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Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

World Journal of Gastrointestinal Oncology 2023年第9期15卷 1653-1661页

作者： Gerald Fletcher Joan Culpepper-Morgan Alvaro Genao Eric Alatevi Department of Gastroenterology NYC Health+Hospitals/HarlemNew YorkNY 10037United States Department of Gastroenterology NYC Health+Hospitals/Harlem506 Lenox AveNew YorkNY 10037United States

BACKGROUND colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United States.METHODS This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million responses.The period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blacks,or Multiracial.There was an increase in utili

关键词： Medicaid expansion colorectal cancer screening Low-income Disparities Minorities Affordable care act

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How the COVID-19 pandemic has affected the colorectal cancer screening in Italy:A minireview

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World Journal of Gastrointestinal Oncology 2022年第8期14卷 1490-1498页

作者： Alessandro Fancellu Simone Veneroni Antonio Santoru Arianna Meloni Valeria Sanna Giorgio C Ginesu Giulia Deiana Panagiotis Paliogiannis Chiara Ninniri Teresa Perra Alberto Porcu Department of Medical Surgicaland Experiemental SciencesUnit of General Surgery 2-Clinica ChirurgicaUniversity of SassariSassari 07100Italy Unit of Oncology AOU SassariSassari 07100Italy Department of Medical Surgicaland Experimental Sciences.Unit of PathologyUniversity of SassariSassari 07100Italy

The coronavirus disease 2019(COVID-19)pandemic has caused detrimental effects on many aspects of healthcare practice.screening programs for the commonest malignancies,namely colorectal cancer(CRC),breast cancer and cervical cancer have been discontinued or interrupted since the beginning of restriction measures aimed to limit transmission of the new coronavirus infection.Robust evidence exists in favour of the role of screening campaigns in reducing mortality from CRC.In fact,the majority of pre-malignant lesions of the colon and rectum can be diagnosed with colonoscopy and treated by endoscopic or surgical resection.Besides,colonoscopy screening allows the diagnosis of CRCs in their pre-clinical stage.Italy was one of the first European countries where a high level of COVID-19 infections and deaths was observed,and one of the first where lockdowns and strict measures were adopted to reduce the risk of COVID-19 diffusion among the population.A systematic review of the literature was performed,including the PubMed,Scopus,Web of Sciences,and Reference Citation Analysis databases,with the aim of critically evaluating the impact of the COVID-19 pandemic on CRC screening in Italy.We found that reduction of CRC screening activity surpassed 50%in most endoscopic units,with almost 600000 fewer CRC screening exams conducted in the first 5 mo of 2020 vs the same period of 2019.While the consequences of the discontinuation of endoscopy screening for the prognosis and mortality of CRC will be evident in the next few years,recent data confirm that CRC is currently treated at a more advanced stage than in the pre-COVID-19 era.Since delays in CRC prevention and early diagnosis may translate to increased CRC-specific mortality,world healthcare systems should adopt strategies to maintain the regularity of CRC screening during subsequent peaks of the COVID-19 pandemic,or future events that might hamper screening programs.

关键词： COVID-19 colorectal cancer screening Italy Minireview

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colorectal cancer screening:The role of CT colonography

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World Journal of Gastroenterology 2010年第32期16卷 3987-3994页

作者： Andrea Laghi Franco Iafrate Marco Rengo Cesare Hassan Department of Radiological Sciences Sapienza-Università di RomaPolo PontinoLatina 04100Italy Department of Radiological Sciences Sapienza-Università di RomaPoliclinico Umberto IRome 00161Italy Gastroenterology and Digestive Endoscopy Unit ''Nuovo Regina Margherita'' HospitalRome 00153Italy

Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American cancer Society,the American College of Radiology,and the US Multisociety Task Force on colorectal cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.

关键词： Computed tomography colonography Colon neoplasms Colon polyps colorectal cancer screening Computed tomography colonography safety Computed tomography colonography accuracy Computed tomography colonography radiation exposure Computed tomography colonography cost-effectiveness

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Molecular methods for colorectal cancer screening:Progress with next-generation sequencing evolution

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World Journal of Gastrointestinal Oncology 2023年第3期15卷 425-442页

作者： Salma Abbes Simone Baldi Hayet Sellami Amedeo Amedei Leila Keskes Laboratory of Parasitic and Fungal Molecular Biology University of SfaxSfax 3029Tunisia Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Drosophila Research Unit-Parasitology and Mycologie Laboratory University of SfaxSfax 3029Tunisia SOD of Interdisciplinary Internal Medicine Careggi University HospitalFlorence 50134Italy Laboratory of Human Molecular Genetic University of SfaxSfax 3029Tunisia

Currently,colorectal cancer(CRC)represents the third most common malignancy and the second most deadly cancer worldwide,with a higher incidence in developed countries.Like other solid tumors,CRC is a heterogeneous genomic disease in which various alterations,such as point mutations,genomic rearrangements,gene fusions or chromosomal copy number alterations,can contribute to the disease development.However,because of its orderly natural history,easily accessible onset location and high lifetime incidence,CRC is ideally suited for preventive intervention,but the many screening efforts of the last decades have been compromised by performance limitations and low penetrance of the standard screening tools.The advent of next-generation sequencing(NGS)has both facilitated the identification of previously unrecognized CRC features such as its relationship with gut microbial pathogens and revolutionized the speed and throughput of cataloguing CRC-related genomic alterations.Hence,in this review,we summarized the several diagnostic tools used for CRC screening in the past and the present,focusing on recent NGS approaches and their revolutionary role in the identification of novel genomic CRC characteristics,the advancement of understanding the CRC carcinogenesis and the screening of clinically actionable targets for personalized medicine.

关键词： colorectal cancer Gut microbiota colorectal cancer screening Next-generation sequencing

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Facilitators and barriers to colorectal cancer screening in an outpatient setting

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World Journal of Clinical Cases 2021年第21期9卷 5850-5859页

作者： Gbeminiyi Samuel MaryKate Kratzer Oghale Asagbra Josef Kinderwater Shiva Poola Jennifer Udom Karissa Lambert Muna Mian Eslam Ali Division of Gastroenterology East Carolina University/Vidant Medical CenterGreenvilleNC 27834United States Department of Internal Medicine East Carolina University/Vidant Medical CenterGreenvilleNC 27834United States Department of Health Services and Information Management East Carolina UniversityGreenvilleNC 27834United States Department of Internal Medicine/Pediatrics Brody School of Medicine/Vidant Medical CenterGreenvilleNC 27834United States

BACKGROUND colorectal cancer(CRC)is the third most common cancer and the second leading cause of cancer-related deaths in the United States.Still,1 in 3 adults aged 50 years to 75 years have not been screened for CRC.Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality.AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina.The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening.METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic.Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year,Cologuard in the past three years,flexible sigmoidoscopy/virtual colonoscopy in the past five years,or colonoscopy in the past ten years.Data on patient socioeconomic status,comorbid conditions,and other determinants of health compliance were included as covariates.RESULTS Age[odds ratio(OR)=1.058;P=0.017],no-show rate percent(OR=0.962;Pscreening mammograms(OR=2.130;Pscreening pap smears(OR=2.708;Pscreening.Race,gender,insurance or employment status,use of blood thinners,family history of CRC,or other comorbid conditions including diabetes,hypertension,congestive heart failure,chronic obstructive pulmonary disease,and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening.CONCLUSION Patient age,history of sleep apnea,and compliance with other health maintenance tests were significant facilitators to CRC screening,while no-show rate percent was a significant barrier in our patient populati

关键词： colorectal cancer screening screening colonoscopy Health maintenance Colonoscopy colorectal cancer Patient adherence

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New endoscopy advances to refine adenoma detection rate for colorectal cancer screening:None is the winner

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World Journal of Gastrointestinal Oncology 2017年第10期9卷 402-406页

作者： Marcello Maida Salvatore Camilleri Michele Manganaro Serena Garufi Giuseppe Scarpulla Section of Gastroenterology S.Elia-M.Raimondi Hospital93100 CaltanissettaItaly

colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these:(1) Visual technologies such as chromoendoscopy and narrow band imaging;(2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and(3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?

关键词： colorectal cancer screening Colonoscopy Adenoma detection rate Diagnostic advances

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Standard-definition White-light,High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting colorectal Adenomas:A Multicenter Randomized Controlled Trial

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Current Medical Science 2024年第3期44卷 554-560页

作者： Chang-wei DUAN Hui-hong ZHAI Hui XIE Xian-zong MA Dong-liang YU Lang YANG Xin WANG Yu-fen TANG Jie ZHANG Hui SU Jian-qiu SHENG Jun-feng XU Peng JIN Chinese PLA General Hospital and Medical School Beijing100853China Department of Gastroenterology Xuanwu HospitalCapital Medical UniversityBeijing100053China Department of Gastroenterology The Seventh Medical Center of Chinese PLA General HospitalBeijing100700China Senior Department of Gastroenterology The First Medical Center of Chinese PLA General HospitalBeijing100853China

Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.

关键词： standard-definition white-light endoscopy high-definition white-light endoscopy narrow-band imaging colonoscopy colorectal cancer screening adenoma detection rate

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Why is early detection of colon cancer still not possible in 2023?

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World Journal of Gastroenterology 2024年第3期30卷 211-224页

作者： Valeria Tonini Manuel Zanni Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy

colorectal cancer(CRC)screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers.Over the years,screening,particularly in those settings where it is well organized,has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them.Despite considerable advancements in screening technologies and strategies,the effectiveness of CRC screening programs remains less than optimal.This paper examined the multifaceted reasons behind the persistent lack of effect-iveness in CRC screening initiatives.Through a critical analysis of current methodologies,technological limitations,patient-related factors,and systemic challenges,we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates.While acknowledging the ad-vancements that have improved aspects of screening,we emphasized the necessity of addressing the identified barriers comprehensively.This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease.screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage.Spending more sooner can mean saving money later.

关键词： colorectal cancer colorectal cancer screening colorectal screening test Colon and rectal cancer

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Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectalcancer screening program

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World Journal of Gastroenterology 2023年第9期29卷 1492-1508页

作者： AkoïKoïvogui Catherine Vincelet Gaëlle Abihsera Hamou Ait-Hadad Hélène Delattre Tu Le Trung Agnès Bernoux Rachel Carroll Jérôme Nicolet Site de Seine-Saint-Denis Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Bondy 93146France Site des Yvelines Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Le Chesnay Cedex 78153France Site du Val-de-Marne Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Joinville-le-Pont 94340France Site de Seine-et-Marne Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Lieusaint 77763France Site des Hauts-de-Seine Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Nanterre 92000France site du Val-d’Oise Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Cergy Saint-Christophe 95800France Site de l’Essonne Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Fontenay-Les-Briis 91640France Siège Paris Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France(CRCDC-IDF)Paris 75015France

BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy per

关键词： colorectal cancer screening screening colonoscopy Faecal immunochemical test Guaiac faecal occult blood test Quality of colonoscopy Severity of tumor lesions

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Missed colorectal cancers in a fecal immunochemical test-based screening program: Molecular profiling of interval carcinomas

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World Journal of Gastrointestinal Oncology 2022年第11期14卷 2195-2207页

作者： Manon van der Vlugt Beatriz Carvalho Joelle Fliers Nahid Montazeri Christian Rausch Esmée J Grobbee Manon van Engeland Manon C W Spaander Gerrit A Meijer Evelien Dekker Department of Gastroenterology and Hepatology Amsterdam University Medical CenterAmsterdam 1105 AZNetherlands Department of Pathology Netherlands Cancer InstituteAmsterdam 1066 CXNetherlands Biostatistics Unit Department of Gastroenterology and HepatologyAmsterdam University Medical CenterAmsterdam 1105 AZNetherlands Department of Gastroenterology and Hepatology Erasmus MC University Medical CenterRotterdam 3015 CNNetherlands Department of Pathology GROW-School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastricht 6202 AZNetherlands

BACKGROUND For optimizing fecal immunochemical test(FIT)-based screening programs,reducing the rate of missed colorectal cancers(CRCs)by FIT(FIT-interval CRCs)is an important aspect.Knowledge of the molecular make-up of these missed lesions could facilitate more accurate detection of all(precursor)lesions.AIM To compare the molecular make-up of FIT-interval CRCs to lesions that are detected by FIT[screen-detected CRCs(SD-CRCs)].METHODS FIT-interval CRCs observed in a Dutch pilot-program of FIT-based screening were compared to a control group of SD-CRCs in a 1:2 ratio,resulting in 27 FIT-interval CRC and 54 SD-CRCs.Molecular analyses included microsatellite instability(MSI),CpG island methylator phenotype(CIMP),DNA sequence mutations and copy number alterations(CNAs).RESULTS Although no significant differences were reached,FIT-interval CRCs were more often CIMP positive and MSI positive(33%CIMP in FIT-interval CRCs vs 21%in SD-CRCs(P=0.274);19%MSI in FIT-interval CRCs vs 12%in SD-CRCs(P=0.469)),and showed more often serrated pathway associated features such as BRAF(30%vs 12%,P=0.090)and PTEN(15%vs 2.4%,P=0.063)mutations.APC mutations,a classic feature of the adenoma-carcinoma-sequence,were more abundant in SD-CRCs(68%vs 40%in FIT-interval CRCs P=0.035).Regarding CNAs differences between the two groups;FIT-interval CRCs less often showed gains at the regions 8p11.22-q24.3(P=0.009),and more often gains at 20p13-p12.1(P=0.039).CONCLUSION Serrated pathway associated molecular features seem to be more common in FIT-interval CRCs,while classic adenoma carcinoma pathway associated molecular features seem to be more common in SD-CRCs.This indicates that proximal serrated lesions may be overrepresented among FITinterval CRCs.

关键词： Fecal immunochemical test-interval colorectal cancer Mutation analysis colorectal cancer screening Serrated pathway Adenoma-carcinoma pathway

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