scholarly journals Current Colorectal Cancer in Thailand

2020 ◽  
Vol 36 (2) ◽  
pp. 78-82
Author(s):  
Varut Lohsiriwat ◽  
Nopdanai Chaisomboon ◽  
Jirawat Pattana-Arun ◽  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Public Awareness ◽  
Population Based ◽  
Current Status ◽  
General Surgeon ◽  
Crc Screening ◽  
Common Cancer ◽  
Immunochemical Test ◽  
Colorectal Surgeons

This article aimed to summarize the current status of colorectal cancer (CRC) in Thailand. In brief, CRC is the third most common cancer and accounts for 11% of the cancer burden in Thailand. It is the only malignancy with an increased incidence in both sexes in Thailand. Over 10,000 new CRC cases occur annually, and about 40% are rectal cancer. Due to the lack of CRC screening and public awareness, nonmetastatic cancer accounts only for 60%–70% of overall cases. The demand for general or colorectal surgeons outmatches the supply at a ratio of 1 general surgeon to 35,000 individuals. There are about 70 board-certified colorectal surgeons serving Thailand’s population of nearly 70 million. As a result, >25% of cancer patients wait more than 1 month before surgery. Regarding training for colorectal surgery, there are 3 major institutes in Bangkok providing a 2-year fellowship program. Cadaveric workshops are an important part of training – especially in laparoscopy for CRC. Recently, a population-based CRC screening program was launched using a fecal immunochemical test. The Ministry of Public Health of Thailand has established additional platforms for laparoscopy to support the potential detection of early CRC following implementation of this nationwide screening program.

scholarly journals Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

2011 ◽  
Vol 17 (4) ◽  
pp. 334 ◽  
Author(s):  
Paul R. Ward ◽  
Sara Javanparast ◽  
Carlene Wilson
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
South Australia ◽  
Linguistically Diverse ◽  
Population Based ◽  
Policy And Practice ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Bowel Cancer Screening

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

scholarly journals A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

2017 ◽  
Vol 6 (3) ◽  
pp. 471-479 ◽  
Author(s):  
Clasine M de Klerk ◽  
Manon van der Vlugt ◽  
Patrick M Bossuyt ◽  
Evelien Dekker
Keyword(s):  
Colorectal Cancer ◽  
General Practitioner ◽  
Cancer Screening ◽  
Odds Ratio ◽  
Screening Program ◽  
Daily Practice ◽  
Fecal Immunochemical Test ◽  
Crc Screening ◽  
Advanced Neoplasia ◽  
Immunochemical Test

Background Symptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia. Methods We prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy. Results Of 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia. Conclusions A large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.

scholarly journals Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program

2018 ◽  
Vol 06 (09) ◽  
pp. E1140-E1148 ◽  
Author(s):  
Liseth Rivero-Sánchez ◽  
Jaume Grau ◽  
Josep María Augé ◽  
Lorena Moreno ◽  
Angels Pozo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Colorectal Adenomas ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Screening Strategies ◽  
Immunochemical Test ◽  
Low Incidence

Abstract Background and study aims Colorectal cancer (CRC) risk after a positive fecal immunochemical test (FIT) and negative colonoscopy is unknown. We aimed to ascertain the cumulative incidence of post-colonoscopy colorectal cancer (PCCRC) and the manifestation of other lesions that could explain the test positivity in individuals with a negative colonoscopy in a population screening program. Patients and method Observational study in participants from the first round of a CRC screening program (2010 – 2012) with positive-FIT (≥ 20 μg/g of feces) and negative colonoscopy (without neoplasia). A 42- to 76-month follow-up was performed searching in the National Health Service database and by a brief structured telephonic interview. Results Of 2659 FIT-positive individuals who underwent colonoscopy, 811 (30.5 %) had a negative colonoscopy. Three PCCRC (0.4 %) were detected within 11 – 28 months and accelerated carcinogenesis was ruled out. Among those with normal colonoscopy, 32 (5 %) relevant lesions were detected at follow-up. One-third of them (11/32) were significant neoplasias: a gastric cancer, a small-bowel lymphoma, six advanced colorectal adenomas, and the three PCCRC. The 21 remaining lesions were inflammatory, vascular disorders, or non-advanced colorectal adenomas. Conclusions The vast majority (95 %) of individuals did not present any subsequent lesion that could explain the FIT positivity. The very low incidence (0.4 %) and characteristics of PCCRC observed in our cohort reinforce the concept that, although a positive FIT preselects high risk individuals, a high quality colonoscopy is the paramount factor in preventing PCCRC. Improving quality standards of colonoscopy are required to strengthen the current CRC screening strategies.

scholarly journals Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Neal Shahidi ◽  
Laura Gentile ◽  
Lovedeep Gondara ◽  
Jeremy Hamm ◽  
Colleen E. McGahan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
Average Risk ◽  
Health Authorities ◽  
Cancer Screening Program ◽  
Immunochemical Test ◽  
A Prospective Study ◽  
The Cost

Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP).Methods.From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 μg/g (≥50 ng/mL) was used.Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs.Conclusions.As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.

scholarly journals Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain)

2021 ◽  
Author(s):  
Vives Nuria ◽  
Binefa Gemma ◽  
Vidal Carmen ◽  
Milà Núria ◽  
Muñoz Rafael ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Perceived Risk ◽  
Screening Program ◽  
Waiting Times ◽  
Population Based ◽  
Emotional Wellbeing ◽  
Short Term ◽  
Crc Screening ◽  
Screening Participation ◽  
Mean Time

Abstract Background By mid-March 2020, colorectal cancer (CRC) screening program in Catalonia was suspended at all levels. Our goal was to assess the short-term impact of the COVID-19 pandemic at a FIT-based CRC screening hub in the metropolitan area of Barcelona. Methods Short-term impact was measured in individuals invited between 1 January and 12 March 2020: screening participation, colonoscopy adherence, interval from positive test result to colonoscopy and psychological distress. Results Lockdown with the first wave of COVID-19 caused 111,000 individuals to defer their screening invitations. Participation among invitees between January - March 2020 was 39.3% (95% CI: 38.9–39.7), a decrease of 5% in comparison with the 41.4% (95% CI: 41.2–41.6) participation in 2019. Adherence to colonoscopy decreased from 89.3% (95% CI: 88.4–90.2) in 2019 to 81.4% (95% CI: 78.9–83.7) in the first quarter of 2020. The mean time to colonoscopy after resumption was 128.7 days (CI 95%: 125.3–132.2). Irrespective of test results, factors associated with higher levels of distress were a greater perceived risk of CRC and greater impairment of emotional wellbeing due to COVID-19. Conclusions The short-term impact of COVID-19 on CRC screening seems to have been modest, with a slight decrease in participation, a moderate decrease in colonoscopy adherence, and lengthened waiting times. However, a marked impact on future CRC incidence and deaths could be expected. Thus, it is critical to revert participation and colonoscopy adherence rates to that previously achieved while reducing the 5-month delay in screening invitations.

Adaptation of a Mailed-FIT Kit and Patient Navigation Intervention to Increase Colorectal Cancer (CRC) Screening Among Spanish-Speaking Hispanic/Latino Patients

2021 ◽  
pp. 154041532110241
Author(s):  
Sou Hyun Jang ◽  
Allison Cole ◽  
Emily V.R. Brown ◽  
Linda Ko
Keyword(s):  
Colorectal Cancer ◽  
Patient Navigation ◽  
Screening Program ◽  
Qualitative Content Analysis ◽  
Future Research ◽  
Care Needs ◽  
Crc Screening ◽  
Spanish Speaking ◽  
Immunochemical Test ◽  
First Time

Background: Hispanic/Latino populations experience significant barriers to colorectal cancer (CRC) screening. ProCRCScreen is a multicomponent CRC screening program that can help primary care clinics improve CRC screening rates, but it needs adaptation to better meet the health care needs of Spanish-speaking Hispanic/Latino populations. Methods: We conducted four focus groups with 22 Spanish-speaking Latino patients and used inductive qualitative content analysis to identify potential program adaptations. Results: We identified lack of social support for CRC screening and confusion about completing stool-based testing as important barriers to CRC screening. Participants recommended increased specificity of the fecal immunochemical test (FIT) instructions to increase the likelihood of successful test completion, especially for first-time screening. They also endorsed patient navigation for support in completing CRC screening. Discussion: We adapted the informational materials and workflows for the ProCRCScreen program. Future research to test the adapted program is needed.

scholarly journals Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e046667
Author(s):  
Tytti Sarkeala ◽  
Martti Färkkilä ◽  
Ahti Anttila ◽  
Marja Hyöty ◽  
Matti Kairaluoma ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Population Based ◽  
Registry Study ◽  
Participation Rates ◽  
Detection Rates ◽  
Men And Women ◽  
Faecal Immunochemical Test ◽  
Crc Screening ◽  
Immunochemical Test ◽  
Population Based Registry

ObjectiveTo assess the feasibility and evaluate the performance of a relaunched colorectal cancer (CRC) screening programme with different cut-offs for men and women.DesignPopulation-based registry study.SettingNine municipalities in Finland which started CRC screening with faecal immunochemical test (FIT) in April 2019 with cut-off levels 70 µg Hg/g faeces for men and 25 µg Hg/g faeces for women.ParticipantsMen (n=13 059) and women (n=14 669) aged 60–66 years invited to screening during the first programme year.Outcome measuresParticipation rates, positivity rates, detection rates of CRC and advanced adenoma (AA), and positive predictive values (PPV) of FIT for CRC and AA.ResultsAltogether 21 993 invitees returned stool samples. The participation rate of women (83.4%; 95% CI 82.8 to 84.0) was significantly higher than that of men (74.7%; 95% CI 73.9 to 75.4). The positivity rates were 2.4% (2.2 to 2.7) and 2.8% (2.5 to 3.1), respectively. In total, 37 CRCs and 116 AAs were detected. The detection rates of CRC and AA per 1000 participants were 1.8 (1.1 to 2.9) and 7.2 (5.6 to 9.1) for men and 1.6 (0.9 to 2.4) and 3.8 (2.8 to 5.0) for women. The PPVs per 100 positive tests were 6.6 (4.0 to 10.3) and 25.7 (20.6 to 31.4) for men and 6.4 (3.9 to 9.8) and 15.5 (11.6 to 20.2) for women.ConclusionsThe chosen FIT strategy narrowed the gap in the diagnostic performance between men and women especially in the detection of CRC. The participation rates were excellent. The levels of positivity and detection rates were moderate and need further action. The results indicate that gender-specific protocols can be introduced to organised CRC screening. It is yet to be seen whether they are more effective than a uniform screening protocol.

scholarly journals Gender-specific cut-off levels in colorectal cancer screening with fecal immunochemical test: A population-based study of colonoscopy findings and costs

2021 ◽  
pp. 096914132110200
Author(s):  
Hanna Ribbing Wilén ◽  
Deborah Saraste ◽  
Johannes Blom
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Diagnostic Yield ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
High Rate ◽  
Lower Sensitivity ◽  
Screening Cost ◽  
Immunochemical Test ◽  
Gender Specific

Objective In the population-based Swedish regional colorectal cancer (CRC) screening program of Stockholm–Gotland using the fecal immunochemical test (FIT), gender-specific cut-off levels of fecal hemoglobin are applied, since previous studies have indicated a lower sensitivity of FIT for CRC in women. The aim was to evaluate the diagnostic yield and the screening costs overall and per detected CRC of this strategy. Methods All individuals aged 60–69 invited to screening in 2015–2017 were included. Cut-off level for positive FIT was 40 µg/g in women and 80 µg/g in men. Those with a positive FIT were referred to colonoscopy. The yield of CRC and screening cost for the study period were assessed and compared to cut-off levels of 80 µg/g in both genders. Results Approximately 230,000 individuals were invited. Overall participation rates were 72% in women and 65% in men ( p < 0.05). FIT was positive in 4256 individuals (2.7% in both genders). In 3758 colonoscopies, 258 (6.9%) CRCs were detected. The positive predictive value for CRC was significantly higher in men (8.3% vs. 5.8%). In 120 women with CRC, 28 (23%) had FIT < 80 µg/g. Negative colonoscopies were more common in women (24% vs. 17%, p < 0.05). Total costs for the study period were 52,000,000SEK (≈5,200,000€), i.e. 16% higher compared to using cut-off levels of 80 µg/g in both genders, and corresponding to a 3% increment in cost per detected CRC. Conclusion The high rate of CRC detected in women in the lowest FIT category outweighs the minor reduction in screening costs if the same cut-off level was used as for men.

scholarly journals Quality Monitoring of a FIT-Based Colorectal Cancer Screening Program

2019 ◽  
Vol 65 (3) ◽  
pp. 419-426 ◽  
Author(s):  
Esther Toes-Zoutendijk ◽  
Johannes M G Bonfrer ◽  
Christian Ramakers ◽  
Marc Thelen ◽  
Manon C W Spaander ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Small Difference ◽  
Regression Analyses ◽  
Detection Rates ◽  
Screening Programs ◽  
Crc Screening ◽  
Specimen Collection ◽  
Cancer Screening Program ◽  
Immunochemical Test

Abstract BACKGROUND Quality assessment is crucial for consistent program performance of colorectal cancer (CRC) screening programs using fecal immunochemical test for hemoglobin (FIT). However, literature on the consistency of FIT performance in laboratory medicine was lacking. This study examined the consistency of FIT in testing positive or detecting advanced neoplasia (AN) for different specimen collection devices, lot reagents, and laboratories. METHODS All participants with a FIT sample with a cutoff concentration of 47 μg Hb/g feces in the Dutch CRC screening program in 2014 and 2015 were included in the analyses. Multivariable logistic regression analyses were performed to estimate the odds ratios of collection devices, reagents, and laboratories on testing positive or detecting AN and positive predictive value (PPV). RESULTS In total, 87519 (6.4%) of the 1371169 participants tested positive. Positivity rates and detection rates of AN differed between collection devices and reagents (all P &lt; 0.01). In contrast, PPVs were not found to vary between collection devices, reagents, or laboratories (all P &gt; 0.05). Positivity rates showed a small difference for laboratories (P = 0.004) but not for detection rates of AN. Size of the population affected by the deviating positivity rates was small (0.1% of the total tested population). CONCLUSIONS Variations were observed in positivity and detection rates between collection devices and reagents, but there was no detected variation in PPV. Although the overall population effect of these variations on the screened population is expected to be modest, there is room for improvement.

scholarly journals Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

2021 ◽  
Vol 09 (11) ◽  
pp. E1649-E1657
Author(s):  
Bernard Denis ◽  
Isabelle Gendre ◽  
Philippe Perrin ◽  
Nicolas Tuzin ◽  
Mathieu Pioche
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Endoscopic Resection ◽  
Screening Program ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
Detection Rates ◽  
Cancer Screening Program ◽  
Adenoma Detection ◽  
Immunochemical Test

Abstract Background and study aims The aim of this study was to analyze presentation, management, and outcomes of large polyps (LPs; ≥ 20 mm) detected in a colorectal cancer (CRC) screening program using a quantitative fecal immunochemical test (FIT). Patients and methods This was a retrospective community- and population-based observational study of all LPs detected in patients aged 50 to 74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5 % malignant and 51.8 % nonpedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54 % for nonpedunculated and 27 % for pedunculated T1 CRCs. The endoscopic resection rate was 82.7 % (95 % confidence interval [CI] 80.3–84.9) for benign LPs (70.2 % [95 % CI 66.4–74.1]) nonpedunculated, 95.2 % [95 % CI 93.4–97.1] pedunculated), varying from 0 to 100 % depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, P < 0.01) and adenoma detection rates (r = 0.25, P = 0.01). Most endoscopists did not refer patients to more experienced endoscopists, and as a result, 60 % to 90 % of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3 % (95 % CI 0.9–12.0) of nonpedunculated and 37.8 % (95 % CI 22.5–55.2) of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusions Compared with current recommendations, there is tremendous room for improvement in community endoscopy practices in the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative for 83 % of benign LPs and 16 % of T1 CRCs.

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