Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on Colon Cancer Screening

Leddin, Desmond; Hunt, Richard H.; Champion, M C; Cockeram, Alan; Flook, Nigel; Gould, Michael; Kim, Young–In; Love, Jonathan; Morgan, David; Natsheh, Susan; Sadowski, Dan

doi:10.1155/2004/983459

Cited by 115 publications

(102 citation statements)

References 13 publications

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“…Given that the time from enrolment in medical school to completion of subspecialty training in gastroenterology is at least 10 years, human resource shortages will probably constitute a barrier to any significant reductions in wait times for digestive health care. Indeed, the anticipated increase in demand for colonoscopy for colon cancer screening is likely to lengthen wait times still further; limited access to digestive disease consultations and investigations may lead to an increase in alternative, less appropriate investigations (21)(22)(23), with the potential for diminished diagnostic accuracy, suboptimal patient care and increased costs. Alternative care models involving primary care physician endoscopists, nurse practitioners, physician extenders such as nurse endoscopists (24) and gastroenterology physician assistants may shorten wait times for consultation and procedures, but these solutions will also require time to implement and they will not provide a substitute for specialist gastroenterologists.…”

Section: Discussionmentioning

confidence: 99%

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Leddin

Armstrong²,

Barkun³

et al. 2008

Canadian Journal of Gastroenterology

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BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. . DISCUSSION: Total wait times for the seven indications exceeded the consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the 'point-of-care', practice audit methodology used for the present study.

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Section: Discussionmentioning

confidence: 99%

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Leddin

Armstrong²,

Barkun³

et al. 2008

Canadian Journal of Gastroenterology

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“…The tool was based on a literature review of FH risk factors for CRC and management guidelines, as well as provincial genetic testing criteria (Leddin et al 2004;Predictive Cancer Genetics Screening Committee 2001). It consists of a laminated card with FH risk categories on one side enabling a risk assessment of "high risk of hereditary/familial CRC," "moderate risk of hereditary/familial CRC," "low risk of hereditary /familial CRC but still at increased risk of CRC," and "population risk."…”

Section: Methodsmentioning

confidence: 99%

“…A significant risk factor for CRC is having a family history (FH) of the disease (Ouakrim et al 2013) with inherited genetic risk factors playing a role in the etiology of CRC in between 15 and 30 % of cases (Vasen et al 2007). About 5 % of CRC is thought to be caused by hereditary syndromes such as Lynch syndrome (previously called hereditary non-polyposis colorectal cancer) (~5 %) and familial adenomatous polyposis (<1 %) (Cremin et al 2009;Leddin et al 2004). The remaining 10-25 % of familial cases of CRC may be due to undiscovered genetic factors and/or nongenetic factors that are shared by relatives (Cremin et al 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Family history of CRC, particularly in a first-degree relative, is associated with increased CRC risk as much as two-to fourfold (Ouakrim et al 2013). This risk is even higher if more than one relative is affected or if a relative was diagnosed under age 50 (Cremin et al 2009;Leddin et al 2004). Those with Lynch syndrome have a lifetime risk of CRC ranging between 30 and 74 % (Dunlop et al 1997;Hampel et al 2005;Jenkins et al 2006) with average age at diagnosis between 44 and 61 years (Cremin et al 2009;Hampel et al 2005).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

et al. 2014

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We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/ Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p<0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p<0.001), and improvement in total mean scores on outcome measures for all vignettes. Most demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.

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“…Screening can stop many of these deaths by detecting colorectal cancer in an early, more treatable stage and by detecting and removing its nonmalignant precursor lesion, the adenoma, thereby preventing colon cancer incidence . screening is not only an efficient tool for reducing colon cancer mortality but also has been estimated to do so at acceptable costs (Leddin et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Markov's Modeling for Screening Strategies for Colorectal Cancer

Barouni

Larizadeh²,

Sabermahani³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

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Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on Colon Cancer Screening

Cited by 115 publications

References 13 publications

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Access to Specialist Gastroenterology Care in Canada: Comparison of Wait Times and Consensus Targets

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

Markov's Modeling for Screening Strategies for Colorectal Cancer

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