A symptom‐based model to predict colorectal cancer in low‐resource countries: Results from a prospective study of patients at high risk for colorectal cancer

Alatise, Olusegun Isaac; Ayandipo, Omobolaji; Adeyeye, Ademola; Seier, Ken; Komolafe, Abiola Olubusola; Bojuwoye, Matthew O.; Afuwape, Oludapo O.; Zauber, Ann G.; Omisore, Adeleye Dorcas; Olatoke, Samuel; Akere, Adegboyega; Famurewa, O.; Gönen, Mithat; Irabor, David O.; Kingham, T. Peter

doi:10.1002/cncr.31399

Cited by 18 publications

(22 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…28 In a more recent cohort of patients with rectal bleeding at the same institution, the adenoma detection rate was 8.5%. 29 This is congruent with a number of other single-institution series from across the country, which demonstrate a relatively low burden of traditional adenomas. 30-32 Unfortunately, there is a dearth of prospective data from asymptomatic individuals from which to draw meaningful conclusions about the true burden and pathogenesis of early colorectal neoplasia in Nigeria.…”

Section: Pathogenesis Of Crc In Nigeriasupporting

confidence: 84%

“…More than 70% of those individuals had resectable disease, which represented a dramatic stage migration for a CRC cohort in Nigeria. 29 Risk stratification, even in traditionally high-risk subgroups (eg, those based on family history), may be required in the Nigerian context while endoscopy capacity remains limited.…”

Section: Targeted High-risk Screening In Nigeriamentioning

confidence: 99%

See 1 more Smart Citation

Is Colorectal Cancer Screening Appropriate in Nigeria?

Knapp

Alatise

Olasehinde

et al. 2019

JGO

Self Cite

View full text Add to dashboard Cite

PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.

show abstract

Section: Pathogenesis Of Crc In Nigeriasupporting

confidence: 84%

Section: Targeted High-risk Screening In Nigeriamentioning

confidence: 99%

Is Colorectal Cancer Screening Appropriate in Nigeria?

Knapp

Alatise

Olasehinde

et al. 2019

JGO

Self Cite

View full text Add to dashboard Cite

show abstract

“…The low prevalence of adenomas in our study is congruent with a growing body of literature from high-volume tertiary care centers performing high-quality endoscopy across Nigeria [ 12 – 14 ]. A prospective, multi-center, Nigerian study of 362 patients with a recent history of self-reported rectal bleeding documented an ADR of 8.2%, despite a CRC prevalence of 18.2% (66/362) [ 27 ]. In a recent prospective study from the University College Hospital in Ibadan, Nigeria, the ADR was 9.1% among asymptomatic adults undergoing CRC screening [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction There is a paucity of prospective data on the performance of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening in sub-Saharan Africa. The aim of this exploratory analysis was to evaluate the feasibility and performance of FIT in Nigeria. Methods This was a prospective, single-arm study. A convenience sample of asymptomatic, average-risk individuals between 40–75 years of age were enrolled at Obafemi Awolowo University Teaching Hospital. Study participants returned in 48 hours with a specimen for ova and parasite (O&P) and qualitative FIT (50ug/g) testing. Participants with a positive FIT had follow-up colonoscopy and those with intestinal parasites were provided treatment. Results Between May-June 2019, 379 individuals enrolled with a median age of 51 years (IQR 46–58). In total, 87.6% (n = 332) returned for FIT testing. FIT positivity was 20.5% (95% CI = 16.3%-25.2%). Sixty-one (89.7%) of participants with a positive FIT had a follow-up colonoscopy (n = 61), of whom 9.8% (95%CI:3.7–20.2%) had an adenoma and 4.9% (95%CI:1.0–13.7%) had advanced adenomas. Presence of intestinal parasites was inversely related to FIT positivity (6.5% with vs. 21.1% without parasites, p = 0.05). Eighty-two percent of participants found the FIT easy to use and 100% would recommend the test to eligible family or friends if available. Conclusions Asymptomatic, FIT-based CRC screening was feasible and well tolerated in this exploratory analysis. However, the high FIT positivity and low positive predictive value for advanced neoplasia raises concerns about its practicality and cost effectiveness in a low-resource setting such as Nigeria.

show abstract

“…For example, the role of symptomatic-based surveillance models is being explored in Nigeria, where a recent multicenter prospective trial investigated a screening tool to predict increased risk of CRC in patients with rectal bleeding. 12 Risk stratification is particularly important in resource-limited regions where the incidence of CRC remains low but mortality is high, as in sub-Saharan Africa. 12 We discuss future directions and technological developments to facilitate risk stratification and screening in the global context at the end of this articles.…”

Section: Screening and Surveillance Approachesmentioning

confidence: 99%

“…12 Risk stratification is particularly important in resource-limited regions where the incidence of CRC remains low but mortality is high, as in sub-Saharan Africa. 12 We discuss future directions and technological developments to facilitate risk stratification and screening in the global context at the end of this articles.…”

Section: Screening and Surveillance Approachesmentioning

confidence: 99%

Colon and Rectal Cancer Management in Low-Resource Settings

Nalluri

Gaertner

2022

Clin Colon Rectal Surg

View full text Add to dashboard Cite

Colorectal cancer (CRC) incidence is rising in low- and middle-income countries, which also face disproportionate mortality from CRC, mainly due to diagnosis at late stages. Various challenges to CRC care exist at multiple societal levels in underserved populations. In this article, barriers to CRC care, strategies for screening, and treatment in resource-limited settings, and future directions are discussed within a global context.

show abstract

A symptom‐based model to predict colorectal cancer in low‐resource countries: Results from a prospective study of patients at high risk for colorectal cancer

Cited by 18 publications

References 35 publications

Is Colorectal Cancer Screening Appropriate in Nigeria?

Is Colorectal Cancer Screening Appropriate in Nigeria?

Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria

Colon and Rectal Cancer Management in Low-Resource Settings

Contact Info

Product

Resources

About