessment of the yield from investment in specific promotion activities could better guide optimal resource allocation.
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Centers for Disease Control and Prevention, U.S./economia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Promoção da Saúde/economia , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/economia , Humanos , Programas de Rastreamento/estatística & dados numéricos , Serviços Preventivos de Saúde , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: Colonoscopy and guaiac fecal occult blood tests and fecal immunochemical tests (FOBT/FIT) are the most common colorectal cancer screening methods in the United States. However, information is limited on the program resources required over time to use these tests. METHODS: We collected cost data from 29 Centers for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP) grantees by using a standardized data collection instrument for 5 program years (2009-2014). We created a panel data set with 124 records and assessed differences by screening test used. RESULTS: Forty-four percent of all programs (N = 124) offered colonoscopy (55 of 124), 32% (39 of 124) offered FOBT/FIT, and 24% (30 of 124) offered both. Overall, total cost per person was higher in program year 1 ($3,962), the beginning of CRCCP than in subsequent program years ($1,714). The cost per person was $3,153 for programs using colonoscopy and $1,291 for those using FOBT/FIT with diagnostic colonoscopy. The average clinical cost per person was $1,369 for colonoscopy and $280 for FOBT/FIT during the program (these do not reflect cost of repeated FOBT/FIT screens). Programs serving a large number of people had lower per-person costs than those serving a small volume, probably because of fixed costs related to nonclinical expenses. CONCLUSION: Colorectal cancer screening programs incur costs in addition to the clinical cost of the screening procedures to support planning and management, contracting with providers, and tracking patients. Because programs can achieve potential economies of scale, partnerships among smaller programs for screening delivery could decrease overall costs.
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Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Gerenciamento Clínico , Detecção Precoce de Câncer/economia , Programas de Rastreamento/economia , Sigmoidoscopia/economia , Idoso , Colonoscopia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Sigmoidoscopia/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community. METHODS: The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost effectiveness of multicomponent interventions used in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. RESULTS: Process measures to evaluate the implementation of interventions to increase community and patient demand for CRC screening, increase patient access, and increase provider delivery of services are presented. In addition, performance measures are identified to assess implementation processes along the continuum of care for screening, diagnosis, and treatment. Series of intermediate and long-term outcome and cost measures also are presented to evaluate the impact of the interventions. CONCLUSIONS: Understanding the effectiveness of multicomponent, evidence-based interventions and identifying successful approaches that can be replicated in other settings are essential to increase screening and reduce CRC burden. The use of common framework, data elements, and evaluation methods will allow the performance of comparative assessments of the interventions implemented across CRCCP sites to identify best practices for increasing colorectal screening, particularly among underserved populations, to reduce disparities in CRC incidence and mortality.
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Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Prática Clínica Baseada em Evidências , Programas de Rastreamento , Avaliação de Programas e Projetos de Saúde/métodos , Idoso , Neoplasias Colorretais/economia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Prática Clínica Baseada em Evidências/economia , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/organização & administração , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/normas , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Econométricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normasRESUMO
BACKGROUND: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening. METHODS: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated. RESULTS: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215. CONCLUSIONS: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center.
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Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/economia , Navegação de Pacientes/economia , Adulto , Idoso , Chicago/epidemiologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/economia , Neoplasias Colorretais/epidemiologia , Análise Custo-Benefício , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Hospitais Universitários , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Navegação de Pacientes/organização & administração , Navegação de Pacientes/normas , Participação do Paciente/economia , Participação do Paciente/estatística & dados numéricosAssuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologiaAssuntos
Colonoscopia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/normas , Sangue Oculto , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: In the first CONCORD study (2008), 5-year survival for patients diagnosed with colon cancer between 1990 and 1994 in the United States was among the highest in the world (60%), but there were large racial disparities in most participating states. The CONCORD-2 study (2015) enabled the examination of survival trends between 1995 and 2009 for US states by race and stage. METHODS: The authors analyzed data from 37 state population-based cancer registries, covering approximately 80% of the US population, for patients who were diagnosed with colon cancer between 2001 and 2009 and were followed through 2009. Survival up to 5 years was corrected for background mortality (net survival) using state-specific and race-specific life tables and age-standardized using the International Cancer Survival Standard weights. Survival is presented by race (all, black, white), stage, state, and calendar period (2001-2003 and 2004-2009) to account for changes in methods used to collect stage. RESULTS: Five-year net survival increased by 0.9%, from 63.7% between 2001 and 2003 to 64.6% between 2004 and 2009. More black than white patients were diagnosed with distant-stage disease between 2001 and 2003 (21.5% vs 17.2%) and between 2004 and 2009 (23.3% vs 18.8%). Survival improved for both blacks and whites, but 5-year net survival was 9-10% lower for blacks than for whites both between 2001 and 2003 (54.7% vs 64.5%) and between 2004 and 2009 (56.6% vs 65.4%). The absolute difference between blacks and whites decreased by only 1% during the decade. CONCLUSIONS: Five-year net survival from colon cancer increased slightly over time. Survival among blacks diagnosed between 2004 and 2009 had still not reached the level of that among whites diagnosed between 1990 and 1994, some 15 to 20 years earlier. These findings suggest a need for more targeted efforts to improve screening and to ensure timely, appropriate treatment, especially for blacks, to reduce this large and persistent disparity in survival. Cancer 2017;123:5014-36. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias do Colo/mortalidade , Sistema de Registros , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/etnologia , Neoplasias do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period. METHODS: Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000. RESULTS: There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods. CONCLUSIONS: There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias Retais/mortalidade , Sistema de Registros , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/etnologia , Neoplasias Retais/patologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two FITs (InSure FIT and OC FIT-CHEK) for detecting advanced colorectal neoplasia. METHODS: The study included 1,006 asymptomatic patients, aged 50-75 years, who were scheduled to receive a screening colonoscopy at gastroenterology practices in the Minneapolis and Indianapolis metropolitan areas. Each participant was asked to complete all three stool tests before their colonoscopy. Each test's performance characteristics were evaluated using the screening colonoscopic results as the reference standard. RESULTS: Sensitivity for detecting advanced colorectal neoplasia was highest for InSure FIT (26.3%, 95% confidence interval (CI) 15.9-40.7), followed by OC FIT-CHEK (15.1%, 95% CI 6.7-26.1) and Hemoccult II SENSA (7.4%, 95% CI 1.9-17.0). InSure FIT was statistically significantly more sensitive than both OC FIT-CHEK (absolute difference in sensitivity=11.2%, 95% CI 0.4-24.2) and Hemoccult II SENSA (difference in sensitivity=18.9%, 95% CI 10.2-32.6). Specificities were relatively high for all tests (between 96.8% and 98.6%). CONCLUSIONS: Our results suggest that some FITs are more sensitive than the HS-gFOBT Hemoccult II SENSA, but these results need to be confirmed in larger asymptomatic populations. Comparisons between the FITs examined in this study and other FITs are needed to determine the best tests for population screening.
Assuntos
Adenoma/diagnóstico , Carcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Fezes/química , Hemoglobinas/análise , Idoso , Colonoscopia , Detecção Precoce de Câncer/métodos , Feminino , Guaiaco , Humanos , Imunoquímica , Indicadores e Reagentes , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Colorectal cancer is a leading cause of cancer-related death in the U.S. Although screening reduces colorectal cancer incidence and mortality, screening rates among U.S. adults remain less than optimal, especially among disadvantaged populations. This study examined the efficacy of patient navigation to increase colonoscopy screening. STUDY DESIGN: RCT. SETTING/PARTICIPANTS: A total of 843 low-income adults, primarily Hispanic and non-Hispanic blacks, aged 50-75 years referred for colonoscopy at Boston Medical Center were randomized into the intervention (n=429) or control (n=427) groups. Participants were enrolled between September 2012 and December 2014, with analysis following through 2015. INTERVENTION: Two bilingual lay navigators provided individualized education and support to reduce patient barriers and facilitate colonoscopy completion. The intervention was delivered largely by telephone. MAIN OUTCOME MEASURE: Colonoscopy completion within 6 months of study enrollment. RESULTS: Colonoscopy completion was significantly higher for navigated patients (61.1%) than control group patients receiving usual care (53.2%, p=0.021). Based on regression analysis, the odds of completing a colonoscopy for navigated patients was one and a half times greater than for controls (95% CI=1.12, 2.03, p=0.007). There were no differences between navigated and control groups in regard to adequacy of bowel preparation (95.3% vs 97.3%, respectively). CONCLUSIONS: Navigation significantly improved colonoscopy screening completion among a racially diverse, low-income population. Results contribute to mounting evidence demonstrating the efficacy of patient navigation in increasing colorectal cancer screening. Screening can be further enhanced when navigation is combined with other evidence-based practices implemented in healthcare systems and the community.