Risk stratification and detection of new colorectal neoplasms after colorectal cancer screening with faecal occult blood test

Bjerrum, Andreas; Milter, Maya Christel; Andersen, O. Ortved; Fischer, Anders; Lynge, Elsebeth

doi:10.1097/meg.0000000000000451

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…Since the 2012 recommendations, a number of studies have been published that included evaluation of risk among patients with 3-10 adenomas. These studies are consistent in demonstrating that individuals with 3-10 adenomas are at increased risk for advanced neoplasia [25][26][27][28][29][30] and even CRC alone 26,31 on follow-up. However, we were specifically interested in whether there was sufficient evidence to support longer surveillance intervals for patients with 3-4 small (<10 mm) adenomas.…”

Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Risksupporting

confidence: 67%

“…Since the 2012 recommendations, additional studies have confirmed and extended the evidence supporting identification of 1 or more adenomas 10 mm size as a high-risk feature. [25][26][27]30,31 A study of 2990 patients from the Netherlands diagnosed with adenoma 1988-2002 and followed through 2008 found size 10 mm was independently associated with 1.7-fold increased risk for metachronous advanced neoplasia (OR, 1.7; 95% CI, 1.2-2.3). 30 A cohort study of 3300 patients diagnosed with adenomas at a large integrated US health care system found that size 10 mm was independently associated with 3.6-fold increased risk for advanced adenoma (OR, 3.6; 95% CI, 2.8-4.5) and 5.2-fold increased risk for CRC on follow-up (OR, 5.2; 95% CI, 1.8-15.1).…”

Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Riskmentioning

confidence: 99%

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Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

et al. 2020

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C olonoscopy is performed routinely for colorectal cancer (CRC) screening, follow-up of other abnormal screening tests, workup of signs and symptoms of gastrointestinal disease, and surveillance after CRC and polyp removal. Post procedure, colonoscopists are expected to provide followup recommendations to patients and referring physicians. Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and postpolypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance. 1 Risk of metachronous advanced neoplasia is associated with findings on prior colonoscopy. After high-quality colonoscopy, patients with no neoplasia detected are at the lowest risk, and those with polyps are risk-stratified based on the histology, number, location, and size of polyps detected. Since the release of the last US Multi-Society Task Force (Task Force) recommendations for post-colonoscopy follow-up and polyp surveillance in 2012, 2 a number of articles have been published on risk of CRC based on colonoscopy findings and patient characteristics, as well as the potential impact of screening and surveillance colonoscopy on outcomes, such as incident CRC and polyps. Further, recent studies increasingly reflect the modern era of colonoscopy with more awareness of the importance of quality factors (eg, adequate bowel preparation, cecal intubation, adequate adenoma detection, and complete polyp resection), and utilization of state of the art technologies (eg, high-definition colonoscopes). Higher-quality colonoscopy could impact the importance of previously identified risk factors. Our aim was to review newly available evidence and update recommendations for follow-up after colonoscopy with or without polypectomy. Methods Evidence Review and Recommendation DevelopmentTo identify issues of greatest importance for the current revision, we developed PICO (patient, intervention, comparison, and outcome) questions (Supplementary Appendix A [SG and DL, with input from TK]). In consultation with a certified medical librarian (KH), literature searches were performed in PubMed, Embase, and CINAHL with a combination of controlled vocabulary and keyword terms for colonoscopy, polyps, and polypectomy surveillance (see Supplementary Appendix B for search terms). English-language articles since January 1, 2012 were retrieved. Searches were run on March 30, 2017, and identified a total of 1904 unique articles (see Supplementary Appendix C for article selection flow).Criteria used for inclusion/exclusion of titles, abstracts, and articles are outlined in Table 1. All titles were reviewed by a single author (SG) and potentially relevant titles were selected for abstract review. All abstracts were reviewed by 2 authors (SG and DL) and potentially relevant abstracts were selected for full article review. Included articles were reviewed in detail by the same 2 authors. The final list of articles selected for review was supplemented by repeating the literature search through S...

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Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Risksupporting

confidence: 67%

Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Riskmentioning

confidence: 99%

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

et al. 2020

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“…For identification of interval cancers, detected prior to the next scheduled screening appointment, we developed an evaluation process in which screening registries and cancer registries were linked, including data on causes of death 11 12 13 . Interval post-colonoscopy colorectal cancer was defined as CRC diagnosed after a screening or surveillance exam in which no cancer was detected and before the date of the next recommended exam 11 .…”

Section: Introductionmentioning

confidence: 99%

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

Portillo¹,

Idígoras²,

Bilbao³

et al. 2018

Endosc Int Open

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Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥ 20 ug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80 %) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1 %) advanced adenomas and 2,607 (5.3 %) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64 %, 63.1 % in academic hospitals and 66.4 % in non-academic hospitals ( P < 0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8 %, 96.2 % and 88.3 %, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3 % vs 48.7 %; odds ratio [OR] 0.87, 95 % confidence interval [CI] 0.84 – 0.91; 95.9 % vs 97 %; OR 0.48, 95 % CI 0.38 – 0.69; and 86.4 % vs 93 %; OR 0.48, 95 % CI 0.45 – 0.5; respectively; P < 0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 cases × 1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30 %). The rate of severe complication was 1.2 % (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329. One patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.

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“…1,42 Colonoscopy screening alone has resulted in a 90% chance of survival and declining CRC incidence rates among adults aged .55 years. 43 However, the survival rate is reduced to ,10% for late diagnosis of metastatic CRC, 1 demonstrating that early detection is key for patient outcomes. The goal is to use defined microbial signatures as a tool to lead to earlier and less invasive methods of CRC diagnosis.…”

Section: Application Of the Microbiome In Crc Prevention And Therapymentioning

confidence: 99%

The Microbiome Colorectal Cancer Puzzle: Initiator, Propagator, and Avenue for Treatment and Research

Knippel

Sears

2021

Journal of the National Comprehensive Cancer Network

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The human gut microbiome has an ever-increasing role in the instigation and progression of colorectal cancer (CRC). Recent investigations have focused on identifying the key causative bacterial species and the composition and structure of the microbiome as a whole that ultimately lead to tumorigenesis in the colon. Understanding the bacterial mechanisms that promote CRC provides a rich area for the development of new screening modalities and therapeutics that may improve patient outcomes. This article reviews the various mechanisms that bacteria in the gut use to induce and/or promote tumor formation, discusses the application of the microbiome in the prevention and therapy of CRC, and provides directions for future research endeavors aiming to develop a more complete understanding of this complex phenomenon.

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Risk stratification and detection of new colorectal neoplasms after colorectal cancer screening with faecal occult blood test

Abstract: Risk stratification of adenoma patients, as recommended by the European guidelines, is appropriate for postpolypectomy surveillance after FOBT screening.

Cited by 15 publications

References 26 publications

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

The Microbiome Colorectal Cancer Puzzle: Initiator, Propagator, and Avenue for Treatment and Research

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