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1.
Rev Med Suisse ; 20(881): 1309-1313, 2024 Jul 03.
Artigo em Francês | MEDLINE | ID: mdl-38961782

RESUMO

Principles to guide and inform population-based screening decisions cover a wide range of aspects beyond the screening test. Colorectal cancer (CRC) meets these requirements for individuals at moderate risk aged 50 to 69. In Switzerland, screening using a biennial faecal occult blood test or colonoscopy every 10 years is reimbursed free of deductible in 12 programs covering 15 cantons. This article assesses the appropriateness of systematic screening from age 45 in the Swiss context. Prioritizing measures to raise awareness among healthcare professionals and high-risk subjects rather than lowering the age of eligibility would not only be more sensible but would also benefit to the population over 50 years old.


Les critères pour proposer un dépistage organisé couvrent de nombreuses dimensions, au-delà des caractéristiques du test de dépistage. Le cancer colorectal (CCR) répond à ces exigences pour les personnes à risque modéré de 50 à 69 ans. En Suisse, un dépistage par un test biennal de détection de sang occulte dans les selles ou par coloscopie tous les 10 ans est remboursé hors franchise dans 12 programmes couvrant 15 cantons. Cet article fait le point de la situation concernant l'adéquation d'un dépistage organisé du CCR dès 45 ans dans le contexte suisse. Prioriser des mesures de sensibilisation auprès des professionnel-le-s de santé et des sujets à haut risque de CCR serait non seulement plus judicieux que d'abaisser l'âge d'éligibilité au dépistage organisé mais bénéficierait aussi à la population de plus de 50 ans.


Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , Programas de Rastreamento , Sangue Oculto , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Suíça/epidemiologia , Detecção Precoce de Câncer/métodos , Pessoa de Meia-Idade , Programas de Rastreamento/métodos , Colonoscopia/métodos , Colonoscopia/estatística & dados numéricos , Fatores Etários , Idoso
2.
World J Gastroenterol ; 30(22): 2849-2851, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38947291

RESUMO

In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology. They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.


Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Sangue Oculto , Fezes/química , Adenoma/diagnóstico , Adenoma/prevenção & controle
3.
World J Gastroenterol ; 30(24): 3048-3051, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38983962

RESUMO

In the last decade, several studies have explored various modalities and strategies for colorectal cancer (CRC) screening, taking into account epidemiological data, individual characteristics, and socioeconomic factors. In this editorial, we comment further on a retrospective study by Agatsuma et al published in the recent issue of the World Journal of Gastroenterology. Our focus is on screening trends, particularly in relation to efforts to improve the currently suboptimal uptake among the general population worldwide, aiming to enhance early diagnosis rates of CRC. There is a need to raise awareness through health edu-cation programs and to consider the use of readily available, non-invasive screening methods. These strategies are crucial for attracting screen-eligible populations to participate in first-line screening, especially those in high- or average-risk groups and in regions with limited resources. Liquid biopsies and biomarkers represent rapidly evolving trends in screening and diagnosis; however, their clinical relevance has yet to be standardized.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Colonoscopia/métodos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Biomarcadores Tumorais/análise , Sangue Oculto , Biópsia Líquida/métodos , Fatores de Risco
4.
BMJ Open ; 14(6): e079482, 2024 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-38909999

RESUMO

INTRODUCTION: Participation in bowel cancer screening is lower in regions where there is high ethnic diversity and/or socioeconomic deprivation. Interventions, such as text message reminders and patient navigation (PN), have the potential to increase participation in these areas. As such, there is interest in the comparative effectiveness of these interventions to increase bowel cancer screening participation, as well as their relative cost-effectiveness. METHODS AND ANALYSIS: This study will use a three-arm randomised controlled trial design to compare the effectiveness and cost-effectiveness of text message reminders and PN to increase the uptake of bowel cancer screening in London. Participants will be individuals who have not returned a completed faecal immunochemical test kit within 13 weeks of receiving a routine invitation from the London bowel cancer screening hub. Participants will be randomised (in a 1:1:1 ratio) to receive either (1) usual care (ie, 'no intervention'), (2) a text message reminder at 13 weeks, followed by repeated text message reminders at 15, 17 and 19 weeks (in the event of non-response) or (3) a text message reminder at 13 weeks, followed by PN telephone calls at 15, 17 and 19 weeks in the event of non-response. The primary endpoint will be participation in bowel cancer screening, defined as 'the return of a completed kit by week 24'. Statistical analysis will use multivariate logistic regression and will incorporate pairwise comparisons of all three groups, adjusted for multiple testing. ETHICS AND DISSEMINATION: Approvals to conduct the research have been obtained from University College London's Joint Research Office (Ref: 150666), the Screening Research, Innovation and Development Advisory Committee ('RIDAC', Ref: 2223 014 BCSP Kerrison), the Health Research Authority (Ref: 22/WM/0212) and the Confidentiality Advisory Group (Ref: 22/CAG/0140). Results will be conveyed to stakeholders, notably those managing the screening programme and published in peer-reviewed journals/presented at academic conferences. TRIAL REGISTRATION NUMBER: ISRCTN17245519.


Assuntos
Neoplasias Colorretais , Análise Custo-Benefício , Detecção Precoce de Câncer , Sangue Oculto , Navegação de Pacientes , Sistemas de Alerta , Telefone , Envio de Mensagens de Texto , Humanos , Londres , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/economia , Neoplasias Colorretais/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
BMC Gastroenterol ; 24(1): 198, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877426

RESUMO

INTRODUCTION: The predictive value of immunological fecal occult blood (iFOB) testing for the screening of colorectal cancer has been well described in the Western world. However, its relevance in Sub-Saharan Africa (SSA) is not well evaluated. It could be altered by the other causes of lower gastrointestinal bleeding such as parasitic infections. The aim of this study was to highlight the performance of an iFOB test for the prediction of colorectal cancer (CRC) during colonoscopy in SSA. METHODOLOGY: We conducted an analytical cross-sectional study in two digestive endoscopic centers of Yaoundé (Cameroon) from the 1st July to the 31 November 2022. Patients presenting with an indication for colonoscopy without any overt gastrointestinal bleeding were included. Sociodemographic and clinical data were collected. All consenting patients underwent a qualitative immunologic occult test through the iFOB test before colonoscopy. Data were analyzed using SPSS version 23.0 software. The performance of the iFOB test for the diagnosis of CRC during colonoscopy was evaluated in terms of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). RESULTS: We included 103 patients during the study period with a male predominance and a sex ratio of 1.7. The median age [IQR] was 52 [38-65] years (range 1 - 84 years). The most common colonoscopic lesions were polyps in 23 patients (22.3%), CRC in 17 patients (16.5%) and hemorrhoids in 15 patients (14.6%). Patients testing positive for iFOB test accounted for 43.7% (45 patients). Among these patients, 31.1% (14 patients) had a CRC. The Se of the occult blood test for CRC detection was calculated to be 82.3% (95%CI: 56.7-96.2); the Sp was 63.9% (95% CI: 53-74); the PPV was 31.1% (95% CI: 24-39) and the NPV was 94.8% (95% CI: 86.6-98.1). CONCLUSION: The iFOB test has a good NPV, but a poor PPV for the diagnosis of CRC in our study.


Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , Sangue Oculto , Valor Preditivo dos Testes , Humanos , Neoplasias Colorretais/diagnóstico , Masculino , Colonoscopia/estatística & dados numéricos , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Idoso , Adulto , Camarões , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/métodos , Adulto Jovem , Adolescente , Sensibilidade e Especificidade , Criança
12.
J Health Care Poor Underserved ; 35(2): 425-438, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828574

RESUMO

OBJECTIVE: There are significant inequities in colorectal cancer (CRC) screening and outcomes. Via literature review, we assessed CRC screening rates for the vulnerable populations served by free clinics. METHODS: A systematic review was conducted for publications on CRC screening in free clinics. Outcomes included CRC screening characteristics, population demographics, and limitations. A methodological quality assessment was completed. RESULTS: Out of 63 references, six studies were included, representing 8,844 participants. Black or Hispanic participants were the plurality in all but one study. All participants were uninsured. Median CRC screening rate was 48.4% (range 6.6-78.9%). Screening methods included colonoscopy, fecal occult blood test, flexible sigmoidoscopy, and fecal immunochemical test. Clinics offering only one screening method had a mean screening rate of 7.2% while those with multiple methods had a screening rate of 65.4%. CONCLUSION: Access to multiple CRC screening modalities correlates with higher screening rates in free clinics. More work is needed to increase CRC screening in free clinics.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Instituições de Assistência Ambulatorial , Sangue Oculto
14.
JNCI Cancer Spectr ; 8(3)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38830030

RESUMO

BACKGROUND: Socioeconomic inequalities in the uptake of colorectal cancer screening are well documented, but the implications on inequities in health gain remain unclear. METHODS: Sixty-year-olds were randomly recruited from the Swedish population between March 2014 and March 2020 and invited to undergo either 2 rounds of fecal immunochemical testing (FIT) 2 years apart (n = 60 137) or primary colonoscopy just once (n = 30 400). By linkage to Statistics Sweden's registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia in each screening arm (intention-to-screen analysis). In the biennial FIT arm, we predicted the probability of exceeding the yield in the primary colonoscopy arm by linear extrapolation of the cumulative yield to (hypothetical) additional rounds of FIT. RESULTS: In the lowest income group, the yield of advanced neoplasia was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after 2 rounds of FIT vs 1.93% (95% CI = 1.49% to 2.40%) in the primary colonoscopy arm. Extrapolation to a third round of FIT implied a 86% probability of exceeding the yield in the primary colonoscopy arm. In the highest income group, we found a more pronounced yield gap between the 2 screening strategies-2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%)- implying a low (2%) predicted probability of exceeding yield after a third round of FIT. CONCLUSIONS: Yield of advanced neoplasia from 2 rounds of FIT 2 years apart was poorer as compared with primary colonoscopy, but the difference was less in lower socioeconomic groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02078804.


Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , Sangue Oculto , Humanos , Neoplasias Colorretais/diagnóstico , Colonoscopia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Pessoa de Meia-Idade , Masculino , Feminino , Suécia , Idoso , Fatores Socioeconômicos , Fezes/química , Renda , Disparidades em Assistência à Saúde , Imunoquímica
15.
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
17.
Prev Chronic Dis ; 21: E30, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38696253

RESUMO

Introduction: Mailed stool testing for colorectal cancer (CRC) may improve screening uptake and reduce the incidence and mortality of CRC, especially among patients at federally qualified health centers (FQHCs). To expand screening programs it is important to identify cost-effective approaches. Methods: We developed a decision-analytic model to estimate the cost, effects on screening and patient outcomes (CRCs detected, CRCs prevented, CRC deaths prevented), and cost-effectiveness of implementing a state-wide mailed stool testing program over 5 years among unscreened, age-eligible (aged 50-75 y) patients at FQHCs in Texas. We compared various outreach strategies and organizational structures (centralized, regional, or a hybrid). We used data from our existing regional mailed stool testing program and recent systematic reviews to set parameters for the model. Costs included start-up and ongoing activities and were estimated in 2022 US dollars from the perspective of a hypothetical third-party payer. Cost-effectiveness was assessed by using both incremental and average cost-effectiveness ratios. Results: Using either a statewide centralized or hybrid organizational configuration to mail stool tests to newly eligible FQHC patients and patients who have responded at least once since program inception is likely to result in the best use of resources over 5 years, enabling more than 110,000 additional screens, detecting an incremental 181 to 194 CRCs, preventing 91 to 98 CRCs, and averting 46 to 50 CRC deaths, at a cost of $10 million to $11 million compared with no program. Conclusions: A statewide mailed stool testing program for FQHC patients can be implemented at reasonable cost with considerable effects on CRC screening outcomes, especially when its structure maximizes program efficiency while maintaining effectiveness.


Assuntos
Neoplasias Colorretais , Análise Custo-Benefício , Detecção Precoce de Câncer , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Texas , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/economia , Pessoa de Meia-Idade , Idoso , Feminino , Masculino , Serviços Postais , Sangue Oculto , Programas de Rastreamento/economia , Programas de Rastreamento/métodos
18.
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
20.
Clin Chim Acta ; 560: 119723, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38735515

RESUMO

BACKGROUND AND AIMS: High temperatures may reduce fecal immunochemical test (FIT) positivity and colorectal cancer (CRC) detection sensitivity. We investigated the effect of temperature on hemoglobin concentration [Hb], in the FOB Gold®. Additionally, we examined FIT pick-up, storage, return times and specimen collection. MATERIALS AND METHODS: In vitro experiments with buffer containing FIT devices, inoculated with Hb-spiked stool. For 7 days, 144 samples were stored in groups of 36 at 4 °C, 22 °C, 30 °C, and 50 °C. Additionally, 54 samples were stored in groups of 18 at 34 °C, 42 °C and 50 °C for 20 h. Paired t-tests and repeated measure ANOVA assessed [Hb] change. Sixty-five screening participants completed a FIT-handling questionnaire. RESULTS: After 7 days, mean [Hb] was stable at 30 °C (0.8 µg Hb/g;95 %CI: -1.5 to 3.1;p = 0.50). For 50 °C, mean [Hb] decreased within 2 days (-21.3 µg Hb/g;95 %CI: -30.2 to -12.5;p < 0.001) and after 20 h (-63.0 µg Hb/g;95 %CI: -88.7 to -37.3;p < 0.001), respectively. All other temperature categories showed significant mean [Hb] increase. Same-day FIT return was reported by 80 %. Eighty-seven percent experienced specimen collection as easy and 33 % kept the FIT refrigerated after collection. CONCLUSIONS: The FOB Gold® is suitable for CRC screening in tropical climates. Although most respondents indicated same-day sample return, we recommend avoiding FIT storage above 30 °C for longer than7 days.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Fezes , Hemoglobinas , Humanos , Neoplasias Colorretais/diagnóstico , Hemoglobinas/análise , Detecção Precoce de Câncer/métodos , Fezes/química , Região do Caribe , Sangue Oculto , Masculino , Feminino , Pessoa de Meia-Idade , Temperatura Alta , Imunoquímica , Idoso
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