Improving uptake of screening for colorectal cancer

Šantare, Daiga; Kojalo, Ilona; Huttunen, Teppo; Rikacovs, Sergejs; Rucevskis, Peteris; Boka, Viesturs; Leja, Mārcis

doi:10.1097/meg.0000000000000314

Cited by 28 publications

(28 citation statements)

References 30 publications

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“…However, the sample size for this indirect comparison had been much smaller (including 15 CRC cases only), and results were reported in much less detail in letter form only 16. In the few previous comparative studies of OC Sensor and FOB Gold, diagnostic performance of these FITs was roughly similar,17–19 even though OC Sensor seemed to show some advantages in terms of analytical performance and test handling 20…”

Section: Discussionmentioning

confidence: 86%

Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population

Brenner

Chen

2017

CLEP

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BackgroundA multitarget stool DNA test (MSDT) that showed higher sensitivity but lower specificity than a fecal immunochemical test (FIT) for hemoglobin in one recent study from the US and Canada, is increasingly used for colorectal cancer (CRC) screening, despite its ~20-fold higher costs compared to FITs. We aimed to assess diagnostic performance of a quantitative FIT in an independent study among participants of screening colonoscopy and to compare it with the previously reported performance of MSDT.MethodsA total of 3494 participants, aged 50–84 years, who underwent screening colonoscopy in private gastroenterological practices in Germany, and who provided a stool sample before colonoscopy to be evaluated by a commercially available quantitative FIT (FOB Gold®) were included. Diagnostic performance (sensitivity, specificity) for detecting CRC or advanced precancerous lesions (APCLs) was evaluated by comparison of test results with findings at screening colonoscopy. In addition to the original cutoff, we used an adjusted cutoff yielding the same specificity as reported for the MSDT to enhance comparability.ResultsThe most advanced finding at colonoscopy was CRC and APCL in 30 (0.86%) and 359 (10.3%) cases, respectively. At a cutoff yielding the same specificity as reported for MSDT (86.6%), the sensitivities (95% CI) of the FIT for detecting CRC and APCL >1 cm were 96.7% (82.8–99.9%) and 54.3% (48.3–60.3%), respectively. These sensitivities are higher than those reported for MSDT (92.3% and 43.6%, p=0.66 and 0.003, respectively).ConclusionIn this large screening population, FIT showed equivalent or better diagnostic performance in comparison to reported performance of MSDT.

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Section: Discussionmentioning

confidence: 86%

Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population

Brenner

Chen

2017

CLEP

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“…43 These data likely reflect the overall increased proportion of advanced cancer cases in the population, paralleling the reported low compliance (only 9.6% in 2013) with the population-based colorectal cancer screening in Latvia. 44 In other European countries, the participation rates in screening programs for colorectal cancer range from 77 to 80% in Germany, 45 68.2% in the Netherlands, 19.9% in Croatia and 22.7% in the Czech Republic. The acceptable minimum participation rate is 45% but the desired target is more than 65%, thus screening in our population cannot be considered efficient.…”

Section: Discussionmentioning

confidence: 99%

<p>The Association Between Inflammation, Epithelial Mesenchymal Transition and Stemness in Colorectal Carcinoma</p>

Briede¹,

Štrumfa²,

Vanags³

et al. 2020

JIR

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Background: Inflammation plays an important albeit dual role in carcinogenesis. Survival studies have highlighted the prognostic significance of peritumorous inflammation. Currently, the theoretical background allows inflammation, epithelial mesenchymal transition (EMT) and the closely associated stem cell differentiation in colorectal carcinoma (CRC) to be linked. However, there is scarce direct morphological evidence. Purpose and methods: The aim of our study was to investigate the role of inflammation in cancer growth and invasion by analyzing the association between inflammation and known morphological prognostic features of colorectal cancer, EMT, stemness and mismatch repair (MMR) protein expression. The study was designed as a retrospective morphological and immunohistochemical assessment of 553 consecutive cases of surgically treated primary CRC. Results: There were statistically significant associations between high-grade inflammation and lower pT (p = 0.002), absence of lymph node metastases (p < 0.001) and less frequent lymphatic (p = 0.003), venous (p = 0.017), arterial (p = 0.012), perineural (p = 0.001) and intraneural (p = 0.01) invasion. In contrast, Crohn's like reaction (CLR) by density of lymphoid follicles in the invasive front lacked significant differences in regard to pT, pN, tumor invasion into surrounding structures (blood or lymphatic vessels, nerves), grade or necrosis (all p > 0.05). The expression of E-cadherin, CD44 and MMR proteins yielded no statistically significant associations with peritumorous inflammation by Klintrup-Mäkinen score or the density of lymphoid follicles. Nevertheless, E-cadherin levels were significantly associated with the density of eosinophils (p = 0.007). Conclusion: High-grade peritumorous inflammation is associated with beneficial morphologic CRC features, including less frequent manifestations of invasion, and is not secondary to tissue damage and necrosis. CLR is not associated with cancer spread by pTN; this finding indirectly suggests an independent role of CLR in carcinogenesis. Further, inflammation by Klintrup-Mäkinen grade and CLR is not dependent on epithelial-mesenchymal transition and stem cell differentiation. Our study highlights the complex associations between inflammation, tumor morphology, EMT, stemness and MMR protein expression in human CRC tissues.

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“…Previous one-time screening studies with varying intervals for sending reminder letters also showed a positive effect on uptake from sending a reminder letter (Baron et al , 2008). Santare et al (2015) reported a very high proportion of 29% FIT devices returned (OC-Sensor) after sending a reminder letter after 21 days, but this was studied in Latvia, which has an opportunistic screening program with very low uptake (7.6%). Tinmouth et al (2015) reported a 9.7% increase in participation after sending a reminder letter in a gFOBT-based CRC screening after 6 months.…”

Section: Discussionmentioning

confidence: 99%

Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening

et al. 2016

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Background:The effectiveness of faecal immunochemical test (FIT)-based screening programs is highly dependent on consistent participation over multiple rounds. We evaluated adherence to FIT screening over four rounds and aimed to identify determinants of participation behaviour.Methods:A total of 23 339 randomly selected asymptomatic persons aged 50–74 years were invited for biennial FIT-based colorectal cancer screening between 2006 and 2014. All were invited for every consecutive round, except for those who had moved out of the area, passed the upper age limit, or had tested positive in a previous screening round. A reminder letter was sent to non-responders. We calculated participation rates per round, response rates to a reminder letter, and differences in participation between subgroups defined by age, sex, and socioeconomic status (SES).Results:Over the four rounds, participation rates increased significantly, from 60% (95% CI 60–61), 60% (95% CI 59–60), 62% (95% CI 61–63) to 63% (95% CI 62–64; P for trend<0.001) with significantly higher participation rates in women in all rounds (P<0.001). Of the 17 312 invitees eligible for at least two rounds of FIT screening, 12 455 (72%) participated at least once, whereas 4857 (28%) never participated; 8271 (48%) attended all rounds when eligible. Consistent participation was associated with older age, female sex, and higher SES. Offering a reminder letter after the initial invite in the first round increased uptake with 12% in subsequent screening rounds this resulted in an additional uptake of up to 10%.Conclusions:In four rounds of a pilot biennial FIT-screening program, we observed a consistently high and increasing participation rate, whereas sending reminders remain effective. The substantial proportion of inconsistent participants suggests the existence of incidental barriers to participation, which, if possible, should be identified and removed.

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Improving uptake of screening for colorectal cancer

Cited by 28 publications

References 30 publications

Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population

Fecal occult blood versus DNA testing: indirect comparison in a colorectal cancer screening population

<p>The Association Between Inflammation, Epithelial Mesenchymal Transition and Stemness in Colorectal Carcinoma</p>

Adherence to colorectal cancer screening: four rounds of faecal immunochemical test-based screening

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