Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. / Análisis de la satisfacción de los participantes en el Programa de detección precoz de cáncer colorrectal de Barcelona: valoración positiva de la farmacia comunitaria.

BACKGROUND AND OBJECTIVE: Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents' opinion and satisfaction with each step of the screening process. MATERIAL AND METHOD: Telephone survey using an ad hoc questionnaire (see annex) administered to a final sample of 1189 people: 310 non-participants in the programme (NoP), 553 participants with a negative test result (PNeg), and 326 participants with a positive result (PPos). RESULTS: High scores were obtained for the clarity of the information provided by the programme (mean 8.9 on a scale 0-10), and for the accessibility and attention at the pharmacy as well as its role as the point for collection and return of FOB test cards (mean >9.3). Aspects that were not so highly rated were: preparation for the colonoscopy (41.6% reported quite a lot or a lot of discomfort), and to a lesser extent telephone accessibility (27.1% reported some difficulties). Participants also expressed concern about receiving a positive test result by telephone (78.9% reported some concern). CONCLUSIONS: Respondents' opinion of the programme was positive overall, and supports the pharmacy as the point for distributing and collecting FOB test cards, as well as the role of the pharmacist in the context of the programme. Some aspects of the screening process will be reviewed in order to improve participant satisfaction and eventually increase uptake.

Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program.

BACKGROUND & AIMS: The latest generation of fecal immunochemical tests (FIT) allows for quantitation of hemoglobin in feces, allowing for selection of optimal cut-off concentrations. We investigated whether individuals with positive results from quantitative FITs, in combination with other factors, could be identified as being at greatest risk for advanced colorectal neoplasia. METHODS: In a retrospective study, we analyzed data from a consecutive series of 3109 participants with positive results from FITs (≥20 µg/g of feces) included in the first round of the Barcelona colorectal cancer screening program, from December 2009 through February 2012. All participants underwent colonoscopy and were assigned to groups with any advanced colorectal neoplasia or with nonadvanced colorectal neoplasia (but with another diagnosis or normal examination findings). RESULTS: Median fecal hemoglobin concentrations were significantly higher in participants with advanced colorectal neoplasia (105 µg/g; interquartile range, 38-288 µg/g) compared with participants with nonadvanced colorectal neoplasia (47 µg/g; interquartile range, 23-119 µg/g) (P < .001). Positive predictive values for advanced colorectal neoplasia, determined using arbitrary fecal hemoglobin concentrations, differed with sex and age. Multivariate logistic regression analysis identified sex (men: odds ratio [OR], 2.07; 95% confidence interval, 1.78-2.41), age (60-69 y: OR, 1.24; 95% confidence interval, 1.07-1.44), and fecal hemoglobin concentration (>177 µg/g: OR, 3.80; 95% confidence interval, 3.07-4.71) as independent predictive factors for advanced colorectal neoplasia. Combining these factors, we identified 16 risk categories associated with different probabilities of identifying advanced colorectal neoplasia. Risk for advanced colorectal neoplasia increased 11.46-fold among individuals in the highest category compared with the lowest category; positive predictive values ranged from 21.3% to 75.6%. CONCLUSIONS: Fecal hemoglobin concentration, in addition to sex and age, in individuals with positive results from FITs can be used to stratify probability for the detection of advanced colorectal neoplasia. These factors should be used to prioritize individuals for colonoscopy examination.

Genetic Variants Associated with Colorectal Adenoma Susceptibility.

BACKGROUND: Common low-penetrance genetic variants have been consistently associated with colorectal cancer risk. AIM: To determine if these genetic variants are associated also with adenoma susceptibility and may improve selection of patients with increased risk for advanced adenomas and/or multiplicity (≥ 3 adenomas). METHODS: We selected 1,326 patients with increased risk for advanced adenomas and/or multiplicity and 1,252 controls with normal colonoscopy from population-based colorectal cancer screening programs. We conducted a case-control association study analyzing 30 colorectal cancer susceptibility variants in order to investigate the contribution of these variants to the development of subsequent advanced neoplasia and/or multiplicity. RESULTS: We found that 14 of the analyzed genetic variants showed a statistically significant association with advanced adenomas and/or multiplicity: the probability of developing these lesions increased with the number of risk alleles reaching a 2.3-fold risk increment in individuals with ≥ 17 risk alleles. CONCLUSIONS: Nearly half of the genetic variants associated with colorectal cancer risk are also related to advanced adenoma and/or multiplicity predisposition. Assessing the number of risk alleles in individuals within colorectal cancer screening programs may help to identify better a subgroup with increased risk for advanced neoplasia and/or multiplicity in the general population.

[Smoking prevalence in Catalonia (Spain), 1982-1998: a gender perspective]. / Prevalencia del tabaquismo en Cataluña, 1982-1998: una perspectiva de género.

BACKGROUND: We aimed at describing the smoking prevalence trend among the Catalan population (Spain) from 1982 to 1998, based on a gender perspective analysis. SUBJECTS AND METHOD: Data obtained from the surveys carried out by the Catalan Department of Health in 1982, 1986, 1990, 1994 and 1998 were analysed. Variables included were those related to smoking status, number of daily cigarettes, age and sex of the interviewed, type of tobacco smoked, age at which the first experience with smoking took place and smoking duration. Results are presented as proportions with 95% confidence interval and means with standard deviation. RESULTS: Global smoking prevalence in the 15 to 64 year-old population has remained stable between 1982 and 1998 (percentual variability: 1.1%). In 1998, there were 37.5% smokers. In women, the prevalence rate increased by 53.5% during the same period, reaching an overall prevalence of 30.7% in 1998. Among males, there was a 23.8% reduction, reaching an overall prevalence of 44.4%. The decreasing smoking prevalence trend observed among 15 to 24 year-old males and females until 1994 breaks between 1994 and 1998 so that the prevalence in young people increases in this period. In 1998, 26.1% women smoke light tobacco versus 10.4% males; women smoke an average 13.8 (8.8) daily cigarettes versus 19.7 (12.6) in males; mean smoking duration among women is 13.9 (10.1) years, while it is 22.6 (16.0) years among males. CONCLUSIONS: Despite the important reduction of smoking prevalence observed among males, the smoking prevalence rate of the Catalan population remains high. The situation is particularly unfavourable in young people of both sexes and in women, whose smoking habit has specific characteristics.