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S1019 Who Are We Missing in Colorectal Cancer Screening?
AGA Abstracts
transfected with RET-PTC2 readily differentiated and assumed a configuration that resembled plexoid bodies. The expression of PGP9.5 and GFAP were increased (2.6 and 2.4 folds respectively by qRT-PCR and 1.6 and 1.4 folds respectively by Western blotting) as compared to control cells transfected with RET-PTC2 and cultured without LMMP. Additionally, the expression of nNOS was increased (3.3 folds by qRT-PCR). Conclusions Our data show that activation of the GDNF receptor RET specifically direct CNS-NSC to acquire an enteric neuronal phenotype. Additionally, gut-derived factors are responsible for driving glial differentiation and the formation of ganglionated plexi. By establishing a permissive and necessary role of RET, these results provide further and critical groundwork for the therapeutic use of neuronal precursors in the gut.
S1020 BMI and Advanced Colorectal Neoplasia in Average Risk Women: Results of Screening Colonoscopy in a Diverse Population Using a High Resolution Colonoscope Joseph C. Anderson, Benjamin Stein, Ramona Rajapakse, Zvi A. Alpern Background:Obesity (BMI>30) has been shown to be a strong risk factor for advanced neoplasia in female patients(CONCeRN DDW 2005). Less is known about the impact of obesity in screening diverse populations. Our goal was to determine the risk of obesity in a diverse cohort of women being screened by colonoscopy under optimal conditions. Methods:To assess the risk of obesity for advanced neoplasia our sample required at least 100 obese women (90% power). Using a standard form, we prospectively collected age, gender, height, weight, education, family history of colorectal and other cancers, detailed smoking history, medication history (including NSAID,vitamin, HRT,insulin, Ca, statin), medical and surgical history, menstrual history, alcohol use, exercise/physical activity and a detailed 5 yr dietary history from asymptomatic patients >40 yrs presenting for screening colonoscopy who consented for our study. One endoscopist using an Olympus high definition scope performed all colonoscopies with a withdrawal time of at least 8 min. All polyps were photo-documented next to a snare catheter for In-Vivo measurement, retrieved for histology and morphology assessed using the Japanese Research Society Classification (JRSC). Flat adenomas:lesions whose height was < 1/2 its diameter. There were 3 smoking categories:1) Never:No tobacco exposure 2) Heavy exposure: smoking more than 10 pack years and still smoking or quit in past 10 yrs 3) Low exposure: those who smoked less than 10 pack yrs or those who quit over 10 yrs prior. Advanced neoplasia was defined as large (>1cm) adenoma, villous adenoma, high-grade dysplasia or cancer.Results: 600 average risk patients (4.7% 1st degree relative with CRC) were screened (349 female and 251 male) (overall avg age 56.9, BMI 28.2). 51% of the women were not Caucasian (30% Hispanic, 12% African descent) 109 were obese. 32% of the women and 46% of the men had any adenomas. 5.7% of the female patients had advanced lesions while 8.0% of the male patients had advanced lesions. Results of a multivariate analysis of risk factors for any and advanced adenomas in women are shown in the table. Conclusions: Obesity was observed to be an important predictor of advanced neoplasia in our diverse population of women. Since this is a modifiable risk factor, which is increasing in prevalence, these data have important health policy implications. Predictors of Colorectal Neoplasia in Women
S1018 Colorectal Cancer (CRC) Screening of Persons with First Degree Relatives (Fdr) with CRC in Aragon, Spain: Application of a Validated Decision Analytic Model to Inform Public Policy Uri Ladabaum, Angel Ferrandez, Angel I. Lanas BACKGROUND: Governments and health authorities debate how to provide CRC screening. In Aragon, Spain, a pilot regional screening colonoscopy program has been launched for FDR of patients with CRC. The long-term clinical and economic consequences of widespread application of this program are not known. AIMS: To use a validated decision analytic model of CRC screening to provide local decision makers with information to shape public policy. METHODS: We adapted a previously published model of CRC screening in the U.S. to represent persons with FDR with CRC in Aragon. The model was calibrated to autopsy data on adenoma prevalence, Aragon 2004 census data and Aragon CRC incidence and agespecific mortality data. CRC risk was assumed to be twice average risk. Local costs were used (colonoscopy 70 €, with polypectomy 140 €; CRC care 12,300-55,900 € depending on stage). Screening colonoscopy every 5 years for ages 40-80 was compared with no screening. Based on published data, 8% of persons were assumed to have FDR with CRC. The cohort was followed until age 85 or death. Life-yrs and costs were discounted at 3%/ yr. RESULTS: For every 1,000 40 yr-old persons with FDR with CRC, screening reduced lifetime CRC cases from 88 to 20, improved stage at diagnosis (65 vs. 40% localized; 29 vs. 37% regional; 7 vs. 23% disseminated), decreased deaths attributable to CRC from 7% to 1%, and resulted in improved mean life expectancy from 78.30 yrs without screening to 78.64 yrs with screening. Screening was more effective (mean 22.51 vs. 22.38 discounted life-yrs/person after age 40) and less costly (mean 656 vs. 1,118 discounted €/person) than no screening. Assuming a steady-state population as in 2004 census data, 47,000 persons age 40-80 were eligible for the program among the region's 1.25 million. In this cohort, screening reduced the annual number of CRC cases from 114 to 26, and decreased total CRC-related expenditures (testing, complications, CRC care) from 3.36 to 1.54 million €/ yr. When Spain's average all-cause health expenditures of 1,200 €/person/yr were considered, screening still decreased total expenditures for the cohort from 62.4 to 60.5 million €/yr. Ongoing screening of the full cohort required 10,300 colonoscopies/yr. CONCLUSION: Screening colonoscopy every 5 years for persons with CRC family history is projected to decrease CRC incidence and mortality and increase life-expectancy while decreasing health expenditures in Aragon, Spain, given local costs. This study demonstrates the use of decision analytic modeling to help inform region-specific public policy decisions.
S1021 Prevalence and Predictors of Fecal Occult Blood Testing After Colonoscopy Deborah A. Fisher, Janet Grubber, Cynthia J. Coffman, Corrine I. Voils, Sally W. Vernon, Dawn Provenzale
S1019
Objectives: Colorectal cancer screening guidelines do not recommend performing fecal occult blood tests (FOBTs) after colonoscopy. If the initial colonoscopy revealed adenomatous polyps or cancer, then the patient should be in a colonoscopy surveillance program. If the colonoscopy was negative for neoplasia, then the recommended interval for the next colonoscopy is 10 years. If FOBT is used for future screening at least 5 years is usually recommended before FOBT screening is resumed. Our objective was to estimate prevalence and predictors of FOBT use after a colonoscopy. Methods: We examined the records from 201 patients who participated in an observational screening behavior study at two VA (Veterans Affairs) medical centers. The subset of patients whose VA or non-VA medical records documented a colonoscopy within the prior 10 years were included in this analysis. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between post-colonoscopoy FOBT use and potential predictors (site, medical record location, age, gender, race, education, marital status). Results: Half of the participants had undergone colonoscopy within the prior 10 years (n=103) and were included in the analysis. Eighty percent were male and 82% Caucasian. Thirty-one percent (n=32) had undergone FOBT subsequent to their colonoscopies. The mean time from colonoscopy to FOBT was 3.1 years (range 28 days-7 years) with 78% of the FOBT done within 5 years. The odds of FOBT post-colonoscopy were 4 times higher among subjects whose colonoscopies were performed outside the VA than among subjects whose colonoscopies were performed in the VA (OR 4.1, 95% CI 1.5-11.6). Increased age was also associated with an increased odds of having had a post-colonoscopy FOBT (OR10 unit increase in age 1.6, 95% CI 1.0-2.6). Gender, education, marital status, and study site were not significantly associated with FOBT after colonoscopy. Conclusions: Almost of a third of primary care patients who had a documented colonoscopy subsequently underwent FOBT, on average, only 3 years after colonoscopy. These FOBTs are not recommended for screening, surveillance, or diagnosis and could generate additional colonoscopy requests for patients who are not yet due. Older age was associated with a post-colonoscopy FOBT, but having had the initial colonoscopy outside the VA was the strongest predictor of subsequent FOBT testing and suggests that outside medical records are perhaps not being sought and/or obtained. Improved integration and/or transfer of records are needed when patients change providers to reduce unnecessary duplication of services.
Who Are We Missing in Colorectal Cancer Screening? George Abdelsayed, Jianmin Tian, Beili Dong, Yan Feng *Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in US and the screening rate has remained too low to achieve the Healthy People 2010 objective for reducing mortality from colorectal cancer (target 13.9 from baseline of 21.2 per 100,000 population in 1998) . Both incidence and screening rates increase with age (under the age of 85), and this parallel phenomenon reveals that low rates of screening beginning at age 50 renders screening lagging behind to prevent CRC. *Methods: BRFSS (Behavior Risk Factors Surveillance System, sponsored by the CDC) is the largest survey data of the adult population in the US. In this study, 195,318 responders of all 50 states aged 50+ in 2006 were pooled and analyzed by using SAS /SUDAAN with weighted mean for disproportionate stratified sample. CRC screenings are defined as either 1) used FOBT test kit within last year, or 2) ever had sigmoidoscopy or colonoscopy. *Results: Among 195,318 responders aged 50+ in 2006, 46% were male, 84% were white (9% African American and 7% others), and 8% Hispanic. The screening rates for the age groups 50-59 and 60+ were 53.0% and 70.5% respectively. Compared with 60+ age group, significantly lower screening rates in the 50-59 age group were found across gender, race, ethnicity, smoking status, BMI, ETOH use, education, income level, health coverage, health status (self-reported), and inaccess to healthcare due to increased cost. Logistic regression within the 50-59 age group showed that male sex, Hispanic, good health status, low education/income, lack of health insurance, and cigarette smoking were independent predictive factors that were associated with lower CRC screening. *Discussion: CRC screening is much lower in the 50-59 age group in the US, especially among the subpopulation of Hispanics, low education and /or income and lack of health coverage. Other studies have shown that given interventions, including mailing brochures to patients and discussion with patients by physicians can increase the screening compliance. Efforts should be directed with priority to the lowest screening population to increase the CRC screening rates. *Keywords: Colorectal cancer, screening, BRFSS
AGA Abstracts
A-160
transfected with RET-PTC2 readily differentiated and assumed a configuration that resembled plexoid bodies. The expression of PGP9.5 and GFAP were increased (2.6 and 2.4 folds respectively by qRT-PCR and 1.6 and 1.4 folds respectively by Western blotting) as compared to control cells transfected with RET-PTC2 and cultured without LMMP. Additionally, the expression of nNOS was increased (3.3 folds by qRT-PCR). Conclusions Our data show that activation of the GDNF receptor RET specifically direct CNS-NSC to acquire an enteric neuronal phenotype. Additionally, gut-derived factors are responsible for driving glial differentiation and the formation of ganglionated plexi. By establishing a permissive and necessary role of RET, these results provide further and critical groundwork for the therapeutic use of neuronal precursors in the gut.
S1020 BMI and Advanced Colorectal Neoplasia in Average Risk Women: Results of Screening Colonoscopy in a Diverse Population Using a High Resolution Colonoscope Joseph C. Anderson, Benjamin Stein, Ramona Rajapakse, Zvi A. Alpern Background:Obesity (BMI>30) has been shown to be a strong risk factor for advanced neoplasia in female patients(CONCeRN DDW 2005). Less is known about the impact of obesity in screening diverse populations. Our goal was to determine the risk of obesity in a diverse cohort of women being screened by colonoscopy under optimal conditions. Methods:To assess the risk of obesity for advanced neoplasia our sample required at least 100 obese women (90% power). Using a standard form, we prospectively collected age, gender, height, weight, education, family history of colorectal and other cancers, detailed smoking history, medication history (including NSAID,vitamin, HRT,insulin, Ca, statin), medical and surgical history, menstrual history, alcohol use, exercise/physical activity and a detailed 5 yr dietary history from asymptomatic patients >40 yrs presenting for screening colonoscopy who consented for our study. One endoscopist using an Olympus high definition scope performed all colonoscopies with a withdrawal time of at least 8 min. All polyps were photo-documented next to a snare catheter for In-Vivo measurement, retrieved for histology and morphology assessed using the Japanese Research Society Classification (JRSC). Flat adenomas:lesions whose height was < 1/2 its diameter. There were 3 smoking categories:1) Never:No tobacco exposure 2) Heavy exposure: smoking more than 10 pack years and still smoking or quit in past 10 yrs 3) Low exposure: those who smoked less than 10 pack yrs or those who quit over 10 yrs prior. Advanced neoplasia was defined as large (>1cm) adenoma, villous adenoma, high-grade dysplasia or cancer.Results: 600 average risk patients (4.7% 1st degree relative with CRC) were screened (349 female and 251 male) (overall avg age 56.9, BMI 28.2). 51% of the women were not Caucasian (30% Hispanic, 12% African descent) 109 were obese. 32% of the women and 46% of the men had any adenomas. 5.7% of the female patients had advanced lesions while 8.0% of the male patients had advanced lesions. Results of a multivariate analysis of risk factors for any and advanced adenomas in women are shown in the table. Conclusions: Obesity was observed to be an important predictor of advanced neoplasia in our diverse population of women. Since this is a modifiable risk factor, which is increasing in prevalence, these data have important health policy implications. Predictors of Colorectal Neoplasia in Women
S1018 Colorectal Cancer (CRC) Screening of Persons with First Degree Relatives (Fdr) with CRC in Aragon, Spain: Application of a Validated Decision Analytic Model to Inform Public Policy Uri Ladabaum, Angel Ferrandez, Angel I. Lanas BACKGROUND: Governments and health authorities debate how to provide CRC screening. In Aragon, Spain, a pilot regional screening colonoscopy program has been launched for FDR of patients with CRC. The long-term clinical and economic consequences of widespread application of this program are not known. AIMS: To use a validated decision analytic model of CRC screening to provide local decision makers with information to shape public policy. METHODS: We adapted a previously published model of CRC screening in the U.S. to represent persons with FDR with CRC in Aragon. The model was calibrated to autopsy data on adenoma prevalence, Aragon 2004 census data and Aragon CRC incidence and agespecific mortality data. CRC risk was assumed to be twice average risk. Local costs were used (colonoscopy 70 €, with polypectomy 140 €; CRC care 12,300-55,900 € depending on stage). Screening colonoscopy every 5 years for ages 40-80 was compared with no screening. Based on published data, 8% of persons were assumed to have FDR with CRC. The cohort was followed until age 85 or death. Life-yrs and costs were discounted at 3%/ yr. RESULTS: For every 1,000 40 yr-old persons with FDR with CRC, screening reduced lifetime CRC cases from 88 to 20, improved stage at diagnosis (65 vs. 40% localized; 29 vs. 37% regional; 7 vs. 23% disseminated), decreased deaths attributable to CRC from 7% to 1%, and resulted in improved mean life expectancy from 78.30 yrs without screening to 78.64 yrs with screening. Screening was more effective (mean 22.51 vs. 22.38 discounted life-yrs/person after age 40) and less costly (mean 656 vs. 1,118 discounted €/person) than no screening. Assuming a steady-state population as in 2004 census data, 47,000 persons age 40-80 were eligible for the program among the region's 1.25 million. In this cohort, screening reduced the annual number of CRC cases from 114 to 26, and decreased total CRC-related expenditures (testing, complications, CRC care) from 3.36 to 1.54 million €/ yr. When Spain's average all-cause health expenditures of 1,200 €/person/yr were considered, screening still decreased total expenditures for the cohort from 62.4 to 60.5 million €/yr. Ongoing screening of the full cohort required 10,300 colonoscopies/yr. CONCLUSION: Screening colonoscopy every 5 years for persons with CRC family history is projected to decrease CRC incidence and mortality and increase life-expectancy while decreasing health expenditures in Aragon, Spain, given local costs. This study demonstrates the use of decision analytic modeling to help inform region-specific public policy decisions.
S1021 Prevalence and Predictors of Fecal Occult Blood Testing After Colonoscopy Deborah A. Fisher, Janet Grubber, Cynthia J. Coffman, Corrine I. Voils, Sally W. Vernon, Dawn Provenzale
S1019
Objectives: Colorectal cancer screening guidelines do not recommend performing fecal occult blood tests (FOBTs) after colonoscopy. If the initial colonoscopy revealed adenomatous polyps or cancer, then the patient should be in a colonoscopy surveillance program. If the colonoscopy was negative for neoplasia, then the recommended interval for the next colonoscopy is 10 years. If FOBT is used for future screening at least 5 years is usually recommended before FOBT screening is resumed. Our objective was to estimate prevalence and predictors of FOBT use after a colonoscopy. Methods: We examined the records from 201 patients who participated in an observational screening behavior study at two VA (Veterans Affairs) medical centers. The subset of patients whose VA or non-VA medical records documented a colonoscopy within the prior 10 years were included in this analysis. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between post-colonoscopoy FOBT use and potential predictors (site, medical record location, age, gender, race, education, marital status). Results: Half of the participants had undergone colonoscopy within the prior 10 years (n=103) and were included in the analysis. Eighty percent were male and 82% Caucasian. Thirty-one percent (n=32) had undergone FOBT subsequent to their colonoscopies. The mean time from colonoscopy to FOBT was 3.1 years (range 28 days-7 years) with 78% of the FOBT done within 5 years. The odds of FOBT post-colonoscopy were 4 times higher among subjects whose colonoscopies were performed outside the VA than among subjects whose colonoscopies were performed in the VA (OR 4.1, 95% CI 1.5-11.6). Increased age was also associated with an increased odds of having had a post-colonoscopy FOBT (OR10 unit increase in age 1.6, 95% CI 1.0-2.6). Gender, education, marital status, and study site were not significantly associated with FOBT after colonoscopy. Conclusions: Almost of a third of primary care patients who had a documented colonoscopy subsequently underwent FOBT, on average, only 3 years after colonoscopy. These FOBTs are not recommended for screening, surveillance, or diagnosis and could generate additional colonoscopy requests for patients who are not yet due. Older age was associated with a post-colonoscopy FOBT, but having had the initial colonoscopy outside the VA was the strongest predictor of subsequent FOBT testing and suggests that outside medical records are perhaps not being sought and/or obtained. Improved integration and/or transfer of records are needed when patients change providers to reduce unnecessary duplication of services.
Who Are We Missing in Colorectal Cancer Screening? George Abdelsayed, Jianmin Tian, Beili Dong, Yan Feng *Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in US and the screening rate has remained too low to achieve the Healthy People 2010 objective for reducing mortality from colorectal cancer (target 13.9 from baseline of 21.2 per 100,000 population in 1998) . Both incidence and screening rates increase with age (under the age of 85), and this parallel phenomenon reveals that low rates of screening beginning at age 50 renders screening lagging behind to prevent CRC. *Methods: BRFSS (Behavior Risk Factors Surveillance System, sponsored by the CDC) is the largest survey data of the adult population in the US. In this study, 195,318 responders of all 50 states aged 50+ in 2006 were pooled and analyzed by using SAS /SUDAAN with weighted mean for disproportionate stratified sample. CRC screenings are defined as either 1) used FOBT test kit within last year, or 2) ever had sigmoidoscopy or colonoscopy. *Results: Among 195,318 responders aged 50+ in 2006, 46% were male, 84% were white (9% African American and 7% others), and 8% Hispanic. The screening rates for the age groups 50-59 and 60+ were 53.0% and 70.5% respectively. Compared with 60+ age group, significantly lower screening rates in the 50-59 age group were found across gender, race, ethnicity, smoking status, BMI, ETOH use, education, income level, health coverage, health status (self-reported), and inaccess to healthcare due to increased cost. Logistic regression within the 50-59 age group showed that male sex, Hispanic, good health status, low education/income, lack of health insurance, and cigarette smoking were independent predictive factors that were associated with lower CRC screening. *Discussion: CRC screening is much lower in the 50-59 age group in the US, especially among the subpopulation of Hispanics, low education and /or income and lack of health coverage. Other studies have shown that given interventions, including mailing brochures to patients and discussion with patients by physicians can increase the screening compliance. Efforts should be directed with priority to the lowest screening population to increase the CRC screening rates. *Keywords: Colorectal cancer, screening, BRFSS
AGA Abstracts
A-160