Physician’s awareness and practices toward colorectal cancer screening guidelines.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 431-431 ◽  
Author(s):  
Sowjanya Kanna ◽  
Asif Ali ◽  
Kiran Anna ◽  
Thimmaiah Theethira Ganapathi ◽  
Raja Shekhar Reddy Sappati Biyyani ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Text Messaging ◽  
Academic Medical Center ◽  
Screening Colonoscopy ◽  
Study Group ◽  
Screening Guidelines ◽  
Crc Screening ◽  
Phone Calls ◽  
Continued Education ◽  
Attending Physicians

431 Background: Colorectal cancer (CRC) is the second most common cancer with an estimated incidence of 72,090 men and 70,480 women and a cause specific mortality of 51,370 in 2010. Despite promotion of CRC screening by various professional societies ACG /AGA and USPSTF, there seems to be an under utilization of screening colonoscopy for unclear reasons. We aimed to study the awareness of physicians towards CRC screening across various levels of training in different specialities. Methods: A survey questionnaire of 16 questions, assessing awareness of CRC screening guidelines was provided to 100 physicians in our academic medical center who are at various levels of training in Primary Care Group (PCG comprising residents, attending physicians in Internal Medicine and Family Medicine) and Specialty Group (SG comprising fellows, attending physicians in Gastroenterology). Results: Out of 100 questionnaires, we received 59 responses (50 PCG and 9 SG) which are included in the results. About 54% of the study group followed CRC guidelines (32% USPSTF CRC screening guidelines compared to 22 % ACG/AGA guidelines) and 46% did not. All the physicians who did not follow the guidelines belonged to the PCG. Most common screening modality chosen was colonoscopy alone (46% PCG and 100% SG), followed by colonoscopy with FOBT (36% PCG), FOBT (12% PCG) and 3% PCG answered barium enema along with FOBT/ sigmoidoscopy. A 100% response from both SG and PCG was obtained for commencing screening colonoscopy at 50 years of age but only 27% of the PCG compared to 80% SG were aware of the screening cessation guidelines. Interestingly a vast majority of the study group (88%) text messaging as a better way of reminder to improve compliance compared to phone calls and postal letters. About 72% of the respondents themselves would want colonoscopy as screening modality compared to 17% for FOBT and 7% for sigmoidoscopy. An overwhelming majority of the study group (80% of both PCG and SG) felt the need for continued education in regards to guidelines for screening in didactic sessions. Conclusions: Despite clear guidelines for screening colonoscopy, we found a significant lack of awareness amongst PCG compared to SG, and our study emphasizes the need for continued education.

scholarly journals Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients

2020 ◽  
Vol 08 (10) ◽  
pp. E1423-E1428
Author(s):  
Monica Riegert ◽  
Monica Nandwani ◽  
Bonny Thul ◽  
Angela Chang Chiu ◽  
Simon C. Mathews ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Indicators ◽  
Nurse Practitioners ◽  
Task Force ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Screening Colonoscopy ◽  
Crc Screening ◽  
Adenoma Detection

Abstract Background and study aims The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option. However, current literature on the performance of non-physicians in endoscopy is limited. The aim of this study was to assess the quality of colonoscopy performed by three gastrointestinal fellowship-trained nurse practitioners (NPs). Methods This was a retrospective study performed at a single tertiary academic medical center. Colonoscopies performed by three gastrointestinal-specialized NPs after having completed training of at least 140 supervised colonoscopies were reviewed for analysis. Inclusion criteria were patients undergoing colonoscopy for colorectal cancer screening purposes. Outcomes included colonoscopy quality indicators as defined by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce (ASGE/ACG) Taskforce. Results The study included 1,012 subjects (mean age 56.2 years, female 51.5 %, African American 73.9 %) who underwent screening colonoscopies by three NPs. Cecal intubation was successful in 997 subjects (98.5 %). Mean adenoma detection rate was 35.6 %. Mean withdrawal time was 18.9 minutes. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding. Conclusions Three fellowship-trained NPs in colonoscopy in the United States satisfied the quality indicators proposed by the ASGE/ACG Task force, demonstrating that adequately trained NPs can perform colonoscopy safely and effectively. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to meet the demands for CRC screening.

scholarly journals Colorectal cancer screening using a stool DNA-based SDC2 methylation test: a multicenter, prospective trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chang Woo Kim ◽  
Hyunjin Kim ◽  
Hyoung Rae Kim ◽  
Bong-Hyeon Kye ◽  
Hyung Jin Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Early Detection ◽  
Prospective Trial ◽  
Screening Colonoscopy ◽  
Quantitative Detection ◽  
Screening Programs ◽  
Crc Screening ◽  
Stool Dna ◽  
Dna 2

Abstract Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. Methods All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central laboratory for analysis. Stool DNA will be isolated using a GT Stool DNA Extraction kit, according to the manufacturer’s protocol. Before performing the methylation test, stool DNA (2 µg per reaction) will be treated with bisulfite, according to manufacturer’s instructions. SDC2 and COL2A1 control reactions will be performed in a single tube. The SDC2 methylation test will be performed using an AB 7500 Fast Real-time PCR system. CT values will be calculated using the 7500 software accompanying the instrument. Results from the EarlyTect™-Colon Cancer test will be compared against those obtained from colonoscopy and any corresponding diagnostic histopathology from clinically significant biopsied or subsequently excised lesions. Based on these results, participants will be divided into three groups: CRC, polyp, and negative. The following clinical data will be recorded for the participants: sex, age, colonoscopy results, and clinical stage (for CRC cases). Discussion This trial investigates the clinical performance of a device that allows quantitative detection of a single DNA marker, SDC2 methylation, in human stool DNA in asymptomatic populations. The results of this trial are expected to be beneficial for CRC screening and may help make colonoscopy a selective procedure used only in populations with a high risk of CRC. Trial registration: This trial (NCT04304131) was registered at ClinicalTrials.gov on March 11, 2020 and is available at https://clinicaltrials.gov/ct2/show/NCT04304131?cond=NCT04304131&draw=2&rank=1.

scholarly journals Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence

2021 ◽  
Vol 18 (9) ◽  
pp. 4398
Author(s):  
Kiara N. Mayhand ◽  
Elizabeth A. Handorf ◽  
Angel G. Ortiz ◽  
Evelyn T. Gonzalez ◽  
Amie Devlin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Study Participant ◽  
Socioeconomic Indicators ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Total Study Population ◽  
Screening Guidelines ◽  
Individual Level ◽  
Crc Screening ◽  
Screening Adherence

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

Su1049 FIT-Positive Colorectal Cancer (CRC) Screening Colonoscopy: High Sensitivity or Just Serendipity?

2016 ◽  
Vol 150 (4) ◽  
pp. S456
Author(s):  
David Gibson ◽  
Blathnaid Nolan ◽  
Joanna Rea ◽  
Maire Buckley ◽  
Gareth Horgan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Sensitivity ◽  
Screening Colonoscopy ◽  
Crc Screening

scholarly journals Mapping the Colorectal Cancer Screening Scientific Landscape in South Africa: A Bibliometric Analysis to Identify Inequalities

2021 ◽  
Vol 2 (1) ◽  
pp. 27-34
Author(s):  
Magwaza S
Keyword(s):  
Colorectal Cancer ◽  
South Africa ◽  
South African ◽  
Bibliometric Analysis ◽  
Screening Colonoscopy ◽  
Scientific Publications ◽  
Crc Screening ◽  
Research Areas ◽  
Keywords Colorectal Cancer ◽  
Research Organisations

Background This paper maps scientific publications to identify areas of CRC screening that are currently receiving greatest emphasis in South African research, as means, to identify the inequality in CRC screening research. Reviewing the publications can assist to identify research funding and research capacity gaps. It can also identify potential for collaboration of authors and institutions to reduce the inequalities. Methods We used bibliometrics to identify and map the scientific publications on CRC screening related to South Africa (SA).The search utilised three databases, namely: Web of Science, Scopus and PubMed to identify articles published between January 2000 to August 2020. We identified the document by type, research areas, journal type, affiliated countries and research organisations, authors with most publications, and funding sources. Results Forty-eight of the 368 publications were included for bibliometric analysis. Of these, there were 88% original articles; 6% were reviews; 4% were books and 2% were abstracts of meetings. The top CRC screening research areas were oncology (21%); gastroenterology and hepatology (13%), public, environmental, occupational health (13%) and genetics and heredity (13%).The top four journals that have published the CRC screening related to South Africa were the South African Medical J. Surgery (10%); South African Medical Journal (7%); Clinical Genetics (5%) and Colorectal Diseases (5%). 19% of articles were published in 2019. There were 28 (58%) articles with first authors from South Africa. There were ten publications without funding declared (21%). The top five research organisations from South Africa that published the most CRC screening research were University of Witwatersrand (36%); University of Western Cape (18%); University of Pretoria (14%); University of Cape Town and KwaZulu-Natal (11%). Conclusion Research and development of novel CRC screening technologies cannot be overemphasised, as catalyst for diverse screening alternatives that are less invasive, affordable and accessible to all those in need to expand access, coverage and increase uptake at local level. Keywords: Colorectal cancer; Bibliometric; Screening; Colonoscopy; Scientific landscape; Inequalities; Cancer; South Africa.

scholarly journals Strongly Divergent Impact of Adherence Patterns on Efficacy of Colorectal Cancer Screening: The Need to Refine Adherence Statistics

2020 ◽  
Author(s):  
Thomas Heisser ◽  
Rafael Cardoso ◽  
Feng Guo ◽  
Tobias Moellers ◽  
Michael Hoffmeister ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Colonoscopy ◽  
German Population ◽  
Long Term Effects ◽  
Screening Programs ◽  
Crc Screening ◽  
New Findings

AbstractObjectiveThe performance of colorectal cancer (CRC) screening programs depends on the adherence to screening offers. However, identical adherence levels may result from varying patterns of the population’s screening behavior. We quantified the effects of different adherence patterns on the long-term performance of CRC screening for annual fecal immunochemical testing (FIT) and screening colonoscopy at ten-year intervals.DesignUsing a multistate Markov model, we simulated scenarios where, while at the same overall adherence level, a certain proportion of the population adheres to all screening offers (‘selective’ adherence) or the entire population uses the screening offers at some point(s) of time, albeit not in the recommended frequency (‘sporadic’ adherence). Key outcomes for comparison were the numbers of prevented CRC deaths and prevented years of potential life lost (YPLL) after 50 simulated years.ResultsFor screening with annual FIT at adherence levels of 10-50%, ratios of prevented CRC deaths (YPLL) resulting from a sporadic versus a selective pattern ranged from 1.9-5.0 (1.9-5.0) for men and from 1.8-4.1 (1.8-4.3) for women, i.e. up to 4-5 times more CRC deaths and YPLL were prevented when the population followed a sporadic instead of a selective adherence pattern. Comparisons of simulated scenarios for screening colonoscopy revealed similar patterns.ConclusionAt the same overall level of adherence, ‘sporadic’ adherence patterns go along with much larger preventive effects than ‘selective’ adherence patterns. Screening programs should prioritize efforts to reach as many people as possible at least sporadically over efforts to maximize full adherence to repeat screening offers. Adherence statistics should be refined to better reflect ‘effective adherence’.What You Need to KnowBACKGROUND AND CONTEXTThe evidence on long-term effects of different patterns of longitudinal adherence (e.g. consistent or sporadic uptake) to colorectal cancer screening offers is limited.NEW FINDINGSIn a simulated hypothetical German population, at identical overall participation levels, large proportions of the population making sporadic use of screening offers were up to 4-5 times more beneficial to achieve sustained reductions of colorectal cancer mortality than small proportions of the population utilizing screening offers at the recommended frequency.LIMITATIONSThis study is limited by model simplifying assumptions and uncertainties related to input parameters.IMPACTEfforts to increase screening uptake should be concentrated on groups of consistent non-responders, e.g. by low-threshold screening offerings, such as directly mailed stool tests. Adherence statistics should be refined to better reflect “effective adherence”.SHORT SUMMARYThis simulation study demonstrates that commonly used adherence metrics for colorectal cancer screening do not sufficiently cover the effect of varying patterns of longitudinal adherence, which may considerably impact the long-term efficacy of screening programs.

Sensitivity of second-generation blood-based methylated Septin9 assay for early-stage colorectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 419-419 ◽  
Author(s):  
Gunter Weiss ◽  
Anne Fassbender ◽  
Thomas Koenig ◽  
Reimo Tetzner
Keyword(s):  
Colorectal Cancer ◽  
Real Time ◽  
Real Time Pcr ◽  
Early Stage ◽  
Screening Colonoscopy ◽  
Molecular Diagnostic ◽  
Control Group ◽  
Average Risk ◽  
Early Stage Disease ◽  
Crc Screening

419 Background: Early detection of colorectal cancer (CRC) has been shown to decrease mortality, although compliance to CRC screening is low. Availability of a blood-based test is expected to improve CRC screening compliance. Specific detection of CRC using the Septin9 biomarker (mSEPT9) in a large prospective trial of an average-risk CRC screening population exhibited 67% sensitivity for CRC with 88% specificity. Laboratory-developed tests detecting mSEPT9 in plasma are now available in North America and a 2nd generation molecular diagnostic blood test for mSEPT9 is available as a CE-marked kit in Europe. The current research evaluated the clinical performance of the 2nd generation mSEPT9 assay. Methods: Bisulfite-converted DNA (bisDNA) was prepared from 3.5 mL human plasma using the 2ndgeneration plasma DNA preparation kit. Resulting bisDNA was analyzed in triplicate on the ABI7500 Fast Dx (Life Technologies, Inc.) using proprietary HeavyMethyl real-time PCR technology for mSEPT9 and the 2nd generation real-time PCR kit. In a case – control design, plasma from 98 CRC patients (n = 87 stages I - III) and 99 age-matched, colonoscopy-verified normal individuals were processed with the mSEPT9 assay. In addition, plasma from 150 prospectively enrolled average risk individuals scheduled for screening colonoscopy was tested. mSEPT9 was qualitatively analyzed such that any detection of mSEPT9 in a PCR was called “positive”. Results: The revised mSEPT9 assay exhibited 95% sensitivity (95% CI: 89-98%) for CRC. Sensitivity for stage I was 89% (95% CI: 72-96%, n = 27) and sensitivity for stage II was 93% (95% CI: 78-98%, n = 29). The control group was positive at a rate of 16% (95% CI: 10-25%). Specificity of the mSEPT9 assay in the screening cohort was 85% (95% CI: 78-89%). Conclusions: The 2nd generation mSEPT9 assay demonstrated improved sensitivity for CRC without significant impact on specificity. The enhanced design and robustness of the assay will further facilitate its standardized use in routine laboratory settings. Finally, the increased sensitivity of the revised mSEPT9 assay improves the detection of early stage disease and demonstrates the feasibility of a blood-based CRC screening technology.

Potential of a New Blood Test for Colorectal Cancer Screening –The Septin 9 Gene Biomarker

2010 ◽  
Vol 06 (01) ◽  
pp. 51 ◽  
Author(s):  
Gunter Weiss ◽  
Thomas Rösch ◽  
◽  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Blood Test ◽  
Compliance Rate ◽  
Screening Colonoscopy ◽  
Potential Candidate ◽  
Crc Screening ◽  
Methylated Dna ◽  
Septin 9

Despite clear evidence for a better prognosis when detected early, in most countries colorectal cancer (CRC) has a low compliance rate in terms of screening. There are several methods of CRC screening ranging from a variety of stool tests, e.g. faecal occult blood test (FOBT), to endoscopy (sigmoidoscopy, colonoscopy). A blood test for CRC detection is a new alternative, at least for patients not willing to accept screening colonoscopy or to undergo FOBT. The septin 9 biomarker is a potential candidate to fulfil this purpose. It has been validated in several case–control studies, showing a strong association of plasma-containing methylated DNA within the septin 9 gene (mSEPT9) with the presence of CRC. If sensitive methylated-DNA-detection technologies are used formSEPT9 detection in blood plasma samples, sensitivities of about 50% for stage I, 70–80% for stages II and III and 90–100% for stage IV at a specificity of ≥90% have been reported in these studies. Screening experts assume that such a blood-based test will increase compliance to CRC screening. Further studies are ongoing or have just been completed, including a large prospective screening trial involving 8,000 individuals in the US and Germany. The main objectives of this clinical investigation, called Prospective Evaluation of Septin 9 Performance for Colorectal Cancer Screening (PRESEPT), are to determine the performance of the septin 9 test for identification of CRC in a screening population and to demonstrate the health economic benefit of septin 9 in this setting. Results are expected in April 2010. This article presents an update on current analytical and clinical data onmSEPT9.

Nurse Practitioner Knowledge of and Experienced Barriers to High-Risk Colorectal Cancer Screenings

2016 ◽  
Vol 9 (2) ◽  
pp. 229-235
Author(s):  
Lecia Reardon
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Health Outcomes ◽  
Nurse Practitioners ◽  
Practice Patterns ◽  
Screening Guidelines ◽  
Targeted Interventions ◽  
Crc Screening ◽  
Screening Barriers ◽  
Improve Health

Problem: Evidence supports earlier preventive colorectal cancer (CRC) screening for high-risk individuals. Awareness of high-risk factors and application to screening guidelines can enable nurse practitioners (NPs) to positively impact screening rates. Application of this knowledge can transform high-risk CRC screenings from tertiary CRC diagnosis to primary and secondary prevention to improve health outcomes. Purpose: To survey NP knowledge, perceived barriers, and current practice patterns in referring high-risk individuals for CRC screenings. Methods: A 16-question Qualtrics Internet survey designed, tested, and emailed to 2,155 primary care NPs in North Carolina. Results: One hundred eighty respondents (8.3%) completed the survey, with 57.5% (n = 104) rating themselves knowledgeable of high-risk CRC screening guidelines. Screening barriers included uninsured status, patient refusal, and lack of access. Aggregate practice screening pattern questions were related to self-perceived knowledge of high-risk CRC guidelines (χ2 = 4.1918, df = 1, p = .04). Conclusion: Over half (57.8%) of the respondents reporting knowledge of high-risk CRC guidelines had statistically significant relationship in aggregate practice patterns. Reduction of screening barriers using targeted interventions may improve health outcomes.

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