Opportunistic Colorectal Cancer Screening using Colonoscopy. Comparative Results between two Historical Cohorts in Bucharest, Romania

Abstract

Background & Aims: Even though Romania has one of the highest incidence and mortality in colorectal cancer (CRC) in Europe, there is currently no organized screening program. We aimed to assess the results of our opportunistic CRC screening using colonoscopy.Methods: A single center retrospective study to include all opportunistic screening colonoscopies performed in two 18 month periods (2007-2008 and 2012-2013) was designed. All asymptomatic individuals without a personal or family history of adenoma or CRC and with complete colonoscopy performed in these two time periods were included.Results: We included 1,807 individuals, 882 in the first period, 925 in the second period. There were 389 individuals aged below 50, 1,351 between 50 and 75 and 67 older than 75 years. There were 956 women (52.9%), with a mean age of 58.5 (median 59, range 23-97). The detection rates were 12.6% for adenomas (6.1% for advanced adenoma) and 3.4% for adenocarcinoma. Adenoma incidence (4.9% in subjects under 50, 14.7% in those aged 50 to 75, and 16.4% in those older than 75, p<0.0001) and size (6.3mm in subjects younger than 50, 9.2mm in those 50 to 75 and 10.8mm in those older than 75, p=0.015) significantly increased with age. Adenoma incidence increased in the second period (14.8% vs. 10.3%, p=0.005), while adenoma size decreased in the second period (8.4mm vs. 10mm, p=0.006). There were no procedure related complications.Conclusions: The neoplasia detection rate was 16% (12.6% adenoma, 3.4% adenocarcinoma). Adenoma incidence and size increased with age in both cohorts. In the second screening period significantly more and smaller adenomas were detected.

Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis

“…The most common reason for excluding full-text articles was that higher-than-averagerisk individuals were included in the study, such as those with a family history of CRC or symptoms prompting the colonoscopy examination. There were 17 total articles included with 51,811 individuals younger than 50 years [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] (Figure 1, Supplementary Table 2). Seven studies were from East Asia (4 from South Korea, 2 from Taiwan, and 1 from China), 5 from the United States, 3 from Europe (Romania, Germany, and Greece), and 2 from the Middle East (Israel and Iran).…”

“…Meta-analysis was performed on additional age categories delineated as younger than 40 years, 37,45,48 40-44 years 37,40,43,45,48 and 45-49 years. [38][39][40]43,45,[47][48][49] Neoplasia outcomes were significantly different by age groups (c 2 ¼ 13.038; P ¼ .001).…”

“…Meta-analysis was performed on additional age categories delineated as younger than 40 years, 37,45,48 40-44 years 37,40,43,45,48 and 45-49 years. [38][39][40]43,45,[47][48][49] Neoplasia outcomes were significantly different by age groups (c 2 ¼ 13.038; P ¼ .001). Pooled rates of EAO-CRN increased from 8.1% (95% CI, 0.050%-0.127%) to 11.7% (95% CI, 0.092%-0.149%) to 17.8% (95% CI, 0.145%-0.216%) for ages younger than 40 years, 40-44 years, and 45-49 years, respectively (Figure 3A).…”

Upconversion 3D Printed Composite with Multifunctional Applications for Tissue Engineering and Photodynamic Therapy

“…It is hypothesized that cells under the effect of mutagenic agents undergo DNA damage, failing to survive the cycle of cell division and thereby undergo a process of necrosis or apoptosis before the end of first division. 65 This may be the reason for the significant lower NDIs of the PC and the PCL/UCNPs-apatite eluate in the 100% concentration in comparison to the NC. There may also be an induction of mitotic delay which, by not permitting the repair of genotoxic lesions, will modify the number of cells entering mitosis by modifying the ratio of mono, bi-, tri-and tetranucleated cells.…”

Screeners vs. Non-screeners for Colorectal Cancer among People over 50 Years of Age: Factual and Psychological Discriminants

“…In countries with a screening programme in place, participation rates range between 4.5% and 71.3% [11]. In countries without a screening programme, Eurostat surveys [13] shows high rates of individuals aged between 50 and 74 years that have never been screened for CRC: Bulgaria approximately 90%, Greece approximately 77%, Slovakia approximately 52%, and Romania approximately 95% [14][15][16]. The country rates should be carefully interpreted for two reasons, first information is self-reported by the patients, and second the numbers might be slightly dated as the Eurostat survey on colorectal cancer screening has not been updated since 2014.…”