Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study

Smith, Heather; Scarffe, Andrew D.; Brunet, N.; Champion, Cait; Kandola, Kami; Tessier, Alisha; Boushey, Robin P.

doi:10.3748/wjg.v26.i48.7652

Cited by 5 publications

(4 citation statements)

References 31 publications

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“… 41 , 42 Third, the obtained TPR of 38% (TSRE) for screening and 85% for follow‐up (Figure 4 ) appeared within the limits of related studies. Evidently, the screening rate of 25.04%, which did not affect the stage distribution in the work by Smith et al, 14 is expectedly lower than the TPR of 38%. It is seemingly discrepant that Levin et al found a peak of early detection when the FIT‐centered screening rate increased to 32.0% (still < 38%) with a follow‐up colonoscopy rate of 72.2% (also lower than the 85%).…”

Section: Discussionmentioning

confidence: 72%

“…However, no studies have specifically examined a threshold screening rate owing to the limited attention of this viewpoint, until the COVID‐19 pandemic. Among a few related studies, Smith et al 14 reported that a screening rate of 25.04% did not differ in stage distribution (stage I–II vs. III–IV) between screening and clinically detected patients with CRC aged 50–74 years. Levin et al 15 reported that a rise in stool test screening rate of up to 32.0% resulted in a peak of early detection of CRC (earlier than stage III–IV) in patients aged 51–75 years.…”

Section: Introductionmentioning

confidence: 99%

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Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

et al. 2022

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Background Colorectal cancer screening (CRCS) needs to be pandemic‐resilient to avoid long‐lasting shutdowns; however, realistic participation target remains unelucidated. This study aimed to identify the lowest acceptable participation rate in CRCS during a pandemic, focusing on vulnerable older populations who require urgent intervention. Methods This nationwide cross‐sectional study included 80,946 inpatients aged 70–85 years who were first diagnosed with colorectal cancer (CRC) after 70 years of age, between April 1, 2014 and March 31, 2019, in Japan. To evaluate the association between area‐level CRCS participation rate and individual early CRC detection, a multilevel logistic regression model was constructed. The mandatorily implemented screening rates were converted to the total screening rate equivalents (TSREs), which reflect the remaining contributions of voluntarily provided screenings. Results Early detections during stages 0–I were significantly observed when primary screening rate was ≥38% (TSRE) and combined follow‐up rate was ≥85%. For early detection during Tis–T1, primary screening rate ≥ 38% (TSRE) and combined follow‐up rate ≥ 90% were necessary. For follow‐up rates ≥70% or ≥75%, there were cases where missed detection of Tis–T1 were observed. Conclusion The results indicate that, even during pandemic, CRCS should achieve a primary screening rate of 38% and follow‐up rate of 85% for vulnerable older populations. These values, lower than the current desirable rates, suggest the maximum possible compromise in balancing the resources between cancer screening and pandemic measures. Moreover, they also indicate the minimum target for shifting to fecal immunochemical test‐focused program. Further explorations with varied CRCS settings are necessary for verification.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

et al. 2022

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“…Fewer annual colonoscopies may reduce colonoscopy wait times, thereby reducing patient anxiety 32 and preventing delays in CRC diagnosis. 33,34 Colonoscopy wait times throughout Canada currently exceed the medically recommended time periods for patients with positive FIT [35][36][37] and for patients with CRC symptoms, 34,38 which has been exacerbated by interruptions in medical services due to the coronavirus disease 2019 pandemic. 39 Fewer annual colonoscopies may also reduce patient's time lost from normal activities 40 and reduce colonoscopy-related morbidity.…”

Section: Discussionmentioning

confidence: 99%

The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model

Steer,

Sun,

Sadowski

et al. 2023

J Med Screen

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Objective To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1–2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective. Methods The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1–2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables. Results Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses. Conclusions Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs.

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“…[ 21 22 ] There are major health impacts, and economic effects of early detection are substantial. [ 23 24 ] However, many countries still lack effective national CRC prevention and screening programs. There has been a nationwide CRC screening program in SA,[ 25 ] and data from the national registry for EO-CRC and LO-CRC before 2017.…”

Section: Discussionmentioning

confidence: 99%

A 5-year evaluation of early-and late-onset sporadic colorectal cancer screening in Central Saudi Arabia

Zacharakis¹,

Almasoud²,

Arahmaner³

et al. 2022

Saudi Journal of Gastroenterology

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Background: The Al-Kharj colorectal cancer (CRC) screening program was implemented for five years (2017-2022) in a central urban area of Riyadh Province, Saudi Arabia, to assess the participation and impact of the program in average-risk individuals. Methods: The high sensitivity-guaiac based-fecal occult blood test (HSgFOBT) was used as a first-line investigation to identify asymptomatic patients, aged 45–75 years, requiring CRC screening using colonoscopy. The program was run in three tertiary hospitals in the area. Results: The five-year participation rate was 73% (35,640/48,897). The average age was 53 years (range 45–75), 49% were female (17,464/35,640), all were asymptomatic, and 77% had adequate bowel preparation. The HSgFOBT (+) rate was 6.3% (n = 2245), and 76% (n = 1701) of these underwent colonoscopy. The prevalence of findings were as follows: CRC, 4.8% (81/1701); advanced adenoma, 9.5% (162/1701); adenoma, 15.9% (270/1701); non-adenomatous polyps, 7.9% (135/1701); and no polyps or tumors, 25.4% (432/1701). Among participants aged 45–50 years, early onset-CRC had female predominance, while those ≥50 years with late onset-CRC were predominantly male. CRC was more prevalent in the left colon (P < 0.005). Conclusions: Approximately one-third of the participants diagnosed with CRC had early-onset CRC. Screening participation was desirable for the defined target population. Public education is necessary along with expanded colonoscopy resources to continue further citizen participation.

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Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study

Cited by 5 publications

References 31 publications

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model

A 5-year evaluation of early-and late-onset sporadic colorectal cancer screening in Central Saudi Arabia

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