Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer

Bujanda, Luís; Sarasqueta, Cristina; Zubiaurre, Leire; Cosme, Ángel; Muñoz, Concepción; Sánchez, Ariadna; Martin, Cheryl; Titó, Llúcia; Piñol, Virgı́nia; Castells, Antoni; Llor, Xavier; Xicola, Rosa M.; Pons, Elisenda; Clofent, Juan; Castro, Máximo; Cuquerella, J.; Medina, Enrique; Gutiérrez, Ana; Arenas, Juan; Jover, Rodrigo

doi:10.1136/gut.2007.120709

Cited by 91 publications

(94 citation statements)

References 38 publications

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“…Although colonoscopy sensitivity for AN detection at a single round is clearly higher than FIT, from a population-based perspective, its effect is limited because of a low adherence in this setting. 32 In contrast, independently of the population, FIT is associated with a high specificity for AN detection and its sensitivity may increase at consecutive rounds. Nevertheless, it must be emphasized that there is no information on adherence to consecutive rounds of FIT screening in familial-risk CRC screening.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

et al. 2014

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Background: There is little information about the fecal immunochemical test (FIT) in familial-risk colorectal cancer (CRC) screening. Objectives: The objective of this article is to investigate whether FIT diagnostic accuracy for advanced neoplasia (AN) differs between average and familial-risk (first-degree relative) patients. Methods: A total of 1317 consecutive participants (595 familial) who collected one stool sample before performing a colonoscopy as a CRC screening test were included. FIT diagnostic accuracy for AN was evaluated with Chi-square test at a 20 mg hemoglobin/g of feces cut-off value. Finally, we determined which variables were independently related to AN. Results: An AN was found in 151 (11.5%) patients. The overall accuracy was not statistically different between both cohorts for AN (88.4%, 91.7%; p ¼ 0.051). At the cut-off stablished, differences in FIT sensitivity (31.1%, 40.6%; p ¼ 0.2) or specificity (96.5%, 97.3%; p ¼ 0.1) were not statistically significant. Finally, independent variables such as sex (male) (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4-3.1), age (50-65, >65 years) (OR 2.1, 95% CI 1.1-4.3; OR 2.7, 95% CI 1.2-6.1), previous colonoscopy (OR 0.4, 95% CI 0.2-0.9) and FIT 20 mg/g feces (OR 17.7, 95% CI 10.8-29.1) were associated with AN diagnosis. Conclusions: FIT accuracy for AN detection is equivalent in average and familial-risk CRC screening cohorts.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

et al. 2014

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“…Colonoscopy is considered to be the most effective method for CRC screening due to the possibility of visualizing the inner surface of the colon, acquiring biopsies, and treating lesions as soon as they are detected [4,5]. However, take-up of screening colonoscopy is limited due to various factors including invasiveness, patient discomfort, fear of pain, and the need for sedation [6,7]. The technology behind flexible endoscopy basically consists of a long (approximately from 130 up to 160 cm), semirigid tube with a steerable head (diameter from 12 up to 14 mm).…”

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confidence: 99%

Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy

et al. 2011

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Background Despite being considered the most effective method for colorectal cancer diagnosis, colonoscopy take-up as a mass-screening procedure is limited mainly due to invasiveness, patient discomfort, fear of pain, and the need for sedation. In an effort to mitigate some of the disadvantages associated with colonoscopy, this work provides a preliminary assessment of a novel endoscopic device consisting in a softly tethered capsule for painless colonoscopy under robotic magnetic steering. Methods The proposed platform consists of the endoscopic device, a robotic unit, and a control box. In contrast to the traditional insertion method (i.e., pushing from behind), a "front-wheel" propulsion approach is proposed. A compliant tether connecting the device to an external box is used to provide insufflation, passing a flexible operative tool, enabling lens cleaning, and operating the vision module. To assess the diagnostic and treatment ability of the platform, 12 users were asked to find and remove artificially implanted beads as polyp surrogates in an ex vivo model. In vivo testing consisted of a qualitative study of the platform in pigs, focusing on active locomotion, diagnostic and therapeutic capabilities, safety, and usability. Results The mean percentage of beads identified by each user during ex vivo trials was 85 ± 11%. All the identified beads were removed successfully using the polypectomy loop. The mean completion time for accomplishing the entire procedure was 678 ± 179 s. No immediate mucosal damage, acute complications such as perforation, or delayed adverse consequences were observed following application of the proposed method in vivo. Conclusions Use of the proposed platform in ex vivo and preliminary animal studies indicates that it is safe and operates effectively in a manner similar to a standard colonoscope. These studies served to demonstrate the platform's added advantages of reduced size, front-wheel drive strategy, and robotic control over locomotion and orientation.

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“…The high rate of adenoma and ADA in the right colon of FDRs of CRC patients [22,58,59] and the occurrence of CRC in the right colon in 30%-40% of FDRs [60,61] indicate that an endoscopic assessment of the entire colon for screening purposes should be preferred to the limited exploration of the left colon. The usefulness of such a recommendation is confirmed by the growing evidence that colonoscopy-based screening programs are able to reduce CRC incidence and mortality.…”

Section: Screening Colonoscopymentioning

confidence: 99%

“…Therefore, more detailed information should be provided to subjects with a family history of CRC regarding the safety of colonoscopy and the possibility of performing the procedure under sedation. In this regard, general practitioners play a decisive role, especially in lesseducated people who are less likely to obtain information in other ways [22,58,70,71] . High-quality colonoscopy is crucial to achieve good CRC screening, therefore several technical factors have to be taken into account [37] .…”

Section: Screening Colonoscopymentioning

confidence: 99%

Familial colorectal cancer screening: When and what to do?

Blanco¹,

Paoluzi²,

Sileri³

et al. 2015

WJG

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Colorectal cancer (CRC) is the third leading cause of death worldwide and represents a clinical challenge. Family members of patients affected by CRC have an increased risk of CRC development. In these individuals, screening is strongly recommended and should be started earlier than in the population with average risk, in order to detect neoplastic precursors, such as adenoma, advanced adenoma, and nonpolypoid adenomatous lesions of the colon. Fecal occult blood test (FOBT) is a non invasive, widespread screening method that can reduce CRC-related mortality. Sigmoidoscopy, alone or in addition to FOBT, represents another screening strategy that reduces CRC mortality. Colonoscopy is the best choice for screening highrisk populations, as it allows simultaneous detection and removal of preneoplastic lesions. The choice of test depends on local health policy and varies among countries. Core tip: One-fifth of people who develop colorectal cancer (CRC) have a first-degree relative (FDR) affected by this malignancy. Screening is an efficient method to reduce mortality for CRC and should be started in FDRs earlier than in the population at average risk. There is a large disparity in guidelines for screening in familial CRC, therefore, here we address the principal indication and methods for screening in this population at increased risk. Recent or emerging methods to improve the participation rate in screening programs are described. Ongoing trials on CRC screening are also reported.

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Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer

Cited by 91 publications

References 38 publications

Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy

Familial colorectal cancer screening: When and what to do?

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