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1.
PLoS One ; 15(9): e0238354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936812

RESUMO

BACKGROUND: African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS: In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS: Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS: Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.


Assuntos
Afro-Americanos/psicologia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Educação de Pacientes como Assunto/métodos , Afro-Americanos/estatística & dados numéricos , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Masculino , Prognóstico
3.
Oncology ; 98(9): 593-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32604093

RESUMO

BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death worldwide. In recent years, researchers have focussed on the role of the intestinal microbiota in both the prevention and the treatment of colorectal cancer. SUMMARY: The evidence in the literature supports that there is a fragile balance between different species of bacteria in the human gut. A disturbance of this balance towards increased levels of the bacteria Fusobacterium nucleatum and Bacteroides fragilis is associated with an increased risk of colorectal cancer. The mechanisms involved include the release of toxins which activate inflammation and the regulation of specific miRNAs (with an increase in the expression of oncogenic miRNAs and a decrease in the expression of tumour suppressor miRNAs), thereby increasing cell proliferation and leading to tumorigenesis. On the other hand, Lactobacillus and Bifidobacterium have a protective effect against the development of colorectal cancer through mechanisms that involve an increase in the levels of anticarcinogenic metabolites such as butyrate and a decrease in the activity of proinflammatory pathways. Even though preliminary studies support that the use of probiotics in the prevention and management of colorectal cancer is promising, more research is needed in this field. Key Message: The association between the intestinal microbiota, diet and colorectal cancer remains an active area of research with expected future applications in the use of probiotics for the prevention and management of this significant disease.


Assuntos
Neoplasias Colorretais/dietoterapia , Neoplasias Colorretais/microbiologia , Microbioma Gastrointestinal/fisiologia , Animais , Bacteroides fragilis/crescimento & desenvolvimento , Bifidobacterium/crescimento & desenvolvimento , Neoplasias Colorretais/prevenção & controle , Fusobacterium nucleatum/crescimento & desenvolvimento , Humanos , Lactobacillus/crescimento & desenvolvimento
4.
PLoS Med ; 17(7): e1003194, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32678831

RESUMO

BACKGROUND: The current organized screening program for colorectal cancer in Germany offers both sexes 5 annual fecal immunochemical tests (FITs) between ages 50 and 54 years, followed by a first screening colonoscopy at age 55 years if all of these FITs were negative. We sought to assess the implications of this approach for key parameters of diagnostic performance. METHODS AND FINDINGS: Using a multistate Markov model, we estimated the expected detection rates of advanced neoplasms (advanced adenomas and cancers) and number needed to scope (NNS) to detect 1 advanced neoplasm at a first screening colonoscopy conducted at age 55 after 5 preceding negative FITs and compared them with the corresponding estimates for a first screening colonoscopy at age 55 with no preceding FIT testing. In individuals with 5 consecutive negative FITs undergoing screening colonoscopy at age 55, expected colonoscopy detection rate (NNS) was 3.7% (27) and 0.10% (1,021) for any advanced neoplasm and cancer, respectively, in men, and 2.1% (47) and 0.05% (1,880) for any advanced neoplasm and cancer, respectively, in women. These NNS values for detecting 1 advanced neoplasm are approximately 3-fold higher, and the NNS values for detecting 1 cancer are approximately 8-fold higher, than those for a first screening colonoscopy at age 55 without prior FITs. This study is limited by model simplifying assumptions and uncertainties related to input parameters. CONCLUSIONS: Screening colonoscopy at age 55 after 5 consecutive negative FITs at ages 50-54, as currently offered in the German cancer early detection program, is expected to have very low positive predictive value. Our results may inform efforts to enhance the design of screening programs.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Modelos Teóricos , Fatores Etários , Colonoscopia/métodos , Fezes , Feminino , Alemanha , Humanos , Imunoquímica , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Sensibilidade e Especificidade
5.
Am J Clin Nutr ; 112(3): 603-612, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32619213

RESUMO

BACKGROUND: Whole grains and other foods containing fiber are thought to be inversely related to colorectal cancer (CRC). However, whether these associations reflect fiber or fiber source remains unclear. OBJECTIVES: We evaluated associations of whole grain and dietary fiber intake with CRC risk in the large NIH-AARP Diet and Health Study. METHODS: We used Cox proportional hazard models to estimate HRs and 95% CIs for whole grain and dietary fiber intake and risk of CRC among 478,994 US adults, aged 50-71 y. Diet was assessed using a self-administered FFQ at baseline in 1995-1996, and 10,200 incident CRC cases occurred over 16 y and 6,464,527 person-years of follow-up. We used 24-h dietary recall data, collected on a subset of participants, to evaluate the impact of measurement error on risk estimates. RESULTS: After multivariable adjustment for potential confounders, including folate, we observed an inverse association for intake of whole grains (HRQ5 vs.Q1 : 0.84; 95% CI: 0.79, 0.90; P-trend < 0.001), but not dietary fiber (HRQ5 vs. Q1: 0.96; 95% CI: 0.88, 1.04; P-trend = 0.40), with CRC incidence. Intake of whole grains was inversely associated with all CRC cancer subsites, particularly rectal cancer (HRQ5 vs. Q1: 0.76; 95% CI: 0.67, 0.87; P-trend < 0.001). Fiber from grains, but not other sources, was associated with lower incidence of CRC (HRQ5 vs. Q1: 0.89; 95% CI: 0.83, 0.96; P-trend < 0.001), particularly distal colon (HRQ5 vs. Q1: 0.84; 95% CI: 0.73, 0.96; P-trend = 0.005) and rectal cancer (HRQ5 vs. Q1: 0.77; 95% CI: 0.66, 0.88; P-trend < 0.001). CONCLUSIONS: Dietary guidance for CRC prevention should focus on intake of whole grains as a source of fiber.


Assuntos
Neoplasias Colorretais/prevenção & controle , Dieta , Fibras na Dieta/administração & dosagem , Grãos Integrais , Idoso , Estudos de Coortes , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Int J Colorectal Dis ; 35(10): 1951-1954, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32500432

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has led to a policy of severe restrictions in almost all countries strongly involved by the pandemic. National Health System is among activities suffering from the COVID-19 and the lockdown. AIM: To evaluate the impact of COVID-19 in colorectal cancer (CRC) prevention. METHODS: We report the change in the hospital organization to meet the growing healthcare needs determined by COVID-19. The limitations of CRC prevention secondary to COVID-19 and their effects on the healthcare are analyzed considering the features of the CRC screening programs in the average-risk population and endoscopic surveillance in patients with inflammatory bowel diseases (IBD). RESULTS: The interruption of CRC prevention may lead to a delayed diagnosis of CRC, possibly in a more advanced stage. The economic burden and the impact on workload for gastroenterologists, surgeons, and oncologists will be greater as long as the CRC prevention remains suspended. To respond to the increased demand for colonoscopy once COVID-19 will be under control, we should optimize the resources. It will be necessary to stratify the CRC risk and reach an order of priority. It should be implemented the number of health workers, equipment, and spaces dedicated to performing colonoscopy for screening purpose and in subjects with alarm symptoms in the shortest time. To this aim, the funds earmarked for healthcare should be increased. CONCLUSION: The economic impact will be dramatic, but COVID-19 is the demonstration that healthcare has to be the primary goal of humans.


Assuntos
Betacoronavirus , Neoplasias Colorretais/prevenção & controle , Infecções por Coronavirus , Detecção Precoce de Câncer/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Neoplasias Colorretais/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Detecção Precoce de Câncer/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Humanos , Itália/epidemiologia , Programas Nacionais de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
7.
Aliment Pharmacol Ther ; 52(1): 73-84, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32452591

RESUMO

BACKGROUND: 5-aminosalicylates (5-ASA) are widely used in inflammatory bowel disease (IBD), but emerging evidence suggests that they may be safely withdrawn in significant subsets of patients. This is important to address: 5-ASA therapy accounts for up to 25% of total healthcare costs in ulcerative colitis (UC), while almost a third of patients with Crohn's disease (CD) receive long-term 5-ASA despite no clear evidence of benefit. Further, rationalising medication burden may improve overall adherence and outcome. AIMS: To summarise the rationale for 5-ASA withdrawal, review the current evidence in both UC and CD and consider the data surrounding colorectal cancer (CRC) prevention, guiding an evidence-based withdrawal strategy. METHODS: PubMed was searched to identify relevant studies. Only papers published in English were reviewed, with priority given to randomised clinical trials and meta-analyses. RESULTS: For patients with UC, consideration of 5-ASA withdrawal should be made on a case-by-case basis, but it appears safest for those in deep remission without any of the following risk factors: younger age (<40 years), remission for less than 2 years, a history of multiple flares, extensive disease. 5-ASA withdrawal should also be considered in patients with UC escalated to biologic therapy who have achieved remission and in all patients with CD. Although 5-ASA therapy may have chemopreventive benefits for CRC, the cost-benefit ratio appears significant, and this indication is not justified by evidence in those who have achieved remission and are continuing therapy with other agents, or in those in sustained remission without a history of extensive disease. CONCLUSIONS: Although the majority of patients with IBD receive 5-ASA during their disease course, safe withdrawal appears possible in many, with important implications for both health economics and patient experience. A number of unanswered questions, however, remain.


Assuntos
Ácidos Aminossalicílicos/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Neoplasias Colorretais/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Suspensão de Tratamento
10.
Ir Med J ; 113(1): 7, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-32298567

RESUMO

Aims To determine the completeness of polyp resection (i.e. achieving an R0 margin) and its relation with Endoscopists, histopathologist, size, location and technique of polypectomy in an NSS cohort. The definition of R0 margin is complete macroscopic resection with a negative microscopic margin at polypectomy. Method NCCS (National Colon Cancer Screening) colonoscopies are offered to bowel cancer screening patients after a positive faecal immunochemical test (FIT) test in a Joint Advisory Group (JAG) accredited Gastrointestinal Endoscopy centre. We histologically evaluated the polyp margins for complete resection, which was defined as the absence of adenomatous or hyperplastic tissue in the resected polyp margins in a cohort of faecal immunochemical test positive patients. Results A total of 186 consecutive NCCS colonoscopies out of a total of 542 performed between 2013 and 2017 were included in this study. Of the polyps excised 152(27%) had a R0 margin histologically, and 30(5%) had involvement of the margin. Surprisingly in 373(67%) of polyps pathologists were unable to assess the margin. Conclusion Achieving an R0 margin should be a key performance indicator for endoscopists performing polypectomy. At the same time more studies on polyp margins are recommended.


Assuntos
Pólipos Intestinais/cirurgia , Margens de Excisão , Estudos de Coortes , Neoplasias Colorretais/prevenção & controle , Endoscopia Gastrointestinal , Humanos
12.
MMWR Morb Mortal Wkly Rep ; 69(10): 253-259, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32163384

RESUMO

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States of cancers that affect both men and women. Despite strong evidence that screening for CRC reduces incidence and mortality, CRC screening prevalence is below the national target. This report describes current CRC screening prevalence by age, various demographic factors, and state. METHODS: Data from the 2018 Behavioral Risk Factor Surveillance System survey were analyzed to estimate the percentages of adults aged 50-75 years who reported CRC screening consistent with the United States Preventive Services Task Force recommendation. RESULTS: In 2018, 68.8% of adults were up to date with CRC screening. The percentage up to date was 79.2% among respondents aged 65-75 years and 63.3% among those aged 50-64 years. CRC screening prevalence was lowest among persons aged 50-54 years (50.0%) and increased with age. Among respondents aged 50-64 years, CRC screening prevalence was lowest among persons without health insurance (32.6%) and highest among those with reported annual household income of ≥$75,000 (70.8%). Among respondents aged 65-75 years, CRC screening prevalence was lowest among those without a regular health care provider (45.6%), and highest among those with reported annual household income ≥$75,000 (87.1%). Among states, CRC screening prevalence was highest in Massachusetts (76.5%) and lowest in Wyoming (57.8%). DISCUSSION: CRC screening prevalence is lower among adults aged 50-64 years, although most reported having a health care provider and health insurance. Concerted efforts are needed to inform persons aged <50 years about the benefit of screening so that screening can start at age 50 years.


Assuntos
Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
Future Oncol ; 16(7): 293-306, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32067473

RESUMO

Colorectal cancer is the third most common cancer in the world and its incidence is on the rise. Dietary intervention has emerged as an attractive strategy to curtail its occurrence and progression. Diet is known to influence the gut microbiome, as dietary factors and gut bacteria can act in concert to cause or protect from colorectal cancer. Several studies have presented evidence for such interactions and have pointed out the different ways by which the diet and gut microbiome can be altered to produce beneficial effects. This review article aims to summarize the interrelationship between diet, gut flora and colorectal cancer so that a better preventive approach can be applied.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Dieta , Suscetibilidade a Doenças , Microbioma Gastrointestinal , Animais , Neoplasias Colorretais/prevenção & controle , Humanos , Prebióticos , Probióticos , Medição de Risco , Fatores de Risco , Simbióticos
14.
Artigo em Inglês | MEDLINE | ID: mdl-32012838

RESUMO

There have been prior attempts to utilize machine learning to address issues in the medical field, particularly in diagnoses using medical images and developing therapeutic regimens. However, few cases have demonstrated the usefulness of machine learning for enhancing health consciousness of patients or the public in general, which is necessary to cause behavioral changes. This paper describes a novel case wherein the uptake rate for colorectal cancer examinations has significantly increased due to the application of machine learning and nudge theory. The paper also discusses the effectiveness of social impact bonds (SIBs) as a scheme for realizing these applications. During a healthcare SIB project conducted in the city of Hachioji, Tokyo, machine learning, based on historical data obtained from designated periodical health examinations, digitalized medical insurance receipts, and medical examination records for colorectal cancer, was used to deduce segments for whom the examination was recommended. The result revealed that out of the 12,162 people for whom the examination was recommended, 3264 (26.8%) received it, which exceeded the upper expectation limit of the initial plan (19.0%). We conclude that this was a successful case that stimulated discussion on potential further applications of this approach to wider regions and more diseases.


Assuntos
Neoplasias Colorretais/prevenção & controle , Aprendizado de Máquina , Mudança Social , Detecção Precoce de Câncer , Humanos , Exame Físico , Tóquio
16.
Gastroenterology ; 158(5): 1313-1325, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31972239

RESUMO

BACKGROUND & AIMS: Sulfur-metabolizing microbes, which convert dietary sources of sulfur into genotoxic hydrogen sulfide (H2S), have been associated with development of colorectal cancer (CRC). We identified a dietary pattern associated with sulfur-metabolizing bacteria in stool and then investigated its association with risk of incident CRC using data from a large prospective study of men. METHODS: We collected data from 51,529 men enrolled in the Health Professionals Follow-up Study since 1986 to determine the association between sulfur-metabolizing bacteria in stool and risk of CRC over 26 years of follow-up. First, in a subcohort of 307 healthy men, we profiled serial stool metagenomes and metatranscriptomes and assessed diet using semiquantitative food frequency questionnaires to identify food groups associated with 43 bacterial species involved in sulfur metabolism. We used these data to develop a sulfur microbial dietary score. We then used Cox proportional hazards modeling to evaluate adherence to this pattern among eligible individuals (n = 48,246) from 1986 through 2012 with risk for incident CRC. RESULTS: Foods associated with higher sulfur microbial diet scores included increased consumption of processed meats and low-calorie drinks and lower consumption of vegetables and legumes. Increased sulfur microbial diet scores were associated with risk of distal colon and rectal cancers, after adjusting for other risk factors (multivariable relative risk, highest vs lowest quartile, 1.43; 95% confidence interval 1.14-1.81; P-trend = .002). In contrast, sulfur microbial diet scores were not associated with risk of proximal colon cancer (multivariable relative risk 0.86; 95% CI 0.65-1.14; P-trend = .31). CONCLUSIONS: In an analysis of participants in the Health Professionals Follow-up Study, we found that long-term adherence to a dietary pattern associated with sulfur-metabolizing bacteria in stool was associated with an increased risk of distal CRC. Further studies are needed to determine how sulfur-metabolizing bacteria might contribute to CRC pathogenesis.


Assuntos
Bactérias/metabolismo , Neoplasias Colorretais/epidemiologia , Fezes/microbiologia , Comportamento Alimentar/fisiologia , Microbioma Gastrointestinal/fisiologia , Idoso , Bactérias/isolamento & purificação , Neoplasias Colorretais/microbiologia , Neoplasias Colorretais/prevenção & controle , Inquéritos sobre Dietas/estatística & dados numéricos , Seguimentos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Incidência , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Enxofre/metabolismo
17.
Artigo em Inglês | MEDLINE | ID: mdl-31906520

RESUMO

A rise in colorectal cancer (CRC) burden is expected around the globe. This study aimed to determine the population attributable fractions (PAFs) of CRC cases contributed by modifiable risk factors in Saudi Arabia. The PAF was calculated for modifiable risk factors with strong evidences of a causal association with CRC. CRC incidence was obtained from the National Cancer Registry, relative risks were retrieved from recent meta-analysis studies, and the prevalence of exposure to risk factors was obtained from national surveys. Conventional statistical formulas were used to calculate PAFs from registered CRC cases, stratified by sex. Three scenarios were proposed to make projections and present the expected effects of prevention interventions on the number of CRC cases in Saudi Arabia for 2025-2040. The results showed the largest fraction of attributable CRC cases among men and women was contributed by physical inactivity (16.13% and 16.45%), followed by excess weight (obesity: 9.71% and 6.93%; overweight: 6.05% and 1.9%); and tobacco smoking (current smoker: 3.04% and 0.18%; former smoker: 3.29% and 0.12%). We estimated that the number of projected cases attributable to physical inactivity, smoking, and excess weight in men and women would increase from 807 and 315 in 2025 to 1360 and 556 in 2040, respectively. In conclusion, physical inactivity, being overweight or obese, and tobacco smoking are major lifestyle factors affecting the incidence of CRC in Saudi Arabia. Prevention interventions and public health programs to reduce their prevalence are warranted.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Adulto , Neoplasias Colorretais/etiologia , Feminino , Humanos , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/epidemiologia , Prevalência , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Comportamento Sedentário , Percepção Social , Fumar Tabaco/efeitos adversos
18.
Public Health ; 181: 80-85, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958673

RESUMO

OBJECTIVES: In the Italian region Friuli Venezia Giulia, public screening is offered for cervical cancer, breast cancer, and colorectal cancer. Participation of the target population is lower than 70%. Our aim was to investigate reasons for non-participation. STUDY DESIGN: This is a qualitative survey. METHODS: A telephone survey was conducted in 2018 on a random sample of persons not adhering in 2017. Only one question about the reason for non-participation was asked. The answers were transcribed verbatim with no personal identifiers and no additional information. The transcribed anonymous answers were then read and classified into mutually exclusive macrocategories and subcategories. RESULTS: A total of 4456 non-adhering persons were surveyed. Personal practical issues were the most common type of barrier reported in all three screening programs, followed by personal beliefs. Program-related issues were more common in cervical cancer screening than in the others. Almost half of the women not participating in the public breast cancer screening and 40% of those not adhering to the public cervical cancer screening had mammography or Pap test out of the public program. CONCLUSIONS: In this region, practitioners should work to overcome practical barriers and discuss personal beliefs. Surveys of non-participants in other geographic areas would be important to adequately inform local policymaking.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/métodos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Idoso , Atitude do Pessoal de Saúde , Detecção Precoce de Câncer , Feminino , Inquéritos Epidemiológicos , Humanos , Itália/epidemiologia , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Pesquisa Qualitativa , Esfregaço Vaginal
19.
Eur J Cancer ; 127: 224-235, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31932176

RESUMO

BACKGROUND: Populations differ with respect to their cancer risk and screening preferences, which may influence the performance of colorectal cancer (CRC) screening programs. This review aims to systematically compare the mortality effect of CRC screening across European regions. METHODS: Six databases including Embase, Medline, Web of Science, PubMed publisher, Google Scholar and Cochrane Library were searched for relevant studies published before March 2018. Bibliographic searches were conducted to select studies assessing the effect of various screening tests (guaiac fecal occult blood test [gFOBT]; flexible sigmoidoscopy [FS]; fecal immunochemical test [FIT] and colonoscopy) on CRC mortality in Europe (PROSPERO protocol: CRD42016042433). Abstract reviewing, data extraction and risk of bias assessment were conducted independently by two reviewers. RESULTS: A total of 18 studies were included; of which, 11 were related to gFOBT, 4 to FS, 2 to FIT and 1 to colonoscopy; 8 were randomised clinical trials, and 10, observational studies, and an approximately equal number of studies represented Northern, Western and Southern European regions. Among individuals invited to screening, CRC mortality reductions varied from 8% to 16% for gFOBT and from 21% to 30% for FS. When studies with a high risk of bias were considered, ranges were more extensive. The estimated effectiveness of gFOBT and FS screening appeared similar across different European regions. CONCLUSIONS: CRC mortality impact of inviting individuals with similar adopted screening strategies (gFOBT or FS) may be consistent across several European settings.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Mortalidade/tendências , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/mortalidade , Europa (Continente)/epidemiologia , Humanos , Prognóstico , Taxa de Sobrevida
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