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1.
Cancer Med ; 13(11): e7330, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38845478

RESUMO

OBJECTIVES: Patients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC. METHODS: A multicenter cross-sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden. RESULTS: About one-third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p < 0.001). Patients with anxiety or depression reported a higher proportion of moderate-to-severe (MS) symptom number than those without (p < 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2-10 times higher than in those without (p < 0.001). Disease stage (ß = -2.55, p = 0.003), anxiety (ß = 15.33, p < 0.001), and depression (ß = 13.63, p < 0.001) were associated with higher symptom burden. CONCLUSIONS: Anxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.


Assuntos
Ansiedade , Neoplasias Colorretais , Depressão , Humanos , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/complicações , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Idoso , China/epidemiologia , Prevalência , Adulto , Idoso de 80 Anos ou mais , Qualidade de Vida , Carga de Sintomas
2.
Am J Gastroenterol ; 119(6): 1056-1065, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38832708

RESUMO

INTRODUCTION: Ultra-processed food (UPF) intake has been associated with a higher risk of obesity, hypertension, type 2 diabetes, and cardiovascular diseases. The initial data on the relationship between UPF consumption and cancer risk were derived from retrospective observational studies with conflicting results. This systematic review and meta-analysis of prospective cohort studies aimed to investigate the association between UPF consumption and gastrointestinal cancer risk. METHODS: PubMed, Embase, and Cochrane databases were searched for prospective cohort studies that compared the highest vs the lowest level of UPF consumption according to NOVA food classification and reported the risk of gastrointestinal cancers by subsite. The association with cancer was quantified as hazard ratios (HR) using a random-effects model. RESULTS: Five prospective cohort studies were included in this review comprising 1,128,243 participants (241,201 participants in the highest and 223,366 in the lowest levels of UPF consumption). The mean follow-up ranged from 5.4 to 28 years. The highest UPF consumption was significantly associated with an increased risk of colorectal cancer (HR 1.11; 95% confidence interval [CI] 1.03-1.21; P = 0.01; I2 = 31%), colon cancer (HR 1.12; 95% CI 1.02-1.23; P = 0.02; I2 = 0%), and non-cardia gastric cancer (HR 1.43; 95% CI 1.02-2.00; P = 0.04; I2 = 0%) compared with the lowest UPF intake. However, no association was found between high UPF consumption and hepatocellular, esophageal, pancreatic, gastric cardia, and rectal cancer. DISCUSSION: The highest level of UPF consumption was significantly associated with colorectal and non-cardia gastric cancer.


Assuntos
Fast Foods , Neoplasias Gastrointestinais , Humanos , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/etiologia , Fast Foods/efeitos adversos , Fatores de Risco , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Alimento Processado
3.
Elife ; 122024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38829205

RESUMO

Background: Comorbidity with type 2 diabetes (T2D) results in worsening of cancer-specific and overall prognosis in colorectal cancer (CRC) patients. The treatment of CRC per se may be diabetogenic. We assessed the impact of different types of surgical cancer resections and oncological treatment on risk of T2D development in CRC patients. Methods: We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001 and 2018. Using nationwide register data, we identified and followed patients from date of surgery and until new onset of T2D, death, or end of follow-up. Results: In total, 46,373 CRC patients were included and divided into six groups according to type of surgical resection: 10,566 Right-No-Chemo (23%), 4645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5257 Left-Chemo (11%), 9618 Rectal-No-Chemo (21%), and 6136 Rectal-Chemo (13%). During 245,466 person-years of follow-up, 2556 patients developed T2D. The incidence rate (IR) of T2D was highest in the Left-Chemo group 11.3 (95% CI: 10.4-12.2) per 1000 person-years and lowest in the Rectal-No-Chemo group 9.6 (95% CI: 8.8-10.4). Between-group unadjusted hazard ratio (HR) of developing T2D was similar and non-significant. In the adjusted analysis, Rectal-No-Chemo was associated with lower T2D risk (HR 0.86 [95% CI 0.75-0.98]) compared to Right-No-Chemo.For all six groups, an increased level of body mass index (BMI) resulted in a nearly twofold increased risk of developing T2D. Conclusions: This study suggests that postoperative T2D screening should be prioritised in CRC survivors with overweight/obesity regardless of type of CRC treatment applied. Funding: The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132).


Assuntos
Neoplasias Colorretais , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Dinamarca/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos de Coortes , Fatores de Risco , Incidência , Idoso de 80 Anos ou mais , Adulto , Sistema de Registros
4.
BMC Prim Care ; 25(1): 202, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849725

RESUMO

BACKGROUND: Annual lung cancer screening (LCS) with low dose CT reduces lung cancer mortality. LCS is underutilized. Black people who smoke tobacco have high risk of lung cancer but are less likely to be screened than are White people. This study reports provider recommendation and patient completion of LCS and colorectal cancer screening (CRCS) among patients by race to assess for utilization of LCS. METHODS: 3000 patients (oversampled for Black patients) across two healthcare systems (in Rhode Island and Minnesota) who had a chart documented age of 55 to 80 and a smoking history were invited to participate in a survey about cancer screening. Logistic regression analysis compared the rates of recommended and received cancer screenings. RESULTS: 1177 participants responded (42% response rate; 45% White, 39% Black). 24% of respondents were eligible for LCS based on USPSTF2013 criteria. One-third of patients eligible for LCS reported that a doctor had recommended screening, compared to 90% of patients reporting a doctor recommended CRCS. Of those recommended screening, 88% reported completing LCS vs. 83% who reported completion of a sigmoidoscopy/colonoscopy. Black patients were equally likely to receive LCS recommendations but less likely to complete LCS when referred compared to White patients. There was no difference in completion of CRCS between Black and White patients. CONCLUSIONS: Primary care providers rarely recommend lung cancer screening to patients with a smoking history. Systemic changes are needed to improve provider referral for LCS and to facilitate eligible Black people to complete LCS.


Assuntos
Negro ou Afro-Americano , Detecção Precoce de Câncer , Neoplasias Pulmonares , Fumar , Brancos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/epidemiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/epidemiologia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Brancos/estatística & dados numéricos
5.
Br J Biomed Sci ; 81: 12862, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38868754

RESUMO

Introduction: Colorectal cancer has a high prevalence and mortality rate in the United Kingdom. Cancerous colorectal lesions often bleed into the gastrointestinal lumen. The faecal immunochemical test (FIT) detects haemoglobin (Hb) in the faeces of patients and is used as a first line test in the diagnosis of colorectal cancer. Materials and Methods: A retrospective audit of all FIT performed and all colorectal cancers diagnosed in the Hull and East Riding of Yorkshire counties of the United Kingdom (population approximately 609,300) between 2018 and 2022 was conducted. FIT were performed using a HM-JACKarc analyser from Kyowa medical. The predominant symptom suggestive of colorectal cancer which prompted the FIT was recorded. Colorectal cancer was diagnosed using the gold standard of histological biopsy following colonoscopy. Results: Between 2018 and 2022, 56,202 FIT were performed on symptomatic patients. Follow on testing identified 1,511 with colorectal cancer. Of these people, only 450 people with a confirmed colorectal cancer had a FIT within the 12 months preceding their diagnosis. Of these 450 FIT results, 36 had a concentration of <10 µg/g and may be considered to be a false negative. The sensitivity of FIT in the patients identified was 92.00%. The most common reason stated by the clinician for a FIT being performed in patients with colorectal cancer was a change in bowel habits, followed by iron deficient anaemia. The number of patients diagnosed with colorectal cancer decreased in 2020, but increased significantly in 2021. Discussion: This study shows that 8.00% of people diagnosed with colorectal cancer in the Hull and East Riding of Yorkshire regions had a negative FIT. This study also shows that the SARS-CoV-2 pandemic affected the number of people diagnosed with colorectal cancer, and therefore skews the prevalence and pre-test probability of a positive test. There are many reasons why a FIT could produce a false negative result, the most likely being biological factors affecting the stability of haemoglobin within the gastrointestinal tract, or pre-analytical factors influencing faecal sampling preventing the detection of haemoglobin. Some colorectal lesions do not protrude into the gastrointestinal lumen and are less likely to bleed. Conclusion: This is the first study showing data from outside of a structured clinical trial and provides the largest study to date showing the sensitivity of FIT in a routine clinical setting. This study also provides evidence for the impact COVID-19 had on the rate of colorectal cancer diagnosis.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Fezes , Sangue Oculto , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Estudos Retrospectivos , Reino Unido/epidemiologia , Feminino , Detecção Precoce de Câncer/métodos , Masculino , Fezes/química , Sensibilidade e Especificidade , Pessoa de Meia-Idade , Hemoglobinas/análise , Idoso , Imunoquímica , Colonoscopia
6.
Am Soc Clin Oncol Educ Book ; 44(3): e431272, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38843475

RESUMO

The worldwide cancer burden is growing, and populations residing in low- and middle-income countries (LMICs) are experiencing a disproportionate extent of this growth. Breast, colorectal, and cervical cancers are among the top 10 most frequently diagnosed malignancies, and they also account for a substantial degree of cancer mortality internationally. Effective screening strategies are available for all three of these cancers. Individuals from LMICs face substantial cost and access barriers to early detection programs, and late stage at diagnosis continues to be a major cause for cancer mortality in these communities. This chapter will review the epidemiology of breast, colorectal, and cervical cancers, and will explore prospects for improving global control through novel approaches to screening in cost-constrained environments.


Assuntos
Países em Desenvolvimento , Detecção Precoce de Câncer , Humanos , Detecção Precoce de Câncer/economia , Neoplasias/epidemiologia , Neoplasias/diagnóstico , Feminino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/diagnóstico
7.
Front Public Health ; 12: 1370282, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38841678

RESUMO

Introduction: The burden of colorectal cancer (CRC) plays a pivotal role in the global cancer epidemic. Our study reported the incidence trends in CRC and the associated effects of age, period, and birth cohort in 204 countries and territories over the past 30 years. Methods: The incidence data of CRC were extracted from the Global Burden of Disease Study (GBD) 2019. We performed the age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) in the incidence rate, the annual percentage change by age group (local drift), and the relative risk (period and cohort effects) of the period and cohort in CRC during 1990-2019. This approach allows examining and distinguishing age, period, and cohort effects in incidence and potentially distinguishing colorectal cancer gaps in prevention and screening. Results: In 2019, the incidence of CRC was 2.17 (95% UI 2.00-2.34) million, of which China, the United States of America, and Japan had the highest incidence population, accounting for 45.9% of the global population. The age-standardized incidence rate (ASIR) was 26.7 (95% UI 28.9-24.6) per 100,000 people, of which 30 countries had an incidence rate greater than 40.0 per 100,000 people. From 1990 to 2019, the middle SDI region had the largest increase in incidence rate, with a net drift of 2.33% (95% CI 2.2-2.46%, p < 0.001). Globally, the incidence population was concentrated in the age group of 50-69 years, and the age group of 30-34 years had the largest increase in incidence rate (local drift 1.19% (95% CI 1.01-1.37%)). At the same time, the sex and age distributions of CRC incidence had significant heterogeneity across regions and countries. In the past 30 years, the incidence rate in 31 countries has been well controlled (net drift <0), and most of them were concentrated in high-and high-middle-SDI regions, such as Australia, Czechia, and Belgium, and the relative risk of incidence generally improved over time and consecutive young birth cohorts. CRC incidence showed an unfavorable trend (net drift ≥1%) in 89 countries, of which 27 countries were more significant (net drift >2%), mostly concentrated in the middle SDI region, such as China, Mexico, and Brazil, and the risk of period and birth cohort was unfavorable. Conclusion: Globally, the incidence of CRC has shown an overall upward trend over the past 30 years, with the exception of some countries with higher SDI values. Significant age-period-cohort differences were observed in the risk of incidence in CRC worldwide. Effective prevention and control policies need to take into account the age-period-cohort effect characteristics of different regions.


Assuntos
Neoplasias Colorretais , Carga Global da Doença , Humanos , Neoplasias Colorretais/epidemiologia , Incidência , Pessoa de Meia-Idade , Masculino , Idoso , Feminino , Adulto , Estudos de Coortes , Saúde Global/estatística & dados numéricos , Idoso de 80 Anos ou mais , Fatores Etários , Adulto Jovem
8.
World J Gastroenterol ; 30(20): 2726-2730, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38855153

RESUMO

The screening of colorectal cancer (CRC) is pivotal for both the prevention and treatment of this disease, significantly improving early-stage tumor detection rates. This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment. However, the adoption of CRC screening methods faces numerous challenges, including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity. Moreover, socioeconomic factors such as regional disparities, economic conditions, and varying levels of awareness affect screening uptake. The coronavirus disease 2019 pandemic further intensified these cha-llenges, leading to reduced screening participation and increased waiting periods. Additionally, the growing prevalence of early-onset CRC necessitates innovative screening approaches. In response, research into new methodologies, including artificial intelligence-based systems, aims to improve the precision and accessibility of screening. Proactive measures by governments and health organizations to enhance CRC screening efforts are underway, including increased advocacy, improved service delivery, and international cooperation. The role of technological innovation and global health collaboration in advancing CRC screening is undeniable. Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening, making a significant impact on the fight against this disease. Given the rise in early-onset CRC, it is crucial for screening strategies to continually evolve, ensuring their effectiveness and applicability.


Assuntos
COVID-19 , Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , Inteligência Artificial , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , SARS-CoV-2/isolamento & purificação , Qualidade de Vida , Colonoscopia
9.
Sci Rep ; 14(1): 13825, 2024 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879601

RESUMO

The purpose of this study was to investigate the causal association between unhealthy lifestyle style factors and the risk of colorectal cancer, with the aim of preventing the occurrence of colorectal cancer by modifying unhealthy lifestyles. A two-sample Mendelian randomization (MR) approach was employed in this study, utilizing the inverse-variance weighted method as the primary research method. This MR analysis analyzed data of 3022 colorectal cancer cases and 174,006 controls from the FinnGen database. Single nucleotide polymorphisms (SNPs) associated with unhealthy lifestyle factors were selected as instrumental variables (IVs), including two obesity-related indicators, BMI (body mass index) and WHR (waist-to-hip ratio). Four phenotypes of smoking (smoking initiation, ever smoked, smoking per day, smoking cessation) and one phenotype of alcohol consumption (drinks per week). Four phenotypes of physical activity (accelerometer-based physical activity, moderate-to-vigorous physical activity, vigorous physical activity, strenuous sports or other exercises). All SNPs were obtained from published genome-wide association studies. The study found that the obesity-related indicator, higher WHR (OR = 1.38, 95% CI 1.12-1.70; P = 0.002) were associated with an increased risk of colorectal cancer, and two smoking phenotypes, cigarettes per day(OR = 1.30, 95% CI 1.01-1.68; P = 0.042)and smoking initiation (OR = 3.48, 95% CI 1.15-10.55; P = 0.028), were potentially associated with an increased risk of colorectal cancer. However, there was no evidence to suggest that physical activities and alcohol consumption were associated with colorectal cancer (all p > 0.05). In addition, the study detected no pleiotropy (all p > 0.05). This MR analysis indicates a causal association between a higher waist-to-hip ratio and the risk of colorectal cancer and a suggestive association between smoking and the risk of colorectal cancer among Europeans. These findings contribute to the understanding of the etiology of colorectal cancer and have potential implications for its prevention.


Assuntos
Neoplasias Colorretais , Estilo de Vida , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Fumar , Humanos , Neoplasias Colorretais/genética , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Fatores de Risco , Fumar/efeitos adversos , Exercício Físico , Estudo de Associação Genômica Ampla , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/genética , Masculino , Índice de Massa Corporal , Feminino , Obesidade/genética , Obesidade/epidemiologia , Relação Cintura-Quadril
10.
Rev Esp Enferm Dig ; 116(6): 319-329, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38767022

RESUMO

INTRODUCTION: population-based screening programs are effective to reduce colorectal cancer-related mortality and incidence. However, given their complex development, sound organization and design do not warrant success. This study provides a strategic analysis of the Spanish programs, as well as recommendations in an attempt to contribute to their optimization. METHODS: a multidisciplinary panel of researchers, supported by the Sociedad Española de Patología Digestiva (SEPD), has performed a SWOT (strengths, weaknesses, opportunities and threats) analysis, from which a proposal of recommendations was developed; their adequacy was judged using an adapted version of the RAND/UCLA method. RESULTS: 5 weaknesses, 3 threats, 5 strengths and 5 opportunities were identified, and a total of 15 recommendations were developed emphasizing aspects with room for improvement in program orientation, particularly the need to increase participation, fight variability and inequities, improve information processes and systems quality, ensure specific, adequate funding, and evaluate health results. CONCLUSION: promoting an operational collaboration framework between all the public health and care levels involved should facilitate effective communication with society regarding the benefits of taking part in population screening programs while persuading decision and policy makers of the critical importance of taking an active, determined stance regarding its implementation.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Espanha/epidemiologia , Humanos , Detecção Precoce de Câncer/normas , Programas de Rastreamento/métodos , Programas de Rastreamento/normas
11.
BMJ Open Gastroenterol ; 11(1)2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724254

RESUMO

OBJECTIVE: In 2019, a BMJ Rapid Recommendation advised against colorectal cancer (CRC) screening for adults with a predicted 15-year CRC risk below 3%. Using Switzerland as a case study, we estimated the population-level impact of this recommendation. DESIGN: We predicted the CRC risk of all respondents to the population-based Swiss Health Survey. We derived the distribution of risk-based screening start age, assuming predicted risk was calculated every 5 years between ages 25 and 70 and screening started when this risk exceeded 3%. Next, the MISCAN-Colon microsimulation model evaluated biennial faecal immunochemical test (FIT) screening with this risk-based start age. As a comparison, we simulated screening initiation based on age and sex. RESULTS: Starting screening only when predicted risk exceeded 3% meant 82% of women and 90% of men would not start screening before age 65 and 60, respectively. This would require 43%-57% fewer tests, result in 8%-16% fewer CRC deaths prevented and yield 19%-33% fewer lifeyears gained compared with screening from age 50. Screening women from age 65 and men from age 60 had a similar impact as screening only when predicted risk exceeded 3%. CONCLUSION: With the recommended risk prediction tool, the population impact of the BMJ Rapid Recommendation would be similar to screening initiation based on age and sex only. It would delay screening initiation by 10-15 years. Although halving the screening burdens, screening benefits would be reduced substantially compared with screening initiation at age 50. This suggests that the 3% risk threshold to start CRC screening might be too high.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Sangue Oculto , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Masculino , Feminino , Detecção Precoce de Câncer/métodos , Idoso , Pessoa de Meia-Idade , Adulto , Suíça/epidemiologia , Medição de Risco/métodos , Programas de Rastreamento/métodos , Simulação por Computador , Fatores Etários , Guias de Prática Clínica como Assunto
12.
Ann Diagn Pathol ; 72: 152323, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38733674

RESUMO

High risk features in colorectal adenomatous polyps include size >1 cm and advanced histology: high-grade dysplasia and villous architecture. We investigated whether the diagnostic rates of advanced histology in colorectal adenomatous polyps were similar among institutions across the United States, and if not, could differences be explained by patient age, polyp size, and/or CRC rate. Nine academic institutions contributed data from three pathologists who had signed out at least 100 colorectal adenomatous polyps each from 2018 to 2019 taken from patients undergoing screening colonoscopy. For each case, we recorded patient age and sex, polyp size and location, concurrent CRC, and presence or absence of HGD and villous features. A total of 2700 polyps from 1886 patients (mean age: 61 years) were collected. One hundred twenty-four (5 %) of the 2700 polyps had advanced histology, including 35 (1 %) with HGD and 101 (4 %) with villous features. The diagnostic rate of advanced histology varied by institution from 1.7 % to 9.3 % (median: 4.3 %, standard deviation [SD]: 2.5 %). The rate of HGD ranged from 0 % to 3.3 % (median: 1 %, SD: 1.2 %), while the rate of villous architecture varied from 1 % to 8 % (median: 3.7 %, SD: 2.5 %). In a multivariate analysis, the factor most strongly associated with advanced histology was polyp size >1 cm with an odds ratio (OR) of 31.82 (95 % confidence interval [CI]: 20.52-50.25, p < 0.05). Inter-institutional differences in the rate of polyps >1 cm likely explain some of the diagnostic variance, but pathologic subjectivity may be another contributing factor.


Assuntos
Pólipos Adenomatosos , Neoplasias Colorretais , Humanos , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/epidemiologia , Pólipos Adenomatosos/diagnóstico , Pessoa de Meia-Idade , Masculino , Feminino , Neoplasias Colorretais/patologia , Neoplasias Colorretais/epidemiologia , Idoso , Colonoscopia , Pólipos do Colo/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/epidemiologia , Adulto , Estados Unidos/epidemiologia , Fatores de Risco
13.
Radiologie (Heidelb) ; 64(6): 471-478, 2024 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-38739177

RESUMO

BACKGROUND: Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5­year survival rate for CRC being approximately 65%. METHODS: This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI). CONCLUSION: Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C­RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings).


Assuntos
Colonografia Tomográfica Computadorizada , Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Colonografia Tomográfica Computadorizada/métodos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Alemanha/epidemiologia , Programas de Rastreamento/métodos , Sensibilidade e Especificidade
14.
Int J Epidemiol ; 53(3)2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38725300

RESUMO

BACKGROUND: Colorectal cancer (CRC) is the third-most-common cancer worldwide and its rates are increasing. Elevated body mass index (BMI) is an established risk factor for CRC, although the molecular mechanisms behind this association remain unclear. Using the Mendelian randomization (MR) framework, we aimed to investigate the mediating effects of putative biomarkers and other CRC risk factors in the association between BMI and CRC. METHODS: We selected as mediators biomarkers of established cancer-related mechanisms and other CRC risk factors for which a plausible association with obesity exists, such as inflammatory biomarkers, glucose homeostasis traits, lipids, adipokines, insulin-like growth factor 1 (IGF1), sex hormones, 25-hydroxy-vitamin D, smoking, physical activity (PA) and alcohol consumption. We used inverse-variance weighted MR in the main univariable analyses and performed sensitivity analyses (weighted-median, MR-Egger, Contamination Mixture). We used multivariable MR for the mediation analyses. RESULTS: Genetically predicted BMI was positively associated with CRC risk [odds ratio per SD (5 kg/m2) = 1.17, 95% CI: 1.08-1.24, P-value = 1.4 × 10-5] and robustly associated with nearly all potential mediators. Genetically predicted IGF1, fasting insulin, low-density lipoprotein cholesterol, smoking, PA and alcohol were associated with CRC risk. Evidence for attenuation was found for IGF1 [explained 7% (95% CI: 2-13%) of the association], smoking (31%, 4-57%) and PA (7%, 2-11%). There was little evidence for pleiotropy, although smoking was bidirectionally associated with BMI and instruments were weak for PA. CONCLUSIONS: The effect of BMI on CRC risk is possibly partly mediated through plasma IGF1, whereas the attenuation of the BMI-CRC association by smoking and PA may reflect confounding and shared underlying mechanisms rather than mediation.


Assuntos
Índice de Massa Corporal , Neoplasias Colorretais , Análise da Randomização Mendeliana , Obesidade , Humanos , Neoplasias Colorretais/genética , Neoplasias Colorretais/epidemiologia , Fatores de Risco , Obesidade/genética , Obesidade/epidemiologia , Fator de Crescimento Insulin-Like I/metabolismo , Consumo de Bebidas Alcoólicas/epidemiologia
15.
Eur J Cancer ; 205: 114104, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38733716

RESUMO

BACKGROUND: The epidemiology of colorectal cancer (CRC) has changed rapidly over the years. The aim of this study was to assess the trends in incidence, treatment, and relative survival (RS) of patients diagnosed with CRC in the Netherlands between 2000 and 2021. PATIENTS AND METHODS: 2 75667 patients diagnosed with CRC between 2000 and 2021 were included from the Netherlands Cancer Registry. Analyses were stratified for disease extent (localised: T1-3N0M0; regional: T4N0M0/T1-4N1-2M0; distant: T1-4N0-2M1) and localisation (colon; rectum). Trends were assessed with joinpoint regression. RESULTS: CRC incidence increased until the mid-2010s but decreased strongly thereafter to rates comparable with the early 2000s. Amongst other trend changes, local excision rates increased for patients with localised colon (2021: 13.6 %) and rectal cancer (2021: 34.9 %). Moreover, primary tumour resection became less common in patients with distant colon (2000-2021: 60.9-12.5 %) or rectal cancer (2000-2021: 47.8-6.9 %), while local treatment of metastases rates increased. Five-year RS improved continuously for localised and regional colon (97.7 % and 72.0 % in 2017, respectively) and rectal cancer (95.2 % and 76.3 % in 2017, respectively). The rate of anti-cancer treatments decreased in distant colon (2010-2021: 80.3 % to 67.2 %; p < 0.001) and rectal cancer (2011-2021: 86.0 % to 77.0 %; p < 0.001). The improvement of five-year RS stagnated for distant colon (2010-2017: 11.2 % to 11.9 %; average percentage of change [APC]: 2.1, 95 % confidence interval [CI]: -7.6, 4.7) and rectal cancer (2009-2017: 12.7 % to 15.6 %; APC: 1.4, 95 % CI: -19.1, 5.5). CONCLUSIONS: Major changes in the incidence and treatment of CRC between 2000 and 2021 were identified and quantified. Five-year RS increased continuously for patients with localised and regional CRC, but stagnated for patients with distant CRC, likely caused by decreased rates of anti-cancer treatment in this group.


Assuntos
Neoplasias Colorretais , Sistema de Registros , Humanos , Países Baixos/epidemiologia , Masculino , Feminino , Incidência , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Neoplasias Colorretais/patologia , Idoso , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Idoso de 80 Anos ou mais , Adulto , Taxa de Sobrevida
16.
Int J Cancer ; 155(3): 445-470, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38692645

RESUMO

The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post-diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random-effects dose-response meta-analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all-cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease-free events). Meta-analyses, including 3-10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega-3 polyunsaturated fatty acids, supplemental calcium, circulating 25-hydroxyvitamin D (25[OH]D) and all-cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer-specific mortality; and for circulating 25(OH)D and recurrence/disease-free survival. The overall evidence was graded as 'limited'. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), whole grains, total, caffeinated, or decaffeinated coffee and all-cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all-cause mortality provided 'limited-suggestive' evidence. All other exposure-outcome associations provided 'limited-no conclusion' evidence. Additional, well-conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors.


Assuntos
Neoplasias Colorretais , Suplementos Nutricionais , Humanos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/epidemiologia , Prognóstico , Dieta , Vitamina D/administração & dosagem , Vitamina D/análogos & derivados , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Observacionais como Assunto
18.
Lancet Gastroenterol Hepatol ; 9(7): 601-608, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38761808

RESUMO

BACKGROUND: Colorectal cancer guidelines recommend screening colonoscopy every 10 years after a negative procedure. If risk reduction extends past 10 years, the recommended interval could be extended, reducing the burden on the individual and health-care system. We aimed to estimate the duration that patients remain at reduced risk of colorectal cancer incidence and mortality after a complete colonoscopy. METHODS: We did a population-based cohort study of individuals aged 50-65 years between Jan 1, 1994, to Dec 31, 2017. We excluded individuals with previous exposure to colonoscopy or colorectal surgery, those previously diagnosed with colorectal cancer, or a history of hereditary or other bowel disorders. We followed up participants until Dec 31, 2018, and identified all colonoscopies performed in this time period. We used a 9-level time-varying measure of exposure, capturing time since last complete colonoscopy (no complete colonoscopy, ≤5 years, >5-10 years, >10-15 years, and >15 years) and whether an intervention was performed (biopsy or polypectomy). A Cox proportional hazards regression model adjusting for age, sex, comorbidity, residential income quintile, and immigration status was used to estimate the association between exposure to a complete colonoscopy and colorectal cancer incidence and mortality. FINDINGS: 5 298 033 individuals (2 609 060 [49·2%] female and 2 688 973 [50·8%] male; no data on ethnicity were available) were included in the cohort, with a median follow-up of 12·56 years (IQR 6·26-20·13). 90 532 (1·7%) individuals were diagnosed with colorectal cancer and 44 088 (0·8%) died from colorectal cancer. Compared with those who did not have a colonoscopy, the risk of colorectal cancer in those who had a complete negative colonoscopy was reduced at all timepoints, including when the procedure occurred more than 15 years earlier (hazard ratio [HR] 0·62 [95% CI 0·51-0·77] for female individuals and 0·57 [0·46-0·70] for male individuals. A similar finding was observed for colorectal cancer mortality, with lower risk at all timepoints, including when the procedure occurred more than 15 years earlier (HR 0·64 [95% CI 0·49-0·83] for female participants and 0·65 [0·50-0·83] for male participants). Those who had a colonoscopy with intervention had a significantly lower colorectal cancer incidence than those who did not undergo colonoscopy if the procedure occurred within 10 years for females (HR 0·70 [95% CI 0·63-0·77]) and up to 15 years for males (0·62 [(0·53-0·72]). INTERPRETATION: Compared with those who do not receive colonoscopy, individuals who have a negative colonoscopy result remain at lower risk for colorectal cancer incidence and mortality more than 15 years after the procedure. The current recommendation of repeat screening at 10 years in these individuals should be reassessed. FUNDING: Canadian Institutes of Health Research.


Assuntos
Colonoscopia , Neoplasias Colorretais , Humanos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Colonoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Feminino , Incidência , Idoso , Ontário/epidemiologia , Estudos de Coortes , Fatores de Tempo , Modelos de Riscos Proporcionais , Detecção Precoce de Câncer/métodos , Comportamento de Redução do Risco
19.
Nutr J ; 23(1): 49, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38741117

RESUMO

BACKGROUND: Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analysis (BPRF) to investigate the relationship of whole grain consumption on type 2 diabetes (T2D), colorectal cancer (CRC), stroke, and ischemic heart disease (IHD). METHODS: We conducted a literature search in the Medline and Web of Science up to June 12, 2023, to identify related cohort studies and systematic reviews. The mean RR (relative risk) curve and uncertainty intervals (UIs), BPRF function, risk-outcome score (ROS), and the theoretical minimum risk exposure level (TMREL) were estimated to evaluate the level of four risk-outcome pairs. RESULTS: In total, 27 prospective cohorts were included in our analysis. Consuming whole grain at the range of TMREL (118.5-148.1 g per day) was associated with lower risks: T2D (declined by 37.3%, 95% UI: 5.8 to 59.5), CRC (declined by 17.3%, 6.5 to 27.7), stroke (declined by 21.8%, 7.3 to 35.1), and IHD (declined by 36.9%, 7.1 to 58.0). For all outcomes except stroke, we observed a non-linear, monotonic decrease as whole grain consumption increased; For stroke, it followed a J-shaped curve (the greatest decline in the risk of stroke at consuming 100 g whole grain for a day). The relationships between whole grain consumption and four diseases are all two-star pairs (ROS: 0.087, 0.068, 0.062, 0.095 for T2D, CRC, stroke, and IHD, respectively). CONCLUSION: Consuming 100 g of whole grains per day offers broad protective benefits. However, exceeding this threshold may diminish the protective effects against stroke. Our findings endorse replacing refined grains with whole grains as the main source of daily carbohydrates. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: We have registered our research in PROSPERO, and the identifier of our meta-analyses is CRD42023447345.


Assuntos
Doenças Cardiovasculares , Neoplasias Colorretais , Diabetes Mellitus Tipo 2 , Grãos Integrais , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Neoplasias Colorretais/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Dieta/métodos , Dieta/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco
20.
Front Endocrinol (Lausanne) ; 15: 1397512, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38745951

RESUMO

Background: The Oxidative Balance Score (OBS) is commonly used to assess oxidative stress and provides a comprehensive evaluation of dietary and lifestyle-related exposures. However, there is limited research on the association between OBS and colorectal cancer (CRC), its subsites, and complications. The objective of this study was to assess the relationship between OBS and the risk of CRC, its subsites, and common complications in a large prospective cohort study. Methods: We included data from 175,808 participants in the UK Biobank data sample repository from 2006 to 2010. We evaluated OBS using a scoring system based on 22 dietary and lifestyle factors. Multiple adjustments, including multivariate Cox proportional hazard regression, gender stratification, subgroup analysis, and sensitivity analysis, were performed to fully explore the relationship between OBS and CRC, its subsites, and complications. The mediation analysis was conducted to investigate whether serum albumin, uric acid, and neutrophil levels mediate the relationship between OBS and CRC. Results: After adjusting for potential confounding factors, a significant negative correlation was found between OBS and the risk of CRC and its subsites (proximal colon cancer, distal colon cancer, and rectal cancer). This correlation was particularly pronounced in male CRC patients. Serum albumin, uric acid, and neutrophil count, which are biomarkers, were found to have a significant mediating effect between OBS and CRC. Conclusion: Our study suggests that higher exposure to antioxidants assessed through OBS (diet and lifestyle rich in antioxidants) may decrease the occurrence of CRC and its subsites.


Assuntos
Neoplasias Colorretais , Estresse Oxidativo , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/sangue , Estudos Prospectivos , Incidência , Idoso , Fatores de Risco , Estilo de Vida , Adulto , Dieta , Ácido Úrico/sangue , Reino Unido/epidemiologia , Seguimentos
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