programas cribado cancer

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: 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: 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.
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