More Favorable Short and Long-Term Outcomes for Screen-Detected Colorectal Cancer Patients

Abstract

BackgroundScreening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC.Materials and MethodsThis retrospective cohort study involved patients aged 50–69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups.ResultsOf 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics.ConclusionsSD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.

Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

“…Survival probabilities for patients with screen-detected CRC have been previously reported in the context of pilot studies prior to implementation of population-based screening programmes 8 , 9 and in a few regional and nationwide studies conducted during the first years of screening roll out, mostly in the early 2000s. 7 , 10 , 11 , 12 , 13 , 14 , 15 These studies reported five-year overall survival (patients aged 50-69, 50-74, or 50-79) of around 80% or above, ie, close to or within the range of our findings.…”

Multiple Sclerosis and the Cancer Diagnosis

“…The cancer diagnostic route taken by patients with MS was previously unknown; however, less breast and colorectal cancer screening detection has been observed in other populations with high comorbid disease burden, 7,33 and less cancer screening has been documented in the broader MS population. [8][9][10]34 Patients with MS and severe disability are less likely to have annual mammograms and screening colonoscopies over age 50 years.…”

“…We studied 3 interrelated outcomes from the cancer diagnostic process: diagnostic route, cancer stage, and diagnostic interval. Whether a patient is diagnosed through a screening or a symptomatic route is associated with the cancer stage at diagnosis 7,21,22 and presenting symptoms are partly a function of cancer stage. Symptom severity can influence the urgency with which the problem is investigated, thereby influencing the length of the diagnostic interval 23 and, concurrently, longer diagnostic intervals have been associated with advanced stage cancer.…”

“…1,2 Cancer screening, through early detection, and timely diagnosis are important drivers of cancer survival in breast and colorectal cancer. [3][4][5][6][7] Screen detection may be lower in persons with MS and a cancer diagnosis. The existing evidence in the MS population as a whole shows compromised access to cancer screening 8,9 and that women with MS who have mobility impairments are less likely to undergo preventative cancer screening than women with MS without mobility impairments.…”

Benefit of Biennial Fecal Occult Blood Screening on Colorectal Cancer in England: A Population-Based Case-Control Study

“…The results of the sensitivity analysis including only known stage are more conservative than our main analysis (although less so for Duke D in particular). The fact that screen-detected cancers are more likely to have stage recorded ( 21 ) confers a conservative bias, increasing the relative risk associated with screening. The results of the sensitivity analysis using inverse probability weighting were similar but not identical to those of our main analysis.…”