A Double-Edged Sword: Quality and Credibility of Colon Cancer Screening Content on YouTube.

Introduction Colorectal cancer (CRC) remains a significant public health challenge globally, with its pathogenesis involving the transformation of benign adenomas into malignant carcinomas. Despite advancements in screening and early detection significantly improving outcomes, the rise of digital platforms like YouTube for disseminating health information presents new challenges. Concerns over the accuracy and reliability of content underline the necessity for rigorous evaluation of these digital health education tools. Methods Our study was conducted at Nassau University Medical Center, East Meadow, New York. We meticulously analyzed YouTube videos on "colon cancer screening awareness," employing strict selection criteria to ensure both relevance and quality, focusing on English-language content with pertinent audio. Videos were evaluated for their quantitative and qualitative attributes-views, subscriber counts, likes/dislikes, comments, and content type, classifying them as scholarly or personal. We assessed video credibility through scientific accuracy using the DISCERN instrument, Global Quality Score (GQS), and Patient Education Materials Assessment Tool (PEMAT), ensuring consistency in quality and reliability evaluation among seven researchers via the intraclass correlation coefficient. These tools - DISCERN for assessing reliability and quality, GQS for evaluating overall quality, and PEMAT for understandability and actionability - facilitated a comprehensive evaluation framework. Our analysis, leveraging descriptive and inferential statistics, scrutinized differences in content quality between academic and private institutions, employing t-tests to identify statistically significant disparities. The study utilized Microsoft Excel (version 16.73, Microsoft Corporation, Redmond, Washington, United States) and IBM SPSS Statistics for Windows, version 29.0 (released 2022; IBM Corp., Armonk, New York, United States). for robust data processing and analysis, confirming the educational value and trustworthiness of the examined YouTube content. Results Our study of 156 YouTube videos on educational content, split between academic (68 videos) and private sources (88 videos), revealed significant quality differences. Using the DISCERN, PEMAT, and GQS metrics, academic videos consistently outperformed private ones, with significant margins: DISCERN (54.61 vs. 34.76), PEMAT (3.02 vs. 2.11), and GQS (3.90 vs. 2.02), supported by low p-values indicating a statistically significant superiority. These findings suggest that the source of content-academic versus private-plays a crucial role in determining the quality and reliability of educational materials on platforms like YouTube, highlighting the academic sector's commitment to higher educational standards. Conclusion The study emphasizes the critical role of credible sources in enhancing the quality of health education content on YouTube, particularly concerning CRC screening. The superiority of academic institutions in providing high-quality content suggests a need for viewers to critically assess the source of information. It also calls for enhanced regulatory oversight and measures to ensure the accuracy and reliability of health information online.

Associations between Missed Colonoscopy Appointments and Multiple Prior Adherence Behaviors in an Integrated Healthcare System: An Observational Study.

BACKGROUND: Missed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments. OBJECTIVE: To assess variability in prior adherence behaviors and their association with missed colonoscopy appointments. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients scheduled for colonoscopy in an integrated healthcare system between January 2016 and December 2018. MAIN MEASURES: Prior adherence behaviors included: any missed outpatient appointment in the previous year; any missed gastroenterology clinic or colonoscopy appointment in the previous 2 years; and not obtaining a bowel preparation kit pre-colonoscopy. Other sociodemographic, clinical, and system characteristics were included in a multivariable model to identify independent associations between prior adherence behaviors and missed colonoscopy appointments. KEY RESULTS: The median age of the 57,590 participants was 61 years; 52.8% were female and 73.4% were white. Of 77,684 colonoscopy appointments, 3,237 (4.2%) were missed. Individuals who missed colonoscopy appointments were more likely to have missed a previous primary care appointment (62.5% vs. 38.4%), a prior gastroenterology appointment (18.4% vs. 4.7%) or not to have picked up a bowel preparation kit (42.4% vs. 17.2%), all p < 0.001. Correlations between the three adherence measures were weak (phi < 0.26). The rate of missed colonoscopy appointments increased from 1.8/100 among individuals who were adherent with all three prior care components to 24.6/100 among those who were nonadherent with all three care components. All adherence variables remained independently associated with nonadherence with colonoscopy in a multivariable model that included other covariates; adjusted odds ratios (with 95% confidence intervals) were 1.6 (1.5-1.8) for outpatient appointments, 1.9 (1.7-2.1) for gastroenterology appointments, and 3.1 (2.9-3.4) for adherence with bowel preparation kits, respectively. CONCLUSIONS: Three prior adherence behaviors were independently associated with missed colonoscopy appointments. Studies to predict adherence should use multiple, complementary measures of prior adherence when available.

Activation of Nuclear Factor Kappa B (NF-kB) Signaling Pathway Through Exercise-Induced Simulated Dopamine Against Colon Cancer Cell Lines.

Introduction Dopamine is an important neuroregulatory hormone and is secreted during exercise. Its role in physiological regulation is not fully uncovered. Recent studies showed that it suppresses inflammation. Colon cancer is one of the most predominant cancers in the population and is influenced by prolonged inflammation. The anti-inflammatory effect of dopamine using the colon cancer model was analyzed in KB cells. Methods KB cells were cultured using Dulbecco's Modified Eagle Medium and Inhibitory Concentration- 50 (IC50) was determined by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay. BCl-2, tumour necrosis factor-α (TNF-α), nuclear factor kappa- B (​​​​​NF-kB), and interleukin (IL)-6 were assessed using reverse transcription polymerase chain reaction (RT-PCR)(at 50 and 100 µg/ ml < IC50). Schrödinger was used for docking analysis using nuclear factor Kappa B (NF-kB) (Protein Data Bank: 5T8O) and dopamine (CID 681). Results Results were represented as mean ± standard deviation and statistically evaluated. Dopamine showed severe growth inhibition in KB cells (IC50- 225±3.1µg/ ml). It downregulated the expression of BCl-2, NF-k, and IL-6, but increased TNF-α expression. Dopamine bonded with NF-kB by two hydrogen bonds with aspartic acid​​-53and alanine-54, respectively). Conclusion The present study revealed that dopamine has a significant anti-cancer potential by blocking NF-kB pathways in KB cells.

Early-Onset Colon Cancer: A Narrative Review of Its Pathogenesis, Clinical Presentation, Treatment, and Prognosis.

Colon cancer remains a leading cause of cancer-related deaths, and there has been a rise in the incidence of early-onset colon cancer or colon cancer diagnosed before the age of 50 years old. Early-onset colon cancer has several differences in clinical presentation, as well as histopathology, genetic alteration, and molecular profiling. Early-onset colon cancer can be differentiated into familial type that includes hereditary familial syndrome and sporadic type. Demographic variance also exists in both developing and developed countries. Due to the rising incidence of colon cancer diagnosed in younger age, it is imperative to examine the available evidence regarding the mortality rate of early-onset colon cancer. Colon cancer is affected by numerous modifiable and non-modifiable risk factors. Increasing obesity and lifestyle disorders in the younger population, such as smoking, may influence this increasing trend. There are existing guidelines for colon cancer screening in both average-risk and high-risk individuals. This narrative review aims to highlight the pathogenesis of early-onset CRC; its clinical presentation, treatment, prognosis; and how it differs from late-onset CRC.

Obstructing Stage IV Adenocarcinoma of the Transverse Colon in a Young Patient With Vitiligo.

Advanced colorectal cancer, while uncommon, can occur in a young patient. We present a rare case of advanced transverse colon cancer in a young patient with vague symptoms and unique comorbid conditions, while reviewing the literature on colorectal cancer and its association with autoimmune conditions. With a recent increase in the incidence of colon cancer in young patients, further research is needed as to whether colorectal cancer screening is warranted in younger cohorts outside of current recommendations and guidelines. Investigations are needed into the factors that may explain this and the public health interventions that can be employed to improve colon cancer prevention. The objective of this report is to highlight the importance of recognizing alarming symptoms and raise awareness of the increasing incidence of early-onset colon cancer in young patients.

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes.

Background Inappropriate or "off-label" use of multi-target stool DNA (mt-sDNA) tests refers to their use in patients for whom colonoscopy or no testing at all is warranted. Examples include a positive family history of colorectal cancer, a history of inflammatory bowel disease, or medical issues necessitating diagnostic colonoscopy, among others. Current understanding of off-label mt-sDNA use for colorectal cancer screening, its associated risks, and outcomes is lacking. We examined off-label mt-sDNA prescription and compliance with testing in an outpatient setting in southeast Michigan. Aims The primary aims of the study were determining the extent of off-label mt-sDNA testing and compliance, and results of all testing, as well as demographic factors associated with off-label prescriptions. The secondary aims were to examine explanations for incomplete testing and factors contributing to successful completion. Methods Using a retrospective design, we identified mt-sDNA orders from outpatient internal medicine clinics between January 1, 2018, to July 31, 2019, to evaluate the proportion of off-label mt-sDNA, results of testing, and follow-up colonoscopies up to one year after order placement. Patients were categorized as "off-label" if any inappropriate criteria were met. Statistical analysis was performed for primary and secondary outcomes. Results From 679 mt-sDNA orders within the study period, 81 (12.1%) had at least one off-label criterion for testing. In total, 404/679 (59.5%) patients completed testing. Lack of follow-up comprised the majority of incompletions (216/275; 78.6%). Only 52 (70.3%) out of 74 positive results were followed by diagnostic colonoscopy. Retired employment status (OR = 1.87; 95%CI, 1.17-2.98; P = 0.008) and age of 76 years or older (OR = 2.28; 95%CI, 0.99-5.21; P = 0.044) were significantly associated with increased risk of off-label mt-sDNA prescription. Increasing age range was associated with higher test completion (χ2 (5) = 12.085, p = 0.034). Multinomial logistic regression revealed an increasing age range (OR = 1.29; 95% CI, 1.09-1.54; P = 0.004), predictive of a positive mt-sDNA result for both groups. There was no significant difference between off-label or on-label groups in the mean number of resected polyps or pathology scores on follow-up colonoscopy. Conclusions Off-label mt-sDNA use remains a concern in the outpatient setting. Compliance for test completion and follow-up colonoscopy for positive results require further improvement. Our findings shed new light on the factors associated with off-label testing while reiterating its burden. We also describe common reasons for incomplete tests in an attempt to augment future colorectal cancer (CRC) screening initiatives.

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

OBJECTIVES: 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. RESULTS: 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. CONCLUSION: 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 LMIC could be adapted using the step-ladder pyramidal approach.

Co-delivery of curcumin and quercetin in shellac nanocapsules for the synergistic antioxidant properties and cytotoxicity against colon cancer cells.

Synergistic bioactivity of dietary polyphenols can enhance functional food development to prevent chronic diseases like cancer. In this study, physicochemical properties and cytotoxicity of curcumin and quercetin co-encapsulated in shellac nanocapsules at different mass ratios were investigated and compared to nanocapsules with one polyphenol and their unencapsulated counterparts. At curcumin and quercetin mass ratio of 4:1, encapsulation efficiency was approximately 80% for both polyphenols, and the nanocapsules showed the highest synergistic antioxidant properties and cytotoxicity for HT-29 and HCT-116 colorectal cancer cells. The nanocapsules had discrete structures smaller than 50 nm and remained stable during 4-week refrigerated storage, and the encapsulated polyphenols were amorphous. After simulated digestions, 48% of the encapsulated curcumin and quercetin were bioaccessible, the digesta retained nanocapsule structures and cytotoxicity, and the cytotoxicity was higher than nanocapsules with only one polyphenol and free polyphenol controls. This study provides insights on utilizing multiple polyphenols as promising anti-cancer agents.

Rectosigmoid Adenocarcinoma Presenting As Nine Days of Constipation.

We report the case of a 56-year-old male presenting with nine days of constipation and absence of flatus without any improvement and who had received conservative management after recent admission at an external hospital. Upon further investigation, the patient was diagnosed with rectosigmoid adenocarcinoma and was successfully surgically treated without any perioperative complications. This case highlights the importance of early detection and interventions necessary to prevent progression of colorectal adenocarcinoma. Easily manageable symptoms such as constipation may require further evaluation by implementing a constipation scoring system to avoid missed diagnoses such as cancer and metastasis. Therefore, the association between constipation and colorectal carcinoma warrants further research investigations as well as clinician awareness to prevent life-threatening complications.

An Unsuspecting Case of Familial Adenomatous Polyposis (FAP).

Familial adenomatous polyposis (FAP) is an inherited and rare disease that typically manifests in the second decade of life. FAP presents as an asymptomatic disease state in its early stages, which affects the gastrointestinal (GI) tract, making it difficult to diagnose. The disease is characterized by numerous adenomatous polyps in the colon or rectum. Adenomatous polyposis coli (APC) gene mutation allows for the unchecked growth of polyps and provides the path for cancerous proliferation. In FAP, APC mutation inheritance has a moderate preponderance for paternal origin. A family history of FAP is an indicator to start early screening in patients, especially those with a paternal family history of the disease. We present a 21-year-old male patient who presented to the clinic with normal hemoglobin, heme-positive stools, and no family history of FAP or colon cancer. The initial assessment and plan was an endoscopy to look for upper and lower GI causes, but if negative, a further hematologic workup would be required. This case highlighted the need for thorough follow-up and workup of occult GI bleed. Clinical suspicion for FAP should be kept in mind, especially in young patients without a family history and unexplained heme-positive stool. Other findings that could suggest FAP include a personal or family history of extra-colonic manifestations such as fibromas, osteomas, or dentition abnormalities.

Colon Cancer Screening Methods: 2023 Update.

Colorectal cancer (CRC) is a significant cause of morbidity and mortality worldwide. National screening guidelines have been implemented to identify and remove precancerous polyps before they become cancer. Routine CRC screening is advised for people with average risk starting at age 45 because it is a common and preventable malignancy. Various screening modalities are currently in use, ranging from stool-based tests (fecal occult blood test (FOBT), fecal immunochemical test (FIT), and FIT-DNA test), radiologic tests (computed tomographic colonography (CTC), double contrast barium enema), and visual endoscopic examinations (flexible sigmoidoscopy (FS), colonoscopy, and colon capsule endoscopy (CCE)) with their varying sensitivity and specificity. Biomarkers also play a vital role in assessing the recurrence of CRC. This review offers a summary of the current screening options, including biomarkers available to detect CRC, highlighting the benefits and challenges encompassing each screening modality.

Colorectal Cancer Diagnostic Methods: The Present and Future.

To meet the needs of the colorectal cancer (CRC) patient population, colorectal cancer screening is continuously updated. The most significant advice is to start CRC screening exams at age 45 for people at average risk for CRC. CRC testing is divided into two categories: stool-based tests and visual inspections. High-sensitivity guaiac-based fecal occult blood testing, fecal immunochemical testing, and multitarget stool DNA testing are stool-based assays. Colon capsule endoscopy and flexible sigmoidoscopy are visualization examinations. There have been arguments about the importance of these tests in detecting and managing precursor lesions because of the lack of validation of screening results. Recent advancements in artificial intelligence and genetics have prompted the creation of newer diagnostic tests, which require validation in diverse populations and cohorts. In this article, we have discussed the present and emerging diagnostic tests.

Adherence to Post-polypectomy Surveillance Guidelines at a Large District General Hospital.

Introduction In 2020, the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regarding post-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital's colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.

The Extract of Perilla frutescens Seed Residue Attenuated the Progression of Aberrant Crypt Foci in Rat Colon by Reducing Inflammatory Processes and Altered Gut Microbiota.

Perilla frutescens (PF) seed residue is a waste from perilla oil production that still contains nutrients and phytochemicals. This study aimed to investigate the chemoprotective action of PF seed residue crude ethanolic extract (PCE) on the inflammatory-induced promotion stage of rat colon carcinogenesis and cell culture models. PCE 0.1 and 1 g/kg body weight were administered by oral gavage to rats after receiving dimethylhydrazine (DMH) with one week of dextran sulfate sodium (DSS) supplementation. PCE at high dose exhibited a reduction in aberrant crypt foci (ACF) number (66.46%) and decreased pro-inflammatory cytokines compared to the DMH + DSS group (p < 0.01). Additionally, PCE could either modulate the inflammation induced in murine macrophage cells by bacterial toxins or suppress the proliferation of cancer cell lines, which was induced by the inflammatory process. These results demonstrate that the active components in PF seed residue showed a preventive effect on the aberrant colonic epithelial cell progression by modulating inflammatory microenvironments from the infiltrated macrophage or inflammatory response of aberrant cells. Moreover, consumption of PCE could alter rat microbiota, which might be related to health benefits. However, the mechanisms of PCE on the microbiota, which are related to inflammation and inflammatory-induced colon cancer progression, need to be further investigated.

Arthrospira (Spirulina) platensis feeding reduces the early stage of chemically induced rat colon carcinogenesis.

Colorectal cancer is the third most diagnosed cancer worldwide and linked to dietary/lifestyle factors. Arthrospira (Spirulina) platensis (AP) contains bioactive compounds with beneficial effects in vivo/in vitro. We evaluated the effects of AP feeding against 1,2-dimethylhydrazine (DMH)-induced colon carcinogenesis. Male Sprague Dawley rats were given subcutaneous injections of DMH (4 × 40 mg/kg body weight) (G1-G3) or vehicle (G4-G5) twice a week (weeks 3-4). During weeks 1-4, animals were fed a diet containing 1 % (G2) or 2 % (G3-G4) AP powder (w/w). After this period, all groups received a balanced diet until week 12. Some animals were euthanised after the last DMH injection (week 4) for histological, immunohistochemical (Ki-67, γ-H2AX and caspase-3) and molecular analyses (real time-PCR for 91 genes), while other animals were euthanised at week 12 for preneoplastic aberrant crypt foci (ACF) analysis. Both AP treatments (G2-G3) significantly decreased the DMH-induced increase in γ-H2AX (DNA damage) and caspase 3 (DNA damage-induced cell death) in colonic crypts at week 4. In addition, Cyp2e1 (Drug metabolism), Notch1, Notch2 and Jag1 genes (Notch pathway) and Atm, Wee1, Chek2, Mgmt, Ogg1 and Xrcc6 genes (DNA repair) were also down-regulated by 2 % AP feeding (G3) at week 4. A significant reduction in ACF development was observed in both AP-treated groups (G2-G3) at week 12. In conclusion, findings indicate that AP feeding reduced acute colonic damage after DMH, resulting in fewer preneoplastic lesions. Our study provided mechanistic insights on dietary AP-preventive effects against early colon carcinogenesis.

Shellac Micelles Loaded with Curcumin Using a pH Cycle to Improve Dispersibility, Bioaccessibility, and Potential for Colon Delivery.

Delivery systems smaller than 50 nm are advantageous for cancer prevention. In this study, curcumin was dissolved in shellac micelles following co-dissolving at pH 13.0 and neutralization using glucono-delta-lactone. With 5% w/v shellac and 0.5-5 mg/mL curcumin, the loading capacity and encapsulation efficiency were up to 8.0 and 92.6%, respectively, and the nanocapsules had an average diameter of 20 nm. Differential scanning calorimetry, FTIR spectroscopy, and fluorescence spectroscopy results confirmed the encapsulation of curcumin in an amorphous state in shellac micelles. The neutral nanocapsule dispersions maintained the particle dimension and had less than 10% curcumin degradation during 4 week storage at 4 °C. Nanoencapsulating curcumin enhanced in vitro bioavailability and antiproliferation activity against colon cancer cells. After simulated digestions, ∼60% of the nanoencapsulated curcumin was not available for intestinal absorption, nanocapsules retained their structure, and nanoencapsulated curcumin remained active against colon cancer cells, indicating the potential delivery for colorectal cancer prevention.

Symptomatic Colorectal Cancer Is Associated With Stage IV Diagnosis in Two Disparate Populations.

In the United States, individuals of Black/African Ancestry (AA) have a higher incidence and mortality from colorectal cancer (CRC) compared to individuals of White/European Ancestry (EA). In order to develop an approach towards disentangling the complex effects of associated race and socioeconomic factors on CRC outcome, we have conducted a manual chart review of sporadic CRC pathological diagnoses (total n = 334) at an urban public hospital (UH) and a suburban university hospital (SH). There were significant differences between the SH and UH CRC patients with respect to Black/AA race (4.2% vs. 89.1%, p < 0.0001) and Medicaid/Self-pay insurance status (14.9% vs. 85.0%, p < 0.0001). While a higher proportion of newly diagnosed CRC patients presented with metastatic stage 4 CRC at the UH (21%) than the SH (12.5%), only the presence of symptoms was significantly associated with stage 4 CRC (odds ratio, OR 7.94, 95% confidence interval, CI 1.83- 34.54, p = 0.0057) in a multivariable generalized linear model (GLM). The proportion of asymptomatic CRC patients was ~20% at both institutions, suggesting that the UH has contributed to reducing CRC disparities. Initiation of CRC screening at the recommended age at both institutions could reduce the proportion of CRC patients presenting with metastatic spread.

Assessing Suitability of a Colorectal Cancer Screening Program in Oman.

Colorectal cancer is among the most common cancers globally and carries a high mortality rate. The incidence of colorectal cancer has been increasing in the Middle East, including in Oman. While many countries have implemented a bowel cancer screening program, Oman has yet to establish one. A standard tool for bowel cancer screening is a fecal immunochemical test where a fecal sample is sent to a laboratory to check for blood content in the feces. In Oman, such fecal test kits are available at the primary health care level, but primary care physicians were unaware of the signs and symptoms or screening methods for colorectal cancer. This review article aims to assess the suitability of a colorectal cancer screening program in Oman using guidelines from the Supporting the Use of Research Evidence (SURE) collaboration.

CT Colonography and Colorectal Carcinoma: Current Trends and Emerging Developments.

Colorectal carcinoma is the third most malignant and second leading cause of death from cancer. The cruelty of this entity is that it takes decades to be symptomatic and is known to be detected late in its timeline by a screening technique. The fatality of this carcinoma only means heightened importance of screening guidelines to be laid down and strict follow-ups by the healthcare providers. A novel method, a potential competitor that could now replace the present screening techniques for colorectal carcinoma, is computed tomographic colonography (CTC) or virtual colonoscopy. Though it first came into existence in 1994, this method is yet to be deeply studied and scrutinized for it to be the next benchmark modality. This review has mainly focused on the various features of CTC. It is contrasted against the gold standard colonoscopy for its superiority, efficacy, cost-effectiveness, patient logistics, and role in detecting extra-colonic lesions. The main focus would be laid on CTC being a screening modality. The review also emphasized why there is a need for the current healthcare providers to incorporate this modality into their practice widely. Although much has been said about CTC and its various aspects of cost-effectiveness, about it being replaced or supplemented for cancer screening, a collaborative effort has to be made by both the fields of radiology and gastroenterology to investigate the outcomes of this not so new technique in daily practice and to avoid misinterpretation of the results due to lack of skill and proficiency.

Increasing Fecal Immunochemical Test Return Rates by Implementing Effective "Reminder to Complete Kit" Communication With Participants: A Quality Improvement Study.

Background The incidence of colorectal cancer (CRC) in the United States is increasing. It remains the second leading cause of cancer death in the United States for men and women combined, mainly due to underutilization of screening methods. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for CRC screening. Methodology At public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on CRC. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants who did not return the completed kits within two weeks were reminded either through (1) a reminder letter, (2) telephone, or (3) a combination of letter reminder and telephone call every two weeks (±three days) for 60 days or five attempts to contact. We de-identified and analyzed the FIT kit return data from April-September 2019 before analyzing these reminder methods. We then calculated the change in return rates from October 2019 to March 2020. Our goal was to increase the FIT return rates by 25% compared to the baseline return rate. Results The pre-intervention return rate of kits for April-September 2019 was 61.52%, and the post-intervention return rate for October 2019-March 2020 was 71.85%. This rate was equal to an approximately 16.79% increase in return rates that was statistically significant (p < 0.01). There was a significant difference in the method of reminder between the two groups, but no significant differences in gender and race/ethnicity between the two groups. There was a significant difference in return rates between race/ethnicities in the October-March cohort with black and Hispanic participants having the highest return rates of 82.3% and 77.25%, respectively. Conclusions FIT remains one of the primary options for CRC screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk. We demonstrated an increase in return rates, although we did not meet our target return rate goal for this project. This study was limited due to a gradual increase in coronavirus disease 2019 (COVID-19) cases and a subsequent shift and conversation of ongoing research into COVID-19.