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T1095 Implementation of Colorectal Cancer Screening in the Netherlands: Results of the First 20,000 Pilot Study
should be performed at younger age among smokers. 3.- Other analyzed parameters seem to have no influence on the age of presentation of CRC.
*Advanced adenoma: high grade dysplasia, villous component >20%, serrated adenoma, adenoma ≥ 10mm ‡ Threshold for a positive FIT †The percentages were corrected for the incomplete follow-up results
T1093
AGA Abstracts
T1095
Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology Jae Kim, Ronald J. Ewing, Robert E. Carroll, Xavier Llor, Richard V. Benya
Implementation of Colorectal Cancer Screening in the Netherlands: Results of the First 20,000 Pilot Study Anne Floortje van Rijn, Leo van Rossum, Paul Fockens, Robert Laheij, Evelien Dekker, Jan B. Jansen
Background: Aberrant crypt foci (ACF) are the earliest histopathological lesions associated with malignant transformation in the colon. ACF's are commonly used as a surrogate marker in colorectal cancer chemoprevention studies performed in rodents, and are increasingly being used for the same purpose in humans. However, relatively few studies of ACF's have been performed in humans, with all having been performed in selected populations (i.e., patients with known histories of adenomas, colorectal cancers, etc.). Furthermore, all endoscopic studies have limited their evaluations to the distal rectum. Consequently little is known regarding ACF prevalence in the entire distal colon in unselected populations, including as a function of sex and race; nor as to which ACF features might be important for predicting polyp histopathology. To address these questions, we have systematically performed magnification chromo-colonoscopy (MCC) on all patients undergoing routine colorectal cancer screening over the past 28-month period. Methods: ACF were classified by location (proximal or distal to the middle rectal fold); size (small: <20 crypts/ACF; medium: 20 - 100 crypts/ ACF; or large: >100 crypts/ACF); and whether they were elevated above the tissue plane. Results: During the duration of this study, 1322 patients were seen in our CRC Screening Clinic, of whom 996 (75.3%) agreed to allow their information to be collected in our ACF Database. Of these, 758 underwent MCC by the end of September 2007. Mean patient age was 58.7±8.4 yrs, of whom 57% were female; 58% African American, 20% Caucasian, and 16% Latino. Total ACF number, along with increasing ACF size and elevation, correlated with the presence of distal hyperplastic polyps; and were higher in African Americans. Total ACF number did not correlate with the presence of distal adenomas. However, ever-smaller ACF's correlated with the presence of distal adenomas; and were independent of age and race. Increasing number of large ACF's were observed in patients with increased numbers of hyperplastic polyps (p< 0.001), but not adenomas; whereas increasing numbers of small ACF's associated with increased numbers of adenomas (p= 0.026). The odds ratio for patients with 6 or more small ACF and adenomas was 5.64 (95%CI: 2.34 - 13.62) as compared to patients with 5 or less; while the odds ratio for patients with 1 or more large ACF and hyperplastic polyps was 6.81 (95%CI: 3.25 - 14.30) as compared to patients with none. Conclusion: Small flat ACF's correlate with the presence of distal adenomas while large raised ACF's correlate with the presence of hyperplastic polyps.
Background: Colorectal cancer (CRC) has a high incidence and mortality rate and in many countries CRC screening is advised. The fecal occult blood test (FOBT) is the only screening technique with scientific evidence of mortality reduction. At this time there is no nationwide CRC screening program in The Netherlands. Prior to the launch of a nation wide screening program a pilot study for implementation of FOBT screening in the Netherlands was advised. The aim of this study was to analyse the acceptance of the newly developed screening program and to compare two different FOBTs. Methods: People aged 50 to 75 years who lived in two regions of the Netherlands (Amsterdam region and Nijmegen region) were eligible for this study. Between May 2006, and January 2007 a total of 20,623 individuals were randomly selected to receive either a 3 day guaiac-based FOBT (gFOBT) or a 1-day immunochemical FOBT (iFOBT). All participants received a package containing either the gFOBT or the iFOBT accompanied by an invitation letter and a leaflet with extensive information on CRC and CRC screening. After two weeks a reminder letter was sent. In case of a positive test participants were invited to one of the two screening units and were advised to undergo colonoscopy. Results: The overall response rate was 53% (10,996/ 20,653). The response was significantly higher in females (57% versus 49%), participants older than 60 years (55% versus 51%), participants living in the Nijmegen region (57% versus 50%), and higher for the iFOBT (60% versus 47%). The overall positivity rate was 6% (639/10,996). The positivity rate was significantly higher in males (8% versus 4%) and participants older than 60 years (7% versus 5%). Eighty-four percent (534/639) of the participants with a positive test underwent a colonoscopy. Positive predictive values were 5% (35/639) for the detection of CRC and 36% (227/639) for advanced adenoma. Twenty one of the 35 (61%) CRCs were early cancers without metastases. Conclusion: This study shows that the newly developed screening program is generally well accepted in the Netherlands with an overall response rate of 53%, which is comparable to other European screening studies. Acceptance of the iFOBT was considerably higher than the gFOBT (60 vs 47%), which makes the iFOBT more likely to be considered as the FOBT of choice for a nationwide screening program.
T1094 T1096 Diagnostic Yield of Screening for Colorectal Cancer in the Netherlands; Randomized Controlled Trial Comparing Two Different Forms of Faecal Occult Blood Testing and Sigmoidoscopy Lieke Hol, Ernst J. Kuipers, Marjolein van Ballegooijen, Anneke van Vuuren, Jaqueline C. Reijerink-Verheij, Alexandra C. van der Togt-van Leeuwen, J. D. Habbema, M. E. Leerdam van
High-Risk Population for Gastric Cancer Development Based On Serum Pepsinogen Status and Lifestyle Factors Yutaka Yamaji, Hirotsugu Watabe, Takao Kawabe, Toru Mitsushima, Masao Omata Introduction: Gastric atrophy is a major risk factor for non-cardiac gastric cancer. Serum pepsinogen status could identify people at high-risk for gastric cancer development during our previous study (Gut 2005;54:764). Lifestyle related factors may additionally affect this risk. We reevaluate these factors in addition to the previously analyzed factors including pepsinogen status. Methods: A total of 6983 Japanese without gastric cancer or peptic ulcers were followed up by annual endoscopy. Forty-three cases of gastric cancer including two cardiac cancers developed during a mean follow up period of 4.7 years and the average number of endoscopic examinations of 5.1. In most subjects, the body length and weight of each subject wearing a standard uniform were measured on the morning of endoscopy and a questionnaire was applied to gather information regarding life habits. The risk of noncardiac gastric cancer development during surveillance was re-analyzed on the basis of serum pepsinogen level, sex, age, body mass index (BMI), alcohol habit, and smoking habit. Results: A total of 6,158 subjects with 37 non-cardiac gastric cancer development (male/female = 4,259/1,899, mean age = 49.0) were entered into analysis. The annual incidence of gastric cancer was 0.04% in the subjects with “normal” pepsinogen, whereas 0.42% in those with “atrophic” pepsinogen status (p < 0.001). In a multivariate analysis, old age (by ten years; OR, 2.92; p < 0.001), alcohol (weekly; OR, 2.65; p = 0.02), smoking (daily; OR, 2.13; p = 0.03) and pepsinogen status (“atrophic”; OR, 6.17; p < 0.001) were independent risk factors, whereas BMI was not. The annual incidence of gastric cancer was 1.2% in the older subjects of >= 60 years old with “atrophic” pepsinogen,status. Moreover, it was as high as 2.9% (6 cases out of 52 subjects during follow-up period) when they had both alcohol and smoking habits. Conclusion: Old age, alcohol and smoking habits additionally promoted the risk for gastric cancer in subjects with gastric atrophy.
Background & Aims: Screening for colorectal cancer (CRC) is widely accepted, but there is lack of consensus about the preferred strategy for CRC screening. We conducted a randomized controlled trial to determine diagnostic yield of guaiac based faecal occult blood test (Haemoccult II; gFOBT), immunochemical FOBT (OC-Hemodia Latex; FIT), and sigmoidoscopy (FS) for CRC screening. Methods: A representative sample of the Dutch population, aged 50-74 years, was randomized prior to invitation to one of the three screening strategies (1:1:1). Individuals with a history of CRC, inflammatory bowel disease or major health problems were excluded. Colonoscopy was indicated for screenees with: adenoma with villous component >20% or high-grade dysplasia, CRC, polyp size ≥10 mm, ≥3 adenomas or ≥20 hyperplastic polyps during FS, or screenees with a positive FIT or gFOBT. At this moment the results of 6200 participants are analyzable. Results: gFOBT was performed by 2138 participants (men: 46%; mean age 61±7), and a FIT by 2494 participants (men 48%; mean age 61±7). 1568 (men 52%; mean age 61±6) people attended FS screening. 158 (10%) of the FS screenees were classified as high-risk and referred for colonoscopy. 1358 screenees without polyps (n=921; 59%) or with non-advanced polyps (437; 28%) were discharged. The positivity rate was 2.6% for the gFOBT and 5.0% (threshold 100ng/ ml) or 7.3% (threshold 50ng/ml) for the FIT. The detection rate of advanced neoplasias was 1.0% for gFOBT, 3.0% for FIT and 7.6% for FS (see table). Conclusions: This is the first randomized controlled population based trial showing differences in diagnostic yield between three screening strategies. The detection rate for advanced neoplasias was eight times higher for FS screening compared to gFOBT. A lower threshold (50ng/ml) for a positive FIT resulted in a higher detection rate for advanced neoplasias (2.2% vs 3.0%), but also in more false-positives.
T1097 The Adenoma and Cancer Detection Rate: Do Inter-Endoscopists' Variations Happen in the Field of a Mass Screening Programme Based On Colonoscopy Following a Positive Faecal Occult Blood Test (FOBT) Result? Jean-François Bretagne, Françoise Riou, Christine Piette, Emmanuelle Leray, Dorina Bratu, Sylvain Manfredi, Gérard Durand Wide variation in adenoma detection rates at screening colonoscopy has recently been underlined in average-risk population. But data are very limited in high-risk groups and particularly in the field of colonoscopy following a positive FOBT result. The aim of this study was to assess the variations of detection rate of colorectal neoplasia among endoscopists and the effects of patients' age and gender on these rates in one district. Patients and methods: This population-based study included average-risk people aged 50 to 74 who participated at the first round of CRC screening (n= 96,054). Only endoscopists who performed at least 30 examinations during the round were included in the study (n=21). Chi2, T and ANOVA tests were used to compare differences in patients' gender and age, and among the endoscopists. Pearson correlation was used to evaluate the relationship between the detection of any
AGA Abstracts
A-482
*Advanced adenoma: high grade dysplasia, villous component >20%, serrated adenoma, adenoma ≥ 10mm ‡ Threshold for a positive FIT †The percentages were corrected for the incomplete follow-up results
T1093
AGA Abstracts
T1095
Aberrant Crypt Focus Size Predicts Distal Polyp Histopathology Jae Kim, Ronald J. Ewing, Robert E. Carroll, Xavier Llor, Richard V. Benya
Implementation of Colorectal Cancer Screening in the Netherlands: Results of the First 20,000 Pilot Study Anne Floortje van Rijn, Leo van Rossum, Paul Fockens, Robert Laheij, Evelien Dekker, Jan B. Jansen
Background: Aberrant crypt foci (ACF) are the earliest histopathological lesions associated with malignant transformation in the colon. ACF's are commonly used as a surrogate marker in colorectal cancer chemoprevention studies performed in rodents, and are increasingly being used for the same purpose in humans. However, relatively few studies of ACF's have been performed in humans, with all having been performed in selected populations (i.e., patients with known histories of adenomas, colorectal cancers, etc.). Furthermore, all endoscopic studies have limited their evaluations to the distal rectum. Consequently little is known regarding ACF prevalence in the entire distal colon in unselected populations, including as a function of sex and race; nor as to which ACF features might be important for predicting polyp histopathology. To address these questions, we have systematically performed magnification chromo-colonoscopy (MCC) on all patients undergoing routine colorectal cancer screening over the past 28-month period. Methods: ACF were classified by location (proximal or distal to the middle rectal fold); size (small: <20 crypts/ACF; medium: 20 - 100 crypts/ ACF; or large: >100 crypts/ACF); and whether they were elevated above the tissue plane. Results: During the duration of this study, 1322 patients were seen in our CRC Screening Clinic, of whom 996 (75.3%) agreed to allow their information to be collected in our ACF Database. Of these, 758 underwent MCC by the end of September 2007. Mean patient age was 58.7±8.4 yrs, of whom 57% were female; 58% African American, 20% Caucasian, and 16% Latino. Total ACF number, along with increasing ACF size and elevation, correlated with the presence of distal hyperplastic polyps; and were higher in African Americans. Total ACF number did not correlate with the presence of distal adenomas. However, ever-smaller ACF's correlated with the presence of distal adenomas; and were independent of age and race. Increasing number of large ACF's were observed in patients with increased numbers of hyperplastic polyps (p< 0.001), but not adenomas; whereas increasing numbers of small ACF's associated with increased numbers of adenomas (p= 0.026). The odds ratio for patients with 6 or more small ACF and adenomas was 5.64 (95%CI: 2.34 - 13.62) as compared to patients with 5 or less; while the odds ratio for patients with 1 or more large ACF and hyperplastic polyps was 6.81 (95%CI: 3.25 - 14.30) as compared to patients with none. Conclusion: Small flat ACF's correlate with the presence of distal adenomas while large raised ACF's correlate with the presence of hyperplastic polyps.
Background: Colorectal cancer (CRC) has a high incidence and mortality rate and in many countries CRC screening is advised. The fecal occult blood test (FOBT) is the only screening technique with scientific evidence of mortality reduction. At this time there is no nationwide CRC screening program in The Netherlands. Prior to the launch of a nation wide screening program a pilot study for implementation of FOBT screening in the Netherlands was advised. The aim of this study was to analyse the acceptance of the newly developed screening program and to compare two different FOBTs. Methods: People aged 50 to 75 years who lived in two regions of the Netherlands (Amsterdam region and Nijmegen region) were eligible for this study. Between May 2006, and January 2007 a total of 20,623 individuals were randomly selected to receive either a 3 day guaiac-based FOBT (gFOBT) or a 1-day immunochemical FOBT (iFOBT). All participants received a package containing either the gFOBT or the iFOBT accompanied by an invitation letter and a leaflet with extensive information on CRC and CRC screening. After two weeks a reminder letter was sent. In case of a positive test participants were invited to one of the two screening units and were advised to undergo colonoscopy. Results: The overall response rate was 53% (10,996/ 20,653). The response was significantly higher in females (57% versus 49%), participants older than 60 years (55% versus 51%), participants living in the Nijmegen region (57% versus 50%), and higher for the iFOBT (60% versus 47%). The overall positivity rate was 6% (639/10,996). The positivity rate was significantly higher in males (8% versus 4%) and participants older than 60 years (7% versus 5%). Eighty-four percent (534/639) of the participants with a positive test underwent a colonoscopy. Positive predictive values were 5% (35/639) for the detection of CRC and 36% (227/639) for advanced adenoma. Twenty one of the 35 (61%) CRCs were early cancers without metastases. Conclusion: This study shows that the newly developed screening program is generally well accepted in the Netherlands with an overall response rate of 53%, which is comparable to other European screening studies. Acceptance of the iFOBT was considerably higher than the gFOBT (60 vs 47%), which makes the iFOBT more likely to be considered as the FOBT of choice for a nationwide screening program.
T1094 T1096 Diagnostic Yield of Screening for Colorectal Cancer in the Netherlands; Randomized Controlled Trial Comparing Two Different Forms of Faecal Occult Blood Testing and Sigmoidoscopy Lieke Hol, Ernst J. Kuipers, Marjolein van Ballegooijen, Anneke van Vuuren, Jaqueline C. Reijerink-Verheij, Alexandra C. van der Togt-van Leeuwen, J. D. Habbema, M. E. Leerdam van
High-Risk Population for Gastric Cancer Development Based On Serum Pepsinogen Status and Lifestyle Factors Yutaka Yamaji, Hirotsugu Watabe, Takao Kawabe, Toru Mitsushima, Masao Omata Introduction: Gastric atrophy is a major risk factor for non-cardiac gastric cancer. Serum pepsinogen status could identify people at high-risk for gastric cancer development during our previous study (Gut 2005;54:764). Lifestyle related factors may additionally affect this risk. We reevaluate these factors in addition to the previously analyzed factors including pepsinogen status. Methods: A total of 6983 Japanese without gastric cancer or peptic ulcers were followed up by annual endoscopy. Forty-three cases of gastric cancer including two cardiac cancers developed during a mean follow up period of 4.7 years and the average number of endoscopic examinations of 5.1. In most subjects, the body length and weight of each subject wearing a standard uniform were measured on the morning of endoscopy and a questionnaire was applied to gather information regarding life habits. The risk of noncardiac gastric cancer development during surveillance was re-analyzed on the basis of serum pepsinogen level, sex, age, body mass index (BMI), alcohol habit, and smoking habit. Results: A total of 6,158 subjects with 37 non-cardiac gastric cancer development (male/female = 4,259/1,899, mean age = 49.0) were entered into analysis. The annual incidence of gastric cancer was 0.04% in the subjects with “normal” pepsinogen, whereas 0.42% in those with “atrophic” pepsinogen status (p < 0.001). In a multivariate analysis, old age (by ten years; OR, 2.92; p < 0.001), alcohol (weekly; OR, 2.65; p = 0.02), smoking (daily; OR, 2.13; p = 0.03) and pepsinogen status (“atrophic”; OR, 6.17; p < 0.001) were independent risk factors, whereas BMI was not. The annual incidence of gastric cancer was 1.2% in the older subjects of >= 60 years old with “atrophic” pepsinogen,status. Moreover, it was as high as 2.9% (6 cases out of 52 subjects during follow-up period) when they had both alcohol and smoking habits. Conclusion: Old age, alcohol and smoking habits additionally promoted the risk for gastric cancer in subjects with gastric atrophy.
Background & Aims: Screening for colorectal cancer (CRC) is widely accepted, but there is lack of consensus about the preferred strategy for CRC screening. We conducted a randomized controlled trial to determine diagnostic yield of guaiac based faecal occult blood test (Haemoccult II; gFOBT), immunochemical FOBT (OC-Hemodia Latex; FIT), and sigmoidoscopy (FS) for CRC screening. Methods: A representative sample of the Dutch population, aged 50-74 years, was randomized prior to invitation to one of the three screening strategies (1:1:1). Individuals with a history of CRC, inflammatory bowel disease or major health problems were excluded. Colonoscopy was indicated for screenees with: adenoma with villous component >20% or high-grade dysplasia, CRC, polyp size ≥10 mm, ≥3 adenomas or ≥20 hyperplastic polyps during FS, or screenees with a positive FIT or gFOBT. At this moment the results of 6200 participants are analyzable. Results: gFOBT was performed by 2138 participants (men: 46%; mean age 61±7), and a FIT by 2494 participants (men 48%; mean age 61±7). 1568 (men 52%; mean age 61±6) people attended FS screening. 158 (10%) of the FS screenees were classified as high-risk and referred for colonoscopy. 1358 screenees without polyps (n=921; 59%) or with non-advanced polyps (437; 28%) were discharged. The positivity rate was 2.6% for the gFOBT and 5.0% (threshold 100ng/ ml) or 7.3% (threshold 50ng/ml) for the FIT. The detection rate of advanced neoplasias was 1.0% for gFOBT, 3.0% for FIT and 7.6% for FS (see table). Conclusions: This is the first randomized controlled population based trial showing differences in diagnostic yield between three screening strategies. The detection rate for advanced neoplasias was eight times higher for FS screening compared to gFOBT. A lower threshold (50ng/ml) for a positive FIT resulted in a higher detection rate for advanced neoplasias (2.2% vs 3.0%), but also in more false-positives.
T1097 The Adenoma and Cancer Detection Rate: Do Inter-Endoscopists' Variations Happen in the Field of a Mass Screening Programme Based On Colonoscopy Following a Positive Faecal Occult Blood Test (FOBT) Result? Jean-François Bretagne, Françoise Riou, Christine Piette, Emmanuelle Leray, Dorina Bratu, Sylvain Manfredi, Gérard Durand Wide variation in adenoma detection rates at screening colonoscopy has recently been underlined in average-risk population. But data are very limited in high-risk groups and particularly in the field of colonoscopy following a positive FOBT result. The aim of this study was to assess the variations of detection rate of colorectal neoplasia among endoscopists and the effects of patients' age and gender on these rates in one district. Patients and methods: This population-based study included average-risk people aged 50 to 74 who participated at the first round of CRC screening (n= 96,054). Only endoscopists who performed at least 30 examinations during the round were included in the study (n=21). Chi2, T and ANOVA tests were used to compare differences in patients' gender and age, and among the endoscopists. Pearson correlation was used to evaluate the relationship between the detection of any
AGA Abstracts
A-482