Temporal trends in mode, site and stage of presentation with the introduction of colorectal cancer screening: a decade of experience from the West of Scotland

Abstract

Background:Population colorectal cancer screening programmes have been introduced to reduce cancer-specific mortality through the detection of early-stage disease. The present study aimed to examine the impact of screening introduction in the West of Scotland.Methods:Data on all patients with a diagnosis of colorectal cancer between January 2003 and December 2012 were extracted from a prospectively maintained regional audit database. Changes in mode, site and stage of presentation before, during and after screening introduction were examined.Results:In a population of 2.4 million, over a 10-year period, 14 487 incident cases of colorectal cancer were noted. Of these, 7827 (54%) were males and 7727 (53%) were socioeconomically deprived. In the postscreening era, 18% were diagnosed via the screening programme. There was a reduction in both emergency presentation (20% prescreening vs 13% postscreening, P⩽0.001) and the proportion of rectal cancers (34% prescreening vs 31% pos-screening, P⩽0.001) over the timeframe. Within non-metastatic disease, an increase in the proportion of stage I tumours at diagnosis was noted (17% prescreening vs 28% postscreening, P⩽0.001).Conclusions:Within non-metastatic disease, a shift towards earlier stage at diagnosis has accompanied the introduction of a national screening programme. Such a change should lead to improved outcomes in patients with colorectal cancer.

A symptom‐based model to predict colorectal cancer in low‐resource countries: Results from a prospective study of patients at high risk for colorectal cancer

“…Two strategies are commonly used to detect early‐stage CRC: population‐based CRC screening and early‐diagnosis strategies in symptomatic patients . Screening for CRC leads to a reduction in emergency presentations, a reduction in the proportion of cancers with adenomatous polyps (adenomas), and a shift to a diagnosis at earlier stages . Screening also allows an increase in the proportion of patients managed with curative intent, even in resource‐limited communities …”

What are the Clinicopathological Features and Outcomes of Sporadic Colorectal Cancer (CRC) in an Ethiopian Cohort with focus on young-onset CRC?

“…Unlike the more varied presentation of traditional-onset patients that included change in bowel habits and significant weight loss, young-onset patients more commonly suffered abdominal pain (41%) and emergency presentation (16%)the latter of which is linked to both poor short and long term outcomes and more invasive disease [4]. This preponderance for abdominal pain in young-patients is thought to reflect the effects of ageing on nociceptive afferent fibres and their subsequent desensitisation to neurochemical and mechanical input [19].…”

“…While the incidence of this disease is rising , mortality for this condition has improved greatly from previous decades through the use of improved diagnostic criteria, awareness of risk factors, treatment modalities and screening led reductions in advanced/emergency presentations [3,4].…”

“…While young-onset CRC has previously been associated with delayed presentation, attributed to superior tolerance of symptoms, low consultation rates and physician misdiagnosis, no appreciable delay was found here with 52% of our young-onset patients presenting within 6 months of symptom onset although as 86% had pT3/pT4 staging perhaps more symptomatic disease and therefore earlier presentation. However, as 23% of young-onset patients presented in the 12-24month range this would suggest patient education of CRC presentation remains an important issue.Unlike the more varied presentation of traditional-onset patients that included change in bowel habits and significant weight loss, young-onset patients more commonly suffered abdominal pain (41%) and emergency presentation (16%)the latter of which is linked to both poor short and long term outcomes and more invasive disease [4]. This preponderance for abdominal pain in young-patients is thought to reflect the effects of ageing on nociceptive afferent fibres and their subsequent desensitisation to neurochemical and mechanical input [19].…”

“…These include a greater incidence of adverse prognostic factors such as mucinous/signet ring histology, venous and perineural invasion and higher tumour stage and grade resulting in worse outcomes [11]. Furthermore, young-onset patients may have a predominance for left-sided/rectal malignancy and not the rightward shift in CRC distribution observed in traditional-onset populations as a result of screening protocols [12,4]. Nevertheless findings between studies regarding young-onset disease are inconsistent partly due to the different definitions regarding what constitutes 'young' as well as infrequent reporting of such cases.…”