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ACTUALIZACIÓN BIBLIOGRÁFICA

Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c colorrectal 2014-11

Gill MD, Bramble MG, Hull MA, Mills SJ, Morris E, Bradburn DM, et al. Screen-detected colorectal cancers are associated with an improved outcome compared with stage-matched interval cancers. Br J Cancer. 2014;111(11):2076–81. Available from: http://dx.doi.org/10.1038/bjc.2014.498.

Conclusions: The improved survival of screen-detected over interval cancers for stages C and D suggest that there may be a biological difference in the cancers in each group. Although lead-time bias may have a role, this may be related to a tumour’s propensity to bleed and therefore may reflect detection through current screening tests.

Geraghty J, Butler P, Seaman H, Snowball J, Sarkar S, Blanks R, et al. Optimising faecal occult blood screening:retrospective analysis of NHS Bowel Cancer Screening data to improve the screening algorithm. Br J Cancer. 2014;111(11):2156–62. Available from: http://dx.doi.org/10.1038/bjc.2014.480.

Conclusions: This study demonstrated a strong correlation between SP% and cancer detection within the NHS BCSP. At the population level, subje…

Bagcchi S. CRC risk knowledge does not affect screening compliance. Lancet Oncol. 2014;15(13):e588. Available from: http://www.sciencedirect.com/science/article/pii/S1470204514710381. doi: http://dx.doi.org/10.1016/S1470-2045(14)71038-1.

McQueen A, Swank PR, Vernon SW. Examining patterns of association with defensive information processing about colorectal cancer screening. J Health Psychol. England; 2014;19(11):1443–58. doi: 10.1177/1359105313493649. PMID: 23864072.
 
To reduce negative psychological affect from information or behavior that is inconsistent with one’s positive self-concept, individuals use a variety of defensive strategies. It is unknown whether correlates differ across defenses. We examined correlates of four levels of defensive information processing about colorectal cancer screening. Cross-sectional surveys were completed by a convenience sample of 287 adults aged 50-75 years. Defenses measures were more consistently associated with individual differences (especially avoidant coping styles); however, situational variables involving health-care providers also were important. Future research should examine changes in defenses after risk communication and their relative impact on colorectal cancer screening.

Chauvin P, Josselin J-M, Heresbach D. The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening. Eur J Heal Econ. Germany; 2014;15(8):801–12. doi: 10.1007/s10198-013-0525-9. PMID: 23974962.
 
When a cost-effectiveness analysis is implemented, the health-care system is usually assumed to adjust smoothly to the proposed new strategy. However, technological innovations in health care may often induce friction in the organization of care supply, implying the congestion of services and subsequent waiting times. Our objective here is to measure how these short run rigidities can challenge cost-effectiveness recommendations favorable to an innovative mass screening test for colorectal cancer. Using Markov modeling, we compare the standard Guaiac fecal occult blood test (gFOBT) with an innovative screening test for colorectal cancer, namely the immunological fecal occult blood test (iFOBT). Waiting time can occur between a positive screening test and the subsequent confirmation colonoscopy. Five scenarios are considered for iFOBT: no further waiting time compared with gFOBT, twice as much waiting time for a period of 5 or 10 years, and twice as much waiting time for a period of 5 or 10 years combined with a 25 % decrease in participation to confirmation colonoscopies. According to our modeling, compared with gFOBT, iFOBT would approximately double colonoscopy demand. Probabilistic sensitivity analysis enables concluding that the waiting time significantly increases the uncertainty surrounding recommendations favorable to iFOBT if it induces a decrease in the adherence rate for confirmation colonoscopy.

Poskus T, Strupas K, Mikalauskas S, Bitinaite D, Kavaliauskas A, Samalavicius NE, et al. Initial results of the National Colorectal Cancer Screening Program in Lithuania. Eur J Cancer Prev. 2014; doi: 10.1097/CEJ.0000000000000096. PMID: 25370682.
 
The aim of the present study was to review the National Colorectal Cancer Screening Program (the Program) in Lithuania according to the criteria set by the European Union. In Lithuania, screening services are provided free of charge to the population. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the Program has its own administrative code. All the information about the performance of the Program is collected in one institution - the NHIF. The results of the Program were retrieved from the database of NHIF from the start of the Program from 1 July 2009 to 1 July 2012. Descriptive analysis of epidemiological indicators was carried out. Results were compared with the references in the guidelines of the European Union for quality assurance in colorectal cancer (CRC) screening and diagnosis. Information service [which involves fecal immunochemical test (FIT)] was provided to 271 396 of 890 309 50-74-year-old residents. The screening uptake was 46.0% over 3 years. During this period, 19 455 (7.2%) FITs were positive and 251 941 (92.8%) FITs were negative. Referral for colonoscopy was performed in 10 190 (52.4%) patients. Colonoscopy was performed in 12 864 (66.1%) patients. Colonoscopy did not indicate any pathological findings in 8613 (67.0%) patients. Biopsies were performed in 4251 (33.0%) patients. The rate of high-grade neoplasia reported by pathologists was 3.9%; the rate of cancer was 3.1% of all colonoscopies. The rate of CRC detected by the Program was 0.2%. The CRC screening program in Lithuania meets most of the requirements for standardized CRC screening programs. The invitation coverage and rate of referral for colonoscopy after positive FIT should be improved.

Garcia M, Mila N, Binefa G, Benito L, Gonzalo N, Moreno V. Fecal hemoglobin concentration as a measure of risk to tailor colorectal cancer screening: are we there yet?. Eur J Cancer Prev. 2014; doi: 10.1097/CEJ.0000000000000090. PMID: 25370684.

 The aim of this paper was to examine the distribution of fecal hemoglobin (f-Hb) concentration in a Spanish colorectal cancer screening population according to sociodemographic characteristics and analyze whether f-Hb was associated with clinical outcomes (type of lesion and its location). From September 2009 to November 2012, we sent 77 744 invitations to individuals aged 50-69 years to provide one sample of feces. f-Hb was measured on samples from 27 606 screenees (35.5%). Colonoscopy findings and pathology data were collected on the 1406 screenees with f-Hb greater than 100 ng Hb/ml (20 mg Hb/g feces). The Mann-Whitney U-test and the Kruskal-Wallis test were used to compare f-Hb (median) according to sociodemographic variables, clinical outcomes, and histological features of adenomas. f-Hb from greater than 100 ng Hb/ml was categorized into quartiles. Regression models were used to determine whether f-Hb was a risk predictor of colorectal lesions. f-Hb was associated directly with the severity of the colorectal lesions. An overlap between individuals with a negative colonoscopy and those with a low-risk adenoma was observed. High-grade dysplasia, villous histology, distal location, and increasing size were all features associated with an increased f-Hb level. f-Hb could be used in individual risk assessment to determine surveillance strategies for colorectal cancer screening.

Clarke N, Sharp L, Osborne A, Kearney PM. Comparison of uptake of colorectal cancer screening based on faecal immunochemical testing (FIT) in males and females: A systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014; doi: 10.1158/1055-9965.EPI-14-0774. PMID: 25378366.

Conclusions:Meta analysis of FIT screening studies indicates significantly lower uptake among men. Impact:Further investigation is required into factors influencing acceptability and participation of FIT screening in both sexes.
Steffen A, Weber MF, Roder DM, Banks E. Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study. Med J Aust. Australia; 2014;201(9):523–7. PMID: 25358576.

CONCLUSION: CRC incidence is lower among individuals with a history of CRC screening, through either FOBT or endoscopy, compared with individuals who have never had CRC screening, lasting for at least 4 years after screening.

 

Nota bibliográfica cribado c colorrectal 2014-10

Grogan PB, Olver IN. A bowel cancer screening plan at last. Med J Aust. 2014;201(8):435–6. Available from: https://www.mja.com.au/journal/2014/201/8/bowel-cancer-screening-plan-last. doi: 10.5694/mja14.01089.
Cenin DR, St John DJB, Ledger MJN, Slevin T, Lansdorp-Vogelaar I. Optimising the expansion of the National Bowel Cancer Screening Program. Med J Aust. 2014;201(8):456–61. Available from: https://www.mja.com.au/journal/2014/201/8/optimising-expansion-national-bowel-cancer-screening-program. doi: 10.5694/mja13.00112.

Conclusions: The findings strongly support the need for rapid implementation of the NBCSP. Compared with the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths (about 35 000) being prevented in the coming 40 years.

Smith SG, Raine R, Obichere A, Wolf MS, Wardle J, von Wagner C. The effect of a supplementary (’gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial. J Behav Med. 2014; doi: 10.1007/s10865-014-9596-z. PMID: 25253443.
 
Guided by Fuzzy Trace Theory, this study examined the impact of a “Gist-based” leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability. Adults aged 45-59 years from four UK general practices were randomly assigned to receive standard information ('The Facts', n = 2,216) versus standard information plus “The Gist” leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The “Gist + Facts” group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest “The Gist” leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected.

Castells A. [The usefulness of fecal tests in colorectal cancer screening]. Gastroenterol Hepatol. Spain; 2014;37 Suppl 3:71–6. doi: 10.1016/S0210-5705(14)70085-8. PMID: 25294268.

 Colorectal cancer is a paradigm of neoplasms that are amenable to preventative measures, especially screening. Currently, to carry this out, there are various strategies that have proven effective and efficient. In countries that have organized population- level screening programs, the most common strategy is fecal occult blood testing. In recent years, new methods have appeared that could constitute viable alternatives in the near future, among which the detection of changes in fecal DNA is emphasized. In this article, we review the most relevant papers on colorectal cancer screening presented at the annual meeting of the American Gastroenterological Association held in Chicago in May 2014, with special emphasis on the medium and long-term performance of strategies to detect occult blood in feces and the first results obtained with fecal DNA testing.

Caserras XB. [Colonoscopies for colorectal cancer screening]. Gastroenterol Hepatol. Spain; 2014;37 Suppl 3:85–92. doi: 10.1016/S0210-5705(14)70087-1. PMID: 25294270.
 
Colonoscopies play a vital role in population screening programs, either for initial examinations or as a test carried out after a positive result from a fecal occult blood test or sigmoidoscopy. Colonoscopies, and ancillary techniques such as polipectomies, must comply with basic quality criteria that must be reflected in the quality standards of screening programs. A quality colonoscopy is absolutely vital to avoid the occurrence of interval cancers. It is extremely important to detect any proximal lesions during a colonoscopy, especially those which are serrated, because they are difficult to identify and due to the increased risk of colorectal cancer. Regarding follow-up programs for resected colorectal polyps, current evidence of the relationship between the risk of neoplasia and certain variables (age, sex, smoker, BMI, diabetes, etc.) must allow for individualized risk and algorithms for screening and follow-up frequency to be developed for these patients. However, initial endoscopic exploration in a screening colonoscopy is essential to establishing the optimum interval and ensuring follow-up. Despite poor adherence to follow-up programs, mostly due to their overuse, follow-up colonoscopies 3 years after resection of all polypoid lesions detect clinically significant lesions as effectively as colonoscopies at one year.

Gwede CK, Koskan AM, Quinn GP, Davis SN, Ealey J, Abdulla R, et al. Patients’ Perceptions of Colorectal Cancer Screening Tests and Preparatory Education in Federally Qualified Health Centers. J cancer Educ. 2014; doi: 10.1007/s13187-014-0733-8. PMID: 25249181.

 This study explored federally qualified health center (FQHC) patients’ perceptions about colorectal cancer screening (CRCS) tests, including immunochemical fecal occult blood tests (iFOBT), as well as preferences for receiving in-clinic education about CRCS. Eight mixed gender focus groups were conducted with 53 patients. Findings centered on three thematic factors: (1) motivators and impediments to CRCS, (2) test-specific preferences and receptivity to iFOBTs, and (3) preferences for entertaining and engaging plain language materials. Results informed the development of educational priming materials to increase CRCS using iFOBT in FQHCs.

Kruse GR, Khan SM, Zaslavsky AM, Ayanian JZ, Sequist TD. Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance. J Gen Intern Med. 2014; doi: 10.1007/s11606-014-3015-6. PMID: 25266407.

CONCLUSIONS: Overuse of screening and surveillance exams are common and should be monitored by healthcare systems. Variations in endoscopist recommendations represent targets for interventions to reduce overuse.

Burki TK. Flexible sigmoidoscopy screening for colorectal cancer. Lancet Oncol. England; 2014. p. e425. PMID: 25328954.

Ricardo-Rodrigues I, Hernandez-Barrera V, Jimenez-Garcia R. Awareness of colonoscopy as a screening method for colorectal cancer and its uptake in Spain. Eur J Cancer Prev. England; 2014;23(5):398–404. doi: 10.1097/CEJ.0000000000000026. PMID: 24681532.
 
The objective of this study was to describe awareness levels of colonoscopy as a screening procedure for colorectal cancer (CRC), to study its uptake and analyze possible associated factors in Spain. This was a cross-sectional study using data from the Oncobarometro survey, carried out by face-to-face interviews with a representative national sample of the Spanish population aged 18 years and older. Awareness was assessed using the following questions: “Do you know of any examination procedures or medical technique used to detect cancer?” and “I”m going to list some screening procedures (including colonoscopy) to see if you know of them as a cancer screening test or whether this is the first time you have heard of them’. To evaluate colonoscopy uptake, participants were asked whether they had undergone a colonoscopy in the past 2 years. The independent variables included sociodemographic, socioeconomic, and health-related factors. 65.7% of the study population was aware of colonoscopy as a screening tool. Individuals from lower socioeconomic groups or those who only had primary education showed a lower level of awareness. 12.8% of participants had undergone a colonoscopy in the past 2 years. This number increased to 45% in the Spanish Autonomous Communities, where screening programs are in place. Colonoscopy screening rates are 10.28 times higher among those who had fecal occult blood testing during the previous 2 years. There is an inverse relationship between social inequality and both awareness and uptake of colonoscopy. Consequently, for screening to be more effective, interventions that reduce barriers to access for target populations should be implemented.

Dreier M, Borutta B, Seidel G, Munch I, Kramer S, Toppich J, et al. Communicating the benefits and harms of colorectal cancer screening needed for an informed choice: a systematic evaluation of leaflets and booklets. PLoS One. United States; 2014;9(9):e107575. doi: 10.1371/journal.pone.0107575. PMID: 25215867.

DISCUSSION: Most of the CRC screening leaflets and booklets in Germany do not meet current EBHI standards. After the study, the publishers of the information materials were provided feedback, including a discussion of our findings. The results can be used to revise existing information materials or to develop new materials that provide correct, balanced, quantified, understandable and unbiased information on CRC screening.

Launois R, Le Moine J-G, Uzzan B, Fiestas Navarrete LI, Benamouzig R. Systematic review and bivariate/HSROC random-effect meta-analysis of immunochemical and guaiac-based fecal occult blood tests for colorectal cancer screening. Eur J Gastroenterol Hepatol. England; 2014;26(9):978–89. doi: 10.1097/MEG.0000000000000160. PMID: 25072382.

CONCLUSION: Our findings support the use of OC-Sensor for CRC detection. The diagnostic estimates obtained may be extended to derive model parameters for economic decision models and to offer insight for future clinical and public health decision making. Our findings could influence the future of FOBTs within the CRC screening arsenal.

Triantafyllou K, Beintaris I, Dimitriadis GD. Is there a role for colon capsule endoscopy beyond colorectal cancer screening? A literature review. World J Gastroenterol. 2014. p. 13006–14. doi: 10.3748/wjg.v20.i36.13006. PMID: 25278694.
 
Colon capsule endoscopy is recommended in Europe alternatively to colonoscopy for colorectal cancer screening in average risk individuals. The procedure has also been proposed to complete colon examination in cases of incomplete colonoscopy or when colonoscopy is contraindicated or refused by the patient. As tissue samples cannot be obtained with the current capsule device, colon capsule endoscopy has no place in diagnosing ulcerative colitis or in dysplasia surveillance. Nevertheless, data are accumulating regarding its feasibility to examine ulcerative colitis disease extent and to monitor disease activity and mucosal healing, even though reported results on the capsule’s performance in this field vary greatly. In this review we present the currently available evidence for the use of colon capsule endoscopy to complement colonoscopy failure to reach the cecum and its use to evaluate ulcerative colitis disease activity and extent. Moreover, we provide an outlook on issues requiring further investigation before the capsule becomes a mainstream alternative to colonoscopy in such cases.

Tinmouth J, Patel J, Austin PC, Baxter NN, Brouwers MC, Earle C, et al. Increasing participation in colorectal cancer screening: Results from a cluster randomized trial of directly mailed gFOBT kits to previous nonresponders. Int J Cancer. 2014; doi: 10.1002/ijc.29191. PMID: 25195923.

 Regular screening using guaiac fecal occult blood test (gFOBT) reduces mortality from colorectal cancer (CRC). The objective of this study was to determine whether the addition of a gFOBT kit to a second mailed invitation compared to a second mailed invitation alone increases CRC screening among eligible persons who did not respond to an initial mailed invitation. We conducted a cluster randomized controlled trial, with the physician as the unit of randomization. Participants were persons who had been invited but who had not responded to an invitation for CRC screening in an earlier pilot project. The intervention group received a mailed gFOBT kit and second mailed CRC screening invitation (n = 2,008) while the control group received a second mailed CRC screening invitation alone (n = 1,586). The primary outcome was the uptake of gFOBT within 6 months of the second mailing. We found that the uptake of gFOBT was more than twice as high in the intervention group (20.1%) compared to the control group (9.6%). The absolute difference between the two groups was 10.5% (95% CI: 7.5-13.4%, p gFOBT kits increase CRC screening participation among previous nonresponders to a mailed invitation and that approximately 10 gFOBT kits would have to be sent by mail in order to screen 1 additional person.

Auge JM, Pellise M, Escudero JM, Hernandez C, Andreu M, Grau J, et al. Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program.Gastroenterology. United States; 2014;147(3):628–36.e1. doi: 10.1053/j.gastro.2014.06.008. PMID: 24937264.

CONCLUSIONS: Fecal hemoglobin concentration, in addition to sex and age, in individuals with positive results from FITs can be used to stratify probability for the detection of advanced colorectal neoplasia. These factors should be used to prioritize individuals for colonoscopy examination.

Pratt VM. Are we ready for a blood-based test to detect colon cancer?. Clin. Chem. United States; 2014. p. 1141–2. doi: 10.1373/clinchem.2014.227132. PMID: 25028508.

Greaney ML, Puleo E, Sprunck-Harrild K, Syngal S, Suarez EG, Emmons KM. Changes in colorectal cancer screening intention among people aged 18-49 in the United States. BMC Public Health. England; 2014;14:901. doi: 10.1186/1471-2458-14-901. PMID: 25179871.

CONCLUSION: Exposure to CRC prevention messages before the age of 50 can increase screening intentions among individuals who did not initially intend to get screened. Peer-led interventions to promote CRC screening should include individual less than 50 years of age, as this may contribute to increased screening at the recommended age threshold.

Hamza S, Cottet V, Touillon N, Dancourt V, Bonithon-Kopp C, Lepage C, et al. Long-term effect of faecal occult blood screening on incidence and mortality from colorectal cancer. Dig Liver Dis. 2014; doi: 10.1016/j.dld.2014.08.041. PMID: 25241134.

CONCLUSION: Our findings confirm, in the long term, that screening with Hemoccult can reduce colorectal cancer mortality. The data also highlight the benefit of regular participation in screening and the absence of effect of screening on colorectal cancer incidence.

Demyati E. Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh. Int J Family Med. Egypt; 2014;2014:457354. doi: 10.1155/2014/457354. PMID: 25328703.

Conclusion. Large percentage of family physicians in this study do not practice CRC screening, despite the knowledge level and the positive attitude.

Zorzi M, Fedeli U, Schievano E, Bovo E, Guzzinati S, Baracco S, et al. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test.Gut. 2014; doi: 10.1136/gutjnl-2014-307508. PMID: 25179811.

CONCLUSIONS: FIT-based screening programmes were associated with a significant reduction in CRC mortality. This effect took place much earlier than reported by gFOBT-based trials and observational studies.

McCoy E, Gerson LB. Is colon capsule endoscopy ready for prime time?. Gastroenterology. United States; 2014;147(3):709–11. doi: 10.1053/j.gastro.2014.07.011. PMID: 25051058.

Anderson JC, Shaw RD. Update on colon cancer screening: recent advances and observations in colorectal cancer screening. Curr Gastroenterol Rep. United States; 2014;16(9):403. doi: 10.1007/s11894-014-0403-3. PMID: 25108645.

 There have been many recent advances and observations regarding colorectal cancer (CRC) screening. New CRC surveillance guidelines have been published to help endoscopists with the management of important clinical issues such as serrated polyps. There have been several important large studies examining the impact of endoscopic process measures such as bowel prep, withdrawal time, and adenoma detection rate on CRC screening. In addition, there have been technical advances in CT colonography including the development of exams that do not require a bowel preparation. Other new technology such as colon capsule endoscopy may aid endoscopists in the challenge of completing the evaluation of the colon in those patients with an incomplete colonoscopy. Finally, there have been large studies which examine the performance characteristics of the so-called non-invasive CRC screening tests such as fecal immunochemical test (FIT) and fecal DNA.

Yen AM-F, Chen SL-S, Chiu SY-H, Fann JC-Y, Wang P-E, Lin S-C, et al. A new insight into fecal hemoglobin concentration-dependent predictor for colorectal neoplasia. Int J Cancer. United States; 2014;135(5):1203–12. doi: 10.1002/ijc.28748. PMID: 24482014.
 
We sought to assess how much of the variation in incidence of colorectal neoplasia is explained by baseline fecal hemoglobin concentration (FHbC) and also to assess the additional predictive value of conventional risk factors. We enrolled subjects aged 40 years and over who attended screening for colorectal cancer with the fecal immunochemical test (FIT) in Keelung community-based integrated screening program. The accelerated failure time model was used to train the clinical weights of covariates in the prediction model. Datasets from two external communities were used for external validation. The area under curve (AUC) for the model containing only FHbC was 83.0% (95% CI: 81.5-84.4%), which was considerably greater than the one containing only conventional risk factors (65.8%, 95% CI: 64.2-67.4%). Adding conventional risk factors did not make significant additional contribution (p = 0.62, AUC = 83.5%, 95% CI: 82.1-84.9%) to the predictive model with FHbC only. Males showed a stronger linear dose-response relationship than females, yielding gender-specific FHbC predictive models. External validation confirms these results. The high predictive ability supported by a dose-dependent relationship between baseline FHbC and the risk of developing colorectal neoplasia suggests that FHbC may be useful for identifying cases requiring closer postdiagnosis clinical surveillance as well as being an early indicator of colorectal neoplasia risk in the general population. Our findings may also make contribution to the development of the FHbC-guided screening policy but its pros and cons in connection with cost and effectiveness of screening should be evaluated before it can be applied to population-based screening for colorectal cancer.

Uraoka T, Hosoe N, Yahagi N. Colonoscopy: is it as effective as an advanced diagnostic tool for colorectal cancer screening?. Expert Rev Gastroenterol Hepatol. 2014;1–4. doi: 10.1586/17474124.2015.960397. PMID: 25252803.

 A broad range of modalities for colorectal cancer (CRC) screening are available worldwide. Although recent studies have been demonstrating developments of CRC screening modalities including colonoscopy, computed tomography colonography or colon video capsule colonoscopy remains the gold standard for the early detection of adenoma or CRC. Because patient preferences and availability of resources play an important role in the selection of CRC screening options, further improvement of each screening modality and its associated research is necessary to consider its involvement in clinical practice.

Chiang T-H, Chuang S-L, Li-Sheng Chen S, Chiu H-M, Ming-Fang Yen A, Yueh-Hsia Chiu S, et al. Difference in Performance of Fecal Immunochemical Tests with the Same Hemoglobin Cut-off Concentration in a Nationwide Colorectal Cancer Screening Program. Gastroenterology. 2014; doi: 10.1053/j.gastro.2014.08.043. PMID: 25200099.

CONCLUSIONS: Different brands of quantitative FITs, even with the same cut-off hemoglobin concentration, perform differently in mass screening. Population-level data should be gathered to verify the credibility of quantitative laboratory findings.

Berstad P, Loberg M, Larsen IK, Kalager M, Holme O, Botteri E, et al. Long-term lifestyle changes after colorectal cancer screening: randomised controlled trial. Gut. 2014; doi: 10.1136/gutjnl-2014-307376. PMID: 25183203.

CONCLUSIONS: The present study suggests that possible unfavourable lifestyle changes after CRC screening are modest. Lifestyle counselling may be considered as part of cancer screening programmes.

 

Nota bibliográfica cribado c colorrectal 2014-09

Libby G, Brewster DH, Steele RJC. Impact of faecal occult blood test screening on emergency admissions and short-term outcomes for colorectal cancer. Br J Surg. 2014; Available from: http://www.ncbi.nlm.nih.gov/pubmed/25219923. doi: 10.1002/bjs.9613. PMID: 25219923.

CONCLUSION: People who participated in FOBT screening had fewer emergency admissions and a shorter LOS. Deprivation was associated negatively with participation, but the impact of FOBT participation on emergency admissions was independent of deprivation level. The reduction in LOS has potential to reduce financial costs.

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany. Clin Gastroenterol Hepatol. 2014; Available from: http://www.ncbi.nlm.nih.gov/pubmed/25218160. doi: 10.1016/j.cgh.2014.08.036. PMID: 25218160.

CONCLUSIONS: Based on a 10-year analysis of data from a national registry in Germany, screening colonoscopies have large potential for prevention and early detection of CRC, with low risk of overdiagnosis.

Kearns B, Whyte S, Chilcott J, Patnick J. Guaiac faecal occult blood test performance at initial and repeat screens in the English Bowel Cancer Screening Programme. Br J Cancer. 2014; Available from: http://dx.doi.org/10.1038/bjc.2014.469.

Conclusions: Performance measures for gFOBT screening were generally lower in the repeat screen compared with the initial screen. Screening for CRC using gFOBT is likely to be cost-effective; however, the use of different screening modalities may result in additional benefits. Future economic evaluations of gFOBT should not assume equal sensitivities between screening rounds.

Zorzi M, Senore C, Da Re F, Barca A, Bonelli LA, Cannizzaro R, et al. Quality of colonoscopy in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut. 2014; Available from: http://gut.bmj.com/content/early/2014/10/02/gutjnl-2014-307954.abstract. doi: 10.1136/gutjnl-2014-307954.

Conclusions The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes.

Allison JE, Fraser CG, Halloran SP, Young GP. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8(2):117–30. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3964261&tool=pmcentrez&rendertype=abstract. doi: 10.5009/gnl.2014.8.2.117. PMID: 24672652.

 Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.

Bevan R, Rubin G, Sofianopoulou E, Patnick J, Rees CJ. Implementing a national flexible sigmoidoscopy screening program: results of the English early pilot. Endoscopy. 2014; Available from: http://www.ncbi.nlm.nih.gov/pubmed/25268309. doi: 10.1055/s-0034-1378119. PMID: 25268309.

Conclusion: Delivery of an FSIG screening program to prevent CRC is feasible and should be implemented using a simple invitation system. The national Bowel Scope program subsequently commenced at pilot sites in May 2013, with full implementation planned by 2016

   

Nota bibliográfica cribado c colorrectal 2014-07/08

Honein-AbouHaidar GN, Rabeneck L, Paszat LF, Sutradhar R, Tinmouth J, Baxter NN. Evaluating the impact of public health initiatives on trends in fecal occult blood test participation in Ontario.BMC Cancer. 2014;14(1):537. Available from: http://www.biomedcentral.com/1471-2407/14/537.  doi: 10.1186/1471-2407-14-537. PMID: 25062552.

CONCLUSION: Although observed increases in FOBT participation cannot be definitively attributed to the various initiatives, the results of the two statistical approaches suggest a causal association between the observed increases in FOBT participation and most of these initiatives.

Cubiella J, Castro I, Hernandez V, Gonzalez-Mao MC, Rivera C, Iglesias F, et al. Characteristics of Adenomas Detected by Fecal Immunochemical Test in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2014; Available from: http://cebp.aacrjournals.org/content/early/2014/07/03/1055-9965.EPI-13-1346.abstract.  doi: 10.1158/1055-9965.EPI-13-1346.

CONCLUSIONS: European guidelines classification and adenoma location coORelates with the likelihood of a positive FIT result. IMPACT: This information allows us to understand the FIT impact in colorectal cancer prevention. Likewise, it should be taken into account in the development of new colorectal adenomas biomarkers.

Hoffman MD, MPH RM. In persons at average risk, stool DNA tests had higher sensitivity than FIT for detecting colorectal cancer. Ann Intern Med. Philadelphia; 2014;161(2). Available from: http://search.proquest.com/docview/1545851035?accountid=15293.  

 Hoffman remarks on Imperiale et al’s study that determined whether a noninvasive, multitarget stool DNA test accurately detects colorectal cancer in persons at average risk, and how it compares with a fecal immunochemical test (FIT). The DNA tests had over twice as many abnormal results as FIT, with a higher rate of false-positive results. This means that more colonoscopies would need to be performed to detect an advanced neoplasm with DNA testing than with FIT testing. However, interpreting false-positive results is complicated because colonoscopy is an imperfect gold standard and DNA testing can detect molecular abnormalities potentially arising from extracolonic neoplasia. Further diagnostic testing could increase the costs and risks of screening. Having unexplained positive DNA test results might also be stressful to patients. DNA testing is a marvelous example of translational research, but it doesn't seem ready for prime time.

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Incidence of colorectal adenomas: Birth cohort analysis among 4.3 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev. 2014; Available from: http://cebp.aacrjournals.org/content/early/2014/07/10/1055-9965.EPI-14-0367.abstract.  doi: 10.1158/1055-9965.EPI-14-0367.

CONCLUSIONS. Annual incidence rates of colorectal adenomas are below 2.5% and 2% among men and women, respectively, and show little variation by age. IMPACT. Risk of clinically manifest colorectal cancer is expected to be very small within 10 years and beyond after negative colonoscopy for men and women at all ages. The use of re-screening after a negative screening colonoscopy above 60 years of age may be very limited.

Shah R, Jones E, Vidart V, Kuppen PJK, Conti JA, Francis NK. Biomarkers for Early Detection of Colorectal Cancer and Polyps: Systematic Review. Cancer Epidemiol Biomarkers Prev. 2014; Available from: http://cebp.aacrjournals.org/content/early/2014/07/03/1055-9965.EPI-14-0412.abstract.  doi: 10.1158/1055-9965.EPI-14-0412.
 
Combinations of fecal and serum biomarkers produce higher sensitivities, specificities and PPVs for early detection of CRC and adenomas. Further research is required to validate these biomarkers in a well-structured population-based study.
 
Brett, AS. Flexible sigmoidoscopy for colorectal cancer screening: More evidence, persistent ironies. JAMA. 2014;312(6):601–2. Available from: http://dx.doi.org/10.1001/jama.2014.8613.

Holme Ø, Løberg M, Kalager M, Al E. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: A randomized clinical trial. JAMA. 2014;312(6):606–15. Available from: http://dx.doi.org/10.1001/jama.2014.8266.

There was no difference between the flexible sigmoidoscopy only vs the flexible sigmoidoscopy and FOBT screening groups.Conclusions and Relevance In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence…

Blom J, Kilpeläinen S, Hultcrantz R, Törnberg S. Five-year experience of organized colorectal cancer screening in a Swedish population - increased compliance with age, female gender, and subsequent screening round. J Med Screen. 2014;21(3):144–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25070434.  doi: 10.1177/0969141314545555. PMID: 25070434.

CONCLUSION: The strong organization of the programme contributed to a high compliance rate, that increased by screening round. The lower participation rate among men and among individuals at younger ages needs further attention.

Løberg M, Kalager M, Holme Ø, Hoff G, Adami H-O, Bretthauer M. Long-Term Colorectal-Cancer Mortality after Adenoma Removal. N Engl J Med. 2014;371(9):799–807. Available from: http://dx.doi.org/10.1056/NEJMoa1315870.  doi: 10.1056/NEJMoa1315870.

Levy BT, Bay C, Xu Y, Daly JM, Bergus G, Dunkelberg J, et al. Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy. J Med Screen. 2014;21(3):133–43. Available from: http://msc.sagepub.com/content/21/3/133.abstract.  doi: 10.1177/0969141314541109.

Conclusions The sensitivity of a single-sample FIT for advanced adenomas or cancer was low. Individuals with distal adenomas had a higher odds of testing positive than those with proximal lesions or no lesions.

Kapidzic A, Grobbee EJ, Hol L, van Roon AHC, van Vuuren AJ, Spijker W, et al. Attendance and Yield Over Three Rounds of Population-Based Fecal Immunochemical Test Screening. Am J Gastroenterol. 2014;109(8):1257–64. Available from: http://dx.doi.org/10.1038/ajg.2014.168.  doi: 10.1038/ajg.2014.168.

CONCLUSIONS: Repeated biennial FIT screening is acceptable with increased participation in successive screening rounds, and >70% of all eligible subjects participating at least once over three rounds. The decline in screen-detected AN over three screening rounds is compatible with a decreased prevalence of AN as a result of repeated FIT screening. These findings provide strong evidence for the effectiveness of FIT screening and stress the importance of ongoing research over multiple screening rounds.

Clark BT, Rustagi T, Laine L. What Level of Bowel Prep Quality Requires Early Repeat Colonoscopy: Systematic Review and Meta-Analysis of the Impact of Preparation Quality on Adenoma Detection Rate. Am J Gastroenterol. 2014; Available from: http://dx.doi.org/10.1038/ajg.2014.232.  

CONCLUSIONS: ADR is not significantly different with intermediate-quality vs. high-quality bowel preparation. Our results confirm the need for early repeat colonoscopy with low-quality bowel preparation, but suggest that patients with intermediate/fair preparation quality may be followed up at standard guideline-recommended surveillance intervals without significantly affecting quality as measured by ADR.

Kaminski MF, Polkowski M, Kraszewska E, Rupinski M, Butruk E, Regula J. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014;63(7):1112–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4078748&tool=pmcentrez&rendertype=abstract.  doi: 10.1136/gutjnl-2013-304965. PMID: 24385598.

CONCLUSIONS: Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.

Wong MCS, Lam TYT, Tsoi KKF, Hirai HW, Chan VCW, Ching JYL, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects. Gut. 2014;63(7):1130–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24045331.  doi: 10.1136/gutjnl-2013-305639. PMID: 24045331.

CONCLUSIONS: The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia

 

Nota bibliográfica cribado c colorrectal 2014-06

Cohen-Cline H, Wernli KJ, Bradford SC, Boles-Hall M, Grossman DC. Use of interactive voice response to improve colorectal cancer screening. Med Care. 2014;52(6):496–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24638119. doi: 10.1097/MLR.0000000000000116. PMID: 24638119.

DISCUSSION: Our analysis provides “real-world” evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.

Digby J, McDonald PJ, Strachan JA, Libby G, Steele RJC, Fraser CG. Deprivation and faecal haemoglobin: implications for bowel cancer screening. J Med Screen. 2014;21(2):95–7. Available from: http://msc.sagepub.com/content/21/2/95.abstract. doi: 10.1177/0969141314535388.

Conclusions Deprivation and f-Hb are related. This has important implications for selection of cut-off f-Hb for screening programmes, and supports the inclusion of deprivation in risk-scoring systems.

Helander S, Hakama M, Malila N. Effect of a pre-screening survey on attendance in colorectal cancer screening: A double-randomized study in Finland. J Med Screen. 2014;21(2):82–8. Available from: http://msc.sagepub.com/content/21/2/82.abstract. doi: 10.1177/0969141314534229.

Conclusions We believe that the observed reduction in attendance in those who had been sent a questionnaire earlier is generally true. Thus, if any survey is enclosed in the screening invitation, this finding should be taken into account when planning the programme. Any extra effort requested may reduce the attendance proportion for screening, reducing the population level impact of screening.

Yang DX, Gross CP, Soulos PR, Yu JB. Estimating the magnitude of colorectal cancers prevented during the era of screening. Cancer. 2014;n/a–n/a. Available from: http://dx.doi.org/10.1002/cncr.28794. doi: 10.1002/cncr.28794.

CONCLUSIONS There has been a significant decline in the incidence of colorectal cancer in the United States, particularly for late-stage disease, during a time of increasing rates of screening.

Van Hees F, Habbema JDF, Meester RG, Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG. Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening?A Cost-Effectiveness Analysis Colorectal Cancer Screening in Unscreened Elderly Persons. Ann Intern Med. 2014;160(11):750–9. Available from: http://dx.doi.org/10.7326/M13-2263.

Conclusion: In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.

Brenner H, Hoffmeister M, Birkner B, Stock C. Men with negative results of guaiac-based fecal occult blood test have higher prevalences of colorectal neoplasms than women with positive results. Int J Cancer. 2014;134(12):2927–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24374771. doi: 10.1002/ijc.28618. PMID: 24374771.

Our findings underline need to move forward from and overcome shortcomings of gFOBT-based colorectal cancer screening.

Bevan R, Lee TJW, Nickerson C, Rubin G, Rees CJ. Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: Data from the English Bowel Cancer Screening Programme. J Med Screen. 2014;21(2):89–94. Available from: http://msc.sagepub.com/content/21/2/89.abstract. doi: 10.1177/0969141314528889.

Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.

   

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