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1.
Artigo em Inglês | MEDLINE | ID: mdl-34501687

RESUMO

The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016-4 March 2020) and intra-pandemic (5 March 2020-1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.


Assuntos
COVID-19 , Neoplasias Colorretais , Alberta/epidemiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
2.
Nutrients ; 13(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34444913

RESUMO

This study was performed to investigate the association between coffee consumption and risk of colorectal cancer in a Korean population and examine whether the association can be altered by adjustment for intake of coffee additives. We conducted a case-control study involving 923 colorectal cancer cases and 1846 controls matched by sex and age (within 5 years). A semi-quantitative food frequency questionnaire was used to assess coffee intakes. High coffee consumption was associated with lower odds of developing colorectal cancer (≥3 cups/day vs. no drinks, OR = 0.68; 95% CI: 0.49-0.96). When we additionally controlled for consumption of coffee additives including sugar and cream, the inverse association became stronger (≥3 cups/day vs. no drinks, OR = 0.22; 95% CI: 0.14-0.33), and a significant inverse linear trend was shown (Ptrend < 0.0001). The inverse associations were observed for proximal (Ptrend = 0.0001) and distal (Ptrend = 0.0003) colon cancer, and rectal cancer (Ptrend < 0.0001) in the stratified analysis by anatomical sub-sites. Regarding sex, inverse associations between coffee consumption and colorectal cancer were found for men (Ptrend < 0.0001) and women (Ptrend = 0.0021). In the stratified analysis by obese status of subjects, inverse linear trends were observed in both non-obese and obese people (Ptrend < 0.0001). High coffee consumption may be associated with a lower risk of colorectal cancer in the Korean population and the degree of decrease in the odds of developing colorectal cancer changes by adjustment for intake of coffee additives.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Café/efeitos adversos , Neoplasias Colorretais/etiologia , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Dieta/etnologia , Inquéritos sobre Dietas , Ingestão de Líquidos/etnologia , Feminino , Aditivos Alimentares/efeitos adversos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco
3.
Int J Mol Sci ; 22(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34360884

RESUMO

Colorectal cancer (CRC) is the third most common cause of cancer-related deaths worldwide. Human papillomaviruses (HPVs) and Epstein-Barr virus (EBV) have been reported to be present in different types of human cancers, including CRCs, where they can play a key role in the onset and/or progression of these cancers. Thus, we herein explored the prevalence of high-risk HPVs and EBV in a cohort of 94 CRC tissue samples and 13 colorectal normal tissues from the Lebanese population using polymerase chain reaction, immunohistochemistry, and tissue microarray methodologies. We found that high-risk HPVs are present in 64%, while EBV is present in 29% of our CRC samples. Additionally, our data showed that high-risk HPV types (16, 18, 35, 58, 51, 45, 52, 31, and 33) are the most frequent in CRC in the Lebanese cohort, respectively. Our data point out that HPVs and EBV are copresent in 28% of the samples. Thus, this study clearly suggests that high-risk HPVs and EBV are present/copresent in CRCs, where they could play an important role in colorectal carcinogenesis. Nevertheless, further investigations using a larger cohort are needed to elucidate the possible cooperation between these oncoviruses in the development of CRC.


Assuntos
Alphapapillomavirus/genética , Neoplasias Colorretais/epidemiologia , Infecções por Vírus Epstein-Barr/epidemiologia , Herpesvirus Humano 4/genética , Infecções por Papillomavirus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Neoplasias Colorretais/virologia , DNA Viral/genética , Infecções por Vírus Epstein-Barr/virologia , Feminino , Humanos , Imuno-Histoquímica , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Prevalência , Fatores de Risco , Adulto Jovem
4.
Ned Tijdschr Geneeskd ; 1642021 05 12.
Artigo em Holandês | MEDLINE | ID: mdl-34346581

RESUMO

Colonoscopy is the reference standard for the detection of polyps and colorectal cancer (CRC). If during colonoscopy, all colorectal lesions are detected and completely removed, this individual will be long-term protected from CRC. The quality of the colonoscopy procedure is essential for an optimal protective effect. Recently published data of negative colonoscopies within the Polish Colonoscopy Screening Program, with a maximum follow-up of 17.4 years, demonstrated that high-quality colonoscopy was associated with a lower CRC incidence and mortality compared to low-quality colonoscopy. Colonoscopy quality was defined by completeness of colonoscopy, quality of the bowel preparation and number of detected colorectal lesions. These results suggest that the interval after a negative colonoscopy for the next screening might be safely prolonged, preventing unnecessary costs and risks for the patient. The quality of the initial colonoscopy is essential and a high quality will be fundamental for surveillance guidelines in the near future.


Assuntos
Neoplasias Colorretais , Pólipos , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-34444383

RESUMO

Colorectal cancer (CRC) is one of the most frequently diagnosed cancers and, as such, is important for public health. The increased incidence of this neoplasm is attributed to non-modifiable controls such as family history and modifiable variable behavioral risk factors involved in lifestyle like diets in Mexico. The presence of these factors is unknown. Therefore, the aim of this study was to evaluate family history and lifestyle factors associated with developing colorectal cancer in a Mexican population. Descriptive statistics and multivariate logistic regression were used to estimate the adjusted odds ratios (OR), as well as the 95% confidence intervals (CI). In this paper, significant differences were demonstrated between cases and controls. A family history of cancer (FHC) increased the probability of CRC [OR = 3.19 (95% CI: 1.81-5.60)]. The area of urban residence was found to be a protective factor compared to the rural area. This was also the case for frequent consumption of fruits [OR = 0.49 (95% CI: 0.28-0.88)], the frequent consumption of beef [OR = 2.95 (95% CI: 1.05-8.26)], pork [OR = 3.26 (95% CI: 1.34-7.90)], and region-typical fried food [OR = 2.79 (95% CI (1.32-5.89)]. These results provide additional evidence supporting the association of some CRC risk factors with family history of cancer, low fruit consumption, high consumption of red meat, and fried foods typical of the region of México. It is important to establish intervention methods, as well as genetic counseling to relatives of patients with CRC.


Assuntos
Neoplasias Colorretais , Animais , Estudos de Casos e Controles , Bovinos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Dieta , Hábitos , Humanos , México/epidemiologia , Razão de Chances , Fatores de Risco
6.
Artigo em Inglês | MEDLINE | ID: mdl-34444406

RESUMO

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan's National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78-2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48-3.28) and 1.79 (95% CI = 1.06-3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.


Assuntos
Neoplasias Colorretais , Hemorroidas , Estudos de Coortes , Colonoscopia , Neoplasias Colorretais/epidemiologia , Hemorroidas/epidemiologia , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco
8.
Artigo em Inglês | MEDLINE | ID: mdl-34360522

RESUMO

Uruguay has the highest colorectal cancer incidence rates in Latin America. Previous studies reported a stable incidence and a slight increase in mortality among males. We aimed to assess colorectal cancer incidence (2002-2017) and mortality trends (1990-2017) by age groups and sex, using data from the National Cancer Registry. Annual percent changes (APCs) were estimated using joinpoint regression models. We included 27,561 colorectal cancer cases and 25,403 deaths. We found an increasing incidence among both males and females aged 40-49, with annual increases of 3.1% (95%CI: 1.21-5.03) and 2.1% (95%CI: 0.49-3.66), respectively, and an increasein the rate in older males (70+) of 0.60% (95%CI: 0.02-1.20) per year between 2002 and 2017. Mortality remained stable among those younger than 50, whereas it decreased for older females aged 50-69 and 70+ (APC: -0.61% (-1.07-0.14) and -0.68% (-1.02-0.34), respectively), and increased for the oldest males (70+; APC: 0.74 (0.47-1.01)). In conclusion, we found rising colorectal cancer incidence accompanied by stable mortality in young adults. Sex disparities were also found among the older adults, with a more favorable pattern for females. Exposures to dietary and lifestyle risk factors, and inequalities in access to and awareness of screening programs, are probably among the main underlying causes and deserve further investigation.


Assuntos
Neoplasias Colorretais , Idoso , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Fatores de Risco , Uruguai/epidemiologia , Adulto Jovem
9.
Medicina (Kaunas) ; 57(7)2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34356963

RESUMO

Background and Objectives: Colonoscopy following an episode of acute diverticulitis is currently recommended to rule out underlying colon cancer. However, a number of studies have debated this recommendation. We aimed to explore whether patients with colonic diverticulosis who experienced an episode of acute diverticulitis had higher prevalence colonic pathologies, essentially colonic adenomas and colorectal carcinoma (CRC) on a follow-up colonoscopy. Materials and Methods: We performed a multicenter retrospective study that included patients with a diagnosis diverticulosis as the control group and allocated patients after diverticulitis according to computed tomography (CT) scan and clinical presentation that had performed colonoscopy within 6 months from the acute diverticulitis episode. We compared the detection rate of colonic pathologic findings in both groups. Results: Overall, 367 patients were included. Of them, 134 patients experienced an episode of diverticulitis vs. 233 patients who did not have diverticulitis. On univariate analysis, there was no difference between all pathological findings (CRC, colonic adenomas; OR (odds ratio) 1.51, p = 0.085), and even for each pathological findings alone, there was no difference (for colonic adenomas, p = 0.07; for CRC, p = 0.87). Further sub-analysis revealed that only male gender (OR 4.03, p = 0.004) and smoking (OR 8.67, p < 0.0001) correlated with colonic adenomas and CRC, while moderate to severe disease was not correlated with colonic pathological findings (OR 0.86, 95% CI (confidence interval) 0.4-1.82, p = 0.68). Conclusions: Post-diverticulitis screening colonoscopy has not found a higher rate of colonic pathological findings, especially colonic neoplasia. Decision to perform colonoscopy after acute diverticulitis should be individualized based on risk stratification of colonic neoplasia.


Assuntos
Adenoma , Carcinoma , Neoplasias do Colo , Neoplasias Colorretais , Doença Diverticular do Colo , Diverticulite , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Estudos de Casos e Controles , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Colonoscopia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Feminino , Humanos , Masculino , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 100(34): e26974, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449465

RESUMO

ABSTRACT: Fasting plasma glucose level was linearly associated with colorectal cancer (CRC) risk. However, the dose-response relationship between fasting blood glucose (FBG) and CRC risk was still uncertain.A total of 11,632 patients without self-reported diabetes mellitus and colorectal polyps' history were identified in the Korean Multicenter Cancer Cohort (1993-2005). The nonlinear relationship was estimated through a restricted cubic spline regression, and a two-piece-wise Cox proportional hazards model was further performed to calculate the threshold effect. Multiple imputation was used to control the bias from missing data.Overall, 1.1% (n = 132) of participants were diagnosed with CRC in the follow-up duration. With a median follow-up duration of 12.0 years, participants with FBG ≥126 mg/dL were associated with higher CRC risk (adjusted hazard ratio [HR], 1.67; 95% confidence interval [CI]: 1.01, 2.76). Landmark analyses limited to long-term survivors demonstrated increased CRC risk with FBG ≥ 126 mg/dL in all subsets (≥3years: HR,1.93 (95% CI: 1.13-3.29); ≥5years: HR, 2.04 (95% CI: 1.-3.63); ≥10years: HR, 2.50 (95% CI: 1.19-5.25)). With FBG smoothly increasing before, the latter increased dramatically after the turning point (P for nonlinearity = 0.283). When FBG was increasing per mmol/L, HR was 1.07(95% CI: 0.90, 1.29) for FBG < 126 mg/dL and 1.27 (95% CI: 1.06, 1.53) for FBG ≥ 126 mg/dL. Besides, HR was 1.09 (95% CI: 1.02, 1.16) for the CRC risk.In the population without self-reported diabetes mellitus and colorectal polyps' history. FBG was linearly associated with CRC risk, especially for FBG over 126 mg/dL.


Assuntos
Glicemia/análise , Neoplasias Colorretais/sangue , Neoplasias Colorretais/epidemiologia , Jejum/sangue , Fatores Etários , Idoso , Comorbidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Autorrelato , Fatores Sexuais , Sudão do Sul
11.
Int J Colorectal Dis ; 36(10): 2215-2225, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34331119

RESUMO

PURPOSE: Observational studies have reported an association between metabolic syndrome (MetS) and colorectal cancer risk with inconsistent risk estimates. We conducted this meta-analysis to evaluate the risk of colorectal cancer in individuals with MetS. METHODS: PubMed, Embase, and Web of Science were searched for related studies from database inception to 21 January 2021. Risk estimates for colorectal cancer were extracted from individual articles and pooled using a fixed-effect or random-effect model according to the heterogeneity. RESULTS: MetS was significantly associated with a higher risk of colorectal cancer in both sexes (relative risk [RR] 1.36, 95% confidence interval [CI] 1.26-1.47, P < 0.001), men (RR 1.33, 95% CI 1.21-1.47, P < 0.001), and women (RR 1.34, 95% CI 1.19-1.52, P < 0.001). The risk of colorectal cancer seemed to increase as the number of MetS components rose. Moreover, the high body mass index (BMI)/waist circumference (WC) and hyperglycemia were all significantly associated with a higher risk of colorectal cancer (RR 1.28 [1.20-1.37] and 1.31 [1.14-1.50] in both sexes, RR 1.31 [1.19-1.45] and 1.23 [1.03-1.46] in men, and RR 1.22 [1.02-1.46] and 1.63 [1.16-2.28] in women, respectively). CONCLUSIONS: MetS was significantly associated with a higher risk of colorectal cancer. The high BMI/WC or hyperglycemia might largely account for this association. Further analysis suggested that, as the number of MetS components increased, the risk of colorectal cancer rose.


Assuntos
Neoplasias Colorretais , Síndrome Metabólica , Índice de Massa Corporal , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Fatores de Risco , Circunferência da Cintura
12.
BMC Public Health ; 21(1): 1280, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193094

RESUMO

BACKGROUND: Although colorectal cancer screening has contributed to decreased incidence and mortality, disparities are present by race/ethnicity. The Citywide Colon Cancer Control Coalition (C5) and NYC Department of Health and Mental Hygiene (DOHMH) promoted screening colonoscopy from 2003 on, and hypothesized future reductions in CRC incidence, mortality and racial/ethnic disparities. METHODS: We assessed annual percent change (APC) in NYC CRC incidence, stage and mortality rates through 2016 in a longitudinal cross-sectional study of NY State Cancer Registry, NYC Vital Statistics, and NYC Community Health Survey (CHS) data. Linear regression tested associations between CRC mortality rates and risk factors. RESULTS: Overall CRC incidence rates from 2000 decreased 2.8% yearly from 54.1 to 37.3/100,000 population in 2016, and mortality rates from 2003 decreased 2.9% yearly from 21.0 to 13.9 in 2016 at similar rates for all racial/ethnic groups. Local stage disease decreased overall with a transient increase from 2002 to 2007. In 2016, CRC incidence was higher among Blacks (42.5 per 100,000) than Whites (38.0), Latinos (31.7) and Asians (30.0). In 2016, Blacks had higher mortality rates (17.9), than Whites (15.2), Latinos (10.4) and Asians (8.8). In 2016, colonoscopy rates among Blacks were 72.2%, Latinos 71.1%, Whites 67.2%, and Asians, 60.9%. CRC mortality rates varied by neighborhood and were independently associated with Black race, CRC risk factors and access to care. CONCLUSIONS: In a diverse urban population, a citywide campaign to increase screening colonoscopy was associated with decreased incidence and mortality among all ethnic/racial groups. Higher CRC burden among the Black population demonstrate more interventions are needed to improve equity.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Humanos , Incidência , Programas de Rastreamento , População Urbana
13.
BMC Public Health ; 21(1): 1238, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34218809

RESUMO

BACKGROUND: Vitamin D has been identified as a potential protective factor in the development of colorectal cancer (CRC). We expect to see a stronger association of ultraviolet B (UVB) exposure and CRC crude rates with increasing age since chronic vitamin D deficiency leads to sustained molecular changes that increase cancer risk. The DINOMIT (disjunction, initiation, natural selection, overgrowth, metastasis, involution, and transition) model postulates various stages of cancer development due to vitamin D deficiency and the associated latency period. The purpose of this study is to examine this age-dependent inverse relationship globally. METHODS: In this ecological study, a series of linear and polynomial regression tests were performed between country-specific UVB estimates adjusted for cloud cover and crude incidence rates of CRC for different age groups. Multiple linear regression was used to investigate the association between crude incidence rates of colorectal cancer and UVB estimate adjusting for urbanization, skin pigmentation, smoking, animal consumption, per capita GDP, and life expectancy. Statistical analysis was followed by geospatial visualization by producing choropleth maps. RESULTS: The inverse relationship between UVB exposure and CRC crude rates was stronger in older age groups at the country level. Quadratic curve fitting was preferred, and these models were statistically significant for all age groups. The inverse association between crude incidence rates of CRC and UVB exposure was statistically significant for age groups above 45 years, after controlling for covariates. CONCLUSION: The age-dependent inverse association between UVB exposure and incidence of colorectal cancer exhibits a greater effect size among older age groups in global analyses. Studying the effect of chronic vitamin D deficiency on colorectal cancer etiology will help in understanding the necessity for population-wide screening programs for vitamin D deficiency, especially in regions with inadequate UVB exposure. Further studies are required to assess the need for adequate public health programs such as selective supplementation and food fortification.


Assuntos
Neoplasias Colorretais , Deficiência de Vitamina D , Idoso , Neoplasias Colorretais/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Raios Ultravioleta/efeitos adversos , Vitamina D
14.
BMJ Open ; 11(7): e048183, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210732

RESUMO

OBJECTIVES: To assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma. DESIGN: Cross-sectional study. SETTING: Two screening centres. PARTICIPANTS: 42 554 men and women, aged 50-74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT). PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas. RESULTS: Among sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7). CONCLUSIONS: Some bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov Identifier: NCT01538550.


Assuntos
Adenoma , Neoplasias Colorretais , Adenoma/diagnóstico , Adenoma/epidemiologia , Idoso , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sangue Oculto
15.
Lancet Gastroenterol Hepatol ; 6(9): 709-722, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34329626

RESUMO

BACKGROUND: Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach. METHODS: In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries. FINDINGS: The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259-36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1-84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015. INTERPRETATION: Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy. FUNDING: Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.


Assuntos
Neoplasias Colorretais/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População/métodos , Neoplasias Colorretais/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Morbidade/tendências
17.
Prev Med ; 151: 106597, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217416

RESUMO

COVID-19 pandemic has severely affected regular public health interventions including population-based cancer screening. Impacts of such screening delays on the changes in structure and screening process and the resultant long-term outcomes are unknown. It is therefore necessary to develop a systematic framework to assess theses impacts related to these components of quality. Using population-based cancer screening with fecal immunochemical test (FIT) as an illustration, the main analysis was to assess how various scenarios of screening delays were associated with the capacity for primary screening and full time equivalent (FTE) for colonoscopy and impact long-term outcomes based on a Markov decision tree model on population level. The second analysis was to quantify how the extent of COVID-19 epidemic measured by social distancing index affected capacity and FTE that were translated to delays with an exponential relationship. COVID-19 epidemic led to 25%, 29%, 34%, and 39% statistically significantly incremental risks of late cancer for the delays of 0.5-year, 1-year,1.5-year, and 2-year, respectively compared with regular biennial FIT screening. The corresponding statistically findings of four delayed schedules for death from colorectal cancer (CRC) were 26%, 28%, 29%, and 30%, respectively. The higher social distancing index led to a lower capacity of uptake screening and a larger reduction of FTE, resulting in longer screening delay and longer waiting time, which further impacted long-term outcomes as above. In summary, a systematic modelling approach was developed for demonstrating the strong impact of screening delays caused by COVID-19 epidemic on long-term outcomes illustrated with a Taiwan population-based FIT screening of CRC.


Assuntos
COVID-19 , Neoplasias Colorretais , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento , Sangue Oculto , Pandemias , SARS-CoV-2 , Taiwan
18.
Prev Med ; 151: 106643, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217421

RESUMO

The COVID-19 pandemic has affected many healthcare services worldwide. Like many other nations, the Netherlands experienced large numbers of individuals affected by COVID-19 in 2020, leading to increased demands on hospitals and intensive care units. The Dutch Ministry of Health decided to suspend the Dutch biennial fecal immunochemical test (FIT) based colorectal cancer (CRC) screening program from March 16, 2020. FIT invitations were resumed on June 3. In this study, we describe the short-term effects of this suspension on a myriad of relevant screening outcomes. As a result of the suspension, a quarter of the individuals due for screening between March and November 2020 had not received their invitation for FIT screening by November 30, 2020. Furthermore, 57.8% of those who received a consecutive FIT between the restart and November 30, 2020, received it outside the upper limit of the standard screening interval (26 months). Median time between positive FIT and colonoscopy did not change as a result of the pandemic. Participation rates of FIT screening and follow-up colonoscopy in the months just before and during the suspension were significantly lower than expected, but returned to normal levels after the suspension. Based on the anticipated 2020 cohort size, we estimate that the number of individuals with advanced neoplasia currently detected up until November 2020 was 31.2% lower compared to what would have been expected without a pandemic. Future studies should monitor the impact on long-term screening outcomes as a result of the pandemic.


Assuntos
COVID-19 , Neoplasias Colorretais , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento , Países Baixos/epidemiologia , Sangue Oculto , Pandemias , SARS-CoV-2
19.
Microb Pathog ; 158: 105111, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34324998

RESUMO

OBJECTION: Helicobacter pylori (H. pylori) infection is considered to increase the risk of colorectal adenoma (CRA) and remains controversial. In this study, we aimed to evaluate the association between H. pylori infection and CAR in the Chinese urban population. METHODS: A cross-sectional study of 301 urban adults, who underwent both screening colonoscopy and 13C urea breath test (13C UBT) from June 2018 to December 2019 at Geriatric Hospital of Nanjing Medical University, was carried out to assess the relationship between H. pylori infection and CRA. All baseline characteristics and laboratory examination of subjects were collected and analyzed by specific personnel. The strength of association between H. pylori infection and the risk of CRA was described by multivariate logistic regression analyses to calculate the odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: Among the 301 subjects, 82 (27.24%) patients with H. pylori positive and 141 (46.84%) were confirmed to have CRA. Multivariate analysis adjusted for age, gender, uric acid and fatty liver revealed that H. pylori infection increased the risk of CRA significantly (adjusted OR 2.007, 95%CI 1.153-3.492, p = 0.014). In addition, the correlation between H. pylori infection and CRA persisted after further adjusting for metabolic variables (adjusted OR 2.029, 95%CI 1.161-3.544, p = 0.013) or other potential confounding factors related to CRA including smoking status, alcohol intake, cholecystitis and gallstone (adjusted OR 1.996, 95%CI 1.141-3.492, p = 0.015). In a gender-based subgroup analysis, H. pylori infection had an increased risk of CRA in male group (adjusted OR 1.997, 95%CI 1.010-3.945, p = 0.047). CONCLUSIONS: H. pylori infection had a significant association with the risk of CRA in Chinese urban populations, which will provide new insights into selecting high-risk subjects with CRA.


Assuntos
Adenoma , Neoplasias Colorretais , Infecções por Helicobacter , Helicobacter pylori , Adenoma/epidemiologia , Adulto , Idoso , China/epidemiologia , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Prevalência , Fatores de Risco , População Urbana
20.
Cancer Epidemiol ; 73: 101973, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34198235

RESUMO

INTRODUCTION: Family history is a risk factor for colorectal cancer (CRC), however whether family history also contributes to non-syndromic early-onset CRC is unknown. METHODS: We estimated risk to first-, second-, and third-degree relatives of early-onset CRC cases in the Utah Pedigree Database. RESULTS: We observed elevated risks beyond RR = 2.0 for early-onset CRC among first- and second-degree relatives of early-onset CRC cases, with RRs of 6.0 and 3.1, respectively. DISCUSSION: Relatives of early-onset CRC cases are at higher risk of both early-onset CRC and CRC at any age, and the location is not necessarily similar to the affected relative.


Assuntos
Neoplasias Colorretais , Família , Predisposição Genética para Doença , Idade de Início , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Humanos , Anamnese , Linhagem , Fatores de Risco
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