Recommendations on screening for colorectal cancer in primary care

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doi:10.1503/cmaj.151125

Cited by 212 publications

(124 citation statements)

References 29 publications

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“…The reason that CRC screening is recommended for people starting at age 50 years in Korea28, as well as in many other national guidelines293031, is because screening colonoscopy studies have shown a significantly increased risk of advanced neoplasms among people older than 50 years323334. Additionally, we considered CRC patients aged 65 years or more as late-onset for the sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

Common risk variants for colorectal cancer: an evaluation of associations with age at cancer onset

Song

Shin

Park

et al. 2017

Sci Rep

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Common genetic risk variants for colorectal cancer (CRC) have been identified at approximately 40 loci by genome-wide association studies (GWAS). We investigated the association of these risk variants by age at onset of CRC using case-only and case-control analysis. A total of 1,962 CRC cases and 2,668 controls from two independent case-control studies conducted by Korea’s National Cancer Center were included in this study. We genotyped 33 GWAS-identified single-nucleotide polymorphisms (SNPs) associated with CRC risk. The risk allele in SNP rs704017, located at 10q22.3 in the ZMIZ1-AS1 gene, was consistently less frequent among CRC patients aged <50 years than among CRC patients aged ≥50 years in the case-only analysis (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.66–0.92, P = 2.7 × 10−3, in an additive model), although this did not surpass the threshold for multiple testing. The direction of associations between rs704017 and CRC risk differed by age group in the combined case-control analysis (<50 years: OR = 0.77, 95% CI = 0.60–0.98, P = 0.03 and ≥50 years: OR = 1.13, 95% CI = 0.98–1.29, P = 0.09, in a dominant model); the p-values for heterogeneity (Pheterogeneity = 7.5 × 10−3) and for interaction were statistically significant (Pinteraction = 7.8 × 10−3, in the dominant model). Our results suggest that the CRC susceptibility SNP rs704017 has a hereditary effect on onset age of CRC.

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Section: Discussionmentioning

confidence: 99%

Common risk variants for colorectal cancer: an evaluation of associations with age at cancer onset

Song

Shin

Park

et al. 2017

Sci Rep

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“…In the meantime, some jurisdictions, including our own, advocate for fecal occult blood testing or flexible sigmoidoscopy as proven entities [12]. Even so, it is agreed that subjects considered at high risk for CRC would be better served by colonoscopy [13]. This would currently apply to those with a significant family history of CRC or a personal history of colonic neoplasia.…”

Section: Introductionmentioning

confidence: 99%

Obesity Increases Prevalence of Colonic Adenomas at Screening Colonoscopy: A Canadian Community-Based Study

Shapero

Chen

Devlin

et al. 2017

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims Obesity is a risk factor for colorectal neoplasia. We examined the influence of obesity and metabolic syndrome (MetS) on prevalence of neoplasia at screening colonoscopy. Methods We evaluated 2020 subjects undergoing first screening colonoscopy. Body mass index (BMI) was calculated at enrolment. Hyperlipidemia (HL), hypertension (HT), and diabetes mellitus (DM) were identified. Details of colonoscopy, polypectomy, and histology were recorded. Odds for adenomas (A) and advanced adenomas (ADV) in overweight (BMI 25.1–30) and obese (BMI > 30) subjects were assessed by multinomial regression, adjusted for covariates. Analyses included relationships between HL, HT, DM, age, tobacco usage, and neoplasia. Discriminatory power of HT, HL, DM, and BMI for neoplasia was assessed by binary logistic regression. Odds were calculated for neoplasia in each colonic segment related to BMI. Results A and ADV were commoner in overweight and obese males, obese females, older subjects, and smokers. HL, HT, and DM were associated with increased odds for neoplasia, significantly for A with hypertension. BMI alone predicted neoplasia as well as HT, HL, DM, or combinations thereof. All segments of the colon were affected. Multiple polyps were particularly prevalent in the obese. Conclusions Obesity and MetS are risk factors for colonic neoplasia in a Canadian population.

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“…This has led to the endorsement of different screening methods by both national and international guidelines [13–17] including guaiac-based fecal occult blood tests, fecal immunochemical tests (FITs), fecal DNA tests, flexible sigmoidoscopy, colonoscopy (CSPY), and computed tomographic colonography, with selection largely based on the performance and cost-effectiveness of the screening strategy [18]. However, arguably the most important parameter is patient preference, which intrinsically impacts screening participation [19–21].…”

Section: Introductionmentioning

confidence: 99%

“…However, arguably the most important parameter is patient preference, which intrinsically impacts screening participation [19–21]. As Canada transitions from opportunistic to programmatic CRC screening, the Canadian Association of Gastroenterology and the Canadian Task Force on Preventative Health have recommended stool-based methods, specifically FIT, to be the preferred method for CRC screening in the average-risk population [13, 17]. …”

Section: Introductionmentioning

confidence: 99%

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

Shahidi

Gentile

Gondara

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims. The Canadian Partnership Against Cancer (CPAC) recommends a fecal immunochemical test- (FIT-) positive predictive value (PPV) for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP). Methods. From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan) with a cut-off of ≥10 μg/g (≥50 ng/mL) was used. Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL) the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL) would increase the PPV for colorectal cancer (CRC) by 1.5% and for high-risk adenomas (HRAs) by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs. Conclusions. As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL) produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.

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Recommendations on screening for colorectal cancer in primary care

Cited by 212 publications

References 29 publications

Common risk variants for colorectal cancer: an evaluation of associations with age at cancer onset

Common risk variants for colorectal cancer: an evaluation of associations with age at cancer onset

Obesity Increases Prevalence of Colonic Adenomas at Screening Colonoscopy: A Canadian Community-Based Study

Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

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