- Email: [email protected]
The best age for screening colonoscopy: A Markov Model study
European Congress of Epidemiology / Revue d’Épidémiologie et de Santé Publique 66S (2018) S277–S437 Aim Describe epidemiological profile of cervical cancer in the Oran University Hospital (EHUO). Methods The data were obtained from two years of registration as part of the cancer registry of EHUO. The central coding is carried out using the supports of CIMO2 and CIM10 . Results were obtained with Epida analysis. Results In total, 161 cases of cervical cancer were registered during the period 2014–2015. The average age of patients is 56.8 ± 2.0 years old. Histological analysis of cancerous cases showed a predominance of squamous cell carcinomas 66.9%, while adenocarcinoma represents 3.4%. Low grades lesions (I and II) are the most common (91.2%). The discovery of cancer is mainly by revealing symptoms 85.6%. Conclusion In our country, cervical cancer is considered a poor prognosis at late stage. But it is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up for all women every 3 years for women between 20 and 65 years old. Keywords Epidemiology; Cervical cancer; Cancer registry Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.138 P2-12
How long does it take until the effects of endoscopic screening on colorectal cancer mortality are fully disclosed? A Markov Model study C. Chen a,b,∗ , C. Stock a , M. Hoffmeister a , H. Brenner a,c,d a Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany b Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany c Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany d German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany ∗ Corresponding author. E-mail address: [email protected] (C. Chen) Introduction Colorectal cancer (CRC) is one of the leading causes of cancer morbidity and mortality worldwide. A recent randomized trial has suggested persisting protection from CRC incidence and mortality of a single flexible sigmoidoscopy for up to 17 years and possibly beyond. We performed a simulation study to explore the time course and magnitude of protection provided by screening colonoscopy against CRC death over 25 years. Methods Using data from the German national screening colonoscopy registry, a multi-state Markov model was set up based on the adenoma-carcinoma pathway to estimate the cumulative CRC mortality when different proportions of the population have a single screening colonoscopy at age 55, or two screening colonoscopies at ages 55 and 65. Ratio and difference of the expected cumulative CRC mortalities among screened and unscreened populations were calculated over follow-up to reflect the impact of screening colonoscopy. Results Cumulative CRC mortality continuously increased with age, and in the absence of screening reached 2.6% and 1.7% at age 80 for men and women, respectively. A single colonoscopy at age 55, even with limited uptake, was predicted to lead to much lower cumulative mortality (0.7% and 0.5% for men and women, respectively at age 80 when uptake was 100%). Relative mortality reduction continued to increase over more than 10 years and reached the maximum around 12–13 years after screening. Although relative risk reduction became attenuated for even longer periods of follow-up, absolute risk reduction steadily increased throughout follow-up and more than 70% of the total risk reduction was observed between 13–25 years. A repeat colonoscopy 10 year later further enhanced the effects and the cumulative mortality remained at 0.1% to 0.2% throughout follow-up when uptake was 100%. Conclusions Even a single (once only) screening colonoscopy has the potential to prevent most of CRC mortalities. Protective effects are expected to be long lasting and to become fully manifest after more than two decades from screening.
Disclosure of interest est.
S289
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.139 P2-13
The best age for screening colonoscopy: A Markov Model study C. Chen a,b,∗ , C. Stock a , M. Hoffmeister a , H. Brenner a,c,d a Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany b Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany c Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany d German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany ∗ Corresponding author. E-mail address: [email protected] (C. Chen) Introduction Colonoscopy has been demonstrated to be effective in reducing colorectal cancer (CRC) incidence and mortality and is commonly used as a screening modality. We performed a simulation study to examine the best age to have screening colonoscopy when capacity is limited, and once-only test is allowed, and compared the estimates with the best ages for two and three screening colonoscopies. Methods A Markov model was set up with the use of data from the German national screening colonoscopy registry to simulate the natural history of the adenoma-carcinoma process. Years of potential life lost (YPLL) from CRC deaths for people aged 50 in Germany were estimated when they have a single screening colonoscopy, or two or three screening colonoscopies with 10-year intervals at various ages. Results CRC was estimated to yield a total of 384,529 and 290,190 YPLL till age 85 in the absence of screening for men and women, respectively. One single screening colonoscopy performed between 50–65 years was expected to reduce this estimate by approximately 49–69%. A U-shaped association was found between screening age and the estimated YPLL, and the optimal age for once-only screening colonoscopy (associated with the least YPLL) was 53 to 54 for males and 54 to 56 for females. For two or three screening colonoscopies, the best starting age fell to 50 or even younger for both genders. Conclusions Our estimates lend support to the suggestion that the current German screening colonoscopy offer starting at age 55 should be extended to cover people aged 50–54. When colonoscopy capacity is limited, different age at initiation of screening for men and women might be considered. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.140 P2-14
Does administration of broad-spectrum antibiotics in febrile neutropenic children trigger the emergence of BMR? A French experience C. Raad a,∗ , J. Grando b , C. Fuhrmann c , C. Bruchon b , Y. Bertrand d , C. Domenech d a Pediatric Hematology and Oncology, Hospices Civils de Lyon IHOPe, Lyon, France b Hygiene epidemiology GH Est, Hospices Civils de Lyon, Lyon, France c Bacteriology, GH est, Hospices Civils de Lyon IHOPe UCLB, Lyon, France d Pediatric Hematology and Oncology, Hospices Civils de Lyon IHOPe UCBL, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (C. Raad) Background Blood stream infections (BSI) remain a major cause of morbidity and mortality in immunocompromised children and increase the length of hospitalisation as well as the cost of treatment. The difficulty of documenting bacteremia at the onset of fever in neutropenic patients led to an early
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.138 P2-12
How long does it take until the effects of endoscopic screening on colorectal cancer mortality are fully disclosed? A Markov Model study C. Chen a,b,∗ , C. Stock a , M. Hoffmeister a , H. Brenner a,c,d a Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany b Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany c Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany d German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany ∗ Corresponding author. E-mail address: [email protected] (C. Chen) Introduction Colorectal cancer (CRC) is one of the leading causes of cancer morbidity and mortality worldwide. A recent randomized trial has suggested persisting protection from CRC incidence and mortality of a single flexible sigmoidoscopy for up to 17 years and possibly beyond. We performed a simulation study to explore the time course and magnitude of protection provided by screening colonoscopy against CRC death over 25 years. Methods Using data from the German national screening colonoscopy registry, a multi-state Markov model was set up based on the adenoma-carcinoma pathway to estimate the cumulative CRC mortality when different proportions of the population have a single screening colonoscopy at age 55, or two screening colonoscopies at ages 55 and 65. Ratio and difference of the expected cumulative CRC mortalities among screened and unscreened populations were calculated over follow-up to reflect the impact of screening colonoscopy. Results Cumulative CRC mortality continuously increased with age, and in the absence of screening reached 2.6% and 1.7% at age 80 for men and women, respectively. A single colonoscopy at age 55, even with limited uptake, was predicted to lead to much lower cumulative mortality (0.7% and 0.5% for men and women, respectively at age 80 when uptake was 100%). Relative mortality reduction continued to increase over more than 10 years and reached the maximum around 12–13 years after screening. Although relative risk reduction became attenuated for even longer periods of follow-up, absolute risk reduction steadily increased throughout follow-up and more than 70% of the total risk reduction was observed between 13–25 years. A repeat colonoscopy 10 year later further enhanced the effects and the cumulative mortality remained at 0.1% to 0.2% throughout follow-up when uptake was 100%. Conclusions Even a single (once only) screening colonoscopy has the potential to prevent most of CRC mortalities. Protective effects are expected to be long lasting and to become fully manifest after more than two decades from screening.
Disclosure of interest est.
S289
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.139 P2-13
The best age for screening colonoscopy: A Markov Model study C. Chen a,b,∗ , C. Stock a , M. Hoffmeister a , H. Brenner a,c,d a Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany b Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany c Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany d German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany ∗ Corresponding author. E-mail address: [email protected] (C. Chen) Introduction Colonoscopy has been demonstrated to be effective in reducing colorectal cancer (CRC) incidence and mortality and is commonly used as a screening modality. We performed a simulation study to examine the best age to have screening colonoscopy when capacity is limited, and once-only test is allowed, and compared the estimates with the best ages for two and three screening colonoscopies. Methods A Markov model was set up with the use of data from the German national screening colonoscopy registry to simulate the natural history of the adenoma-carcinoma process. Years of potential life lost (YPLL) from CRC deaths for people aged 50 in Germany were estimated when they have a single screening colonoscopy, or two or three screening colonoscopies with 10-year intervals at various ages. Results CRC was estimated to yield a total of 384,529 and 290,190 YPLL till age 85 in the absence of screening for men and women, respectively. One single screening colonoscopy performed between 50–65 years was expected to reduce this estimate by approximately 49–69%. A U-shaped association was found between screening age and the estimated YPLL, and the optimal age for once-only screening colonoscopy (associated with the least YPLL) was 53 to 54 for males and 54 to 56 for females. For two or three screening colonoscopies, the best starting age fell to 50 or even younger for both genders. Conclusions Our estimates lend support to the suggestion that the current German screening colonoscopy offer starting at age 55 should be extended to cover people aged 50–54. When colonoscopy capacity is limited, different age at initiation of screening for men and women might be considered. Disclosure of interest est.
The authors declare that they have no competing inter-
https://doi.org/10.1016/j.respe.2018.05.140 P2-14
Does administration of broad-spectrum antibiotics in febrile neutropenic children trigger the emergence of BMR? A French experience C. Raad a,∗ , J. Grando b , C. Fuhrmann c , C. Bruchon b , Y. Bertrand d , C. Domenech d a Pediatric Hematology and Oncology, Hospices Civils de Lyon IHOPe, Lyon, France b Hygiene epidemiology GH Est, Hospices Civils de Lyon, Lyon, France c Bacteriology, GH est, Hospices Civils de Lyon IHOPe UCLB, Lyon, France d Pediatric Hematology and Oncology, Hospices Civils de Lyon IHOPe UCBL, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (C. Raad) Background Blood stream infections (BSI) remain a major cause of morbidity and mortality in immunocompromised children and increase the length of hospitalisation as well as the cost of treatment. The difficulty of documenting bacteremia at the onset of fever in neutropenic patients led to an early