Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study

Cardoso, Rafael; Guo, Feng; Heisser, Thomas; Hackl, Monika; Ihle, Petra; Schutter, Harlinde De; Damme, Nancy Van; Valerianova, Z.; Atanasov, T.; Májek, Ondřej; Mužı́k, Jan; Nilbert, Mef; Tybjerg, Anne Julie; Innos, Kaire; Mägi, Margit; Malila, Nea; Bouvier, Anne–Marie; Bouvier, Véronique; Launoy, Guy; Woronoff, Anne‐Sophie; Cariou, Mélanie; Robaszkiewicz, Michel; Delafosse, Patricia; Poncet, F.; Katalinic, Alexander; Walsh, Paul; Senore, Carlo; Rosso, Stefano; Vincerževskienė, Ieva; Lemmens, Valery; Elferink, M.A.G.; Johannesen, Tom Børge; Kørner, Hartwig; Pfeffer, F.; Bento, Maria José; Rodrigues, Jéssica; Costa, Filipa Alves da; Miranda, Ana; Zadnik, Vesna; Žagar, Tina; Marques, Arantza Lopez de Munain; Marcos‐Gragera, Rafael; Puigdemont, Montse; Galcerán, Jaume; Carulla, Marià; Chirlaque, María‐Dolores; Ballesta, M. Teresa Sánchez; Sundquist, Kristina; Sundquist, Jan; Weber, Marco; Jordan, Andrea; Herrmann, Christian; Mousavi, Seyed Mohsen; Ryzhov, Anton; Hoffmeister, Michael; Brenner, Hermann

doi:10.1016/s1470-2045(21)00199-6

Cited by 231 publications

(179 citation statements)

References 22 publications

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“…Colonoscopy is generally considered the gold standard test for early detection of CRC and its precursors as it rarely misses advanced colonic lesions [22], and screening by this highly sensitive method has been estimated to reduce the risk of developing or dying from CRC by 60-70% [23]. A recent study showed that in countries with long-standing screening colonoscopy programs, CRC incidence and mortality decreased substantially over time [24]. Despite the large potential of colonoscopy-based screening, there are also major concerns related to the design and characteristics of conventional screening colonoscopy offers that may substantially limit the effectiveness of such offers and call for novel approaches to overcome them.…”

Section: Discussionmentioning

confidence: 99%

Making colonoscopy-based screening more efficient: a ‘gateopener’ approach

Heisser

Cardoso

Niedermaier

et al. 2021

Preprint

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Objectives To assess the potential of an innovative approach to colonoscopy-based screening for colorectal cancer (CRC), by use of a single, low threshold fecal immunochemical test (FIT) as a "gateopener" for screening colonoscopy. Design Simulation study using COSIMO, a validated Markov-based simulation model, in a hypothetical German population. Setting Modelled scenarios included either direct invitation to screening colonoscopy or mailing a single ("gateopener") FIT along with an invitation to colonoscopy contingent on a FIT value above a low threshold yielding a 50% positivity rate (e.g., every other pre-test will be positive). The main analyses focused on scenarios assuming identical colonoscopy uptake, resulting from higher adherence to the gateopener FIT than to primary use of colonoscopy and avoidance of colonoscopy in those with below-threshold FIT values. Participants Hypothetical cohorts of 100,000 previously unscreened men and women using screening at different ages and with varying levels of adherence. Interventions Screening colonoscopy without and with preceding gateopener FIT. Main outcome measure Detected and prevented CRC cases and deaths within 10 years. Results Across all ages and both sexes, use of screening colonoscopy contingent on a positive gateopener FIT yielded approximately doubled cancer detection rates as compared to conventional screening. In those spared from undergoing screening colonoscopy due to a negative FIT pretest, numbers needed to screen were 10-times higher as compared to those for individuals with a positive FIT, peaking in more than 2500 and more than 3800 (hypothetically) needed colonoscopies to detect one case of cancer in 50-year-old men and women, respectively. At identical levels of colonoscopy use, gateopener screening resulted in 51-53% and 63-68% more prevented CRC cases and deaths, respectively. Conclusions By directing colonoscopy capacities to those most likely to benefit from it, offer of screening colonoscopy contingent on a "gateopener" low-threshold FIT would substantially enhance efficiency of colonoscopy screening.

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Section: Discussionmentioning

confidence: 99%

Making colonoscopy-based screening more efficient: a ‘gateopener’ approach

Heisser

Cardoso

Niedermaier

et al. 2021

Preprint

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“…Colorectal cancer screening (CRC) has been implemented in numerous countries worldwide and often consists of a fecal immunochemical test (FIT) followed by colonoscopy [ 1 ]. In the Danish CRC Screening Program, a colonoscopy is considered incomplete when the caecum is not reached, or when the colonic mucosa is not sufficiently visible in all segments [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

et al. 2022

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The aim of this study is to investigate the association between socioeconomic status (SES) and the risk of having an incomplete colonoscopy (IC) in the Danish Colorectal Cancer (CRC) Screening Program. In this register-based study we included 71,973 participants who underwent colonoscopy after a positive fecal immunochemical test in the Danish CRC Screening Program. The main exposure, SES, was defined by income and education, and the outcome by complete or incomplete colonoscopy. Among the participants, 5428 (7.5%) had an incomplete colonoscopy. The odds ratio (OR) for ICs due to inadequate bowel preparation was 1.67 (95% CI: 1.46; 1.91) for income in the 1 quartile compared to income in the 4th quartile. ORs for income in the 2nd quartile was 1.38 (95% CI: 1.21; 1.56) and 1.17 (95% CI: 1.03; 1.33) for income in the 3rd quartile. For the educational level, an association was seen for high school/vocational education with an OR of 0.87 (95% CI: 0.79; 0.97) compared to higher education. For ICs due to other reasons, the level of income was associated with the risk of having an IC with an OR of 1.19 (95% CI: 1.05; 1.35) in the 1st quartile and an OR of 1.19 (95% CI: 1.06; 1.34) in the 2nd quartile. For the educational level, there were no significant associations. Low income is associated with high risk of having an IC, whereas educational level does not show the same unambiguous association.

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“…To date, this evidence is largely based on the guaiac faecal occult blood test (gFOBT). However, these tests are considered obsolete 10 and screening programmes world wide, 11 including all in the United Kingdom, and many in Europe, 12 have replaced, or are replacing, the gFOBT with the FIT. Unlike the gFOBT, the FIT is specific for human haemoglobin (Hb) and can provide a quantitative estimate of the f-Hb concentration.…”

Section: Introductionmentioning

confidence: 99%

Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

et al. 2021

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Objective There is evidence that colorectal cancer screening using faecal haemoglobin is less effective in women than men. The faecal haemoglobin concentrations were therefore examined in women and men with screen-detected colorectal cancer. Setting Scottish Bowel Screening Programme, following the introduction of a faecal immunochemical test from November 2017, to March 2020. Methods Data were collated on faecal haemoglobin concentrations, pathological stage and anatomical site of the main lesion in participants who had colorectal cancer detected. The data in women and men were compared. Results For the faecal haemoglobin concentrations studied (>80 µg Hb/g faeces), the distributions indicated lower concentrations in women. Marked differences were found between women and men diagnosed with colorectal cancer. The median faecal haemoglobin concentration for women ( n = 720) was 408 µg Hb/g faeces compared to 473 µg Hb/g faeces for men ( n = 959) ( p = 0.004) and 50.6% of the results were >400 µg Hb/g faeces in women; in men, this was 57.8%. The difference in faecal haemoglobin concentrations in women and men became less statistically significant as stage advanced from stages I–IV. For right-sided, left-sided and rectal colorectal cancer, a similar gender difference persisted in all sites. Differences in faecal haemoglobin between the genders were significant for left-sided cancers and stage I and approached significance for rectal cancers and stage II, but all sites and stages showed lower median faecal haemoglobin concentrations for women. Conclusions To minimise gender inequalities, faecal immunochemical test-based colorectal cancer screening programmes should evaluate a strategy of using different faecal haemoglobin concentration thresholds in women and men.

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Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study

Cited by 231 publications

References 22 publications

Making colonoscopy-based screening more efficient: a ‘gateopener’ approach

Making colonoscopy-based screening more efficient: a ‘gateopener’ approach

Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

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