- Email: [email protected]
Mo2002 Streptococcus Bovis Bacteremia and Gastrointestinal Malignancy: Dogma Revisited
restricted comparisons of subjects who were only exposed to pantoprazole versus subjects only exposed to other PPIs. Discussion: We found no evidence for an excess risk of gastric cancer, other GI cancers or any cancer for pantoprazole versus other PPIs. Our findings are consistent with a population based Danish study that utilized similar methods and support those of a recent meta-analysis.
Mo2002 Streptococcus Bovis Bacteremia and Gastrointestinal Malignancy: Dogma Revisited Ju-En Thlick, Zoe Bider-Canfield, Bechien U. Wu
Mo2004 Using Social Media to Advance Effective Outreach, Education and Support to Address the Increasing Incidence of Colorectal Cancer (CRC) Among Young Adults: The Initial Experience of the Colon Cancer Challenge Foundation Thomas K. Weber, Joie Singh, Susan K. Peterson, Robin B. Mendelsohn, Sidney J. Winawer, Ann G. Zauber, Cindy Borassi, Francine Tidona, Kate L. McNamara, Anik Sachdeva
BACKGROUND: Streptococcus bovis bacteremia (SBB) has been associated with gastrointestinal (GI) malignancies, namely colorectal cancer. For this reason, screening colonoscopy for SBB patients is recommended in current practice. However, these recommendations are primarily based on data from case reports and case series. AIM: Determine the incidence of gastrointestinal malignancies in patients with SBB in a regional population-based setting. METHODS: We performed a retrospective cohort study on data from January 2000 December 2013 from a regional, integrated healthcare system in Southern California. All adult patients with positive S. bovis blood cultures were identified. New cases of GI malignancy were identified through an internal prospective cancer registry. Incidence rates (IR) of primary GI malignancies (e.g. colorectal, esophageal, gastric, small intestinal, pancreatic, hepatocellular carcinoma, cholangiocarcinoma, gallbladder, and appendiceal) among the SBB patients were compared to the age- and sex-matched reference population. A priori, we planned to evaluate the impact of S. bovis subspecies on the risk of malignancy. Patients were censored based on death, loss to follow-up, or study end. RESULTS: 356 cases (209 male, 58.7%) with a mean follow-up of 8.75 years (3,115 person-years) of SBB were identified, and among these, 54 new cases of primary GI malignancy were identified. The reference population consisted of 13,976,494 patients with a mean follow-up of 2.76 years (38,630,000 person-years), and among these, 33,208 primary GI malignancies developed. The age-sex adjusted incidence rates for the SBB and the reference populations to develop any GI malignancy were 1301.26 per 100,000 (95% CI 700.28-1902.23) and 85.94 per 100,000 (95% CI 84.99-86.89), respectively; the overall standardized incidence rate ratio (SIRR) for risk of any GI malignancy was 15.14 (95% CI 9.54-24.03; p<0.0001). More specifically, for colon cancer (n= 23 cases in the SBB population), the SIRR was 17.10 (95% CI 8.4134.76; p<0.0001). The highest SIRRs were associated with hepatocellular carcinoma (n=7, SIRR=20.49 (95% CI 8.01-52.40, p<0.0001)) and with gastric cancer (n=5, SIRR=25.75 (95% CI 5.21-127.28, p=0.0001)). We were unable to evaluate the impact of S. bovis subspecies as sub-speciation was not routinely performed. CONCLUSION: To our knowledge, this is the largest longitudinal cohort study to date to systematically evaluate the incidence of gastrointestinal malignancy in patients with SBB. We have confirmed that SBB is associated with an increased risk for colon cancer. However, the greatest increase in relative risk was for primary liver and stomach cancers.
BACKGROUND: There has been a dramatic increase in colorectal cancer (CRC) incidence among young adults (YA) aged 20 to 49 years. However the use of social media to study this trend is unknown. Similarly, the use of social media by public charities with cancer control missions has not been well described. In this study we: 1. Review current evidence supporting the use of social media as well as email by public charities attempting to address YA CRC; and 2. Present the experience of one CRC focused 501c3 in using social media to build a community of young CRC survivors and supporters. METHODS: Under expert guidance we constructed search terms to survey current literature for reports describing the use of social media in studying YA CRC as well as its use in providing prevention, treatment and quality of life support for survivors. The results of this search informed an analysis of social media use by the Colon Cancer Challenge Foundation (CCCF) in its efforts to build a YA CRC prevention and support community. RESULTS: Multiple permutations of relevant terms including but not limited to "social media", "colorectal cancer", "young adult" , "public charities", "survivors", "support" and "prevention" yielded 650 results. Twenty six (4%) of these focused on CRC. There were no results with YA CRC in the title or topic of the article nor did the term "social media and cancer charities" yield any results. A review of the digital constituent records of the CCCF 27,579 contacts with 12,856 active communicants. This included: 8,785 Facebook likes with a 5.53% engagement rate (industry average is approximately 2%), 67% of whom were under age 44 and 82% were women; and 200,000 Twitter contacts per month with 1,963 active followers and a reach of 2.9 million people. CCCFs on-line and social media community included 1038 members of families affected by CRC as well as 368 CRC survivors 253 (68%) of whom were under age 45. CONCLUSIONS: These results show that the use of social media in cancer prevention and in the support of cancer survivor communities is active and growing. However, studies on social media use in CRC accounts for a small percentage (< 5%) of the published literature. The use of social media to reach YA CRC appears to be understudied despite national data showing that this age group is more likely to use social media compared with older survivors. These gaps suggest important opportunities for increasing the use of social media in CRC prevention and survivorship efforts, and for conducting research on the impact of social media on achieving prevention and survivorship outcomes. The CCCFs experience confirms the attractiveness of social media to young CRC survivors and suggests it will be an increasingly important and effective future outreach tool for survivors and their families as well as individuals at risk for YA CRC. Mo2005
Table 1. Incidence rates of gastrointestinal malignancy in patients with and without S. bovis, and incidence rate ratio, 2000-2013
Incidence of Recurrence of Intestinal Metaplasia (IM) and Early Neoplasia (EN) After Endoscopic Eradication Therapy (EET) for Barrett's Esophagus (BE): A Systematic Review and Meta-Analysis Larissa L. Fujii-Lau, Srinivas Gaddam, Dayna S. Early, Steven A. Edmundowicz, Srinadh Komanduri, V. Raman Muthusamy, Ananya Das, Vladimir M. Kushnir, Daniel Mullady, Faris Murad, Sachin Wani
Mo2003 Long-Term Prospective Observational Study of Cancer Risk Among Pantoprazole Users Douglas A. Corley, Francesca Kolitsopoulos, Jennifer L. Schneider
Background: Endoscopic eradication therapy (EET) is now recommended for the management of BE patients with EN (low and high grade dysplasia and intramucosal cancer). While effectiveness of current treatment modalities [radiofrequency ablation (RFA) with or without focal endoscopic mucosal resection (ER) and stepwise complete ER (SRER)] has been established, limited and conflicting data exists regarding durability and recurrence rates post EET. Aim: To perform a systematic review and meta-analysis: 1. to determine the incidence of recurrent intestinal metaplasia (IM) and EN in BE patients undergoing EET. 2. to compare recurrent IM and EN rates between treatment modalities [RFA with or without ER (RFA) vs. SRER] Methods: Systematic search (1966-2014) was performed for EET studies reporting on outcomes and estimates of recurrence rates of IM and EN after achieving complete eradication (CE) of IM and EN. Studies were included if they met the following criteria: n≥20, follow up of at least 1-year and reported number of recurrences. Data extracted included study and patient characteristics, mean follow-up time, surveillance biopsy protocol, and recurrences. Pooled incidence [per 100 patient years (PY)] and risk ratios with 95% CI were obtained. Heterogeneity was measured by using I2 statistic. Subgroup analyses including impact of study design, setting, location, pretreatment histology, patient characteristics, surveillance biopsy protocol, and definition of CE (1 or 2 consecutive endoscopies negative for IM and EN) on recurrence rates were performed to explain heterogeneity between groups. Results: 33 studies were identified; 20 studies (n=3398) reporting on RFA therapy and 13 studies (n=719) on SRER. Overall, the pooled incidence of any recurrence was 6.5 (95% CI 4.8-8.1)/100 PY (Figure), IM recurrence 4.2 (2.9-5.4)/100 PY, and EN recurrence 1.4 (0.9-1.8)/100 PY. The IM and EN recurrence rates for the RFA and SRER groups are highlighted in Table. Compared to the SRER group, the RFA group had significantly higher overall [8 (5.7-10.3)/100 PY vs 4.3 (2.5-6.1)/100 PY, p 0.01] and IM recurrence rates [5.7 (3.9-7.5)/ 100 PY vs 2.4 (1-3.7)/ 100 PY, p 0.004]. Significant heterogeneity between studies was identified. Factors associated with IM recurrence (manuscripts vs. abstracts, prospective studies, surveillance biopsy protocol - every 1 cm) and EN (prospective studies and BE length) post RFA are highlighted in Table. The same factors were assessed for IM and EN recurrence post SRER therapy and were not found to be significant. Conclusion: Results of this study define incidence rates of overall, IM and EN recurrence rates post EET and reinforce the importance of close surveillance after achieving CE of IM and EN. Future
Introduction: Proton pump inhibitors (PPIs), including pantoprazole, have been shown to be carcinogenic in rodent studies. Given pantoprazole has a longer half-life than some other commonly used PPIs, which may increase both effectiveness and risk, we conducted a longterm observational study to assess whether the risk of cancer is increased in long-term pantoprazole users versus long-term users of other PPIs. Methods: This was a cohort study of cancer patients from the Kaiser Permanente Northern California health maintenance organization, with up to 15 years of follow-up. Based on exposure status, subjects were divided into 2 groups, those who had: 1) received a ≥240-day supply of pantoprazole within a 12 month period from 2000 through 2003; 2) received a ≥240-day supply of any other PPI within a 12 month period from 1996 through 2003. Subjects were excluded if they had: used any PPI within the 6 months prior to the exposure period; any cancer diagnosis prior to or during the exposure period; a diagnosis of Zollinger-Ellison Syndrome prior to or during the exposure period. Follow-up initiated 1 year after meeting the inclusion criteria and continued until Dec 2011. The primary objective was to compare incidence rates of gastric cancer after long-term exposure to pantoprazole versus long-term exposure to other PPIs. Secondary objectives assessed if the risk of 4 other gastrointestinal (GI) cancers (colorectal, liver, small intestine and pancreas) and the overall risk of cancer was increased in pantoprazole users versus users of other PPIs. Results: Approximately 62,000 subjects were identified for inclusion in the study (34,178 pantoprazole and 27,686 other PPIs). Age (median [IQR], yrs: 59 [49-71] vs 60 [50-71]), sex (female, %: 55.7 vs 56.4) and total follow-up (person-years: 274699.5 vs 272320.7) were similar between the pantoprazole and other PPI groups. Median duration of therapy was similar for both groups. The primary analyses demonstrated overall comparable risks of gastric cancer, other GI, or any cancer between the pantoprazole and other PPI groups. The analyses of gastric cancer and all malignancies did not demonstrate an excess risk for pantoprazole for either the crude or adjusted analyses. The analyses of the composite GI malignancies demonstrated an excess risk for pantoprazole in the crude analyses, but not in analyses adjusted for age, sex and other factors. Similarly, no excess risk was found in sensitivity analyses which provided
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AGA Abstracts
AGA Abstracts
survival among all groups were similarly poor, and no significant difference in survival was observed between U.S. Born and FB Asian patients with GC.
Mo2002 Streptococcus Bovis Bacteremia and Gastrointestinal Malignancy: Dogma Revisited Ju-En Thlick, Zoe Bider-Canfield, Bechien U. Wu
Mo2004 Using Social Media to Advance Effective Outreach, Education and Support to Address the Increasing Incidence of Colorectal Cancer (CRC) Among Young Adults: The Initial Experience of the Colon Cancer Challenge Foundation Thomas K. Weber, Joie Singh, Susan K. Peterson, Robin B. Mendelsohn, Sidney J. Winawer, Ann G. Zauber, Cindy Borassi, Francine Tidona, Kate L. McNamara, Anik Sachdeva
BACKGROUND: Streptococcus bovis bacteremia (SBB) has been associated with gastrointestinal (GI) malignancies, namely colorectal cancer. For this reason, screening colonoscopy for SBB patients is recommended in current practice. However, these recommendations are primarily based on data from case reports and case series. AIM: Determine the incidence of gastrointestinal malignancies in patients with SBB in a regional population-based setting. METHODS: We performed a retrospective cohort study on data from January 2000 December 2013 from a regional, integrated healthcare system in Southern California. All adult patients with positive S. bovis blood cultures were identified. New cases of GI malignancy were identified through an internal prospective cancer registry. Incidence rates (IR) of primary GI malignancies (e.g. colorectal, esophageal, gastric, small intestinal, pancreatic, hepatocellular carcinoma, cholangiocarcinoma, gallbladder, and appendiceal) among the SBB patients were compared to the age- and sex-matched reference population. A priori, we planned to evaluate the impact of S. bovis subspecies on the risk of malignancy. Patients were censored based on death, loss to follow-up, or study end. RESULTS: 356 cases (209 male, 58.7%) with a mean follow-up of 8.75 years (3,115 person-years) of SBB were identified, and among these, 54 new cases of primary GI malignancy were identified. The reference population consisted of 13,976,494 patients with a mean follow-up of 2.76 years (38,630,000 person-years), and among these, 33,208 primary GI malignancies developed. The age-sex adjusted incidence rates for the SBB and the reference populations to develop any GI malignancy were 1301.26 per 100,000 (95% CI 700.28-1902.23) and 85.94 per 100,000 (95% CI 84.99-86.89), respectively; the overall standardized incidence rate ratio (SIRR) for risk of any GI malignancy was 15.14 (95% CI 9.54-24.03; p<0.0001). More specifically, for colon cancer (n= 23 cases in the SBB population), the SIRR was 17.10 (95% CI 8.4134.76; p<0.0001). The highest SIRRs were associated with hepatocellular carcinoma (n=7, SIRR=20.49 (95% CI 8.01-52.40, p<0.0001)) and with gastric cancer (n=5, SIRR=25.75 (95% CI 5.21-127.28, p=0.0001)). We were unable to evaluate the impact of S. bovis subspecies as sub-speciation was not routinely performed. CONCLUSION: To our knowledge, this is the largest longitudinal cohort study to date to systematically evaluate the incidence of gastrointestinal malignancy in patients with SBB. We have confirmed that SBB is associated with an increased risk for colon cancer. However, the greatest increase in relative risk was for primary liver and stomach cancers.
BACKGROUND: There has been a dramatic increase in colorectal cancer (CRC) incidence among young adults (YA) aged 20 to 49 years. However the use of social media to study this trend is unknown. Similarly, the use of social media by public charities with cancer control missions has not been well described. In this study we: 1. Review current evidence supporting the use of social media as well as email by public charities attempting to address YA CRC; and 2. Present the experience of one CRC focused 501c3 in using social media to build a community of young CRC survivors and supporters. METHODS: Under expert guidance we constructed search terms to survey current literature for reports describing the use of social media in studying YA CRC as well as its use in providing prevention, treatment and quality of life support for survivors. The results of this search informed an analysis of social media use by the Colon Cancer Challenge Foundation (CCCF) in its efforts to build a YA CRC prevention and support community. RESULTS: Multiple permutations of relevant terms including but not limited to "social media", "colorectal cancer", "young adult" , "public charities", "survivors", "support" and "prevention" yielded 650 results. Twenty six (4%) of these focused on CRC. There were no results with YA CRC in the title or topic of the article nor did the term "social media and cancer charities" yield any results. A review of the digital constituent records of the CCCF 27,579 contacts with 12,856 active communicants. This included: 8,785 Facebook likes with a 5.53% engagement rate (industry average is approximately 2%), 67% of whom were under age 44 and 82% were women; and 200,000 Twitter contacts per month with 1,963 active followers and a reach of 2.9 million people. CCCFs on-line and social media community included 1038 members of families affected by CRC as well as 368 CRC survivors 253 (68%) of whom were under age 45. CONCLUSIONS: These results show that the use of social media in cancer prevention and in the support of cancer survivor communities is active and growing. However, studies on social media use in CRC accounts for a small percentage (< 5%) of the published literature. The use of social media to reach YA CRC appears to be understudied despite national data showing that this age group is more likely to use social media compared with older survivors. These gaps suggest important opportunities for increasing the use of social media in CRC prevention and survivorship efforts, and for conducting research on the impact of social media on achieving prevention and survivorship outcomes. The CCCFs experience confirms the attractiveness of social media to young CRC survivors and suggests it will be an increasingly important and effective future outreach tool for survivors and their families as well as individuals at risk for YA CRC. Mo2005
Table 1. Incidence rates of gastrointestinal malignancy in patients with and without S. bovis, and incidence rate ratio, 2000-2013
Incidence of Recurrence of Intestinal Metaplasia (IM) and Early Neoplasia (EN) After Endoscopic Eradication Therapy (EET) for Barrett's Esophagus (BE): A Systematic Review and Meta-Analysis Larissa L. Fujii-Lau, Srinivas Gaddam, Dayna S. Early, Steven A. Edmundowicz, Srinadh Komanduri, V. Raman Muthusamy, Ananya Das, Vladimir M. Kushnir, Daniel Mullady, Faris Murad, Sachin Wani
Mo2003 Long-Term Prospective Observational Study of Cancer Risk Among Pantoprazole Users Douglas A. Corley, Francesca Kolitsopoulos, Jennifer L. Schneider
Background: Endoscopic eradication therapy (EET) is now recommended for the management of BE patients with EN (low and high grade dysplasia and intramucosal cancer). While effectiveness of current treatment modalities [radiofrequency ablation (RFA) with or without focal endoscopic mucosal resection (ER) and stepwise complete ER (SRER)] has been established, limited and conflicting data exists regarding durability and recurrence rates post EET. Aim: To perform a systematic review and meta-analysis: 1. to determine the incidence of recurrent intestinal metaplasia (IM) and EN in BE patients undergoing EET. 2. to compare recurrent IM and EN rates between treatment modalities [RFA with or without ER (RFA) vs. SRER] Methods: Systematic search (1966-2014) was performed for EET studies reporting on outcomes and estimates of recurrence rates of IM and EN after achieving complete eradication (CE) of IM and EN. Studies were included if they met the following criteria: n≥20, follow up of at least 1-year and reported number of recurrences. Data extracted included study and patient characteristics, mean follow-up time, surveillance biopsy protocol, and recurrences. Pooled incidence [per 100 patient years (PY)] and risk ratios with 95% CI were obtained. Heterogeneity was measured by using I2 statistic. Subgroup analyses including impact of study design, setting, location, pretreatment histology, patient characteristics, surveillance biopsy protocol, and definition of CE (1 or 2 consecutive endoscopies negative for IM and EN) on recurrence rates were performed to explain heterogeneity between groups. Results: 33 studies were identified; 20 studies (n=3398) reporting on RFA therapy and 13 studies (n=719) on SRER. Overall, the pooled incidence of any recurrence was 6.5 (95% CI 4.8-8.1)/100 PY (Figure), IM recurrence 4.2 (2.9-5.4)/100 PY, and EN recurrence 1.4 (0.9-1.8)/100 PY. The IM and EN recurrence rates for the RFA and SRER groups are highlighted in Table. Compared to the SRER group, the RFA group had significantly higher overall [8 (5.7-10.3)/100 PY vs 4.3 (2.5-6.1)/100 PY, p 0.01] and IM recurrence rates [5.7 (3.9-7.5)/ 100 PY vs 2.4 (1-3.7)/ 100 PY, p 0.004]. Significant heterogeneity between studies was identified. Factors associated with IM recurrence (manuscripts vs. abstracts, prospective studies, surveillance biopsy protocol - every 1 cm) and EN (prospective studies and BE length) post RFA are highlighted in Table. The same factors were assessed for IM and EN recurrence post SRER therapy and were not found to be significant. Conclusion: Results of this study define incidence rates of overall, IM and EN recurrence rates post EET and reinforce the importance of close surveillance after achieving CE of IM and EN. Future
Introduction: Proton pump inhibitors (PPIs), including pantoprazole, have been shown to be carcinogenic in rodent studies. Given pantoprazole has a longer half-life than some other commonly used PPIs, which may increase both effectiveness and risk, we conducted a longterm observational study to assess whether the risk of cancer is increased in long-term pantoprazole users versus long-term users of other PPIs. Methods: This was a cohort study of cancer patients from the Kaiser Permanente Northern California health maintenance organization, with up to 15 years of follow-up. Based on exposure status, subjects were divided into 2 groups, those who had: 1) received a ≥240-day supply of pantoprazole within a 12 month period from 2000 through 2003; 2) received a ≥240-day supply of any other PPI within a 12 month period from 1996 through 2003. Subjects were excluded if they had: used any PPI within the 6 months prior to the exposure period; any cancer diagnosis prior to or during the exposure period; a diagnosis of Zollinger-Ellison Syndrome prior to or during the exposure period. Follow-up initiated 1 year after meeting the inclusion criteria and continued until Dec 2011. The primary objective was to compare incidence rates of gastric cancer after long-term exposure to pantoprazole versus long-term exposure to other PPIs. Secondary objectives assessed if the risk of 4 other gastrointestinal (GI) cancers (colorectal, liver, small intestine and pancreas) and the overall risk of cancer was increased in pantoprazole users versus users of other PPIs. Results: Approximately 62,000 subjects were identified for inclusion in the study (34,178 pantoprazole and 27,686 other PPIs). Age (median [IQR], yrs: 59 [49-71] vs 60 [50-71]), sex (female, %: 55.7 vs 56.4) and total follow-up (person-years: 274699.5 vs 272320.7) were similar between the pantoprazole and other PPI groups. Median duration of therapy was similar for both groups. The primary analyses demonstrated overall comparable risks of gastric cancer, other GI, or any cancer between the pantoprazole and other PPI groups. The analyses of gastric cancer and all malignancies did not demonstrate an excess risk for pantoprazole for either the crude or adjusted analyses. The analyses of the composite GI malignancies demonstrated an excess risk for pantoprazole in the crude analyses, but not in analyses adjusted for age, sex and other factors. Similarly, no excess risk was found in sensitivity analyses which provided
S-765
AGA Abstracts
AGA Abstracts
survival among all groups were similarly poor, and no significant difference in survival was observed between U.S. Born and FB Asian patients with GC.