Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies

Petersen, Mathias M.; Ferm, Linnea; Kleif, Jakob; Piper, Thomas B.; Rømer, Eva; Christensen, Ib Jarle; Nielsen, Hans Jørgen

doi:10.3390/cancers12092610

Cited by 8 publications

(3 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Colonoscopy has been widely used in colorectal cancer (CRC) screening as the reference standard to detect precancerous lesions and early‐stage cancers. 1 The invasiveness nature and high cost of colonoscopy, as well as the constraints on capacity, however, impose restrictions on its full utilization in mass screening, 2 particularly in countries or areas with low incidence of CRC and limited healthcare resources. A triage screening strategy, usually a colonoscopy examination following a positive result of a faecal occult blood test (FOBT), has been suggested to reduce colonoscopy requirements by around 30%, 3 , 4 and demonstrates huge potential in reducing the disease burden of CRC in numerous randomized trials and observational studies.…”

Section: Introductionmentioning

confidence: 99%

Improved risk scoring systems for colorectal cancer screening in Shanghai, China

Yang

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

Background: An optimal risk-scoring system enables more targeted offers for colonoscopy in colorectal cancer (CRC) screening. This analysis aims to develop and validate scoring systems using parametric and non-parametric methods for average-risk populations.Methods: Screening data of 807,695 subjects and 2806 detected cases in the firstround CRC screening program in Shanghai were used to develop risk-predictive models and scoring systems using logistic-regression (LR) and artificial-neuralnetwork (ANN) methods. Performance of established scoring systems was evaluated using area under the receiver operating characteristic curve (AUC), calibration, sensitivity, specificity, number of high-risk individuals and potential detection rates of CRC.Results: Age, sex, CRC in first-degree relatives, chronic diarrhoea, mucus or bloody stool, history of any cancer and faecal-immunochemical-test (FIT) results were identified as predictors for the presence of CRC. The AUC of LR-based system was 0.642 when using risk factors only in derivation set, and increased to 0.774 by further incorporating one-sample FIT results, and to 0.808 by including two-sample FIT results, while those for ANN-based systems were 0.639, 0.763 and 0.805, respectively. Better calibrations were observed for the LR-based systems than the ANN-based ones. Compared with the currently used initial tests, parallel use of FIT with LR-based systems resulted in improved specificities, less demands for colonoscopy and higher detection rates of CRC, while parallel use of FIT with ANN-based systems had higher sensitivities; incorporating FIT in the scoring systems further increased specificities, decreased colonoscopy demands and improved detection rates of CRC. Conclusions: Our results indicate the potentials of LR-based scoring systems incorporating one-or two-sample FIT results for CRC mass screening. External validation is warranted for scaling-up implementation in the Chinese population.

show abstract

Section: Introductionmentioning

confidence: 99%

Improved risk scoring systems for colorectal cancer screening in Shanghai, China

Yang

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…This situation has complicated the chronic problem, present before the pandemic, of insufficient colonoscopy availability in many public health systems. Indeed, waiting lists for endoscopies (for patients with symptoms) and CRC screening have been the norm (16)(17)(18). Here, we evaluated two scenarios and options for coping with this problem in CRC screening programs that use FIT to select patients for diagnostic colonoscopies.…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

et al. 2021

View full text Add to dashboard Cite

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

show abstract

“…This is indeed the indication for the SEPT9 test in average-risk individuals older than 50 [54, 61]. Another option for implementing a blood test in screening programs is triaging FIT-positive individuals for improved selection to colonoscopy [62]. Figure 6 shows a schematic representation of the possible implementation of a blood test in CRC screening, both as an alternative to FIT aiming to increase participation rates, and as a triage approach to optimize selection to colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Serum methylation of GALNT9, UPF3A, WARS, and LDB2 as non-invasive biomarkers for the early detection of colorectal cancer and premalignant adenomas

Gallardo-Gómez

Rodríguez-Girondo

Planell

et al. 2021

Preprint

View full text Add to dashboard Cite

Early detection has proven to be the most effective strategy to reduce the incidence and mortality of colorectal cancer (CRC). Nevertheless, most current screening programs suffer from low participation rates. A blood test may improve both the adherence to screening and the selection to colonoscopy. In this study, we conducted a serum-based discovery and validation of cfDNA methylation biomarkers for CRC screening in a multicentre cohort of 453 serum samples including healthy controls, benign pathologies, advanced adenomas (AA), and CRC. First, we performed an epigenome-wide methylation analysis with the MethylationEPIC array using a sample pooling approach, followed by a robust prioritization of candidate biomarkers for the detection of advanced neoplasia (AN: AA and CRC). Then, candidate biomarkers were validated by pyrosequencing in independent individual cfDNA samples. We report GALNT9, UPF3A, WARS, and LDB2 as new non-invasive biomarkers for the early detection of AN. The combination of GALNT9/UPF3A by logistic regression discriminated AN with 78.8% sensitivity and 100% specificity, outperforming the commonly used fecal immunochemical test and the methylated SEPT9 blood test. Overall, our results suggest that the combination methylated GALNT9/UPF3A has the potential to serve as a highly specific and sensitive blood-based test for screening and early detection of CRC.

show abstract

Triage May Improve Selection to Colonoscopy and Reduce the Number of Unnecessary Colonoscopies

Cited by 8 publications

References 67 publications

Improved risk scoring systems for colorectal cancer screening in Shanghai, China

Improved risk scoring systems for colorectal cancer screening in Shanghai, China

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Serum methylation of GALNT9, UPF3A, WARS, and LDB2 as non-invasive biomarkers for the early detection of colorectal cancer and premalignant adenomas

Contact Info

Product

Resources

About