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1.
Ned Tijdschr Geneeskd ; 1652021 06 29.
Artigo em Holandês | MEDLINE | ID: mdl-34346601

RESUMO

Prophylactic salpingo-oophorectomy (PSO) can be offered to all patients suffering from colorectal cancer to prevent ovarian metastasis (OM). Arguments to offer PSO are given for discussion: 1. PSO for colorectal cancer is mentioned in various guidelines, 2. Other disciplines such as gynecology and urology, offer or routinely perform PSO during abdominal surgery, 3. A better prognosis could be achieved, 4. It has been shown that systemic therapy has limited effects on OM, since ovaria are considered to be 'sanctuary sites', 5. In postmenopausal women negative side effects of PSO are expected to be very low, 6. PSO for prevention of OM is thought to be a cost effective oncological procedure, 7. Reducing the risk of the occurrence of primary ovarian cancer could be a positive side effect, and 8. It is part of 'shared decision making'.


Assuntos
Neoplasias Colorretais , Neoplasias Ovarianas , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Neoplasias Ovarianas/prevenção & controle , Ovariectomia , Salpingo-Ooforectomia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34360481

RESUMO

Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3-24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6-15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03-2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs.


Assuntos
Neoplasias Colorretais , Meios de Comunicação , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Técnicas de Apoio para a Decisão , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento
3.
Nutrients ; 13(7)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34209683

RESUMO

Gut microbiota dysbiosis is a common feature in colorectal cancer (CRC) and inflammatory bowel diseases (IBD). Adoption of the Mediterranean diet (MD) has been proposed as a therapeutic approach for the prevention of multiple diseases, and one of its mechanisms of action is the modulation of the microbiota. We aimed to determine whether MD can be used as a preventive measure against cancer and inflammation-related diseases of the gut, based on its capacity to modulate the local microbiota. A joint meta-analysis of publicly available 16S data derived from subjects following MD or other diets and from patients with CRC, IBD, or other gut-related diseases was conducted. We observed that the microbiota associated with MD was enriched in bacteria that promote an anti-inflammatory environment but low in taxa with pro-inflammatory properties capable of altering intestinal barrier functions. We found an opposite trend in patients with intestinal diseases, including cancer. Some of these differences were maintained even when MD was compared to healthy controls without a defined diet. Our findings highlight the unique effects of MD on the gut microbiota and suggest that integrating MD principles into a person's lifestyle may serve as a preventive method against cancer and other gut-related diseases.


Assuntos
Neoplasias Colorretais/prevenção & controle , Dieta Mediterrânea , Disbiose/prevenção & controle , Gastroenteropatias/prevenção & controle , Microbioma Gastrointestinal/fisiologia , Adulto , Colo/microbiologia , Neoplasias Colorretais/microbiologia , Disbiose/microbiologia , Feminino , Gastroenteropatias/microbiologia , Humanos , Doenças Inflamatórias Intestinais/microbiologia , Doenças Inflamatórias Intestinais/prevenção & controle , Masculino , Pessoa de Meia-Idade
4.
Prev Med ; 151: 106681, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217422

RESUMO

The COVID-19 pandemic has contributed to decreases in breast, colorectal, and cervical cancer screenings between 86 and 94% compared to three-year averages. These postponed screenings have created backlogs that systems will need to address as healthcare facilities re-open for preventive care. The American Cancer Society is leading a 17-month intervention with 22 federally qualified health centers (FQHCs) across the United States aimed at reducing cancer incidence and mortality disparities and alleviating additional strain caused by COVID-19. This study describes COVID-related cancer screening service disruptions reported by participating FQHCs. Selected FQHCs experienced service disruptions and/or preventive care cancellations due to COVID-19 that varied in severity and duration. Fifty-nine percent stopped cancer screenings completely. Centers transitioned to telehealth visits or rescheduled for the future, but the impact of these strategies may be limited by continued pandemic-related disruptions and the inability to do most screenings at home; colon cancer screening being the exception. Most centers have resumed in-person screening, but limited in person appointments and high levels of community transmission may reduce FQHC abilities to provide catch-up services. FQHCs provide critical cancer prevention services to vulnerable populations. The delivery of culturally competent, high-quality healthcare can mitigate and potentially reverse racial and ethnic disparities in cancer prevention testing and treatment. Ensuring and expanding access to care as we move out of the pandemic will be critical to preventing excess cancer incidence and mortality in vulnerable populations.


Assuntos
COVID-19 , Neoplasias Colorretais , Telemedicina , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Pandemias , Melhoria de Qualidade , SARS-CoV-2 , Estados Unidos
5.
Molecules ; 26(12)2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34201125

RESUMO

The Mediterranean diet is a central element of a healthy lifestyle, where polyphenols play a key role due to their anti-oxidant properties, and for some of them, as nutripharmacological compounds capable of preventing a number of diseases, including cancer. Due to the high prevalence of intestinal cancer (ranking second in causing morbidity and mortality), this review is focused on the beneficial effects of selected dietary phytophenols, largely present in Mediterranean cooking: apigenin, curcumin, epigallocatechin gallate, quercetin-rutine, and resveratrol. The role of the Mediterranean diet in the prevention of colorectal cancer and future perspectives are discussed in terms of food polyphenol content, the effectiveness, the plasma level, and the importance of other factors, such as the polyphenol metabolites and the influence of the microbiome. Perspectives are discussed in terms of microbiome-dependency of the brain-second brain axis. The emergence of polyphenol formulations may strengthen the efficiency of the Mediterranean diet in the prevention of cancer.


Assuntos
Neoplasias Colorretais/prevenção & controle , Polifenóis/farmacologia , Animais , Antioxidantes/farmacologia , Dieta Mediterrânea , Humanos , Intestinos/efeitos dos fármacos , Microbiota/efeitos dos fármacos
6.
BMJ Health Care Inform ; 28(1)2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34244178

RESUMO

OBJECTIVES: A customised data management system was required for a rapidly implemented COVID-19-adapted colorectal cancer pathway in order to mitigate the risks of delayed and missed diagnoses during the pandemic. We assessed its performance and robustness. METHODS: A system was developed using Microsoft Excel (2007) to retain the spreadsheets' intuitiveness of direct data entry. Visual Basic for Applications (VBA) was used to construct a user-friendly interface to enhance efficiency of data entry and segregate the data for operational tasks. RESULTS: Large data segregation was possible using VBA macros. Data validation and conditional formatting minimised data entry errors. Computation by the COUNT function facilitated live data monitoring. CONCLUSION: It is possible to rapidly implement a makeshift database system with clinicians' regular input. Large-volume data management using a spreadsheet system is possible with appropriate data definition and VBA-programmed data segregation. The described concept is applicable to any data management system construction requiring speed and flexibility in a resource-limited situation.


Assuntos
COVID-19 , Neoplasias Colorretais , Procedimentos Clínicos , Gerenciamento de Dados , Neoplasias Colorretais/prevenção & controle , Bases de Dados Factuais , Detecção Precoce de Câncer , Humanos , Software , Fatores de Tempo , Interface Usuário-Computador
7.
Trials ; 22(1): 452, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266464

RESUMO

BACKGROUND: Australian guidelines recommend that all people aged 50-70 years old actively consider taking daily low-dose aspirin (100-300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50-70 years, on informed decision-making and uptake of aspirin. METHODS: Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50-70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. DISCUSSION: This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50-70-year-olds to reduce the risk of CRC and other chronic diseases. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965 . Registered on 10 October 2020.


Assuntos
Aspirina , Neoplasias Colorretais , Idoso , Aspirina/efeitos adversos , Doença Crônica , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Técnicas de Apoio para a Decisão , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitória
8.
Rev Esp Salud Publica ; 952021 Jul 21.
Artigo em Espanhol | MEDLINE | ID: mdl-34267174

RESUMO

OBJECTIVE: The population-based Program for the Prevention of Colorectal Cancer (PPCRC) was implemented in 2005 in the Valencian Community, following the guidelines of the European Union. To achieve the desired effectiveness in these programs, it is necessary to achieve a series of requirements, assessable through the program indicators. The objective of this study was to analyze the evolution of the program indicators from 2006 to 2016. METHODS: The accumulated indicators for the period were calculated. The Poisson regression model was used to compare the indicators by age groups and sex, by type of screening, by type of fecal occult blood test (FOBT) and by year. RESULTS: The number of people invited to participate was 1,934,266. The participation rate was 44.4%, being 87.6% in the subsequent screening and 33.7% in the initial one, with men over 60 having the lowest participation figures. Except for the positive predictive value (PPV) for low risk adenomas, which was higher in a group of men aged 50 to 59 years of successive screening, the detection rates and PPV for the different types of lesions were higher in the initial screening, with immunological test and in the group of men over 60 years old. Throughout the period, there was a decrease in the test positivity rates and in the advanced adenomas and cancers detection rates. CONCLUSIONS: The PPCCR reaches levels of quality for which the effectiveness of the program is demonstrated. However, the insufficient participation of some population groups highlights the need to carry out studies to achieve the desired objectives in all population groups and thus result in greater effectiveness of the program.


Assuntos
Neoplasias Colorretais/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Espanha
9.
Health Psychol ; 40(5): 305-315, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34152784

RESUMO

OBJECTIVE: This study examined how standard and culturally targeted versions of gain and loss-framed messaging affect African Americans' colorectal cancer (CRC) screening receptivity and behavior, as well as their anticipation of experiencing racism in undertaking CRC screening. METHOD: Screening-deficient African Americans (N = 457) viewed an informational video about CRC risks, prevention, and screening and were randomized to receive a gain or loss-framed message about screening. Half of participants viewed an additional culturally targeted message about overcoming racial disparities in CRC by obtaining screening. Using the Theory of Planned Behavior, we measured general receptivity to CRC screening. We also measured arousal of anticipatory racism in response to messaging. Finally, we offered participants a no-cost fecal immunochemical testing kit (FIT Kit) and measured uptake and use. RESULTS: Message framing interacted with culturally targeted messaging to affect CRC screening receptivity and behavior. Participants were no more receptive to CRC screening when standard loss-framing was used, but were more favorable if loss-framing was culturally targeted. Targeted loss-framing also reduced anticipatory racism, which partially mediated effects on screening receptivity. Finally, although participants least often accepted a FIT Kit with standard loss-framing, effects of messaging on FIT Kit uptake and use were not significant. CONCLUSION: This study adds to growing recognition of important cultural nuance in effective use of message framing. Current finding also suggest that targeted and framed messaging could synergistically impact the extent to which African Americans engage in CRC screening, although specific impacts on FIT Kit screening are less certain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Afro-Americanos/psicologia , Neoplasias Colorretais/etnologia , Competência Cultural , Detecção Precoce de Câncer/estatística & dados numéricos , Comunicação em Saúde/métodos , Afro-Americanos/estatística & dados numéricos , Idoso , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Racismo/psicologia
10.
Nutrients ; 13(5)2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-34063614

RESUMO

An economic experiment was conducted in France in 2020 to evaluate consumer attitudes toward two ham products associated with different colorectal cancer risks. We focused specifically on comparing a conventional ham and a new hypothetical antioxidant-enriched ham with a reduced risk of provoking colorectal cancer. Study participants were given descriptions of the two hams before carrying out successive rounds of willingness-to-pay (WTP) assessments. The results show that WTP was higher for the antioxidant-enriched ham than for the conventional ham. WTP estimates were also impacted by providing additional information about the reduction in colorectal cancer risk associated with the antioxidant-enriched ham. Based on the participants' WTP, we came up with ex ante estimates for the social impacts of introducing the antioxidant-enriched ham onto the market, and we suggest that it would be socially optimal to promote the product. Competition arising from pre-existing product labelling and marketing assertions could greatly limit the market potential of antioxidant-enriched ham, which suggests that alternative approaches may be necessary, such as regulations mandating antioxidant enrichment. These results also concern all countries with high levels of meat consumption.


Assuntos
Neoplasias Colorretais/prevenção & controle , Comportamento do Consumidor/economia , Preferências Alimentares/psicologia , Alimentos Fortificados/economia , Carne de Porco/economia , Adulto , Antioxidantes , Comportamento de Escolha , Comércio , Dieta Saudável/economia , Dieta Saudável/psicologia , Feminino , Alimentos Fortificados/análise , França , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Carne de Porco/análise , Adulto Jovem
11.
Int J Mol Sci ; 22(10)2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-34063506

RESUMO

The review begins with molecular genetics, which hit the field unveiling the involvement of oncogenes and tumor suppressor genes in the pathogenesis of colorectal cancer (CRC) and uncovering genetic predispositions. Then the notion of molecular phenotypes with different clinical behaviors was introduced and translated in the clinical arena, paving the way to next-generation sequencing that captured previously unrecognized heterogeneity. Among other molecular regulators of CRC progression, the extent of host immune response within the tumor micro-environment has a critical position. Translational sciences deeply investigated the field, accelerating the pace toward clinical transition, due to its strong association with outcomes. While the perturbation of gut homeostasis occurring in inflammatory bowel diseases can fuel carcinogenesis, micronutrients like vitamin D and calcium can act as brakes, and we discuss underlying molecular mechanisms. Among the components of gut microbiota, Fusobacterium nucleatum is over-represented in CRC, and may worsen patient outcome. However, any translational knowledge tracing the multifaceted evolution of CRC should be interpreted according to the prognostic and predictive frame of the TNM-staging system in a perspective of clinical actionability. Eventually, we examine challenges and promises of pharmacological interventions aimed to restrain disease progression at different disease stages.


Assuntos
Neoplasias Colorretais/etiologia , Neoplasias Colorretais/prevenção & controle , Microambiente Tumoral/imunologia , Anticarcinógenos/farmacologia , Biomarcadores Tumorais/análise , Neoplasias Colorretais/patologia , Metilação de DNA , Resistencia a Medicamentos Antineoplásicos , Fusobacterium nucleatum/metabolismo , Microbioma Gastrointestinal , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/patologia , Micronutrientes/farmacologia , Microambiente Tumoral/genética , Microambiente Tumoral/fisiologia
13.
Clin Transl Gastroenterol ; 12(5): e00344, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33955373

RESUMO

INTRODUCTION: Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, it is unclear whether the reduction in CRC risk may differ by genetic susceptibility. METHODS: We evaluated this question in a cohort of 304,740 participants of European descent aged 50 years and older. Genetic susceptibility was measured using a polygenic risk score (PRS) constructed with risk variants identified in genomewide association studies. Cox models were used to estimate hazard ratios and 95% confidence intervals of CRC risk. RESULTS: Over a median follow-up of 7.0 years, 2,261 incident CRC cases and 528 CRC deaths were identified. CRC screening was associated with a significantly reduced CRC incidence among individuals with a high (hazard ratio, 0.80; 95% confidence interval, 0.71-0.92) and intermediate PRS (0.84, 0.71-0.98) but not among those with a low PRS (1.03, 0.86-1.25; Pinteraction, 0.005). A similar but more evident difference was observed for mortality (Pinteraction, 0.046), with more than 30% reduced mortality observed in the high PRS group (0.69, 0.52-0.91). Among the younger group (age 50-60 years), CRC screenings were associated with a slightly (but nonsignificantly) elevated incidence and mortality in the low PRS group but a reduced risk in the high PRS group (Pinteraction, 0.043 [incidence]; 0.092 [mortality]). No significant interaction was observed in the older group (age > 60 years). DISCUSSION: Individuals with a higher genetic risk benefited more substantially from CRC screenings than those with a lower risk. Our findings suggest that PRS may be used to develop personalized CRC screening to maximize its effect on CRC prevention.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/mortalidade , Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias Colorretais/genética , Neoplasias Colorretais/prevenção & controle , Feminino , Seguimentos , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Reino Unido/epidemiologia
14.
Am J Prev Med ; 61(3): 402-409, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33994253

RESUMO

INTRODUCTION: The Centers for Disease Control and Prevention administers the Colorectal Cancer Control Program to increase colorectal cancer screening rates among people aged 50-75 years in areas where rates are lower than state or national levels. The aim of this study is to better understand the effectiveness of specific Colorectal Cancer Control Program components. METHODS: The study population included clinics enrolled in the Colorectal Cancer Control Program during Years 1 and 2. Clinic data collected by the Centers for Disease Control and Prevention annually from 2015 to 2017 for program evaluation were used. The outcome variable was screening rate change through Program Year 2, and predictor variables were a new implementation or enhancement of evidence-based interventions and other program components. The analysis, conducted in 2020, used ordinary least square and generalized estimating equations regressions and first difference models to estimate the associations of independent variables with the outcome. RESULTS: Of the total 336 clinics, 50%-70% newly implemented or enhanced different evidence-based interventions. Among these, client reminders were most highly associated with the increase in screening rates (8.0 percentage points). Provider reminder was not significantly associated with any change in screening rates. Among all program components, having a colorectal cancer screening champion was most highly (8.4 percentage points) associated with screening rate change. Results from different models were slightly different but in agreement. CONCLUSIONS: Client reminders, provider assessment and feedback, and colorectal cancer screening champions were associated with increased clinic-level colorectal cancer screening rates. Universal implementation of these strategies can substantially increase colorectal cancer screening rates in the U.S.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Medicina Baseada em Evidências , Humanos , Programas de Rastreamento , Avaliação de Programas e Projetos de Saúde
15.
Clin Transl Gastroenterol ; 12(3): e00319, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33939384

RESUMO

INTRODUCTION: Noninvasive colorectal cancer (CRC) screening methods with higher sensitivity for advanced colorectal neoplasia (ACN) than the fecal immunochemical test (FIT) alone are warranted. This study aimed to elucidate the diagnostic performance of a risk stratification score calculated using baseline individual characteristics and its combination with FIT for detecting ACN. METHODS: This cross-sectional analysis of data from a prospective cohort in Izu Oshima, Japan, included asymptomatic individuals age 40-79 years who underwent both 2-day quantitative FIT and screening colonoscopy. The 8-point risk score, calculated based on age, sex, CRC family history, body mass index, and smoking history, was assessed. Colonoscopy results were used as reference. RESULTS: Overall, 1,191 individuals were included, and 112 had ACN. The sensitivity and specificity of the 1-/2-day FIT (cutoff: 50-200 ng Hb/mL) for ACN were 17.9%-33.9% (4.9%-22.0% for right-sided ACN) and 91.8%-97.6%, respectively. The risk score's c-statistic for ACN was 0.66, and combining the score (cutoff: 5 points) with 1-/2-day FIT (cutoff: 50-200 ng Hb/mL) yielded a sensitivity and specificity for ACN of 46.4%-56.3% (43.9%-48.8% for right-sided ACN) and 76.6%-80.8%, respectively. The specificity of the risk score and FIT combination for all adenomatous lesions was 82.4%-86.4%. DISCUSSION: The 8-point risk score remarkably increased the sensitivity for ACN, particularly for right-sided ACN. Although the specificity decreased, it was still maintained at a relatively high level. The risk score and FIT combination has the potential to become a viable noninvasive CRC screening option.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Doenças Assintomáticas/epidemiologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade
16.
BMJ ; 373: n877, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947661

RESUMO

OBJECTIVE: To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC. DESIGN: Case-control study. SETTING: Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden. PARTICIPANTS: 68 060 patients with CRC and 333 753 matched controls. MAIN OUTCOME MEASURES: Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC. RESULTS: After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4% (5742/68 060) in cases and 5.7% (18 860/333 753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (≥2 first degree relatives: 1.70, 1.52 to 1.90, P<0.001 for trend) and decreasing age at polyp diagnosis (<50 years: 1.77, 1.57 to 1.99, P<0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years (≥2 first degree relatives: 3.34, 2.05 to 5.43, P=0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P<0.001 for interaction). CONCLUSIONS: After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.


Assuntos
Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Anamnese , Lesões Pré-Cancerosas/epidemiologia , Reto/patologia , Crianças Adultas/estatística & dados numéricos , Idade de Início , Idoso , Estudos de Casos e Controles , Colo/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Sistema de Registros/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Fatores Sexuais , Irmãos , Suécia/epidemiologia
18.
BMC Med Inform Decis Mak ; 21(1): 165, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016116

RESUMO

BACKGROUND: Several epidemiological and cohort studies suggest that regular low-dose aspirin use independently reduces the long-term incidence and risk of colorectal cancer deaths by approximately 20%. However, there are also risks to aspirin use, mainly gastrointestinal bleeding and haemorrhagic stroke. Making informed decisions depends on the ability to understand and weigh up benefits and risks of available options. A decision aid to support people to consider aspirin therapy alongside participation in the NHS bowel cancer screening programme may have an additional impact on colorectal cancer prevention. This study aims to develop and user-test a brief decision aid about aspirin to enable informed decision-making for colorectal screening-eligible members of the public. METHODS: We undertook a qualitative study to develop an aspirin decision aid leaflet to support bowel screening responders in deciding whether to take aspirin to reduce their risk of colorectal cancer. The iterative development process involved two focus groups with public members aged 60-74 years (n = 14) and interviews with clinicians (n = 10). Interviews (n = 11) were used to evaluate its utility for decision-making. Analysis was conducted using a framework approach. RESULTS: Overall, participants found the decision aid acceptable and useful to facilitate decision-making. They expressed a need for individualised risk information, more detail about the potential risks of aspirin, and preferred risk information presented in pictograms when offered different options. Implementation pathways were discussed, including the possibility of involving different clinicians in the process such as GPs and/or community pharmacists. A range of potentially effective timepoints for sending out the decision aid were identified. CONCLUSION: An acceptable and usable decision aid was developed to support decisions about aspirin use to prevent colorectal cancer.


Assuntos
Aspirina , Neoplasias Colorretais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Tomada de Decisões , Técnicas de Apoio para a Decisão , Detecção Precoce de Câncer , Humanos , Programas de Rastreamento
19.
Ann Palliat Med ; 10(4): 4897-4905, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33966428

RESUMO

BACKGROUND: With the changes in lifestyle and diet, the incidence and mortality of colorectal cancer (CRC) is increasing in China. CRC mainly develops from colorectal adenomas (CRAs). There is a lack of chemopreventative drugs with definite efficacy for CRAs. Tiaochang Xiaoliu Decoction (TXD) was developed by Professor Yunjian Luo and has been used clinically over the last ten years for the prevention of CRA recurrence. To facilitate its clinical use, TXD was further standardized and produced as "Tiaochang Xiaoliu Decoction Granules (TXDG)". A study was designed to investigate the preventive effects of TXDG on the recurrence of CRA. METHODS: A randomized, double-blinded, controlled, and multi-center experiment is proposed to assess the effectiveness and safety of TXDG. Patients with CRAs (after complete polypectomy under colonoscopy) will be randomly divided into two groups, one will be treated with TXDG (the TXDG group) and the other will be treated with a TXDG mimetic agent (the TXDG mimetic group). The patients will be treated for 6 months and followed up for 3 years. Follow-up colonoscopy is expected to be carried out within 1 to 3 years after the baseline examinations. The primary outcome measure is adenoma detection rate within 1 to 3 years. The secondary outcome measures are the number, location, and pathology of the adenomas, and the polyp detection rate. DISCUSSION: Reliable objective evidence will be provided to evaluate the efficacy and safety of TXDG as an accessorial therapy for CRA occurrence in post-polypectomy patients. TRIAL REGISTRATION: ChiCTR2000035257.


Assuntos
Adenoma , Neoplasias Colorretais , Preparações Farmacêuticas , Adenoma/tratamento farmacológico , Adenoma/prevenção & controle , China , Colonoscopia , Neoplasias Colorretais/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
J Biomed Sci ; 28(1): 24, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33827580

RESUMO

Thyroid hormone analogues-particularly, L-thyroxine (T4) has been shown to be relevant to the functions of a variety of cancers. Integrin αvß3 is a plasma membrane structural protein linked to signal transduction pathways that are critical to cancer cell proliferation and metastasis. Thyroid hormones, T4 and to a less extend T3 bind cell surface integrin αvß3, to stimulate the extracellular signal-regulated kinase 1/2 (ERK1/2) pathway to stimulate cancer cell growth. Thyroid hormone analogues also engage in crosstalk with the epidermal growth factor receptor (EGFR)-Ras pathway. EGFR signal generation and, downstream, transduction of Ras/Raf pathway signals contribute importantly to tumor cell progression. Mutated Ras oncogenes contribute to chemoresistance in colorectal carcinoma (CRC); chemoresistance may depend in part on the activity of ERK1/2 pathway. In this review, we evaluate the contribution of thyroxine interacting with integrin αvß3 and crosstalking with EGFR/Ras signaling pathway non-genomically in CRC proliferation. Tetraiodothyroacetic acid (tetrac), the deaminated analogue of T4, and its nano-derivative, NDAT, have anticancer functions, with effectiveness against CRC and other tumors. In Ras-mutant CRC cells, tetrac derivatives may overcome chemoresistance to other drugs via actions initiated at integrin αvß3 and involving, downstream, the EGFR-Ras signaling pathways.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/prevenção & controle , Integrina alfaVbeta3/uso terapêutico , Transdução de Sinais , Tiroxina/uso terapêutico , Genes erbB-1 , Genes ras , Humanos
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