Colorectal cancer (CRC) screening has been demonstrated to reduce CRC incidence and mortality. However, besides such benefits, CRC screening is also associated with potential harmful effects. In an ...ideal world, screening would only be directed to the small proportion of the population that might potentially benefit. Risk‐based screening can be seen as a first step towards this ideal world, by redistributing screening resources from low‐risk to high‐risk individuals. In theory, this should result in scarce resources being used in individuals who benefit most, while intensity of screening is reduced in individuals who benefit less, hence improving the benefit‐harm ratio among all invitees. Available strategies that have been proposed for risk‐based CRC screening include using information on age, sex, prior screening history, lifestyle and/or genetic information. Implementation of risk‐based screening requires careful consideration of reliable risk prediction models, participation with screening and informed decision‐making. While it is important to recognise the limitations of current approaches, available evidence suggests that it might be feasible to start planning the introduction of tailored strategies within screening programmes. Implementing risk‐based screening based on age, sex and prior screening history alone would already represent a substantial improvement over current uniform screening approaches. We propose that it is time that screening programmes start there and continue striving towards more comprehensive approaches embedding primary prevention as an effective approach to lower risk for everyone.
On the basis of long-term follow-up data from the National Polyp Study, the authors estimate that mortality from colorectal cancer was about 50% lower among patients who had adenomatous polyps ...removed than in the general population.
It has been a long-standing belief that screening for colorectal cancer can affect mortality from the disease in two ways: by detecting cancers at an early, curable stage and by detecting and removing adenomas.
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Detection of early-stage colorectal cancer has been shown to be associated with a reduction in mortality from colorectal cancer in screening trials.
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However, an adenomatous polyp is a much more common neoplastic finding on endoscopic screening. We previously reported that colonoscopic polypectomy in the National Polyp Study (NPS) cohort reduced the incidence of colorectal cancer.
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An important question is whether the cancers prevented by colonoscopic . . .
Abstract Gastric cancer is the second leading cause of cancer-related death worldwide. A meta-analysis of seven randomized controlled trials concluded that Helicobacter pylori eradication reduces ...gastric cancer incidence by 35%. Current consensus is that H. pylori screening and treatment is cost-effective only in high-risk populations. This paper provides an up-to-date overview of the evidence for cost-effectiveness of H. pylori screening and treatment in different population settings and risk levels for H. pylori infection. Ten unique cost-effectiveness or cost–utility analyses were identified. All found that screening for H. pylori to prevent gastric cancer in the general population costs less than $50,000 per LYG. This finding was robust for differences in H. pylori prevalence, gender and ethnicity. Based on limited evidence, re-treatment (for treatment failure), repeated screening, limiting screening and treatment to those with the CagA phenotype, or universal treatment, does not appear to be cost-effective. However, most included studies failed to consider both the broader benefits as well as the adverse effects of widespread use of antibiotics for H. pylori.
Populations differ with respect to their cancer risk and screening preferences, which may influence the performance of colorectal cancer (CRC) screening programs. This review aims to systematically ...compare the mortality effect of CRC screening across European regions.
Six databases including Embase, Medline, Web of Science, PubMed publisher, Google Scholar and Cochrane Library were searched for relevant studies published before March 2018. Bibliographic searches were conducted to select studies assessing the effect of various screening tests (guaiac fecal occult blood test gFOBT; flexible sigmoidoscopy FS; fecal immunochemical test FIT and colonoscopy) on CRC mortality in Europe (PROSPERO protocol: CRD42016042433). Abstract reviewing, data extraction and risk of bias assessment were conducted independently by two reviewers.
A total of 18 studies were included; of which, 11 were related to gFOBT, 4 to FS, 2 to FIT and 1 to colonoscopy; 8 were randomised clinical trials, and 10, observational studies, and an approximately equal number of studies represented Northern, Western and Southern European regions. Among individuals invited to screening, CRC mortality reductions varied from 8% to 16% for gFOBT and from 21% to 30% for FS. When studies with a high risk of bias were considered, ranges were more extensive. The estimated effectiveness of gFOBT and FS screening appeared similar across different European regions.
CRC mortality impact of inviting individuals with similar adopted screening strategies (gFOBT or FS) may be consistent across several European settings.
•Populations differ with respect to their cancer risk and screening preferences.•This systematic review assessed published evidence of colorectal cancer screening in Europe.•Screening studies from Northern, Western and Southern European regions were reviewed.•Similar adopted screening strategies (guaiac fecal occult blood test or flexible sigmoidoscopy) may have a consistent impact across Europe.
Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons.
To estimate life expectancy for elderly persons without a history ...of cancer, taking into account comorbid conditions.
Population-based cohort study.
A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information.
Medicare beneficiaries aged 66 years or older between 1992 and 2005 without a history of cancer (n = 407 749).
Medicare claims were used to identify comorbid conditions included in the Charlson index. Survival probabilities were estimated by comorbidity group (no, low/medium, and high) and for the 3 most prevalent conditions (diabetes, chronic obstructive pulmonary disease, and congestive heart failure) by using the Cox proportional hazards model. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Survival probabilities from the U.S. life tables providing the most similar survival experience to the cohort of interest were used.
Persons with higher levels of comorbidity had shorter life expectancies, whereas those with no comorbid conditions, including very elderly persons, had favorable life expectancies relative to an average person of the same chronological age. The estimated life expectancy at age 75 years was approximately 3 years longer for persons with no comorbid conditions and approximately 3 years shorter for those with high comorbidity relative to the average U.S. population.
The cohort was limited to Medicare fee-for-service beneficiaries aged 66 years or older living in selected geographic areas. Data from the Surveillance, Epidemiology, and End Results cancer registry and Medicare claims lack information on functional status and severity of comorbidity, which might influence life expectancy in elderly persons.
Life expectancy varies considerably by comorbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients.
The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data ...from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round.
What's new?
In 2014, the Netherlands implemented colorectal cancer (CRC) screening based on non‐invasive fecal immunochemical testing (FIT), which offers a practical approach for population‐based CRC detection. In the Dutch program's first round, to match local resources, FIT cut‐off was increased, resulting in reduced positivity rates and reduced colonoscopy referrals, at the cost of missing advanced neoplasias. The current study shows that many of these missed advanced neoplasias were detected in subsequent screening, suggesting that increased FIT cut‐off had marginal impact on screening outcome. The findings could benefit other CRC screening programs in establishing effective FIT cut‐offs.
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