The Prevalence Rate and Anatomic Location of Colorectal Adenoma and Cancer Detected by Colonoscopy in Average-Risk Individuals Aged 40-80 Years

Strul, Hana; Kariv, Revital; Leshno, Moshe; Halak, Aharon; Jakubowicz, Markus; Santo, M; Umansky, Mark; Shirin, Haim; Degani, Ya'ara; Revivo, Miri; Halpern, Zamir; Arber, Nadir

doi:10.1111/j.1572-0241.2006.00430.x

Cited by 173 publications

(128 citation statements)

References 16 publications

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“…Although estimation of the size of polyps during endoscopy could be inaccurate, many advanced adenomas in our study had a diameter of less than one centimeter and also all lesions that were located in the proximal colon had diameters less than one centimeter. Our results are comparable with other reports, and in addition emphasizes that small polyps also have the potential risk for progression towards malignancy (Strul et al, 2006;Rondagh et al, 2012).…”

Section: Discussionsupporting

confidence: 82%

“…The prevalence of CRC in developed countries has been reported between 0.4 and 0.7%. These figures are not comparable with our results (Imperiale et al, 2000;Lieberman et al, 2000;Strul et al, 2006;Boursi et al, 2009;Yang et al, 2014). Genetics and environmental factors could be considered as attributing factors in the discrepancy of this contrast between the countries.…”

Section: Discussioncontrasting

confidence: 57%

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Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Sohrabi¹,

Zamani²,

Ajdarkosh³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard. Aim: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population. Materials and Methods: A total of 1,208 eligible asymptomatic, average-risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists. Results: The mean age of participants was 56.5 ± 9.59 and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms .The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma. Conclusions: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.

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Section: Discussionsupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 57%

Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Sohrabi¹,

Zamani²,

Ajdarkosh³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…In view of the recent implementation of several nationwide screening programs using FIT in Western countries, it is important to address potential factors which may affect performance of these tests, as this knowledge may help to design tailored screening strategies. In our study conducted in subjects with average risk, the adenoma detection rate, one of the quality indicators for colonoscopy, was 26% and is in line with previously published data ranging from 21% to 29% (23)(24)(25). It should be acknowledged that colonoscopy has a miss rate of up to 22% for polyps of any size, as has been reported by a recent meta-analysis of back-to-back colonoscopy studies (26).…”

Section: Discussionsupporting

confidence: 76%

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Bakker

Jonkers

Sanduleanu

et al. 2011

Cancer Prevention Research

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Given the current increase in colorectal cancer screening, information on performance of screening tests is needed, especially in groups with a presumed lower test performance. We compared test performance of immunologic fecal occult blood testing (FIT) and pseudosigmoidoscopy with colonoscopy for detection of advanced adenomas in an average risk screening population. In addition, we explored the influence of gender, age, and location on test performance. FIT was collected prior to colonoscopy with a 50 ng/mL cutoff point. FIT results and complete colonoscopy findings were available from 329 subjects (mean age: 54.6 AE 3.7 years, 58.4% women). Advanced adenomas were detected in 38 (11.6%) of 329 subjects. Sensitivity for advanced adenomas of FIT and sigmoidoscopy were 15.8% (95% CI: 6.0-31.3) and 73.7% (95% CI: 56.9-86.6), respectively. No sensitivity improvement was obtained using the combination of sigmoidoscopy and FIT. Mean fecal hemoglobin in FIT positives was significantly lower for participants with only proximal adenomas versus those with distal ones (P ¼ 0.008), for women versus men (P ¼ 0.023), and for younger (<55 years) versus older (!55 years) subjects (P ¼ 0.029). Sensitivities of FIT were 0.0% (95% CI: 0.0-30.9) in subjects with only proximal versus 21.4% (95% CI: 8.3-41.0) in those with distal nonadvanced adenomas; 5.3% (95% CI: 0.0-26.0) in women versus 26.3% (95% CI: 9.2-51.2) in men; 9.5% (95% CI: 1.2-30.4) in younger versus 23.5% (95% CI: 6.8-49.9) in older subjects. Sigmoidoscopy had a significantly higher sensitivity for advanced adenomas than FIT. A single FIT showed very low sensitivity, especially in subjects with only proximal nonadvanced adenomas, in women, and in younger subjects. This points to the existence of "low" FIT performance in subgroups and the need for more tailored screening strategies. Cancer Prev Res; 4(10); 1563-71. Ó2011 AACR.

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“…Following a diagnosis of colorectal cancer, patients entered a stage-specific colorectal cancer health state for the next five years during which time they had a yearly probability of dying of other causes, dying of colorectal cancer, or sustaining a relapse. If a patient survived five years without relapse, they were assumed to be diseasefree and underwent surveillance colonoscopy every five years (Strul et al, 2006). In summary, in above figure that shown Markov states for the natural history of colorectal cancer.…”

Section: Resultsmentioning

confidence: 99%

Markov's Modeling for Screening Strategies for Colorectal Cancer

Barouni

Larizadeh²,

Sabermahani³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

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The Prevalence Rate and Anatomic Location of Colorectal Adenoma and Cancer Detected by Colonoscopy in Average-Risk Individuals Aged 40-80 Years

Cited by 173 publications

References 16 publications

Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Markov's Modeling for Screening Strategies for Colorectal Cancer

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