Long-Term Mortality after Screening for Colorectal Cancer

Shaukat, Aasma; Mongin, Steven J.; Geisser, Mindy S.; Lederle, Frank A.; Bond, John H.; Mandel, Jack S.; Church, Timothy R.

doi:10.1056/nejmoa1300720

Cited by 732 publications

(550 citation statements)

References 32 publications

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“…However, this group may not be an appropriate age group to target, because it has lower CRC incidence and mortality than older groups and stratified analysis of trials of FOBT have not shown benefits of CRC screening in the 50-55 age group. 31,32 Screening of healthy individuals above the age of 75, especially those with no prior CRC screening, may be appropriate, because they have higher CRC incidence and mortality than younger individuals; 1 no CRC screening RCT has included people older than 75. Although the decreased odds of CRC screening among single men was not statistically significant in our study, the trend we observed supports findings in other studies.…”

Section: Discussionmentioning

confidence: 99%

Screening rates for colorectal cancer in Canada: a cross-sectional study

et al. 2015

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Introduction: Implementation of population-based colorectal cancer (CRC) screening programs should reduce disparities in participation in CRC screening. We estimated CRC screening rates in 2012 in Canada and assessed predictors of screening in provinces with and without well-established population-based screening programs. Methods:We used data from the Canadian Community Health Survey for 2012 to calculate the prevalence of up-to-date CRC screening, defined as fecal occult blood testing (FOBT) within 2 years before the survey or flexible sigmoidoscopy or colonoscopy within 10 years before the survey, or both. Weighted proportions of individuals with up-to-date screening were calculated and logistic regression analysis performed to assess predictors of up-to-date CRC screening, including differences in participation by income level. Results:The prevalence of up-to-date CRC screening among people 50-74 years of age in 2012 was 55.2%, ranging from 41.3% in the territories to 67.2% in the province of Manitoba. The rate for sigmoidoscopy or colonoscopy was 37.2% (highest in Ontario, at 43.3%), and for FOBT it was 30.1% (highest in Manitoba, at 51.7%). About 41% of those who had an FOBT also had a sigmoidoscopy or colonoscopy. Individuals in the highest income group were more likely than those in lower-income groups to be up to date with CRC screening, even in provinces with well-established population-based screening programs.Interpretation: More than half of Canadians were up to date with CRC screening in 2012, but there were large differences among provinces. Differences by income group in provinces with population-based screening programs need particular attention. Abstract E150CMAJ OPEN, 3(2)

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Section: Discussionmentioning

confidence: 99%

Screening rates for colorectal cancer in Canada: a cross-sectional study

et al. 2015

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“…Colorectal cancer screening significantly reduces colorectal cancer incidence and mortality, as demonstrated by large studies with a long follow-up period (1)(2)(3)(4). The Netherlands has recently implemented a colorectal cancer screening program, consisting of biennial fecal immunochemical testing (FIT) in individuals aged 55 to 75 years.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impact of the Dutch Colorectal Cancer Screening Program on Cancer Incidence and Mortality—Model-Based Exploration of the Serrated Pathway

Greuter

Demirel

Lew

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: We aimed to predict the long-term colorectal cancer incidence, mortality, and colonoscopy demand of the recently implemented Dutch colorectal cancer screening program.Methods: The Adenoma and Serrated pathway to Colorectal Cancer model was set up to simulate the Dutch screening program consisting of biennial fecal immunochemical testing combined with the new Dutch surveillance guidelines, between 2014 and 2044. The impact of screening and surveillance was evaluated under three sets of natural history assumptions differing in the contribution of the serrated pathway to colorectal cancer incidence. In sensitivity analyses, other assumptions concerning the serrated pathway were varied. Model-predicted outcomes were yearly colorectal cancer incidence, mortality, and colonoscopy demand per year.Results: Assuming an aging population, colorectal cancer incidence under 30 years of screening is predicted to decrease by 35% and 31% for a contribution of 0% and 30% of the serrated

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“…15 However, gFOBT has limitations largely because of its reliance on detecting a more nonspecific marker for bleeding (ie, heme through a peroxidase reaction). Newer tests like FIT and sDNA have clear biological advantages over gFOBT16; however, the evidence for these tests is less mature.17 For FIT and a select few sDNA18, 19 and 20 panels, there are cross-sectional, population-based studies in which colonoscopy is the reference standard.…”

Section: Quality Of Evidencementioning

confidence: 99%

Stool Testing for Colorectal Cancer Screening

Robertson

Imperiale

2015

Gastroenterology

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Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality and is widely recommended. However, despite the demonstrated benefits of screening and ongoing efforts to improve screening rates, a large percentage of the population remains unscreened.Noninvasive stool based tests offer great opportunity to enhance screening uptake. The evidence supporting the use of both fecal immunochemical testing (FIT) and stool DNA (sDNA) has been growing rapidly and both tests are now commercially available for use. Other stool biomarkers (eg, RNA and protein based) are also actively under study both for use independently and as adjuncts to the currently available tests. This mini review provides current, state of the art knowledge about noninvasive stool based screening. It includes a more detailed examination of those tests currently in use (ie, FIT and sDNA) but also provides an overview of stool testing options under development (ie, protein and RNA). Keywords Stool Testing for Colorectal Cancer ScreeningColorectal cancer (CRC) screening is available across the United States, Europe, and Asia. Unlike screening tests for breast and prostate cancer, there is strong evidence that CRC screening reduces disease-specific morbidity and mortality.1 For fecal occult blood testing2 and flexible sigmoidoscopy,3 and 4 several large randomized trials show a mortality benefit, whereas observational studies show a mortality benefit for colonoscopy5 and 6 relative to usual care.Although CRC screening is widely available, the specifics of the programs vary across countries. Programmatic screening with fecal occult blood, flexible sigmoidoscopy, and colonoscopy has been successfully used in Canada, Europe and Asia. In the United States, screening is largely opportunistic7 and guidelines endorse a panel of options.8 Evidence suggests that colonoscopy is currently the dominant approach9 and so the role of the gastrointestinal specialist has largely been centered on providing high quality endoscopy. However, market forces may impact this practice. Gastrointestinal specialists likely will be increasingly relied upon to develop CRC screening programs for the populations they serve.10 In this capacity, knowledge about noninvasive stool based options will become increasingly important.This mini-review provides current, state of the art knowledge about noninvasive stool based screening. The key advantages of noninvasive screening approaches are reviewed and the current state of evidence supporting such use summarized ( Related to this latter concept is the false-positive rate, which is a function of specificity. A test with high specificity and low false positive rate reduces risks of harm from both unnecessary testing and overdiagnosis.11 It also helps reduce the cost of screening, another desirable feature, particularly from a population-based perspective. Of course, the test should be able to detect the target lesion, making sensitivity of the test or program very important. For CRC screening, a noninvasive tes...

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Long-Term Mortality after Screening for Colorectal Cancer

Cited by 732 publications

References 32 publications

Screening rates for colorectal cancer in Canada: a cross-sectional study

Screening rates for colorectal cancer in Canada: a cross-sectional study

Long-Term Impact of the Dutch Colorectal Cancer Screening Program on Cancer Incidence and Mortality—Model-Based Exploration of the Serrated Pathway

Stool Testing for Colorectal Cancer Screening

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