Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?

BACKGROUND: Colorectal cancer (CRC) is a global health concern, with advanced-stage diagnoses contributing to poor prognoses. The efficacy of CRC screening has been well-established; nevertheless, a significant proportion of patients remain unscreened, with > 70% of cases diagnosed outside screening. Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources, the association between the diagnostic routes and identification of these subgroups has been less appreciated. In the Japanese cancer registry, the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms. AIM: To clarify the stage at CRC diagnosis based on diagnostic routes. METHODS: We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals. The diagnostic routes were primarily classified into three groups: Cancer screening, follow-up, and symptomatic. The early-stage was defined as Stages 0 or I. Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups, referencing the follow-up group. The adjusted covariates were age, sex, and tumor location. RESULTS: Of the 2083 patients, 715 (34.4%), 1064 (51.1%), and 304 (14.6%) belonged to the follow-up, symptomatic, and cancer screening groups, respectively. Among the 2083 patients, CRCs diagnosed at an early stage were 57.3% (410 of 715), 23.9% (254 of 1064), and 59.5% (181 of 304) in the follow-up, symptomatic, and cancer screening groups, respectively. The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group [P < 0.001, adjusted odds ratio (aOR), 0.23; 95% confidence interval (95%CI): 0.19-0.29]. The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups (P = 0.493, aOR for early-stage diagnosis in the cancer screening group vs follow-up group = 1.11; 95%CI = 0.82-1.49). CONCLUSION: CRCs detected during hospital visits for comorbidities were diagnosed earlier, similar to cancer screening. CRC screening should be recommended, particularly for patients without periodical hospital visits for comorbidities.

An open-label clinical trial of milnacipran in fibromyalgia syndrome with co-morbid depressive symptoms.

OBJECTIVE: To evaluate the efficacy of the serotonin and noradrenaline reuptake inhibiting antidepressant, milnacipran, in patients with fibromyalgia syndrome and co-morbid depression. METHODS: Twenty patients with fibromyalgia syndrome and co-morbid depressive symptoms were treated with the serotonin and noradrenaline reuptake inhibitor, milnacipran, in an open label study. The initial dose of milnacipran was 30 mg/day which could be increased as needed up to 100 mg/day. Patients were evaluated at baseline and after 4, 8 and 12 weeks of treatment. Pain level and global symptomatology were determined using visual analogue scales. Pain was also accessed by use of the face scale, while the severity of depression was determined using the Zung self-rating depression scale. RESULTS: Two patients withdrew because of persistent nausea. Pain and general symptomatology were significantly improved at the end of the study, with five patients having a reduction in pain of greater than 50%. Post-hoc analysis showed that the 11 patients who were no longer depressed at the end of the study had the greatest improvement in pain and overall FMS symptomatology. CONCLUSION: The data suggest that milnacipran may be effective in the treatment of FMS, especially when associated with depression. Qnt] Psych Clin Pract 2004; 8: 47-51).