This analysis of Norwegian registry data suggests that colonoscopic surveillance during the 8 years after removal of low-risk adenomas is not required for a reduction in colorectal-cancer mortality.
...Screening programs for colorectal cancer are currently implemented in many Western populations
1
,
2
because randomized trials have documented an association between screening and a sustained reduction in colorectal-cancer mortality.
3
The benefit is most likely due to early detection of cancer, endoscopic removal of adenomas, and surveillance of patients who are considered to be at high risk for the development of new neoplastic lesions.
4
,
5
However, precise quantification of the risk of death from cancer after adenoma removal has been hampered by the scarceness of large, population-based studies with long follow-up periods.
Previous studies were performed in populations undergoing intensive surveillance, . . .
Improving cancer screening programs Kalager, Mette; Bretthauer, Michael
Science (American Association for the Advancement of Science),
01/2020, Letnik:
367, Številka:
6474
Journal Article
Recenzirano
Evaluating diagnostic tests in learning screening programs could improve public health
National cancer screening programs, such as mammography for breast cancer, are widely implemented to reduce ...cancer incidence and mortality in high-income countries. Their introduction is also being considered in low- and middle-income countries. For many cancer types, the benefits and harms of different screening tests and the intervals at which they should be implemented are unknown. Thus, randomized comparison testing is warranted. However, this is not possible because most people in high-income countries have already undergone screening or have refused screening and are not comparable (
1
). There is an ethical, medical, economic, and societal imperative for continuous evaluation of cancer screening programs to ensure that their benefits outweigh any harms. This may be achievable if the screening programs can become the arena for clinical testing through the implementation of learning screening programs.
Assessment of the effect of breast-cancer screening has been hampered by difficulty in measuring secular trends. In this study, data from a cancer registry were used to determine secular trends and ...to evaluate the effect of screening on breast-cancer mortality.
On the basis of several randomized clinical trials,
1
–
3
the World Health Organization concluded in 2002 that screening mammography for women between the ages of 50 and 69 years reduced the rate of death from breast cancer by 25%.
4
Nevertheless, the use of screening mammography is still debated, chiefly because of concern regarding methodologic limitations in some of the randomized trials.
5
In addition, the benefit of mammography when implemented in a population-based service program remains poorly quantified. Therefore, continued evaluation of breast-cancer screening programs is warranted.
6
The main challenge in quantifying the reduction in mortality from nonrandomized screening programs is . . .
Artificial intelligence (AI)-based polyp detection systems are used during colonoscopy with the aim of increasing lesion detection and improving colonoscopy quality.
We performed a systematic review ...and meta-analysis of prospective trials to determine the value of AI-based polyp detection systems for detection of polyps and colorectal cancer. We performed systematic searches in MEDLINE, EMBASE, and Cochrane CENTRAL. Independent reviewers screened studies and assessed eligibility, certainty of evidence, and risk of bias. We compared colonoscopy with and without AI by calculating relative and absolute risks and mean differences for detection of polyps, adenomas, and colorectal cancer.
Five randomized trials were eligible for analysis. Colonoscopy with AI increased adenoma detection rates (ADRs) and polyp detection rates (PDRs) compared to colonoscopy without AI (values given with 95 %CI). ADR with AI was 29.6 % (22.2 % - 37.0 %) versus 19.3 % (12.7 % - 25.9 %) without AI; relative risk (RR 1.52 (1.31 - 1.77), with high certainty. PDR was 45.4 % (41.1 % - 49.8 %) with AI versus 30.6 % (26.5 % - 34.6 %) without AI; RR 1.48 (1.37 - 1.60), with high certainty. There was no difference in detection of advanced adenomas (mean advanced adenomas per colonoscopy 0.03 for each group, high certainty). Mean adenomas detected per colonoscopy was higher for small adenomas (≤ 5 mm) for AI versus non-AI (mean difference 0.15 0.12 - 0.18), but not for larger adenomas (> 5 - ≤ 10 mm, mean difference 0.03 0.01 - 0.05; > 10 mm, mean difference 0.01 0.00 - 0.02; high certainty). Data on cancer are unavailable.
AI-based polyp detection systems during colonoscopy increase detection of small nonadvanced adenomas and polyps, but not of advanced adenomas.
Main Recommendations
The following recommendations for post-polypectomy colonoscopic surveillance apply to all patients who had one or more polyps that were completely removed during a high quality ...baseline colonoscopy.
1
ESGE recommends that patients with complete removal of 1 – 4 < 10 mm adenomas with low grade dysplasia, irrespective of villous components, or any serrated polyp < 10 mm without dysplasia, do not require endoscopic surveillance and should be returned to screening.
Strong recommendation, moderate quality evidence.
If organized screening is not available, repetition of colonoscopy 10 years after the index procedure is recommended. Strong recommendation, moderate quality evidence.
2
ESGE recommends surveillance colonoscopy after 3 years for patients with complete removal of at least 1 adenoma ≥ 10 mm or with high grade dysplasia, or ≥ 5 adenomas, or any serrated polyp ≥ 10 mm or with dysplasia.
Strong recommendation, moderate quality evidence.
3
ESGE recommends a 3 – 6-month early repeat colonoscopy following piecemeal endoscopic resection of polyps ≥ 20 mm.
Strong recommendation, moderate quality evidence.
A first surveillance colonoscopy 12 months after the repeat colonoscopy is recommended to detect late recurrence.
Strong recommendation, high quality evidence.
4
If no polyps requiring surveillance are detected at the first surveillance colonoscopy, ESGE suggests to perform a second surveillance colonoscopy after 5 years.
Weak recommendation, low quality evidence.
After that, if no polyps requiring surveillance are detected, patients can be returned to screening.
5
ESGE suggests that, if polyps requiring surveillance are detected at first or subsequent surveillance examinations, surveillance colonoscopy may be performed at 3 years.
Weak recommendation, low quality evidence.
A flowchart showing the recommended surveillance intervals is provided (Fig. 1).
Clostridium difficile
is the leading cause of nosocomial infectious diarrhea. New treatment strategies are needed. In this letter, preliminary data on fecal therapy as primary treatment are assessed.
Norway and Sweden have similar populations and health care systems, but different reactions to the COVID-19 pandemic. Norway closed educational institutions, and banned sports and cultural ...activities; Sweden kept most institutions and training facilities open. We aimed to compare peoples' attitudes towards authorities and control measures, and perceived impact of the pandemic and implemented control measures on life in Norway and Sweden.
Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. The survey contained questions about perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries.
3508 individuals participated in the survey (Norway 3000; Sweden 508). 79% were women, the majority were 30-49 years (Norway 60%; Sweden 47%), and about 45% of the participants in both countries had more than 4 years of higher education. Participants had high trust in the health services, but differed in the degree of trust in their government (High trust in Norway 17%; Sweden 37%). More Norwegians than Swedes agreed that school closure was a good measure (Norway 66%; Sweden 18%), that countries with open schools were irresponsible (Norway 65%; Sweden 23%), and that the threat from repercussions of the mitigation measures were large or very large (Norway 71%; Sweden 56%). Both countries had a high compliance with infection preventive measures (> 98%). Many lived a more sedentary life (Norway 69%; Sweden 50%) and ate more (Norway 44%; Sweden 33%) during the pandemic.
Sweden had more trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries despite the differences in infection control measures.
Colonoscopy as a Triage Screening Test Bretthauer, Michael; Kalager, Mette
The New England journal of medicine,
02/2012, Letnik:
366, Številka:
8
Journal Article
Recenzirano
Colorectal cancer is the third most common cancer worldwide. The lifetime risk of colorectal cancer in the United States is approximately 5%. Clinical symptoms develop late in the course of the ...disease, and precursor lesions (adenomas) can be easily detected and removed. The disease is a candidate for early detection and prevention by screening. This issue of the
Journal
features two important studies that shed light on a number of interesting features in screening for colorectal cancer.
1
,
2
Zauber and colleagues present long-term follow-up data on mortality from colorectal cancer from the National Polyp Study.
1
After a mean period of . . .
In this correspondence we respond to critique of our randomized trial of Covid-19 transmission in fitness centers. The trial was performed in Norway during May and June 2020.
Recognizing Data Generation Kalager, Mette; Adami, Hans-Olov; Bretthauer, Michael
The New England journal of medicine,
05/2016, Letnik:
374, Številka:
19
Journal Article
Recenzirano
Odprti dostop
To the Editor:
The International Committee of Medical Journal Editors (ICMJE) recently announced data-sharing requirements for member journals.
1
Among the issues that were raised is giving adequate ...academic credit to the people who design clinical trials, enroll and treat patients, and curate the resulting data. Two main parties are involved in data sharing: those who have performed a clinical trial and possess the data (data generators) and those who want to use those data for other purposes (data reanalysts). Data-sharing requirements need to ensure that the interests of both parties are protected.
Data-sharing requirements may discourage researchers from initiating and . . .
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