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Su1038 Performance of Fecal Immunochemical Test (FIT) in Patients With a Family History of Colorectal Cancer
AGA Abstracts
Su1037
Su1039
Aspirin versus Screening for Colorectal Cancer Prevention: Comparative Effectiveness Network Meta-Analysis Louise Emilsson, Oeyvind Holme, Michael Bretthauer, Nancy R. Cook, Julie E. Buring, Magnus Loberg, Hans-Olov Adami, Howard D. Sesso, Michael Gaziano, Mette Kalager
Balancing the Benefit of Colorectal Prevention and Risk of Peptic Ulcer Bleeding in the Long Term Use of Aspirin: A 10-Year Follow-Up Population Cohort of 746,739 Subjects Joseph Sung, Kelvin K. Tsoi
Abstract Background and aims Both aspirin use and screening with either flexible sigmoidoscopy or fecal occult blood testing (FOBT) may reduce mortality from colorectal cancer, but comparative effectiveness is unknown. We aimed to compare aspirin use versus screening with regard to incidence and mortality of colorectal cancer. Methods We searched Medline, EMBASE and the COCHRANE central register (CENTRAL) for relevant randomized trials identified until 31st of October 2015. Randomized trials in average-risk populations that reported colorectal cancer mortality, colorectal cancer incidence, or both, with a minimum follow-up of 2 years, and more than 100 randomized individuals were included. We calculated relative risks (RRs) with 95% predictive intervals (PrIs)) for the comparison of the interventions by frequentist network meta-analyses. Results The effect of aspirin on colorectal cancer mortality was similar to FOBT (RR 1.03; 95%PrI 0.76-1.39) and flexible sigmoidoscopy (RR 1.16; 95%PrI 0.84-1.60). Aspirin was more effective than FOBT (RR 0.36; 95% PrI 0.220.59) and flexible sigmoidoscopy (RR 0.37; 95% PrI 0.22-0.62) in preventing death from or cancer in the proximal colon. Aspirin was equally effective as screening in reducing colorectal cancer incidence, while flexible sigmoidoscopy was superior to FOBT (RR 0.83; 95% PrI 0.72-0.97). Limitations No head-to-head trials have been performed. Aspirin is compared to placebo, while FOBT and flexible sigmoidoscopy were compared to no screening. Conclusions Aspirin seems equally effective as flexible sigmoidoscopy or FOBT screening to reduce colorectal cancer incidence and mortality and possibly more effective for cancers in the proximal colon. A randomized comparative effectiveness trial of aspirin versus screening is warranted. Keywords Colorectal cancer; screening; aspirin; network meta-analysis.
Background: Previous studies have shown that aspirin may reduce colorectal cancer (CRC) incidence and mortality, but it would increase the risk of peptic ulcer bleeding (PUB). Aim: To assess the benefit and risk of long term use of aspirin in a large hospital-based cohort. Method: Using a large population data-set from 42 publically funded hospitals in Hong Kong, we retrieve data from all hospital admissions from 2000 to 2004 and their outcome in the fellow-up period until 2014. Aspirin users were matched for age and gender in 1:2 to non-aspirin users in this comparison. The odds ratios of incidence and mortality of CRC and PUB between aspirin-users and non-aspirin-users were computed by logistic regression and Cox-proportional hazards regression models. Results: There were 254,887 aspirin users and 491,852 non-aspirin users recruited in this study with a mean follow up period of 138 months. PUB was reported in 11.9% of aspirin users compared to 7.1% of non-aspirin users (p-value < 0.001), leading to ulcer-related mortality of 0.10% and 0.14% respectively (pvalue < 0.001). CRC was reported in 2.9% in aspirin users compared to 3.4% in non-aspirin users (p-value < 0.001), leading to CRC-related mortality of 1.1% and 1.7% respectively (p-value < 0.001). The use of aspirin has resulted in 18% reduction of CRC incidence (OR 0.82 (95% CI 0.80 to 0.85)) and 11% reduction of CRC mortality (HR 0.89 (95%CI 0.86 to 0.92)). At the same time, it leaded to 75% increase in PUB incidence (OR 1.75 (95% CI 1.72- 1.78)) and 4% increase in PUB-related mortality (HR 1.04 (95% CI 1.02 to 1.06)). The reduction in CRC-related mortality was more pronounced in the older age-groups (6579 years and >80 years) than those in the younger age-groups (<50 years and 50-65 years) (Figure). Conclusion: The use of aspirin has led to a significant reduction in CRC incidence and mortality but also significant increase in PUB incidence and mortality. The magnitude of mortality reduction by CRC (11%) is more pronounced than mortality increase by PUB (4%).
Su1038 Performance of Fecal Immunochemical Test (FIT) in Patients With a Family History of Colorectal Cancer Sarvenaz Moosavi, Laura Gentile, Lovedeep Gondara, Colleen McGahan, Robert A. Enns, Jennifer J. Telford Objective: To demonstrate the performance of FIT in detection of high-risk lesions amongst patients with high-risk family history of colorectal cancer (CRC) Methods: Three communities participated in a CRC screening pilot program from 01/09 to 04/13. Eligible participants were asymptomatic men and women 50 to 75 years of age. All data was recorded prospectively in a central database. Participants with a family history of CRC were identified and offered colonoscopy, but also asked to complete FIT prior to colonoscopy. Participants received 2 FIT kits and were instructed to take one sample each from two consecutive bowel movements. The FIT was considered abnormal if either test was > 100 ng/mL buffer. Family history was divided into 3 groups: 1 FDR diagnosed > 60 years, 1 FDR diagnosed < 60 year, and > 2 FDRs with CRC at any age. High-risk findings (HRF) at colonoscopy were defined as cancer, tubular adenoma >10 mm, high-grade dysplasia, villous adenoma, sessile serrated adenoma/ polyp, and traditional serrated adenoma. The study was approved by the BC Cancer Agency Ethics. Results: 613 patients with positive family history of CRC completed FIT and underwent colonoscopy: 128 had at least one positive FIT and 485 had negative FIT. A total of 89 colonoscopies had HRFs, including 6 cancers and 43 high-risk polyps. The positive and negative predictive values of FIT in the detection of CRC were 7% and 100% respectively. Univariate analysis demonstrated positive FIT, male gender, and increasing age but not type of family history were significantly associated with detection of HRF. On multivariate logistic regression, positive FIT, but not age, gender or type of family history, was associated with HRF (Table 1). Conclusion: FIT performs well in patients with a family history of CRC and is more strongly associated with high-risk findings on colonoscopy than age, gender or type of family history. Multivariate Analysis of High-Risk Findings
Su1040 Local Recurrence After Incomplete Resection of Colorectal Advanced Adenomas JaeKwang Lee, Hyun-soo Kim, Chang Keun Park, Jae Kwon Jung Background and Aims : Colonoscopy can detect precancerous lesions, which can subsequently be removed, thus reducing colorectal cancer (CRC) incidence and mortality. However, recent data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons for such interval CRC cases, incomplete resection is known as a significant contributor. There are few studies regarding incompletely resected polyps, especially advanced adenoma (eg, >1cm in size or containing high-grade dysplasia or a villous component). So, we studied the prognosis in cases of incompletely resected advanced adenoma. Patient and Methods: We retrospectively reviewed patients who had advanced colorectal adenomas that were incompletely resected by either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between January 2003 and March 2015. Patients who did not follow up after EMR or ESD were excluded. The primary outcomes were the incomplete resection rate of advanced adenoma as determined by histopathologic examination and the recurrence rate of incompletely resected advanced adenoma. Furthermore, we investigated the probable contributing factors that may have led to a relapse of incompletely resected advanced adenoma. Results: 7,105 patient's colorectal polyps were resected by EMR or ESD between January 2003 and March 2015, and 2,233 of these cases were advanced adenoma. Of these, 354 (15.8%) patient's polyps were resected incompletely and only 163 patients were followed up. Of those followed up, 31 patients(19.0%) experienced local recurrence. Risk factors for recurrence after incomplete resection were evaluated. Patient's age, Morphology of the adenoma and use of rescue therapy such as APC were found to be associated with adenoma recurrence. Conclusion: Our study shows that adjunctive ablation of the resection sites of advanced adenomas would be useful in reducing local recurrence. And incompletely resected advanced adenomas in older patients or in patients with sessile-type adenomas must be strictly monitored. Key Words: Advanced adenoma, Colon cancer screening
AGA Abstracts
S-452
Su1037
Su1039
Aspirin versus Screening for Colorectal Cancer Prevention: Comparative Effectiveness Network Meta-Analysis Louise Emilsson, Oeyvind Holme, Michael Bretthauer, Nancy R. Cook, Julie E. Buring, Magnus Loberg, Hans-Olov Adami, Howard D. Sesso, Michael Gaziano, Mette Kalager
Balancing the Benefit of Colorectal Prevention and Risk of Peptic Ulcer Bleeding in the Long Term Use of Aspirin: A 10-Year Follow-Up Population Cohort of 746,739 Subjects Joseph Sung, Kelvin K. Tsoi
Abstract Background and aims Both aspirin use and screening with either flexible sigmoidoscopy or fecal occult blood testing (FOBT) may reduce mortality from colorectal cancer, but comparative effectiveness is unknown. We aimed to compare aspirin use versus screening with regard to incidence and mortality of colorectal cancer. Methods We searched Medline, EMBASE and the COCHRANE central register (CENTRAL) for relevant randomized trials identified until 31st of October 2015. Randomized trials in average-risk populations that reported colorectal cancer mortality, colorectal cancer incidence, or both, with a minimum follow-up of 2 years, and more than 100 randomized individuals were included. We calculated relative risks (RRs) with 95% predictive intervals (PrIs)) for the comparison of the interventions by frequentist network meta-analyses. Results The effect of aspirin on colorectal cancer mortality was similar to FOBT (RR 1.03; 95%PrI 0.76-1.39) and flexible sigmoidoscopy (RR 1.16; 95%PrI 0.84-1.60). Aspirin was more effective than FOBT (RR 0.36; 95% PrI 0.220.59) and flexible sigmoidoscopy (RR 0.37; 95% PrI 0.22-0.62) in preventing death from or cancer in the proximal colon. Aspirin was equally effective as screening in reducing colorectal cancer incidence, while flexible sigmoidoscopy was superior to FOBT (RR 0.83; 95% PrI 0.72-0.97). Limitations No head-to-head trials have been performed. Aspirin is compared to placebo, while FOBT and flexible sigmoidoscopy were compared to no screening. Conclusions Aspirin seems equally effective as flexible sigmoidoscopy or FOBT screening to reduce colorectal cancer incidence and mortality and possibly more effective for cancers in the proximal colon. A randomized comparative effectiveness trial of aspirin versus screening is warranted. Keywords Colorectal cancer; screening; aspirin; network meta-analysis.
Background: Previous studies have shown that aspirin may reduce colorectal cancer (CRC) incidence and mortality, but it would increase the risk of peptic ulcer bleeding (PUB). Aim: To assess the benefit and risk of long term use of aspirin in a large hospital-based cohort. Method: Using a large population data-set from 42 publically funded hospitals in Hong Kong, we retrieve data from all hospital admissions from 2000 to 2004 and their outcome in the fellow-up period until 2014. Aspirin users were matched for age and gender in 1:2 to non-aspirin users in this comparison. The odds ratios of incidence and mortality of CRC and PUB between aspirin-users and non-aspirin-users were computed by logistic regression and Cox-proportional hazards regression models. Results: There were 254,887 aspirin users and 491,852 non-aspirin users recruited in this study with a mean follow up period of 138 months. PUB was reported in 11.9% of aspirin users compared to 7.1% of non-aspirin users (p-value < 0.001), leading to ulcer-related mortality of 0.10% and 0.14% respectively (pvalue < 0.001). CRC was reported in 2.9% in aspirin users compared to 3.4% in non-aspirin users (p-value < 0.001), leading to CRC-related mortality of 1.1% and 1.7% respectively (p-value < 0.001). The use of aspirin has resulted in 18% reduction of CRC incidence (OR 0.82 (95% CI 0.80 to 0.85)) and 11% reduction of CRC mortality (HR 0.89 (95%CI 0.86 to 0.92)). At the same time, it leaded to 75% increase in PUB incidence (OR 1.75 (95% CI 1.72- 1.78)) and 4% increase in PUB-related mortality (HR 1.04 (95% CI 1.02 to 1.06)). The reduction in CRC-related mortality was more pronounced in the older age-groups (6579 years and >80 years) than those in the younger age-groups (<50 years and 50-65 years) (Figure). Conclusion: The use of aspirin has led to a significant reduction in CRC incidence and mortality but also significant increase in PUB incidence and mortality. The magnitude of mortality reduction by CRC (11%) is more pronounced than mortality increase by PUB (4%).
Su1038 Performance of Fecal Immunochemical Test (FIT) in Patients With a Family History of Colorectal Cancer Sarvenaz Moosavi, Laura Gentile, Lovedeep Gondara, Colleen McGahan, Robert A. Enns, Jennifer J. Telford Objective: To demonstrate the performance of FIT in detection of high-risk lesions amongst patients with high-risk family history of colorectal cancer (CRC) Methods: Three communities participated in a CRC screening pilot program from 01/09 to 04/13. Eligible participants were asymptomatic men and women 50 to 75 years of age. All data was recorded prospectively in a central database. Participants with a family history of CRC were identified and offered colonoscopy, but also asked to complete FIT prior to colonoscopy. Participants received 2 FIT kits and were instructed to take one sample each from two consecutive bowel movements. The FIT was considered abnormal if either test was > 100 ng/mL buffer. Family history was divided into 3 groups: 1 FDR diagnosed > 60 years, 1 FDR diagnosed < 60 year, and > 2 FDRs with CRC at any age. High-risk findings (HRF) at colonoscopy were defined as cancer, tubular adenoma >10 mm, high-grade dysplasia, villous adenoma, sessile serrated adenoma/ polyp, and traditional serrated adenoma. The study was approved by the BC Cancer Agency Ethics. Results: 613 patients with positive family history of CRC completed FIT and underwent colonoscopy: 128 had at least one positive FIT and 485 had negative FIT. A total of 89 colonoscopies had HRFs, including 6 cancers and 43 high-risk polyps. The positive and negative predictive values of FIT in the detection of CRC were 7% and 100% respectively. Univariate analysis demonstrated positive FIT, male gender, and increasing age but not type of family history were significantly associated with detection of HRF. On multivariate logistic regression, positive FIT, but not age, gender or type of family history, was associated with HRF (Table 1). Conclusion: FIT performs well in patients with a family history of CRC and is more strongly associated with high-risk findings on colonoscopy than age, gender or type of family history. Multivariate Analysis of High-Risk Findings
Su1040 Local Recurrence After Incomplete Resection of Colorectal Advanced Adenomas JaeKwang Lee, Hyun-soo Kim, Chang Keun Park, Jae Kwon Jung Background and Aims : Colonoscopy can detect precancerous lesions, which can subsequently be removed, thus reducing colorectal cancer (CRC) incidence and mortality. However, recent data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons for such interval CRC cases, incomplete resection is known as a significant contributor. There are few studies regarding incompletely resected polyps, especially advanced adenoma (eg, >1cm in size or containing high-grade dysplasia or a villous component). So, we studied the prognosis in cases of incompletely resected advanced adenoma. Patient and Methods: We retrospectively reviewed patients who had advanced colorectal adenomas that were incompletely resected by either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between January 2003 and March 2015. Patients who did not follow up after EMR or ESD were excluded. The primary outcomes were the incomplete resection rate of advanced adenoma as determined by histopathologic examination and the recurrence rate of incompletely resected advanced adenoma. Furthermore, we investigated the probable contributing factors that may have led to a relapse of incompletely resected advanced adenoma. Results: 7,105 patient's colorectal polyps were resected by EMR or ESD between January 2003 and March 2015, and 2,233 of these cases were advanced adenoma. Of these, 354 (15.8%) patient's polyps were resected incompletely and only 163 patients were followed up. Of those followed up, 31 patients(19.0%) experienced local recurrence. Risk factors for recurrence after incomplete resection were evaluated. Patient's age, Morphology of the adenoma and use of rescue therapy such as APC were found to be associated with adenoma recurrence. Conclusion: Our study shows that adjunctive ablation of the resection sites of advanced adenomas would be useful in reducing local recurrence. And incompletely resected advanced adenomas in older patients or in patients with sessile-type adenomas must be strictly monitored. Key Words: Advanced adenoma, Colon cancer screening
AGA Abstracts
S-452