An updated Asia Pacific Consensus Recommendations on colorectal cancer screening

Sung, Joseph J.Y.; Ng, Siew C.; Chan, Francis K.L.; Chiu, Han–Mo; Kim, H.; Matsuda, Takahisa; Ng, Simon Siu Man; Lau, James Y.; Zheng, Shu; Adler, Samuel N.; Reddy, Nageshwar; Yeoh, Khay-Guan; Tsoi, Kelvin K.F.; Ching, Jessica; Kuipers, Ernst J.; Rabeneck, Linda; Young, Graeme P.; Steele, Robert; Lieberman, David A.; Goh, Khean‐Lee

doi:10.1136/gutjnl-2013-306503

Cited by 354 publications

(355 citation statements)

References 121 publications

(93 reference statements)

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“…46 On the contrary, CTC and CCE were not recommended for screening. In the US, surveillance programme guidelines from the American Cancer Society provided two sets of test options for asymptomatic adults aged ≥50 years.…”

Section: Current Guidelinesmentioning

confidence: 99%

“…44 Other guidelines including the National Institutes of Health Asia Pacific Consensus Recommendations do not support its use, however, stating its lack of evidence as a screening technique in an average-risk population. 45,46 Studies of CTC in the literature use detection of polyps in general as the end-point. Data for detection of invasive carcinoma as well as reduction in CRC mortality were not available.…”

Section: Computed Tomographic Colonographymentioning

confidence: 99%

“…69 The impact of FS as a screening tool is well established in the literature and accepted in various screening protocols. 44,46 This technique should be included as an alternative choice for a populationwide screening programme, and the shortage of endoscopists could be partially addressed by training specialised nurses in the procedure. 74 Combining flexible sigmoidoscopy with guaiac and immunohistochemical faecal occult blood testing Flexible sigmoidoscopy cannot replace the role of colonoscopy in individuals with a positive faecal occult blood test.…”

Section: Flexible Sigmoidoscopymentioning

confidence: 99%

See 2 more Smart Citations

Alternatives to colonoscopy for population-wide colorectal cancer screening

Leung¹,

Foo²,

Chan³

et al. 2016

Hong Kong Med J

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Section: Current Guidelinesmentioning

confidence: 99%

Section: Computed Tomographic Colonographymentioning

confidence: 99%

Section: Flexible Sigmoidoscopymentioning

confidence: 99%

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Alternatives to colonoscopy for population-wide colorectal cancer screening

Leung¹,

Foo²,

Chan³

et al. 2016

Hong Kong Med J

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“…11 The association between NAFLD and an increased rate of colorectal adenomas was also established by Hwang et al 12 In particular, NAFLD patients aged 40-50 years had a higher risk of advanced neoplasia than controls, implying that earlier CRC screening before 50 years might be considered. The updated Asia Pacific Consensus recommendations on CRC screening 6 suggested colonoscopy as the test of choice for increased risk individuals, such as those with family history or obesity. Nevertheless, there has been no explicit recommendation on whether these groups should be screened at an earlier age, and which screening test is more preferred.…”

mentioning

confidence: 99%

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

Wong

Ching

Chan

et al. 2015

Intl Journal of Cancer

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Patients with nonalcoholic fatty liver disease (NAFLD) and family history of colorectal cancer (CRC) are at higher risks but how they should be screened remains uncertain. Hence, we evaluated the cost-effectiveness of CRC screening among patients with NAFLD and family history by different strategies. A hypothetical population of 100,000 subjects aged 40-75 years receive: (i) yearly fecal immunochemical test (FIT) at 50 years; (ii) flexible sigmoidoscopy (FS) every 5 years at 50 years; (iii) colonoscopy 10 yearly at 50 years; (iv) colonoscopy 10 yearly at 50 years among those with family history/NAFLD and yearly FIT at 50 years among those without; (v) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and yearly FIT at 50 years among those without and (vi) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and colonoscopy 10 yearly at 50 years among those without. The incremental cost-effectiveness ratio (ICER) was studied by Markov modeling. It was found that colonoscopy, FS and FIT reduced incidence of CRC by 49.5, 26.3 and 23.6%, respectively. Using strategies 4, 5 and 6, the corresponding reduction in CRC incidence was 29.9, 30.9 and 69.3% for family history, and 33.2, 34.7 and 69.8% for NAFLD. Compared with no screening, strategies 4 (US$1,018/life-year saved) and 5 (US$7,485) for family history offered the lowest ICER, whilst strategy 4 (US$5,877) for NAFLD was the most cost-effective. These findings were robust when assessed with a wide range of deterministic sensitivity analyses around the base case. These indicated that screening patients with family history or NAFLD by colonoscopy at 50 years was economically favorable.Colorectal Cancer (CRC) presents a leading global burden of disease, accounting for 10% of all malignancies and 8% of cancer mortality worldwide. 1 Its incidence is rising rapidly in both Western and Asia Pacific countries. 2 Screening was found to be effective in reducing CRC-related mortality by 33, 40 and 56% using fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FS) and colonoscopy, respectively. 3,4 Guidelines from Western and Asian countries 5,6 recommend population-based CRC screening in average-risk subjects aged 50-75 years.Fecal immunochemical tests (FITs) and FS are widely used in most countries as primary screening tools. FS is gaining popularity in European countries, whilst colonoscopy is becoming the predominant mode of screening in the United States. 7 None of the screening tests, however, appears optimal across all settings, and it is still inconclusive which of the available options could offer the best balance of costs and benefits.It has been reported that first-degree relatives (FDRs) of patients with CRC have a twofold increased risk of developing CRC compared to the general population. 8,9 Ng et al. recently found that siblings of CRC patients had a strong and significantly increased risk of advanced neoplasia than siblings of healthy individuals. 10 In addition, Wong et al. reported that patients with nonalcoholic...

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“…1 There is concrete evidence for the effectiveness of screening in reducing CRC-related mortality. 2 In some developed nations such as the US, colonoscopy has been used as a primary screening tool. 3 Because not all countries are equipped with adequate colonoscopy resources for populationbased screening, it is recommended for individuals with increased risk for CRC only.…”

mentioning

confidence: 99%

Challenges to the adoption of risk algorithms for colorectal cancer screening programmes: perspectives for future research

Huang¹,

Huang²

2017

Hong Kong Med J

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An updated Asia Pacific Consensus Recommendations on colorectal cancer screening

Abstract: Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region.

Cited by 354 publications

References 121 publications

Alternatives to colonoscopy for population-wide colorectal cancer screening

Alternatives to colonoscopy for population-wide colorectal cancer screening

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

Challenges to the adoption of risk algorithms for colorectal cancer screening programmes: perspectives for future research

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