The Effect of Fecal Occult-Blood Screening on the Incidence of Colorectal Cancer

Mandel, Jack S.; Church, Timothy R.; Bond, John H.; Ederer, Fred; Geisser, Mindy S.; Mongin, Steven J.; Snover, Dale C.; Schuman, Leonard M.

doi:10.1056/nejm200011303432203

Cited by 1,249 publications

(698 citation statements)

References 30 publications

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“…In the United States, practice of colorectal cancer screening is excellent, achieving 90-95% of health care providers recommending screening (Task Force 2002). Our study results showed that CRC screening is underutilized as more than half of the study subjects were not practicing CRC screening in spite of the documented survival benefit from CRC screening (Klabunde 2003, Mandel 2000and Hardcastle 1996. This can be attributed to lack of information and knowledge among the doctors about the recommended screening guidelines and poor awareness about the timing of initiation of screening and its benefits.…”

Section: Discussionmentioning

confidence: 81%

Knowledge and Awareness about Colorectal Cancer and Its Screening Guidelines among Doctors in Al Ahsa, Eastern Province, Kingdom of Saudi Arabia

Surendra

Hashir²,

Harbi

et al. 2016

GJHS

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Introduction: Cancer is a major public health problem. Worldwide, colorectal cancer (CRC) is a leading cause of deaths due to cancer in both men and women. Among, Saudi men, CRC is the most common malignancy while it is the third most common among Saudi women. Over, two decades the incidence and deaths due to CRC have been steadily increasing in Saudi Arabia. Regular and timely screening has the potential in reducing the incidence and deaths due to colorectal cancer. The present study is conducted to evaluate the knowledge and awareness about colorectal cancer and its screening among the doctors. Objectives:To measure the frequency of knowledge and awareness about colorectal cancer and its screening guidelines among doctors in Al-Ahssa. Methods:A questionnaire based survey of the doctors (Specialists & residents), working in different hospitals and primary health centers under the Ministry of Health in Al Ahssa region, Eastern province, KSA. Knowledge and awareness about colorectal cancer and its screening among the doctors is evaluated.Results: Over 80% of the doctors knew, screening reduces deaths due to CRC. Only 60% were aware about the risk factors and less than 50% knew the clinical features of CRC. About 60% doctors agreed Colonoscopy is gold standard screening test. While, less than 60% knew the ideal age to initiate screening and the actual interval of screening tests in the standard risk and high-risk population. Fewer than 25% doctors were aware about the American cancer society recommended screening guidelines. Majority of the doctors expressed keen interest to know and receive information about CRC and its screening guidelines.Conclusions: Regular and timely screening reduces deaths due to CRC. There is a need for improving knowledge and awareness of doctors about CRC and its screening. Awareness among the doctors improves uptake of screening by the general and high-risk population.

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Section: Discussionmentioning

confidence: 81%

Knowledge and Awareness about Colorectal Cancer and Its Screening Guidelines among Doctors in Al Ahsa, Eastern Province, Kingdom of Saudi Arabia

Surendra

Hashir²,

Harbi

et al. 2016

GJHS

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“…3 A and B, showing incidence by birth cohort in various age groups, also exhibit shifting peaks near calendar year 1985. The increase in incidence by calendar year may be related to improved screening for colon cancer, whereas the drop after 1985 could be due to the gradual wearing off of the resulting ''harvesting'' effect (31).…”

Section: Resultsmentioning

confidence: 99%

Multistage carcinogenesis and the incidence of colorectal cancer

Luebeck

Moolgavkar

2002

Proc. Natl. Acad. Sci. U.S.A.

315

335

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We use general multistage models to fit the age-specific incidence of colorectal cancers in the Surveillance, Epidemiology, and End Results registry, which covers Ϸ10% of the U.S. population, while simultaneously adjusting for birth cohort and calendar year effects. The incidence of colorectal cancers in the Surveillance, Epidemiology, and End Results registry is most consistent with a model positing two rare events followed by a high-frequency event in the conversion of a normal stem cell into an initiated cell that expands clonally to give rise to an adenomatous polyp. Only one more rare event appears to be necessary for malignant transformation. The two rare events involved in initiation are interpreted to represent the homozygous loss of adenomatous polyposis coli gene function. The subsequent transition of a preinitiated stem cell into an initiated cell capable of clonal expansion via symmetric division is predicted to occur with a frequency too high for a mutational event but may reflect a positional effect in colonic crypts. Our results suggest it is not necessary to invoke genomic instability to explain colorectal cancer incidence rates in human populations. Temporal trends in the incidence of colon cancer appear to be dominated by calendar year effects. The model also predicts that interventions, such as administration of nonsteroidal anti-inflammatory drugs, designed to decrease the growth rate of adenomatous polyps, are very efficient at lowering colon cancer risk substantially, even when begun later in life. By contrast, interventions that decrease the rate of mutations at the adenomatous polyposis coli locus are much less effective in reducing the risk of colon cancer.T he first attempts to formulate a quantitative description of carcinogenesis reflecting essential biological processes on the pathway from a normal cell to a cancer cell go back almost half a century (1). Perhaps the best known model is due to Armitage and Doll (2), who noticed that the age-specific incidence of many carcinomas appeared to increase approximately with power of age, which could be related to the number of rate-limiting steps involved in the formation of a malignant tumor. However, it was also realized that a two-stage model with clonal expansion of intermediate cell populations could generate similar age-specific incidence curves (3). These considerations, combined with the idea of recessive oncogenesis first formulated by Knudson (4), led to the two-stage clonal expansion (TSCE) model, which explicitly incorporates clonal expansion as a stochastic process during carcinogenesis (5-7).Recent studies of the genetic profiles of various tumors suggest the involvement of several genes during tumorigenesis. A case in point is colorectal cancer, perhaps the best studied cancer in terms of the putative sequence of genetic events in its pathogenesis (8-12). Over the past 10 years, an impressive number of studies have been carried out identifying several molecular pathways involved in the development of colorectal cancer (see ref...

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“…Presymptomatic detection of localized cancer will result in a reduction in morbidity and/or mortality [6,7,8]. If screening detects preinvasive lesions, namely dysplasia, it will reduce cancer incidence [9]. …”

Section: Justification Of New Test Developmentmentioning

confidence: 99%

New Stool Screening Tests for Colorectal Cancer

Young

Cole

2007

Digestion

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Background/Aims: The purpose of this review is to clarify the place of new-technology stool tests in screening for colorectal neoplasia. Findings: New technologies have been based on blood and cellular products of neoplasia. Fecal occult blood tests (FOBTs) based on guaiac (i.e. GFOBTs) have been proved to be effective, but their impact on mortality is modest. When GFOBTs are reconfigured to provide improved sensitivity for cancer, their specificity often becomes unacceptable. Fecal immunochemical tests (FITs) targeting the human hemoglobin molecule have been shown to have better sensitivity for neoplasia without an unacceptable deterioration in specificity. The new stool-sampling technologies for FITs also improve population participation rates in screening. Most recently, quantitative FITs have become available; these provide flexibility for the end-user as a desired sensitivity: specificity ratio can be selected that is feasible in the context of available colonoscopic resources. A multi-target fecal DNA test, comprising a test for undegraded DNA and certain common mutations, was found more sensitive for cancer, but not for adenoma, than the early GFOBTs. A more recent version including an epigenetic marker for the vimentin gene has further improved sensitivity for cancer, but performance relative to GFOBT or FIT is not clear. These ‘fecal DNA tests’ have not proved to be more specific for neoplasia than tests that detect blood. Conclusions: FIT should replace GFOBT as the first test in two-step screening of large populations. It is not yet clear that tests targeting nonhemoglobin molecular events provide a clear advantage over FIT.

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The Effect of Fecal Occult-Blood Screening on the Incidence of Colorectal Cancer

Abstract: The use of either annual or biennial fecal occult-blood testing significantly reduces the incidence of colorectal cancer.

Cited by 1,249 publications

References 30 publications

Knowledge and Awareness about Colorectal Cancer and Its Screening Guidelines among Doctors in Al Ahsa, Eastern Province, Kingdom of Saudi Arabia

Knowledge and Awareness about Colorectal Cancer and Its Screening Guidelines among Doctors in Al Ahsa, Eastern Province, Kingdom of Saudi Arabia

Multistage carcinogenesis and the incidence of colorectal cancer

New Stool Screening Tests for Colorectal Cancer

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