Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy

Schoen, Robert E.; Pinsky, Paul F.; Weissfeld, Joel L.; Yokochi, Lance; Church, Timothy R.; Laiyemo, Adeyinka O.; Bresalier, Robert S.; Andriole, Gerald L.; Buys, Saundra S.; Crawford, E. David; Fouad, Mona N.; Isaacs, Claudine; Johnson, Christine Cole; Reding, Douglas J.; O’Brien, Barbara; Carrick, Danielle M.; Wright, Patrick; Riley, Thomas L.; Purdue, Mark P.; Izmirlian, Grant; Kramer, Barnett S.; Miller, Anthony B.; Gohagan, John K.; Prorok, Philip C.; Berg, Christine D.

doi:10.1056/nejmoa1114635

Cited by 875 publications

(625 citation statements)

References 38 publications

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“…Early detection through screening has been shown to be cost-effective (Tappenden et al, 2007) and effective in reducing CRC mortality (Hewitson, Glasziou, Irwig, Towler, & Watson, 2007;Schoen et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Solmi

Wagner

Kobayashi

et al. 2015

Social Science & Medicine

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Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60 to 69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality.We used data from 1,833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition.There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%).Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

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Section: Introductionmentioning

confidence: 99%

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Solmi

Wagner

Kobayashi

et al. 2015

Social Science & Medicine

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“…Screening for CRC has been shown to decrease CRC mortality for average risk as well as high-risk individuals (Atkin et al 2010;Hardcastle et al 1996;Hewitson et al 2008;Kronborg et al 1996;Mandel et al 1993;Schoen et al 2012). The American College of Physicians (ACP) recommends that clinicians assess risk for CRC in all adults, and that average-risk individuals screen for CRC using fecal occult blood testing (FOBT) annually, flexible sigmoidoscopy every 5 years, or optical colonoscopy every 10 years, beginning at age 50 and continuing until age 75 (Qaseem et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

et al. 2014

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We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/ Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p<0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p<0.001), and improvement in total mean scores on outcome measures for all vignettes. Most demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.

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“…The endoscopic removal of pre-malignant lesions also reduces the incidence of CRC by avoiding the progression to cancer. Randomized trials in people of average risk invited to participate in screening have shown a reduction in CRC incidence [4][5][6][7] and mortality [4,[7][8][9][10].The EU recommends population-based screening for breast, cervical and colorectal cancer using evidence-based methods with quality assurance of the entire screening process [11]. The EU policy takes into account the principles of cancer screening developed by the World Health Organization [12] and the extensive experience in the EU in piloting and implementing population-based cancer screening programmes [13].…”

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confidence: 99%

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Karsa¹,

Patnick²,

Segnan³

et al. 2012

Endoscopy

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Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. IntroductionAccording to recent estimates by the International Agency for Research on Cancer [1], colorectal cancer (CRC) is the most common cancer in Europe with 432 000 new cases reported annually in men and women combined. It is the second most common cause of cancer deaths in Europe with 212 000 deaths reported in 2008.Worldwide, CRC ranks third in incidence and fourth in mortality with an estimated 1.2 million cases and 0.6 million deaths annually. In the 27 Member States of the European Union (EU), CRC ranks first in incidence and second in mortality, with approximately 334000 new cases and 149000 deaths estimated in 2008.Even in those Member States in the lower range for age-standardized rates of CRC, the burden of disease is significantly greater when compared with many other HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript regions of the world (see reference [1]). CRC is therefore an important health problem across the EU.Screening can be effective in cancer control in populations with a significant burden of CRC, provided the services are of high quality [2]. The aim of CRC screening is to lower the burden of cancer in the population by discovering disease in its early, latent stages [3]. Evidence-based methods permit treatment that is more effective than if disease is diagnosed later when symptoms have occurred. Early treatment of invasive lesions, for example by endoscopic resection of early CRC, can also be less detrimental for quality of life. The endoscopic removal of pre-malignant lesions also reduces the incidence of CRC by avoiding the progression to cancer. Randomized trials in people of average risk invite...

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Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy

Cited by 875 publications

References 38 publications

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

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