- Email: [email protected]
Tu1201 Should Gender Be Considered in CRC Screening Guidelines?
AGA Abstracts
established. The aim of the study was to determine whether fecal [Hb] was associated with diagnosis, gender or age in CRC surveillance and screening populations. Methods: We compared the absolute [Hb] for different diagnostic outcomes in positive FIT participants in CRC surveillance and population screening cohorts. A positive FIT was defined as returning a fecal [Hb] greater than or equal to 100 ng/ml (OC-Sensor, Eiken Chemical Co., Japan) in any of 2 consecutive stool samples. Fecal [Hb] surpassed this positivity threshold in 347 surveillance patients (192 men) who subsequently underwent colonoscopy. Fecal [Hb] and colonoscopy outcomes were compared to data from FIT positive participants concurrently undergoing population screening (n=151, 84 men). Colonoscopy findings, gender and age (>60y, 61-70y, >70y) were used to stratify results according to either advanced neoplasia (carcinoma, adenoma >10 mm, > 2 adenoma s, or villous change), or other diagnoses. After normalisation of data (Box Cox transformation) [Hb] were compared for each group for each diagnostic outcome (IQR) by unpaired t test. Data are median (IQR). Results: Advanced neoplasia was seen in 37% of screened and 20% of surveillance patients. Screening participants (especially men) with advanced neoplasia had significantly higher [Hb] than those with other diagnoses , or than surveillance patients with either advanced neoplasia or other diagnoses (see table) . There was no difference between screening and surveillance populations for other diagnoses. There were no differences in fecal [Hb] between genders or across age bands. Conclusions: Surveillance population patients with advanced neoplasia have lower fecal [Hb] compared to similar participants in population screening. There is no difference in [Hb] between surveillance patients with advanced neoplasia and those with other diagnoses. These data indicate that discrimination for advanced neoplasia by fecal [Hb] is reduced in patients undergoing surveillance. Furthermore, caution should be exercised when extrapolating the significance of [Hb] from screening to surveillance populations.
Tu1199 Factors Related With Detection of Polyps in Screening Colonoscopy. Influence of Right vs Left-Side Polyp Location Rodrigo Jover, M. Eduardo Polanía, Marta Ponce, Antonio Peris, Joaquin Cubiella, Luis Bujanda, Angel Lanas, Maria Pellise, Alberto Herreros de Tejada, Akiko Ono, Guillermo Cacho, Jose Antonio Hermo, Agustin Seoane, Maria Chaparro, José C. Marín, Yanira González-Méndez, Servando Fernández_Díez, Enrique Quintero, Antoni Castells Colonoscopy and polypectomy plays a central role in colorectal cancer (CRC) prevention. However, some studies suggest lack of efficacy of colonoscopy in the prevention of rightside CRC that could be related to different aspects involving colonoscopy quality. The aim of this study is to know which factors are related with the detection of right and left-side polyps in screening colonoscopy. Methods. A total of 3,288 people have been evaluated in the colonoscopy arm of the COLONPREV study, a randomized trial aimed to compare colonoscopy vs FIT in CRC screening. Polyps were considered as right-sided if they are located in the cecum, ascending or transverse colon. Univariate and logistic regression multivariate analysis were performed in order to evaluate factors related with the finding of colon polyps or CRC and right or left-side polyps. Results. Polyps or CRC were found in 1,564 patients (47.6%%). A total of 948 patients (60.6%) had polyps or CRC in their right colon and 616 (39.4%) had only left-side polyps or CRC. In the univariate analysis factors influencing detection of polyps or CRC anywhere in the colon were: hospital, older age, male gender, endoscopists with withdrawal time in normal colonoscopy longer than 6 minutes, cecal intubation, colonic cleansing with sodium fosfate and use of sedation. In the multivariate analysis only withdrawal time (OR 1.79; 95% CI 1.44-2.30), gender (OR 0.42; 95%CI 0.36-0.50), cecal intubation (OR 0.52; 95%CI 0.34-0.79) and use of sedation (OR 2.05; 95%CI 1.27-3.31) were independently associated with detection of colonic polyps or CRC. Factors influencing detection of lesions in the right colon were: hospital, withdrawal time longer than 6 minutes, male gender, older age, cecal intubation, use of sedation, use of sodium fosfate, use of propofol in sedation and sedation assisted by anesthesist. In the multivariate analysis, independent factors related with detection of right-side lesions were: male gender (OR 2.42; 95%IC 1.94-3.01), withdrawal time (OR 0.69; 95%CI 0.52-0.91), cecal intubation (OR 1.84; 95%CI 1.04-3.26) and use of sedation (OR 1.15; 95%CI 1.051.26). For left-side polyps only the hospital, withdrawal time and male gender were related with its detection. In the multivariate analysis, independent factors related with detection of left-side polyps were only longer withdrawal time (OR 0.62; 95% CI 0.49-0.77) and male gender (OR 1.22; 95%CI 1.01-1.49). Conclusion. Withdrawal time is the most important modifiable factor related with detection of colonic polyps. Factors related with detection of right or left-side polyps are different, and use of sedation improves particularly the detection of right-sided polyps.
*p< 0.05, advanced neoplasia, screening group versus surveillance; +p<0.01, #p<0.03, Screening group, advanced neoplasia versus other, ** p<0.06 Screening group, advanced neoplasia versus other (women) Tu1198 Reduced Health Literacy in Veterans is Related to Poor Knowledge and Negative Attitudes Toward Colorectal Cancer (CRC) Screening. the Value Study: Veterans as Leaders in Understanding and Education Leor Azoulay, Ian M. Gralnek, Dawn Provenzale, Jennifer Talley, Joan M. Griffin
Tu1200 Fecal Immunochemical Test Results in Different Stages of Colorectal Cancer: A Colonoscopy Controlled Study Ilhame Ben Larbi, Sietze T. Van Turenhout, Frank A. Oort, Jochim S. Terhaar sive Droste, René W. van der Hulst, Pieter Scholten, Ruud J. Loffeld, Annekatrien Depla, Veerle M. Coupe, Anneke A. Bouman, Gerrit A. Meijer, Chris J. Mulder
Background: Health literacy (HL) is a person's ability to read, understand and use healthcare information to make decisions and follow instructions for tests and treatments. Reduced HL may be associated with less knowledge and negative attitudes/beliefs towards disease, and may be a risk factor for poor CRC screening adherence and CRC disease outcomes. Aims/Methods: We conducted a cross-sectional survey to evaluate differences in knowledge, attitudes, and beliefs regarding CRC and CRC screening by HL skills in US Veterans. Patients at four geographically and racially diverse VA medical centers were stratified by age (<50yrs, 50-75yrs, >75yrs) and randomly selected to participate. Interviewers collected demographic data and assessed HL using the Short Test of Functional Health Literacy in Adults (STOFHLA), a well-validated HL instrument. HL was defined as either adequate or inadequate/ marginal. Veterans 50-75 years old were then queried about their knowledge (10 items), salience (7 items), worry (3 items), social norms (2 items), efficacy (3 items), and susceptibility (4 items) about CRC and CRC screening. We then assessed relationships between HL level and these constructs. Separate analyses were conducted for those with and without a personal history of CRC or colon polyps. Results: 3,850 Veteran patients were asked to participate and 2,456 (64%) agreed. 29.3% (n=719) were ages 50-75 years (mean age=61.5) and completed the S-TOFHLA and CRC questions. 72.0% (n=518) had no CRC or polyp history. Of those without CRC or polyp history, 71.6% were White; 27.4% completed HS and 55.6% had attended or graduated from college; 54.6% were married or living with someone. 10.6% (n=76) had inadequate/marginal HL. Regardless of the patient's history of CRC or polyps, those with inadequate/marginal HL, compared to those with adequate HL, were significantly less likely to know that tests to detect CRC were available, p=0.029, LR=5.2 and p=0.014, LR=6.4. Those with a history of CRC or polyps were significantly less likely to know that personal risk of CRC is higher if a family member had CRC (p=0.006, LR=8.8) and that CRC tests are necessary even if problems are not present (p=0.008, LR=7.1). Moreover, patients with inadequate/marginal HL were significantly more likely to report a strong influence of family members regarding CRC screening (p=0.028, LR=5.3). Conclusion: Veterans with inadequate/marginal HL had significantly less knowledge and were more strongly influenced by family attitudes about CRC and CRC screening. Yet, in other constructs assessed, these same Veterans had similar knowledge, beliefs and attitudes toward CRC and CRC screening as those with adequate HL. CRC screening programs for Veterans should use clear communication strategies to present information about CRC and CRC screening to Veterans and their families.
AGA Abstracts
Background Most fecal immunochemical test (FIT) screening studies are not colonoscopy controlled and therefore FIT sensitivity and specificity for colorectal cancer (CRC) can not be determined directly. Moreover, FIT screening studies often have a low yield of CRC cases, which makes it difficult to stratify the FIT results per cancer stage. Therefore, accurate data on FIT performance particularly in early stage tumors are lacking. Aim To determine the performance of a frequently used FIT at different cut-off levels stratified for stage. Patients and methods Subjects scheduled for colonoscopy between 2006 and 2010 in five hospitals were asked to perform a FIT (OC sensor®) before elective colonoscopy. FIT results were compared to colonoscopy outcomes. Cut-off levels of ≥50, ≥75 and ≥100 ng haemoglobin/ ml were used to call a test positive. Primary outcome variables were sensitivity and specificity for all stages of CRC. Results In 5,836 subjects who underwent complete colonoscopy, 159 (2.7%) were diagnosed with CRC. Fifty-four (34%) were diagnosed with stage I, 45 (28%) with stage II, 44 (28%) with stage III, 16 (10%) with stage IV cancer. Sensitivity of FIT using a cut-off level of ≥50 ng/ml for stage I, II, III and IV CRC was 85.2%, 88.9%, 97.7%, 93.8%, respectively. Sensitivity of FIT using a cut-off level of ≥75 ng/ml for stage I, II, III and IV CRC was 83.3%, 88.9%, 97.7%, 93.8%, respectively. Sensitivity of FIT using a cutoff level of ≥100 ng/ml for stage I, II, II and IV CRC was 81.5%, 88.9%, 93.2%, 93.8%, respectively. Specificities ranged from 82.8% to 87.9% with increasing cut-off levels. Conclusion In this large mixed referral population with a high yield of early stage CRC, FIT sensitivity for stage I and II CRC was very good, even at higher cut-off levels. Tu1201 Should Gender Be Considered in CRC Screening Guidelines? Menachem Moshkowitz, Ohad Toledano, Lior Galazan, Erwin Santo, Aharon Hallak, Nadir Arber Background: Currently, CRC screening programs are generally identical for women and men around the world. Based on gender differences in the epidemiology of CRC, it was proposed to initiate screening programs a decade earlier in men than in women. Aim: To determine and compare the prevalence of adenomas, advanced adenomas (AdAs) and colorectal cancers (CRC) in different age groups in men and women and to explore whether such gender differences exist in the Israeli population? Patients and Methods: Included were 1835 subjects, 910 of them were totally asymptomatic and 925 with mild symptoms such as mild abdominal discomfort, chronic constipation or inguinal hernia. All colonoscopies were performed by one endoscopist (NA) Results: There were 1089 men (59.3%) and 746 women (40.7%), mean ages 56 (27-85) and 57 (range: 29-88) respectively. Adenomas were found in 18.97% (347), AdAs in 6.3% (116), HGD in 0.78% (13), and CRC in 0.43% (8). Male sex was slightly associated with a higher prevalence of adenomas (20.2% vs 17.02% , P=NS), however, AdAs were more common among women (6.03% vs 3.3% P< 0.05). .CRC prevalance was
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. equal . 0.46% and 0.4% (P=NS). Advanced lesions (AdAs, HGD or CRC) were more prevalent among women in both age groups (> 50 Yrs: 6.97% vs 4.3% , <50 Yrs: 6.2% vs 0; p<0.05 ). There were no statistically differences in the rate of neoplasia between those with mild symptoms to those without any symptoms. Conclusions: 1. The total prevalence of adenomas among Israeli women is only slightly less than that of men, 2. The prevalence of advanced adenomas is higher than that of Israeli men, 3. These results do not support a gender differentiation for initiated CRC screening in Israel.
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Background/Aims: Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. The incidence of colorectal adenoma is also increasing. This study is conducted to evaluate the risk of colorectal neoplasm (CRN), as a precursor of CRC, in this age group. Methods: We enrolled the consecutive 1,250 subjects (mean age 43 year, 831 male), who visited our health promotion center for routine health evaluation from January 2004 through December 2006 and underwent total colonoscopy. The medical records, colonoscopic findings, and pathology reports were reviewed to evaluate the risk factors associated with CRN. Results: Among total patients, 279 (22.3%) had colorectal neoplasm and 17 (1.4%) of them had advanced neoplasm in the colonoscopy. Male had significantly higher prevalence of CRN than that in female (27.3% vs 12.4%, p<.01). The prevalence of CRN was significant higher in the old age (45-49 years) group than in the young age group (20-44 years) (29.0% vs 17.4%, p <0.01). In univariate analysis, type II diabetes, hypertension, alcohol intake and smoking, serum triglyceride, fasting blood glucose, body mass index, and waist circumference were significantly associated with CRN. In multivariate analysis, old age (OR 2.38, 95% CI, 1.56-3.63), male (OR 2.45, 95% CI, 1.61-3.88), smoking (OR 1.49, 95% CI, 1.06-2.09), and waist circumference (OR 1.56, 95% CI, 1.04-2.26) were significantly identified as a risk of CRN. Conclusions: The risk of CRN increase in male gender, age, smoking, and abdominal obesity in adults younger than 50 years. Therefore it should be considered that screening colonoscopy is conducted in male older than age 45 years.
Table 1 Tu1202 Failure to Record a Family History of Familial Cancer in Patients' Notes is Associated With Early Stage Colorectal Cancer Koen Kessels, Nicolette L. de Groot, Herma Fidder, Robin Timmer, Mark Stolk, Martijn G. van Oijen, Johan Offerhaus, Peter D. Siersema
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BACKGROUND: Lynch syndrome associated colorectal cancer (CRC) usually presents at a relatively young age. The Revised Bethesda Guidelines advise screening for Lynch syndrome in patients diagnosed with CRC and a positive family history (FH) of CRC and related cancers. Recording of FH of CRC and related cancers in young patients diagnosed with CRC is known to be insufficient; however, the extent of non-recording is unknown. Identification of factors associated with the failure to record the FH may improve adherence to the Revised Bethesda Guidelines. AIM: To evaluate whether a FH of CRC and related cancers was recorded in patients' notes and to identify factors associated with insufficient recording of the FH in patients with CRC who are 60 years or younger. METHODS: In one university and two general hospitals, all patients diagnosed with CRC at an age of 60 or younger between 1999 and 2008 with an electronic medical record were included. All electronic medical records were evaluated for a recorded FH of CRC and other Lynch syndrome associated cancers. Patient- and tumor characteristics were retrieved from the Dutch Comprehensive Cancer Centre (IKNL) and the Dutch Pathological Archive (PALGA). Multivariate analysis was performed using the binary logistics module of PASW Statistics version 17. RESULTS: A total of 1,421 patients diagnosed with CRC aged 60 years or younger were included of which 710 had an electronic medical record. FH was not recorded in 294/710 (41%) patients. Multivariate analysis showed that from 1999 to 2008, recording of a FH of CRC and related cancers improved with an odds ratio (OR) of 1.09 (95%CI 1.03-1.16) per year. In addition, early stage (stage 0 to II) CRC was associated with the failure to record the FH (OR 1.55, 95%CI 1.14-2.12). Other factors, including younger age at diagnosis (OR 0.99, 95%CI 0.97-1.01), male gender (OR 1.16, 95%CI 0.85-1.57), proximal tumor localization (OR 1.15, 95%CI 0.82-1.61), poor differentiation grade (OR 0.97, 95%CI 0.641.46) and mucinous histology (OR 0.89, 95%CI 0.56-1.40) were not associated with the failure to record FH of CRC and other Lynch syndrome associated cancers. CONCLUSION: A FH of CRC and other Lynch syndrome associated cancers was not recorded in more than 40% of patients who presented with CRC aged 60 years or younger. Recording of the FH improved gradually over the years. As early stage CRC was found to be associated with the failure to record FH, this suggests that particularly advanced stage CRC makes physicians, patients or both aware that the detected CRC may have a relationship with a FH of CRC and related cancers.
Higher Risk of a False Negative Fecal Immunochemical Testing (FIT) Result in Smokers and in Higher Age Groups Inge Stegeman, Thomas R. de Wijkerslooth, Esther M. Stoop, Monique van Leerdam, Marjolein van Ballegooijen, Roderik A. Kraaijenhagen, Ernst J. Kuipers, Paul Fockens, Evelien Dekker, Patrick M. Bossuyt Background Fecal immunochemical stool testing (FIT) is used as a non-invasive triaging test for colonoscopy in screening for colorectal cancer (CRC). FIT should be applied at regular intervals for a maximal preventive effect, given the considerable false negative rate in the detection of advanced neoplasia This false negative rate may differ across subgroups, which could influence the optimal interval for screening. We therefore aimed to identify subgroups at increased risk of false negative FIT results. Methods We collected data in the Colonoscopy or Colonography for Screening study, a multicenter screening trial conducted in Amsterdam and Rotterdam, the Netherlands between June 2009 and October 2010. In this study 5,924 randomly selected, asymptomatic men and women between 50 and 75 years of age were invited to undergo colonoscopy. Screening participants were asked for one sample FIT (OC-sensor) and to complete a risk questionnaire prior to colonoscopy. We calculated the risk of a false negative FIT result (cut-off 50ng/ml) using logistic regression, as defined by age, BMI, sex, pack years of smoking, smoking status, fiber intake and calcium intake. A false negative was defined as an individual with a negative FIT result with detected advanced neoplasia during colonoscopy. The risk was calculated in the whole group (risk of a false negative) as well as in the subgroup of participants with advanced neoplasia (false positive rate or 1 minus sensitivity). Results Of the 1,426 screening participants, 1,112 Participants completed the FIT and the questionnaire; 110 (8.9%) had advanced neoplasia, 7 (0.5%) participants had CRC and 103 (8.3%) had advanced adenoma. In total, 77 (6.9%) persons had a false negative FIT result. In the total screening population, participants at higher age (OR 1.05 per year; CI 1.02-1.02) and smokers (OR 1.80; CI 1.02-3.21) had a significantly higher risk of a false negative FIT result. In the group of participants with advanced neoplasia we did not find significant differences in the false negative rate between risk subgroups. Conclusion The chances of having a false negative FIT are higher in smokers and in people at advanced age, both known risk factors for advanced neoplasia.
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Fit in the Elderly: Performance of a Frequently Used Fecal Immunochemical Test in Subjects 75 of Age and Older Ilhame Ben Larbi, Sietze T. Van Turenhout, Frank A. Oort, Jochim S. Terhaar sive Droste, René W. van der Hulst, Pieter Scholten, Ruud J. Loffeld, Annekatrien Depla, Veerle M. Coupe, Anneke A. Bouman, Gerrit A. Meijer, Chris J. Mulder
Screening Colonoscopy for the Eldely Above 75 Years Old Ja Seol Koo, Dong Hun Lee, Bo Sung Kwon, Seung Young Kim, Sung Woo Jung, Rok Seon Choung, Hyung Joon Yim, Sang Woo Lee, Jai Hyun Choi Backgraound & Aims: Colorectal cancer (CRC) is the third most prevalent cancer in Korea. However, current CRC screening guidelines did not address the elderly above 75 years of age without prior screening. There is limited data to support recommendations in this age group. We conduct the study to evaluate whether the prevalence of colorectal neoplasm (CRN) in the asymptomatic subjects aged between 75 years and 85 years. METHODS: Using endoscopic report data of Korea University Ansan Hospital, we searched the patients aged between 75 and 85 years who had undergone total colonoscopy from 2002 to 2009 . Among the patients, those with a history of positive stool occult blood test, previous colonoscopy, inflammatory bowel disease or CRN and those with cardinal symptoms such as lower gastrointestinal bleeding, anemia, weight loss, and bowel habit change, were excluded. A total 446 patients were enrolled and their endoscopic findings and histological reports were reviewed retrospectively. Endoscopic findings revealed the location and morphologic type of colorectal polyps. Advanced neoplasia were defined as adenoma ≥ 1 cm, polyps with villous histology or high grade dysplasia, and invasive cancer. RESULTS: Among a total 446 elderly patients who had screening colonoscopy, 211(47.3%) were male and 235(52.7%) female patients. Adenomas were detected in 207(46.4%) patients and advanced neoplasia were also detected in 90(20.0%) patients. CRC was diagnosed in 14 (3.1%) patients. Proximal adenomatous polyps were detected in 127(28.4%) patients and among them, 47(10.5%) had advanced neoplasia and 8(1.8%) had CRC. And in 155 patients (34.8%) with distal adenomas, 43(9.6%) had significant CRN and 6(1.3%) had CRC. The adverse events were not developed in the elderly patients during screening colonoscopy. Conclusion: Although screening colonoscopy is not routinely recommended in the elderly, Our study showed that
Background Individuals ≥ 75 years of age are excluded from most colorectal cancer (CRC) screening programs using fecal immunochemical tests (FITs), as screening is not considered to be cost effective in this group. Due to the increase in life expectancy in industrialised countries this could change in the near future. At present, little is known on the performance of FITs in subjects ≥ 75 years. Aim To assess the performance of a frequently used fecal immunochemical test in subjects ≥ 75 of age to detect CRC, early stage CRC and advanced adenoma. Patients and Methods Subjects ≥ 75 years old scheduled for colonoscopy between 2006 and 2010 in five hospitals, were asked to perform a FIT (OCsensor®) before elective colonoscopy. FIT results were compared to colonoscopy outcomes. A cut-off level of ≥ 75 ng haemoglobin/ml was used to call a test positive. Primary outcome variables were sensitivity and specificity for CRC, early stage CRC and advanced adenoma. Results In 729 individuals ≥ 75 years who underwent total colonoscopy, 37 individuals (5%) were diagnosed with CRC, 24 of whom with early stage disease (i.e. stage I or II). Advanced adenomas were found in 113 patients (15.5%). Positivity rate was 22.5%. Sensitivity of FIT for CRC, early stage CRC and advanced adenoma was 94.5%, 96.0% and 43.3%, respectively. Specificity of FIT for CRC and advanced adenoma was 81.3% and 82.3%, respectively. For screen relevant lesions (i.e. early stage CRC and advanced adenoma) sensitivity and specificity was 52.9% and 82.5%, respectively. Conclusion In a mixed referral population FIT was found to have a high sensitivity for CRC and in particular for early stage CRC in subjects aged ≥75 years.
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AGA Abstracts
AGA Abstracts
Risk of Colorectal Neoplasm in Adults Younger Than 50 Years of Age Ja Seol Koo, Dong Hun Lee, Seung Young Kim, Rok Seon Choung, Sung Woo Jung, Hyung Joon Yim, Sang Woo Lee, Jai Hyun Choi
established. The aim of the study was to determine whether fecal [Hb] was associated with diagnosis, gender or age in CRC surveillance and screening populations. Methods: We compared the absolute [Hb] for different diagnostic outcomes in positive FIT participants in CRC surveillance and population screening cohorts. A positive FIT was defined as returning a fecal [Hb] greater than or equal to 100 ng/ml (OC-Sensor, Eiken Chemical Co., Japan) in any of 2 consecutive stool samples. Fecal [Hb] surpassed this positivity threshold in 347 surveillance patients (192 men) who subsequently underwent colonoscopy. Fecal [Hb] and colonoscopy outcomes were compared to data from FIT positive participants concurrently undergoing population screening (n=151, 84 men). Colonoscopy findings, gender and age (>60y, 61-70y, >70y) were used to stratify results according to either advanced neoplasia (carcinoma, adenoma >10 mm, > 2 adenoma s, or villous change), or other diagnoses. After normalisation of data (Box Cox transformation) [Hb] were compared for each group for each diagnostic outcome (IQR) by unpaired t test. Data are median (IQR). Results: Advanced neoplasia was seen in 37% of screened and 20% of surveillance patients. Screening participants (especially men) with advanced neoplasia had significantly higher [Hb] than those with other diagnoses , or than surveillance patients with either advanced neoplasia or other diagnoses (see table) . There was no difference between screening and surveillance populations for other diagnoses. There were no differences in fecal [Hb] between genders or across age bands. Conclusions: Surveillance population patients with advanced neoplasia have lower fecal [Hb] compared to similar participants in population screening. There is no difference in [Hb] between surveillance patients with advanced neoplasia and those with other diagnoses. These data indicate that discrimination for advanced neoplasia by fecal [Hb] is reduced in patients undergoing surveillance. Furthermore, caution should be exercised when extrapolating the significance of [Hb] from screening to surveillance populations.
Tu1199 Factors Related With Detection of Polyps in Screening Colonoscopy. Influence of Right vs Left-Side Polyp Location Rodrigo Jover, M. Eduardo Polanía, Marta Ponce, Antonio Peris, Joaquin Cubiella, Luis Bujanda, Angel Lanas, Maria Pellise, Alberto Herreros de Tejada, Akiko Ono, Guillermo Cacho, Jose Antonio Hermo, Agustin Seoane, Maria Chaparro, José C. Marín, Yanira González-Méndez, Servando Fernández_Díez, Enrique Quintero, Antoni Castells Colonoscopy and polypectomy plays a central role in colorectal cancer (CRC) prevention. However, some studies suggest lack of efficacy of colonoscopy in the prevention of rightside CRC that could be related to different aspects involving colonoscopy quality. The aim of this study is to know which factors are related with the detection of right and left-side polyps in screening colonoscopy. Methods. A total of 3,288 people have been evaluated in the colonoscopy arm of the COLONPREV study, a randomized trial aimed to compare colonoscopy vs FIT in CRC screening. Polyps were considered as right-sided if they are located in the cecum, ascending or transverse colon. Univariate and logistic regression multivariate analysis were performed in order to evaluate factors related with the finding of colon polyps or CRC and right or left-side polyps. Results. Polyps or CRC were found in 1,564 patients (47.6%%). A total of 948 patients (60.6%) had polyps or CRC in their right colon and 616 (39.4%) had only left-side polyps or CRC. In the univariate analysis factors influencing detection of polyps or CRC anywhere in the colon were: hospital, older age, male gender, endoscopists with withdrawal time in normal colonoscopy longer than 6 minutes, cecal intubation, colonic cleansing with sodium fosfate and use of sedation. In the multivariate analysis only withdrawal time (OR 1.79; 95% CI 1.44-2.30), gender (OR 0.42; 95%CI 0.36-0.50), cecal intubation (OR 0.52; 95%CI 0.34-0.79) and use of sedation (OR 2.05; 95%CI 1.27-3.31) were independently associated with detection of colonic polyps or CRC. Factors influencing detection of lesions in the right colon were: hospital, withdrawal time longer than 6 minutes, male gender, older age, cecal intubation, use of sedation, use of sodium fosfate, use of propofol in sedation and sedation assisted by anesthesist. In the multivariate analysis, independent factors related with detection of right-side lesions were: male gender (OR 2.42; 95%IC 1.94-3.01), withdrawal time (OR 0.69; 95%CI 0.52-0.91), cecal intubation (OR 1.84; 95%CI 1.04-3.26) and use of sedation (OR 1.15; 95%CI 1.051.26). For left-side polyps only the hospital, withdrawal time and male gender were related with its detection. In the multivariate analysis, independent factors related with detection of left-side polyps were only longer withdrawal time (OR 0.62; 95% CI 0.49-0.77) and male gender (OR 1.22; 95%CI 1.01-1.49). Conclusion. Withdrawal time is the most important modifiable factor related with detection of colonic polyps. Factors related with detection of right or left-side polyps are different, and use of sedation improves particularly the detection of right-sided polyps.
*p< 0.05, advanced neoplasia, screening group versus surveillance; +p<0.01, #p<0.03, Screening group, advanced neoplasia versus other, ** p<0.06 Screening group, advanced neoplasia versus other (women) Tu1198 Reduced Health Literacy in Veterans is Related to Poor Knowledge and Negative Attitudes Toward Colorectal Cancer (CRC) Screening. the Value Study: Veterans as Leaders in Understanding and Education Leor Azoulay, Ian M. Gralnek, Dawn Provenzale, Jennifer Talley, Joan M. Griffin
Tu1200 Fecal Immunochemical Test Results in Different Stages of Colorectal Cancer: A Colonoscopy Controlled Study Ilhame Ben Larbi, Sietze T. Van Turenhout, Frank A. Oort, Jochim S. Terhaar sive Droste, René W. van der Hulst, Pieter Scholten, Ruud J. Loffeld, Annekatrien Depla, Veerle M. Coupe, Anneke A. Bouman, Gerrit A. Meijer, Chris J. Mulder
Background: Health literacy (HL) is a person's ability to read, understand and use healthcare information to make decisions and follow instructions for tests and treatments. Reduced HL may be associated with less knowledge and negative attitudes/beliefs towards disease, and may be a risk factor for poor CRC screening adherence and CRC disease outcomes. Aims/Methods: We conducted a cross-sectional survey to evaluate differences in knowledge, attitudes, and beliefs regarding CRC and CRC screening by HL skills in US Veterans. Patients at four geographically and racially diverse VA medical centers were stratified by age (<50yrs, 50-75yrs, >75yrs) and randomly selected to participate. Interviewers collected demographic data and assessed HL using the Short Test of Functional Health Literacy in Adults (STOFHLA), a well-validated HL instrument. HL was defined as either adequate or inadequate/ marginal. Veterans 50-75 years old were then queried about their knowledge (10 items), salience (7 items), worry (3 items), social norms (2 items), efficacy (3 items), and susceptibility (4 items) about CRC and CRC screening. We then assessed relationships between HL level and these constructs. Separate analyses were conducted for those with and without a personal history of CRC or colon polyps. Results: 3,850 Veteran patients were asked to participate and 2,456 (64%) agreed. 29.3% (n=719) were ages 50-75 years (mean age=61.5) and completed the S-TOFHLA and CRC questions. 72.0% (n=518) had no CRC or polyp history. Of those without CRC or polyp history, 71.6% were White; 27.4% completed HS and 55.6% had attended or graduated from college; 54.6% were married or living with someone. 10.6% (n=76) had inadequate/marginal HL. Regardless of the patient's history of CRC or polyps, those with inadequate/marginal HL, compared to those with adequate HL, were significantly less likely to know that tests to detect CRC were available, p=0.029, LR=5.2 and p=0.014, LR=6.4. Those with a history of CRC or polyps were significantly less likely to know that personal risk of CRC is higher if a family member had CRC (p=0.006, LR=8.8) and that CRC tests are necessary even if problems are not present (p=0.008, LR=7.1). Moreover, patients with inadequate/marginal HL were significantly more likely to report a strong influence of family members regarding CRC screening (p=0.028, LR=5.3). Conclusion: Veterans with inadequate/marginal HL had significantly less knowledge and were more strongly influenced by family attitudes about CRC and CRC screening. Yet, in other constructs assessed, these same Veterans had similar knowledge, beliefs and attitudes toward CRC and CRC screening as those with adequate HL. CRC screening programs for Veterans should use clear communication strategies to present information about CRC and CRC screening to Veterans and their families.
AGA Abstracts
Background Most fecal immunochemical test (FIT) screening studies are not colonoscopy controlled and therefore FIT sensitivity and specificity for colorectal cancer (CRC) can not be determined directly. Moreover, FIT screening studies often have a low yield of CRC cases, which makes it difficult to stratify the FIT results per cancer stage. Therefore, accurate data on FIT performance particularly in early stage tumors are lacking. Aim To determine the performance of a frequently used FIT at different cut-off levels stratified for stage. Patients and methods Subjects scheduled for colonoscopy between 2006 and 2010 in five hospitals were asked to perform a FIT (OC sensor®) before elective colonoscopy. FIT results were compared to colonoscopy outcomes. Cut-off levels of ≥50, ≥75 and ≥100 ng haemoglobin/ ml were used to call a test positive. Primary outcome variables were sensitivity and specificity for all stages of CRC. Results In 5,836 subjects who underwent complete colonoscopy, 159 (2.7%) were diagnosed with CRC. Fifty-four (34%) were diagnosed with stage I, 45 (28%) with stage II, 44 (28%) with stage III, 16 (10%) with stage IV cancer. Sensitivity of FIT using a cut-off level of ≥50 ng/ml for stage I, II, III and IV CRC was 85.2%, 88.9%, 97.7%, 93.8%, respectively. Sensitivity of FIT using a cut-off level of ≥75 ng/ml for stage I, II, III and IV CRC was 83.3%, 88.9%, 97.7%, 93.8%, respectively. Sensitivity of FIT using a cutoff level of ≥100 ng/ml for stage I, II, II and IV CRC was 81.5%, 88.9%, 93.2%, 93.8%, respectively. Specificities ranged from 82.8% to 87.9% with increasing cut-off levels. Conclusion In this large mixed referral population with a high yield of early stage CRC, FIT sensitivity for stage I and II CRC was very good, even at higher cut-off levels. Tu1201 Should Gender Be Considered in CRC Screening Guidelines? Menachem Moshkowitz, Ohad Toledano, Lior Galazan, Erwin Santo, Aharon Hallak, Nadir Arber Background: Currently, CRC screening programs are generally identical for women and men around the world. Based on gender differences in the epidemiology of CRC, it was proposed to initiate screening programs a decade earlier in men than in women. Aim: To determine and compare the prevalence of adenomas, advanced adenomas (AdAs) and colorectal cancers (CRC) in different age groups in men and women and to explore whether such gender differences exist in the Israeli population? Patients and Methods: Included were 1835 subjects, 910 of them were totally asymptomatic and 925 with mild symptoms such as mild abdominal discomfort, chronic constipation or inguinal hernia. All colonoscopies were performed by one endoscopist (NA) Results: There were 1089 men (59.3%) and 746 women (40.7%), mean ages 56 (27-85) and 57 (range: 29-88) respectively. Adenomas were found in 18.97% (347), AdAs in 6.3% (116), HGD in 0.78% (13), and CRC in 0.43% (8). Male sex was slightly associated with a higher prevalence of adenomas (20.2% vs 17.02% , P=NS), however, AdAs were more common among women (6.03% vs 3.3% P< 0.05). .CRC prevalance was
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. equal . 0.46% and 0.4% (P=NS). Advanced lesions (AdAs, HGD or CRC) were more prevalent among women in both age groups (> 50 Yrs: 6.97% vs 4.3% , <50 Yrs: 6.2% vs 0; p<0.05 ). There were no statistically differences in the rate of neoplasia between those with mild symptoms to those without any symptoms. Conclusions: 1. The total prevalence of adenomas among Israeli women is only slightly less than that of men, 2. The prevalence of advanced adenomas is higher than that of Israeli men, 3. These results do not support a gender differentiation for initiated CRC screening in Israel.
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Background/Aims: Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. The incidence of colorectal adenoma is also increasing. This study is conducted to evaluate the risk of colorectal neoplasm (CRN), as a precursor of CRC, in this age group. Methods: We enrolled the consecutive 1,250 subjects (mean age 43 year, 831 male), who visited our health promotion center for routine health evaluation from January 2004 through December 2006 and underwent total colonoscopy. The medical records, colonoscopic findings, and pathology reports were reviewed to evaluate the risk factors associated with CRN. Results: Among total patients, 279 (22.3%) had colorectal neoplasm and 17 (1.4%) of them had advanced neoplasm in the colonoscopy. Male had significantly higher prevalence of CRN than that in female (27.3% vs 12.4%, p<.01). The prevalence of CRN was significant higher in the old age (45-49 years) group than in the young age group (20-44 years) (29.0% vs 17.4%, p <0.01). In univariate analysis, type II diabetes, hypertension, alcohol intake and smoking, serum triglyceride, fasting blood glucose, body mass index, and waist circumference were significantly associated with CRN. In multivariate analysis, old age (OR 2.38, 95% CI, 1.56-3.63), male (OR 2.45, 95% CI, 1.61-3.88), smoking (OR 1.49, 95% CI, 1.06-2.09), and waist circumference (OR 1.56, 95% CI, 1.04-2.26) were significantly identified as a risk of CRN. Conclusions: The risk of CRN increase in male gender, age, smoking, and abdominal obesity in adults younger than 50 years. Therefore it should be considered that screening colonoscopy is conducted in male older than age 45 years.
Table 1 Tu1202 Failure to Record a Family History of Familial Cancer in Patients' Notes is Associated With Early Stage Colorectal Cancer Koen Kessels, Nicolette L. de Groot, Herma Fidder, Robin Timmer, Mark Stolk, Martijn G. van Oijen, Johan Offerhaus, Peter D. Siersema
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BACKGROUND: Lynch syndrome associated colorectal cancer (CRC) usually presents at a relatively young age. The Revised Bethesda Guidelines advise screening for Lynch syndrome in patients diagnosed with CRC and a positive family history (FH) of CRC and related cancers. Recording of FH of CRC and related cancers in young patients diagnosed with CRC is known to be insufficient; however, the extent of non-recording is unknown. Identification of factors associated with the failure to record the FH may improve adherence to the Revised Bethesda Guidelines. AIM: To evaluate whether a FH of CRC and related cancers was recorded in patients' notes and to identify factors associated with insufficient recording of the FH in patients with CRC who are 60 years or younger. METHODS: In one university and two general hospitals, all patients diagnosed with CRC at an age of 60 or younger between 1999 and 2008 with an electronic medical record were included. All electronic medical records were evaluated for a recorded FH of CRC and other Lynch syndrome associated cancers. Patient- and tumor characteristics were retrieved from the Dutch Comprehensive Cancer Centre (IKNL) and the Dutch Pathological Archive (PALGA). Multivariate analysis was performed using the binary logistics module of PASW Statistics version 17. RESULTS: A total of 1,421 patients diagnosed with CRC aged 60 years or younger were included of which 710 had an electronic medical record. FH was not recorded in 294/710 (41%) patients. Multivariate analysis showed that from 1999 to 2008, recording of a FH of CRC and related cancers improved with an odds ratio (OR) of 1.09 (95%CI 1.03-1.16) per year. In addition, early stage (stage 0 to II) CRC was associated with the failure to record the FH (OR 1.55, 95%CI 1.14-2.12). Other factors, including younger age at diagnosis (OR 0.99, 95%CI 0.97-1.01), male gender (OR 1.16, 95%CI 0.85-1.57), proximal tumor localization (OR 1.15, 95%CI 0.82-1.61), poor differentiation grade (OR 0.97, 95%CI 0.641.46) and mucinous histology (OR 0.89, 95%CI 0.56-1.40) were not associated with the failure to record FH of CRC and other Lynch syndrome associated cancers. CONCLUSION: A FH of CRC and other Lynch syndrome associated cancers was not recorded in more than 40% of patients who presented with CRC aged 60 years or younger. Recording of the FH improved gradually over the years. As early stage CRC was found to be associated with the failure to record FH, this suggests that particularly advanced stage CRC makes physicians, patients or both aware that the detected CRC may have a relationship with a FH of CRC and related cancers.
Higher Risk of a False Negative Fecal Immunochemical Testing (FIT) Result in Smokers and in Higher Age Groups Inge Stegeman, Thomas R. de Wijkerslooth, Esther M. Stoop, Monique van Leerdam, Marjolein van Ballegooijen, Roderik A. Kraaijenhagen, Ernst J. Kuipers, Paul Fockens, Evelien Dekker, Patrick M. Bossuyt Background Fecal immunochemical stool testing (FIT) is used as a non-invasive triaging test for colonoscopy in screening for colorectal cancer (CRC). FIT should be applied at regular intervals for a maximal preventive effect, given the considerable false negative rate in the detection of advanced neoplasia This false negative rate may differ across subgroups, which could influence the optimal interval for screening. We therefore aimed to identify subgroups at increased risk of false negative FIT results. Methods We collected data in the Colonoscopy or Colonography for Screening study, a multicenter screening trial conducted in Amsterdam and Rotterdam, the Netherlands between June 2009 and October 2010. In this study 5,924 randomly selected, asymptomatic men and women between 50 and 75 years of age were invited to undergo colonoscopy. Screening participants were asked for one sample FIT (OC-sensor) and to complete a risk questionnaire prior to colonoscopy. We calculated the risk of a false negative FIT result (cut-off 50ng/ml) using logistic regression, as defined by age, BMI, sex, pack years of smoking, smoking status, fiber intake and calcium intake. A false negative was defined as an individual with a negative FIT result with detected advanced neoplasia during colonoscopy. The risk was calculated in the whole group (risk of a false negative) as well as in the subgroup of participants with advanced neoplasia (false positive rate or 1 minus sensitivity). Results Of the 1,426 screening participants, 1,112 Participants completed the FIT and the questionnaire; 110 (8.9%) had advanced neoplasia, 7 (0.5%) participants had CRC and 103 (8.3%) had advanced adenoma. In total, 77 (6.9%) persons had a false negative FIT result. In the total screening population, participants at higher age (OR 1.05 per year; CI 1.02-1.02) and smokers (OR 1.80; CI 1.02-3.21) had a significantly higher risk of a false negative FIT result. In the group of participants with advanced neoplasia we did not find significant differences in the false negative rate between risk subgroups. Conclusion The chances of having a false negative FIT are higher in smokers and in people at advanced age, both known risk factors for advanced neoplasia.
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Fit in the Elderly: Performance of a Frequently Used Fecal Immunochemical Test in Subjects 75 of Age and Older Ilhame Ben Larbi, Sietze T. Van Turenhout, Frank A. Oort, Jochim S. Terhaar sive Droste, René W. van der Hulst, Pieter Scholten, Ruud J. Loffeld, Annekatrien Depla, Veerle M. Coupe, Anneke A. Bouman, Gerrit A. Meijer, Chris J. Mulder
Screening Colonoscopy for the Eldely Above 75 Years Old Ja Seol Koo, Dong Hun Lee, Bo Sung Kwon, Seung Young Kim, Sung Woo Jung, Rok Seon Choung, Hyung Joon Yim, Sang Woo Lee, Jai Hyun Choi Backgraound & Aims: Colorectal cancer (CRC) is the third most prevalent cancer in Korea. However, current CRC screening guidelines did not address the elderly above 75 years of age without prior screening. There is limited data to support recommendations in this age group. We conduct the study to evaluate whether the prevalence of colorectal neoplasm (CRN) in the asymptomatic subjects aged between 75 years and 85 years. METHODS: Using endoscopic report data of Korea University Ansan Hospital, we searched the patients aged between 75 and 85 years who had undergone total colonoscopy from 2002 to 2009 . Among the patients, those with a history of positive stool occult blood test, previous colonoscopy, inflammatory bowel disease or CRN and those with cardinal symptoms such as lower gastrointestinal bleeding, anemia, weight loss, and bowel habit change, were excluded. A total 446 patients were enrolled and their endoscopic findings and histological reports were reviewed retrospectively. Endoscopic findings revealed the location and morphologic type of colorectal polyps. Advanced neoplasia were defined as adenoma ≥ 1 cm, polyps with villous histology or high grade dysplasia, and invasive cancer. RESULTS: Among a total 446 elderly patients who had screening colonoscopy, 211(47.3%) were male and 235(52.7%) female patients. Adenomas were detected in 207(46.4%) patients and advanced neoplasia were also detected in 90(20.0%) patients. CRC was diagnosed in 14 (3.1%) patients. Proximal adenomatous polyps were detected in 127(28.4%) patients and among them, 47(10.5%) had advanced neoplasia and 8(1.8%) had CRC. And in 155 patients (34.8%) with distal adenomas, 43(9.6%) had significant CRN and 6(1.3%) had CRC. The adverse events were not developed in the elderly patients during screening colonoscopy. Conclusion: Although screening colonoscopy is not routinely recommended in the elderly, Our study showed that
Background Individuals ≥ 75 years of age are excluded from most colorectal cancer (CRC) screening programs using fecal immunochemical tests (FITs), as screening is not considered to be cost effective in this group. Due to the increase in life expectancy in industrialised countries this could change in the near future. At present, little is known on the performance of FITs in subjects ≥ 75 years. Aim To assess the performance of a frequently used fecal immunochemical test in subjects ≥ 75 of age to detect CRC, early stage CRC and advanced adenoma. Patients and Methods Subjects ≥ 75 years old scheduled for colonoscopy between 2006 and 2010 in five hospitals, were asked to perform a FIT (OCsensor®) before elective colonoscopy. FIT results were compared to colonoscopy outcomes. A cut-off level of ≥ 75 ng haemoglobin/ml was used to call a test positive. Primary outcome variables were sensitivity and specificity for CRC, early stage CRC and advanced adenoma. Results In 729 individuals ≥ 75 years who underwent total colonoscopy, 37 individuals (5%) were diagnosed with CRC, 24 of whom with early stage disease (i.e. stage I or II). Advanced adenomas were found in 113 patients (15.5%). Positivity rate was 22.5%. Sensitivity of FIT for CRC, early stage CRC and advanced adenoma was 94.5%, 96.0% and 43.3%, respectively. Specificity of FIT for CRC and advanced adenoma was 81.3% and 82.3%, respectively. For screen relevant lesions (i.e. early stage CRC and advanced adenoma) sensitivity and specificity was 52.9% and 82.5%, respectively. Conclusion In a mixed referral population FIT was found to have a high sensitivity for CRC and in particular for early stage CRC in subjects aged ≥75 years.
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AGA Abstracts
AGA Abstracts
Risk of Colorectal Neoplasm in Adults Younger Than 50 Years of Age Ja Seol Koo, Dong Hun Lee, Seung Young Kim, Rok Seon Choung, Sung Woo Jung, Hyung Joon Yim, Sang Woo Lee, Jai Hyun Choi