Strategies for Colorectal Cancer Screening Ladabaum, Uri; Dominitz, Jason A.; Kahi, Charles ...
Gastroenterology (New York, N.Y. 1943),
January 2020, 2020-01-00, 20200101, Letnik:
158, Številka:
2
Journal Article
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The incidence of colorectal cancer (CRC) is increasing worldwide. CRC has high mortality when detected at advanced stages, yet it is also highly preventable. Given the difficulties in implementing ...major lifestyle changes or widespread primary prevention strategies to decrease CRC risk, screening is the most powerful public health tool to reduce mortality. Screening methods are effective but have limitations. Furthermore, many screen-eligible people remain unscreened. We discuss established and emerging screening methods, and potential strategies to address current limitations in CRC screening. A quantum step in CRC prevention might come with the development of new screening strategies, but great gains can be made by deploying the available CRC screening modalities in ways that optimize outcomes while making judicious use of resources.
Colonoscopy examination does not always detect colorectal cancer (CRC)— some patients develop CRC after negative findings from an examination. When this occurs before the next recommended ...examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers PICRCs).
A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach.
The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon.
A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.
LINKED CONTENT
This article is linked to Lenfant et al papers. To view these articles, visit https://doi.org/10.1111/apt.17753 and https://doi.org/10.1111/apt.17912
There was no statistically significant difference in ADR for morning compared to afternoon procedures (36.1% vs 36.5%, P =0.888). Because the morning session was 6 hours in duration and afternoon was ...only 3 hours, ADR was also determined for each successive 3-hour time interval. When examining the effect of operator characteristics on ADR, we found no significant difference in ADR based on endoscopist age. Adenoma Detection Rate (ADR) Based on Time of Day, Patient Factors, and Provider Factors ADR% P Total n = 986 n=2725 Time of day n (%) .906 7am-9:59am 462 (35.7%) 1292 10am-12:59pm 333 (36.6%) 909 1pm-4pm 191 (36.4%) 524 Patient age n (%) < 0.001 < 50 59 (25.5%) 231 50-60 304 (29.9%) 1018 61-70 444 (40.6%) 1094 >70 179 (46.9%) 382 Provider age n (%) 0.206 < 50 334 (34.6%) 965 ≥50 652 (37.0%) 1760 Provider gender n (%) 0.001 Female 200 (30.6%) 654 Male 786 (37.1%) 2071 Provider experience n (%) < 0.001 10-15 years 200 (30.6%) 654 16-20 years 134 (43.1%) 311 >20 years 652 (37.0%) 1760 Number of procedures performed p 0.1 n=5410 0-10 procedures per day 36% 11-14 procedures per day 37% 15+ procedures per day 30% Author Notes *PresenterLankenau Medical Center, Wynnewood, PA.
Introduction: At our county hospital system in Houston, Texas, there is a backlog of colonoscopies due to many factors including delays during the COVID pandemic and patient availability during ...normal working hours. Outcomes included variations in Boston Bowel Preparation Scale (BBPS), adenoma detection rate (ADR), and cecal intubation rate (CIR), as well as the time between positive fecal immunochemical test (FIT) and colonoscopy. Weekend Colonoscopy Patient, Procedure, and Procedural Quality Characteristics Weekdays (N = 76) Saturdays (N = 19) P-value n % n % Gender Female 40 52.6 13 68.4 0.30 Male 36 47.4 6 31.6 Ethnicity Hispanic 34 44.7 9 47.4 1.00 Race White/Caucasian 27 35.5 6 31.6 0.97 African American 23 30.3 7 36.8 Asian 2 2.6 0 0.0 Other 24 31.6 6 31.6 Insurance Coverage 41 53.9 13 68.4 0.31 Primary Language English 42 55.3 11 57.9 1.00 Spanish 28 36.8 8 42.1 No show and/or cancelled 17 22.4 1 5.3 0.11 ASA* 2 14 23.7 6 33.3 0.54 3 45 76.3 12 66.7 BBPS* ≤5 1 1.7 0 0.0 0.53 6 12 20.3 0 0.0 7 5 8.5 0 0.0 8 3 5.1 7 38.9 9 38 64.4 11 61.1 Adenoma(s) detected 23 39.0 10 55.6 0.28 Cecal intubation rate 57 96.6 18 100.0 Diagnostic for positive FIT 11 14.5 9 47.4 0.01 Average number of days between positive FIT and colon 312 405 0.40 N, colonoscopies performed (59 for weekday, 18 for Saturdays).
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