scholarly journals Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Jill Tinmouth ◽  
Emily T. Vella ◽  
Nancy N. Baxter ◽  
Catherine Dubé ◽  
Michael Gould ◽  
...  
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Fecal Occult ◽  
Evidence Summary ◽  
Screening Intervals ◽  
Meta Analyses

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC.Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions.Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality.Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

scholarly journals Colorectal Cancer Screening: Physicians’ Knowledge of Risk Assessment and Guidelines, Practice, and Description of Barriers and Facilitators

2006 ◽  
Vol 20 (11) ◽  
pp. 713-718 ◽  
Author(s):  
Maida J Sewitch ◽  
Pascal Burtin ◽  
Martin Dawes ◽  
Mark Yaffe ◽  
Linda Snell ◽  
...  
Keyword(s):  
Care Delivery ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Health Care Delivery System ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Barriers To Screening ◽  
Fecal Occult ◽  
Risk Patients

BACKGROUND: Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening.OBJECTIVE: To assess physicians’ knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours.METHODS: Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours.RESULTS: All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities.CONCLUSIONS: Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.

scholarly journals Resource Implications for a Population-Based Colorectal Cancer Screening Program in Canada: A Study of the Impact on Colonoscopy Capacity and Costs in London, Ontario

2007 ◽  
Vol 21 (6) ◽  
pp. 371-377 ◽  
Author(s):  
Agatha Lau ◽  
James C Gregor
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Crc Screening ◽  
Fecal Occult ◽  
Annual Screening

OBJECTIVE: Cancer Care Ontario has recommended a population-based colorectal cancer (CRC) screening program using fecal occult blood testing. Patients who test positive should undergo further investigation, preferably colonoscopy. So far, no studies have been performed to quantify the costs or demands on the health care system at the community level. The number of consultations, colonoscopies and polypectomies, and the corresponding direct medical costs generated by the CRC screening program, between 2006 and 2015 in London, Ontario, were estimated using a decision analysis model in comparison with the population health model.METHODS: A faxed survey study was conducted to examine the current CRC screening practice among family physicians in London. Data from the survey and randomized studies were applied to a decision analysis model, which simulated the steps involved in population-based biennial and annual CRC screening between 2006 and 2015. The number of consultations, colonoscopies and polypectomies, and their associated costs were calculated.RESULTS: For a cohort population of 140,000, between 50 and 74 years of age, in 2006 to 2015, it is estimated that an average of 412 consultations, 463 colonoscopies and 174 polypectomies will be performed per 100,000 screen eligible population per year in biennial screening, and double in annual screening, reflecting an average of 8.7% or 17.6% increase annually in outpatient colonoscopies, respectively, compared with 2003. A mean of $285,000 or $562,000 per year would be required to support the extra consultation and endoscopic procedures generated by the biennial or annual screening.CONCLUSION: Population-based fecal occult blood testing screening for CRC appears to be a manageable strategy if a modest increase in endoscopic resources is allocated.

scholarly journals The Addition of Other Fecal Biomarkers Does Not Improve the Diagnostic Accuracy of Immunochemical Fecal Occult Blood Test Alone in a Colorrectal Cancer Screening Cohort

2021 ◽  
Vol 8 ◽  
Author(s):  
Gonzalo Hijos-Mallada ◽  
Alberto Lué ◽  
Raul Velamazan ◽  
Nuria Saura ◽  
Carlos Abril ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Advanced Neoplasia ◽  
Fecal Occult ◽  
Fecal Biomarkers

Background: Screening with fecal occult blood test reduces colorectal cancer (CRC) incidence and mortality, and is currently implemented in most countries. However, around 40% of screening colonoscopies are normal. Thus, strategies to avoid these colonoscopies are highly necessary. Adding other fecal biomarkers, such as fecal calprotectin (FC), lactoferrin, and transferrin may be useful, but evidence is scarce.Aims: To evaluate the diagnostic accuracy of fecal occult blood immunochemical test (FIT), FC, and a one-step combo card test for the simultaneous semi-qualitative detection of human hemoglobin (hHb), transferrin (hTf), calprotectin (hCp) and lactoferrin (hLf) in a CRC screening program population.Methods: Single-center, prospective observational study, enrolling patients included in a CRC screening program, referred for a colonoscopy due to a positive FIT test. Participants collected a stool sample prior to bowel preparation, and FIT, FC and the combo semi-qualitative tests were performed on the sample. Sensitivity, specificity, positive and negative predictive values and area under receiver operator curve (AUC) for diagnosis of advanced neoplasia, advanced adenoma and CRC were estimated for each biomarker and their combinations. The primary endpoint of the study was to assess whether these biomarkers could improve the diagnostic accuracy of FIT alone.Results: 336 consecutive patients (64% males) were recruited. Advanced neoplasia was found in 129/336 (38.4%) patients, and of these, 22/336 (6.5%) were diagnosed of CRC. 153/336 (45.5%) colonoscopies were completely normal. The AUC for the diagnosis of advanced neoplasia were 0.725 (95%CI 0.665–0.784) for FIT, 0.477 (95%CI 0.413–0.541) for FC and 0.732 (95%CI 0.674–0.791) for the combination of both (FIT + FC) quantitative tests. The AUCs for the combo test were 0.70 (95%CI 0.641–0.760) for hHb, 0.625 (95%CI 0.562–0.698) for hTf, 0.532 (95%CI 0.469–0.595) for hCp, 0.531 (95%CI 0.466–0.595 ) for hLf and 0.681 (95%CI 0.620–0.741) for the combination of the four biomarkers.Conclusion: In average-risk population, FIT appears to be the best fecal marker for the diagnosis of CRC and advanced adenoma. None of the other biomarkers explored or their combinations provided a better diagnostic accuracy. Only hTF showed an acceptable diagnostic accuracy. FC and hLF were not useful in this setting.

scholarly journals Gastroscopy Following a Positive Fecal Occult Blood Test and Negative Colonoscopy: Systematic Review and Guideline

2010 ◽  
Vol 24 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Johane Allard ◽  
Roxanne Cosby ◽  
M Elisabeth Del Giudice ◽  
E Jan Irvine ◽  
David Morgan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Crc Screening ◽  
Fecal Occult

BACKGROUND: A sizeable number of individuals who participate in population-based colorectal cancer (CRC) screening programs and have a positive fecal occult blood test (FOBT) do not have an identifiable lesion found at colonoscopy to account for their positive FOBT screen.OBJECTIVE: To evaluate the evidence and provide recommendations regarding the use of routine esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancers in patients participating in a population-based CRC screening program who are FOBT positive and colonoscopy negative.METHODS: A systematic review was used to develop the evidentiary base and to inform the evidence-based recommendations provided.RESULTS: Nine studies identified a group of patients who were FOBT positive and colonoscopy negative. Three studies found no cases of UGI cancer. Four studies reported cases of UGI cancer; three found UGI cancer in 1% or less of the population studied, and one study found one case of UGI cancer that represented 7% of their small subgroup of FOBT-positive/colonoscopy-negative patients. Two studies did not provide outcome information that could be specifically related to the FOBT-positive/colonoscopy-negative subgroup.CONCLUSION: The current body of evidence is insufficient to recommend for or against routine EGD as a means of detecting gastric or esophageal cancers for patients who are FOBT positive/colonoscopy negative, in a population-based CRC screening program. The decision to perform EGD should be individualized and based on clinical judgement.

scholarly journals Validity of Fecal Occult Blood Test in the National Cancer Screening Program, Korea

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e79292 ◽  
Author(s):  
Aesun Shin ◽  
Kui Son Choi ◽  
Jae Kwan Jun ◽  
Dai Keun Noh ◽  
Mina Suh ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Fecal Occult ◽  
Cancer Screening Program

Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 761-769 ◽  
Author(s):  
Mathieu Pioche ◽  
Christell Ganne ◽  
Rodica Gincul ◽  
Antoine De Leusse ◽  
Julien Marsot ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Computed Tomography Colonography ◽  
Invitation Letter ◽  
Fecal Occult

Abstract Objective Some patients (10 % – 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy. Methods An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE. Results A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, (P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy. Conclusion Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy.

scholarly journals The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program

2018 ◽  
Vol 06 (04) ◽  
pp. E437-E442 ◽  
Author(s):  
Lucas Cavallaro ◽  
Cesare Hassan ◽  
Pierenrico Lecis ◽  
Ermenegildo Galliani ◽  
Elisabetta Dal Pont ◽  
...  
Keyword(s):  
Detection Rate ◽  
Screening Program ◽  
Occult Blood ◽  
Adenoma Detection Rate ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Adenoma Detection ◽  
Number Of Patients ◽  
The Impact

Abstract Background and study aims Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). Patients and methods We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. Results SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different (P = 0.7). ADR was 47 % for SC and 52 % for EAC, P = 0.1. MAP in SC and EAC were 0.87 (range: 0 – 7) and 1.11 (range: 0 – 13) respectively, P = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P = 0.5. Conclusion Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.

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