Screening Colonoscopy in Chinese and Western Patients: A Comparative Study

Soon, Maw–Soan; Kozarek, Richard A.; Ayub, Kamran; Soon, Anny; Lin, Tzu-Chao; Lin, Otto S.

doi:10.1111/j.1572-0241.2005.00355.x

Cited by 72 publications

(64 citation statements)

References 23 publications

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“…This is quite a high prevalence when compared with other studies of the Chinese population. In Taiwan, Cheng et al [21] reported an advanced polyps' prevalence of 1.3%, and Soon et al [22] a prevalence of 4.0%. We aimed at investigating the change of distribution and the mean age of onset of colorectal polyps, if any, over the past eight years in a regional hospital.…”

Section: Introductionmentioning

confidence: 99%

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

Lam

Wong²,

Mulder³

et al. 2007

WJG

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AIM:To investigate the distribution and frequency of advanced polyps over eight years. RESULTS: 1856 polyps (33% advanced polyps) and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6 ± 13.8 years, respectively. Advanced polyps were mainly left sided (59.5%). Advanced polyps were found in patients ≤ 60 years from 17.7% in periodⅠ to 26.3% in period Ⅱ (P < 0.05), especially in male subjects ≤ 60 years (21.6% vs 31.6%, P < 0.05). Advanced tubulovillous polyps rose from 21.5% in period Ⅰ to 29.5% in period Ⅱ (P < 0.05). Whereas cancers in male patients ≤ 60 years were similar in both periods: 23.2% vs 16.5% (P > 0.05). METHODS: CONCLUSION:Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shift towards a proximal location.

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Section: Introductionmentioning

confidence: 99%

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

Lam

Wong²,

Mulder³

et al. 2007

WJG

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show abstract

“…Regarding the sample size of the validation cohort, we made reference to the study by Yeoh et al in Asian countries, which indicated a minimum of 1,800 cases to attain a power of 80% for detection of a risk factor with OR of 2 at an alpha level of 0.05. This is based on the estimated prevalence of advanced neoplasia of 4.5% in other Asian colorectal advanced neoplasia studies 14,33,35 . Development of risk score from the derivation cohort.…”

Section: Methodsmentioning

confidence: 99%

An Algorithm to Predict Advanced Proximal Colorectal Neoplasia in Chinese Asymptomatic Population

Huang

Chen

Yuan

et al. 2017

Clinical Gastroenterology and Hepatology

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This study aims to develop and validate a new algorithm that incorporates distal colonoscopic findings to predict advanced proximal neoplasia (APN) in a Chinese asymptomatic population. We collected age, gender, and colonoscopic findings from a prospectively performed colonoscopy study between 2013 and 2015 in a large hospital-based endoscopy unit in Shanghai, China. Eligible subjects were allocated to a derivation group (n = 3,889) and validation group (n = 1,944) by random sampling. A new index for APN and its cut-off level were evaluated from the derivation cohort by binary logistic regression. The model performance was tested in the validation cohort using area under the curve (AUC). Age, gender, and distal finding were found to be independent predictors of APN in the derivation cohort (p < 0.001). Worldwide, colorectal cancer (CRC) is the third most common cancer in males and ranks the second in females, with an estimated 1.4 million cases and 693,900 deaths reported in 2012 1 . The increasing incidence and mortality of CRC in many low-income and middle-income countries, including China, highlights the pressing need for CRC control 2 . Screening has been proven an effective and cost-efficient strategy to reduce CRC mortality 3 . CRC prevention should be the primary goal of screening. Tests that are employed to detect early cancer and adenomatous polyps have been recommended for average-risk subjects aged 50 years or above 4 , and these include colonoscopy and flexible sigmoidoscopy (FS). In recent decades, proximal shift of CRC and advanced proximal neoplasia (APN) with no distal lesions detected 5-9 are increasingly observed, and this has an implication on the use of FS in clinical practice. Nevertheless, colonoscopy might not be suited as a primary screening test in resource-limited countries with limited colonoscopy capacity 10 . It may be more cost-effective and cost-saving to reserve colonoscopy for subjects with high risk for APN in population-based screening 11,12 . To address this need, Imperiale et al.12 proposed a 7-point scoring system to predict APN by using age, gender, and distal findings at FS as predictors and a high discrimination value was reported in its internal validation group. Its generalizability remain unknown in Chinese subjects, since the incidence and distribution of colorectal neoplasia are different among different ethnic groups 13 . Levitzky et al. has performed an external validation of the model devised by Imperiale et al., and the discriminatory capability was found to be lower in a different population, including black and Hispanic 11 . to the primary objective of this study is to develop and validate a new model specifically tailored to predict APN in a Chinese asymptomatic population. We conducted this cross-sectional study in a large hospital-based endoscopy unit.

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“…20 As the screening cohort did not receive FS, the sensitivity and specificity of FS was assumed to be 75-80 and 60-90%, respectively, according to published literature. 21,22 The population was expected to develop CRC according to the age-specific incidence rates of CRC in Hong Kong 15 in the absence of CRC screening. We made reference to a study conducted in Japan 23 and three landmark randomized controlled trials, [24][25][26] and assumed that FIT could reduce CRC incidence by 33%.…”

Section: Clinical Transition Probabilitiesmentioning

confidence: 99%

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

Wong

Ching

Chan

et al. 2015

Intl Journal of Cancer

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Patients with nonalcoholic fatty liver disease (NAFLD) and family history of colorectal cancer (CRC) are at higher risks but how they should be screened remains uncertain. Hence, we evaluated the cost-effectiveness of CRC screening among patients with NAFLD and family history by different strategies. A hypothetical population of 100,000 subjects aged 40-75 years receive: (i) yearly fecal immunochemical test (FIT) at 50 years; (ii) flexible sigmoidoscopy (FS) every 5 years at 50 years; (iii) colonoscopy 10 yearly at 50 years; (iv) colonoscopy 10 yearly at 50 years among those with family history/NAFLD and yearly FIT at 50 years among those without; (v) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and yearly FIT at 50 years among those without and (vi) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and colonoscopy 10 yearly at 50 years among those without. The incremental cost-effectiveness ratio (ICER) was studied by Markov modeling. It was found that colonoscopy, FS and FIT reduced incidence of CRC by 49.5, 26.3 and 23.6%, respectively. Using strategies 4, 5 and 6, the corresponding reduction in CRC incidence was 29.9, 30.9 and 69.3% for family history, and 33.2, 34.7 and 69.8% for NAFLD. Compared with no screening, strategies 4 (US$1,018/life-year saved) and 5 (US$7,485) for family history offered the lowest ICER, whilst strategy 4 (US$5,877) for NAFLD was the most cost-effective. These findings were robust when assessed with a wide range of deterministic sensitivity analyses around the base case. These indicated that screening patients with family history or NAFLD by colonoscopy at 50 years was economically favorable.Colorectal Cancer (CRC) presents a leading global burden of disease, accounting for 10% of all malignancies and 8% of cancer mortality worldwide. 1 Its incidence is rising rapidly in both Western and Asia Pacific countries. 2 Screening was found to be effective in reducing CRC-related mortality by 33, 40 and 56% using fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FS) and colonoscopy, respectively. 3,4 Guidelines from Western and Asian countries 5,6 recommend population-based CRC screening in average-risk subjects aged 50-75 years.Fecal immunochemical tests (FITs) and FS are widely used in most countries as primary screening tools. FS is gaining popularity in European countries, whilst colonoscopy is becoming the predominant mode of screening in the United States. 7 None of the screening tests, however, appears optimal across all settings, and it is still inconclusive which of the available options could offer the best balance of costs and benefits.It has been reported that first-degree relatives (FDRs) of patients with CRC have a twofold increased risk of developing CRC compared to the general population. 8,9 Ng et al. recently found that siblings of CRC patients had a strong and significantly increased risk of advanced neoplasia than siblings of healthy individuals. 10 In addition, Wong et al. reported that patients with nonalcoholic...

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Screening Colonoscopy in Chinese and Western Patients: A Comparative Study

Cited by 72 publications

References 23 publications

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

An Algorithm to Predict Advanced Proximal Colorectal Neoplasia in Chinese Asymptomatic Population

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

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