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BackgroundHigh participation rates are important for a colorectal cancer (CRC) screening programme to be effective. Having a long travelling distance to screening centres may impede participation.MethodsWe analysed the association between driving time from home address to screening centre and participation among individuals invited to screening with faecal immunochemical test (FIT) (n = 68,624) or sigmoidoscopy (n = 46,076) in a randomized trial in Norway in 2012–17. Two screening centres were involved. We fitted multiple logistic regression models, adjusted for demographic, socioeconomic and health characteristics, and reported odds ratios (OR) with 95% confidence intervals (CI).ResultsParticipation rates were 58.9 % (n = 40,445) for FIT and 51.9 % (n = 23,911) for sigmoidoscopy. In sigmoidoscopy, participation was 56.9 % and 47.9 % in those living < 20 and > 60 min by car from the screening centres, respectively. For each 10 min driving time increase, OR for participating in sigmoidoscopy screening was 0.93 (95 % CI 0.91–0.95). There was a significant difference between the two screening centres (p-value for heterogeneity <0.001). Participation in FIT screening were 61.2 % and 57.1 % in those with < 20 and > 60 min driving time, respectively, and the OR was 0.98 (95 % CI 0.96–0.99) for each 10 min increase (heterogeneity between screening methods, P-value <0.001). Among those with a positive FIT, compliance to colonoscopy was higher in those living < 20 compared to > 60 min from the centres (95.1 % vs. 92.9 %, respectively, OR 0.86; 95 % CI 0.77–0.93 for each 10 min increase).ConclusionsDriving time to screening centre was a significant predictor of participation, mainly in sigmoidoscopy. There were local differences in the impact of driving time on participation. Driving time also affected compliance to colonoscopy after a positive FIT. When planning a CRC screening programme, one should consider offering people living far from screening sites special assistance to facilitate their participation. 相似文献
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Priscilla Sassoli de Bianchi Cinzia Campari Silvia Mancini Orietta Giuliani Patrizia Landi Luisa Paterlini Carlo Naldoni Alba C. Finarelli Fabio Falcini Maurizio Ponz de Leon Romano Sassatelli Elisabetta Borciani Fabio Fornari Giorgio Gatti Marella Zatelli Corrado Zurlini Federica Rossi Rossella Corradini Lauro Bucchi 《Cancer epidemiology》2013,37(4):469-473
Background: In some Italian areas, colonoscopic surveillance of first-degree relatives (FDRs) of colorectal cancer (CRC) patients is provided as a part of local population-based faecal occult blood test (FOBT) screening programmes. The objective of the present study was to assess the feasibility and early results of this surveillance model. Methods: Data from district screening centres were used to evaluate the process of identification and selection of eligible FDRs (residence in the Emilia-Romagna Region, age 40–75 years, no recent colonoscopy) of screen-detected CRC patients and the detected prevalence of disease. The probability for an FDR to undergo colonoscopy and to be diagnosed with CRC and advanced adenoma was estimated using the Kaplan–Meier method. The sex- and age-standardised ratio of detected prevalence to that expected based on results from a colonoscopy screening study of the Italian general population was estimated. Results: Between 2005 and 2011, 9319 FDRs of 2437 screen-detected CRC patients (3.8 per patient) were identified and contacted. Their likelihood of being eligible for, and accepting, colonoscopy was 0.11 (95% confidence interval: 0.11–0.12). Among the 926 subjects undergoing colonoscopy, the prevalence of previous negative screening FOBT was 63%. Eleven CRCs (1.2%) and 100 advanced adenomas (10.8%) were detected. The standardised ratio of detected prevalence to that expected was 0.91 (95% confidence interval: 0.19–2.66) for CRC and 1.48 (1.04–2.05) for advanced adenoma. Conclusions: The procedure of selection of FDRs was extremely ineffective. Due to previous negative screening tests, the prevalence of disease was less than expected. A population-based FOBT screening programme is a highly unsuitable setting for the provision of surveillance to FDRs of CRC patients. 相似文献
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BackgroundIn May of 2018, the American Cancer Society lowered the age of colorectal cancer (CRC) screening initiation from 50 to 45 years and in October 2020, United States Preventive Services Task Force published draft guidelines also lowering age of screening initiation to 45 years. Evaluating guideline adherence is needed; however, the majority of prior research on cancer screening do not distinguish whether colonoscopy was performed for true screening purposes or for post-symptomatic diagnosis.MethodsUsing data from the National Health Interview Survey between 2010 to mid-2018, we assessed response to the question “What was the MAIN reason you had [last] colonoscopy?” stratified by age (45−49 versus 50+ years). Multivariable logistic regression defined adjusted odds ratios of receiving last colonoscopy for screening controlling for relevant demographic characteristics. To estimate the cost burden of colonoscopy, the proportion of respondents reporting paying out of pocket for their last colonoscopy was assessed.ResultsAmong 29,074 participants who had undergone a colonoscopy, 44.4 % of those aged 45–50 reported routine procedure as the reason for their most recent colonoscopy, as compared to 82.4 % in the 50+ age group (p < 0.001). Characteristics associated with undergoing colonoscopy as a routine procedure included Black race and male sex for both age cohorts (p < 0.01 for all). Notably, almost half (46.9 %) of participants younger than 50 years paid part of or the full cost of their colonoscopy, as compared to 30.7 % over the age of 50 (p < 0.001).ConclusionsThe majority of adults aged 45−49 self-report that last colonoscopy was not performed for screening, which is unsurprising given guidelines for screening for individuals under 50. As guidelines change, continued surveillance of colonoscopy patterns across age cohorts is needed, and studies should also incorporate reasons for testing. 相似文献
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Proteomic analysis of human tissue and plasma samples has been a useful tool in recent years for the identification of potential biomarkers to aid in the early diagnosis of colorectal cancer. However, biomarkers relating to the crucial transition between adenomatous lesions and invasive colorectal malignancy have not previously been described. The work of Choi et al. (Proteomics 2013, 13, 2361–2374) attempts to address this issue. Using plasma samples from age‐matched patients with colorectal adenomas or invasive disease this group identified a range of plasma proteins and cytokines that were differentially expressed. This information not only provides insights into the biology of the adenoma to carcinoma progression sequence but it also represents a step towards the goal of achieving diagnostically accurate and clinically acceptable biomarkers in early colorectal cancer. 相似文献
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目的:以常规体检者和明确诊断的大肠癌患者为研究对象,对其血清进行多肽谱分析,统计分析获得大肠癌特异血清多肽峰,为大肠癌的分子诊断提供理论依据,提高大肠癌的早期诊断水平。方法:1)收集研究对象外周非抗凝血并记录其人口学特征,将非抗凝血进行离心分离血清并保存;2)用Dynabeads RPC18磁珠分离提取血清蛋白质,Bruker UltraFlex TOF/TOF采集信号并用分析软件Clinprot tools 2.2(Bruker)分析筛选出大肠癌血清显著差异峰;3)用SPSS13.0分析大肠癌患者和健康人多肽峰的差异,进行Logistic回归分析差异多肽对形成大肠癌的影响。结果:本次研究共获得111名健康人和94名大肠癌患者的血清多肽峰信息,其中109名健康人和91名大肠癌患者同时具有性别、年龄等人口学信息。筛选出差异多肽峰105个,其中76个多肽在大肠癌患者和健康人间的分布差异有统计学意义(P0.05)。运用Logistic回归分析,进入回归方程(P0.05)的有:年龄,质荷比(m/z)分别为1061.10、1213.09、1607.32、1867.02、1897.95、2011.67和5078.81的七种多肽。结论:液体蛋白芯片飞行时间质谱系统可高效、精确地筛查血清多肽。大肠癌患者与健康人的血清多肽存在差异,筛选得到的质荷比(m/z)分别为1061.10、1213.09、1607.32、1867.02、1897.95、2011.67和5078.81的七种多肽可能作为早期诊断大肠癌的潜在肿瘤标志物。 相似文献
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大肠癌是全世界最常见的恶性肿瘤之一,由于其发病率和死亡率较高严重影响了人类健康。由于大肠癌的发病是缓慢渐进的,早期进行有效的筛查可以延长患者的寿命及改善其生活质量并达到预防和治疗的目的。近几年,随着分子生物学及基因组学的不断发展,出现了许多新的筛查方法,这为大肠癌的防治提供了更多的机会,也给患者及其家庭带来了生命的曙光。目前国内外对大肠癌筛查新方法相关方面的研究尚不多,综述也较少。现就近几年国内外大肠癌的一些筛查新策略及研究进展综述如下。 相似文献
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BackgroundLynch syndrome (LS) is the first cause of inherited colorectal cancer (CRC), being responsible for 2–4% of all diagnoses. Identification of affected individuals is important as they have an increased lifetime risk of multiple CRC and other neoplasms, however, LS is consistently underdiagnosed at the population level. We aimed to evaluate the yield of LS screening in CRC in a single-referral centre and to identify the barriers to its effective implementation.MethodsLS screening programme included individuals with CRC < 70 years, multiple CRC, or endometrial cancer at any age. Mismatch repair (MMR) protein immunohistochemistry (IHC) analysis was performed in routine practice on the surgical specimen and, if MLH1 IHC was altered, MLH1 gene promoter methylation was analysed. Results were collected in the CRC multidisciplinary board database. LS suspected individuals (altered MMR IHC without MLH1 promoter methylation) were referred to the Cancer Genetic Counselling Unit (CGCU). If accepted, a genetic study was performed. Two checkpoints were included: review of the pathology data and verification of patient referral by a genetic counsellor.ResultsBetween 2016 and 2019, 381 individuals were included. MMR IHC analysis was performed in 374/381 (98.2 %) CRC cases and MLH1 promoter methylation in 18/21 (85.7 %). Seventeen of the 20 LS suspected individuals were invited for referral at the CGCU. Two cases were not invited and the remaining patient died of cancer before completion of tumour screening. Fifteen individuals attended and a genetic analysis was performed in 15/20 (75 %) LS suspected individuals. Ten individuals were diagnosed with LS, in concordance with the IHC profile (2.7 % of the total cohort). This led to cascade testing in 58/75 (77.3 %) of the available adult relatives at risk, identifying 26 individuals with LS.ConclusionsEstablishing a standardized institutional LS screening programme with checkpoints in the workflow is key to increasing the yield of LS identification. 相似文献
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Wei-Chih Su Wei-Yu Kao Tsung-Kun Chang Hsiang-Lin Tsai Ching-Wen Huang Yen-Cheng Chen Ching-Chun Li Yi-Chien Hsieh Hsing-Jung Yeh Chun-Chao Chang Jaw-Yuan Wang 《Bioscience reports》2021,41(1)
Despite the steadily increasing worldwide incidence of colorectal cancer (CRC), an effective noninvasive approach for early detection of CRC is still under investigation. The guaiac-based fecal occult blood test (FOBT) and fecal immunochemical test (FIT) have gained popularity as noninvasive CRC screening tests owing to their convenience and relatively low costs. However, the FOBT and FIT have limited sensitivity and specificity. To develop a noninvasive tool for the detection of CRC, we investigated the sensitivity, specificity, and accuracy of a stool DNA test targeting methylated syndecan-2 (SDC2), which is frequently methylated in patients with CRC. The present study enrolled 62 patients diagnosed as having stage 0-IV CRC and 76 healthy participants between July 2018 and June 2019 from two institutions. Approximately 4.5 g of stool sample was collected from each participant for detection of human methylated SDC2 gene. In total, 48 of 62 (77.4%) patients with CRC showed positive results, whereas 67 out of 76 (88.2%) healthy participants showed negative results. The area under the curve of the receiver operating characteristic curve constructed was 0.872 for discrimination between patients with CRC and healthy individuals. The present study highlights the potential of the fecal methylated SDC2 test as a noninvasive detection method for CRC screening with a relatively favorable sensitivity of 77.4%, a specificity of 88.2% and a positive predictive value of 84.2% compared with other available fecal tests. Further multicenter clinical trials comprising subjects of varied ethnicities are required to validate this test for the mass screening of patients with CRC. 相似文献
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目的:明确预警症状(腹部包块、便秘、排便习惯改变、腹泻、肛周异物感、长期腹痛、便血或肛门出血)对结直肠癌的诊断效能。方法:收集我院2016年1月至2016年12月的结肠镜检查数据,计算各个预警症状的诊断敏感度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比。结果:预警症状总的诊断敏感度和特异度分别是6.63%和94.33%。所有的预警症状诊断敏感度最高的是便血,敏感度为19.28%,最低的是腹泻,敏感度为2.41%。相对而言,便血和长期腹痛的准确度较高,分别达到了19.28%和11.45%。除了长期腹痛之外,其他所有的预警症状的诊断特异度都达到了90%以上。结论:超过一半的结直肠癌患者没有出现预警症状,用预警症状来诊断结直肠癌具有较低的敏感度和较高的特异度,需要更多的研究来证明预警症状的临床意义。 相似文献
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Mahmood Rasool Peter Natesan Pushparaj Abdelbaset Buhmeida Sajjad Karim 《Saudi Journal of Biological Sciences》2021,28(10):5906-5912
Colorectal cancer (CRC) is one of the topmost causes of death in males in Saudi Arabia. In females, it was also within the top five cancer types. CRC is heterogeneous in terms of pathogenicity and molecular genetic pathways. It is very important to determine the genetic causes of CRC in the Saudi population. BRAF is one of the major genes involved in cancers, it participates in transmitting chemical signals from outside the cells into the nucleus of the cells and it is also shown to participate in cell growth. In this study, we mapped the spectrum of BRAF mutations in 100 Saudi patients with CRC. We collected tissue samples from colorectal cancer patients, sequenced the BRAF gene to identify gene alterations, and analyzed the data using different bioinformatics tools. We designed a three-dimensional (3D) homology model of the BRAF protein using the Swiss Model automated homology modeling platform to study the structural impact of these mutations using the Missense3D algorithm. We found six mutations in 14 patients with CRC. Four of these mutations are being reported for the first time. The novel frameshift mutations observed in CRC patients, such as c.1758delA (E586E), c.1826insT (Q609L), c.1860insA and c.1860insA/C (M620I), led to truncated proteins of 589, 610, and 629 amino acids, respectively, and potentially affected the structure and the normal functions of BRAF. These findings provide insights into the molecular etiology of CRC in general and to the Saudi population. BRAF genetic testing may also guide treatment modalities, and the treatment may be optimized based on personalized gene variations. 相似文献
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BackgroundPopulation trends in PSA testing and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA testing, prostate cancer incidence and mortality in Australia and factors that influence them.MethodsWe calculated and described standardised time trends in PSA tests, prostate biopsies, treatment of benign prostatic hypertrophy (BPH) and prostate cancer incidence and mortality in Australia in men aged 45–74, 75–84, and 85 + years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008 before declining in men aged 45–84 years. Prostate biopsies and cancer incidence fell from 1995 to 2000 in parallel with decrease in trans-urethral resections of the prostate (TURP) and, latterly, changes in pharmaceutical management of BPH. After 2000, changes in biopsies and incidence paralleled changes in PSA screening in men 45–84 years, while in men ≥85 years biopsy rates stabilised, and incidence fell. Prostate cancer mortality in men aged 45–74 years remained low throughout. Mortality in men 75–84 years gradually increased until mid 1990s, then gradually decreased. Mortality in men ≥ 85 years increased until mid 1990s, then stabilised.ConclusionAge specific prostate cancer incidence largely mirrors PSA testing rates. Most deviation from this pattern may be explained by less use of TURP in management of BPH and consequent less incidental cancer detection in TURP tissue specimens. Mortality from prostate cancer initially rose and then fell below what it was when PSA testing began. Its initial rise and fall may be explained by a possible initial tendency to over-attribute deaths of uncertain cause in older men with a diagnosis of prostate cancer to prostate cancer. Decreases in mortality rates were many fold smaller than the increases in incidence, suggesting substantial overdiagnosis of prostate cancer after introduction of PSA testing. 相似文献
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BackgroundProgressive telomere shortening may be related to genomic instability and carcinogenesis. Prospective evidence relating telomere length (TL) with colorectal cancer (CRC) risk has been limited and inconsistent.MethodsWe examined the association between pre-diagnostic peripheral blood leukocyte TL and CRC risk in two matched case-control studies nested within the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). Relative leukocyte TL was measured using qPCR among 356 incident CRC cases and 801 controls (NHS: 186/465, HPFS: 170/336).ResultsWe did not find a significant association between pre-diagnostic TL and CRC risk [in all participants, multivariable-adjusted odds ratio (OR) (95% CI) for TL Quartile 1 (shortest) vs. Quartile 4 (longest) = 1.36 (0.85, 2.17), P-trend = 0.27; OR (95% CI) per 1 SD decrease in TL = 1.12 (0.92, 1.36)].ConclusionsOur prospective analysis did not support a significant association between pre-diagnostic leukocyte TL and CRC risk. 相似文献
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目的:探讨血栓弹力图(TEG)指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性。方法:选取2017年1月-2019年3月在我院收治的食管癌手术治疗需输血的99例患者作为研究对象,将99例患者随机分为常规凝血功能检测组和TEG组,常规凝血功能检测组采用常规凝血实验检查结果指导输血,TEG组采用TEG检查结果指导输血,对比两组输血前后的常规凝血实验检测指标以及临床用血量,对比TEG组输血前后的TEG指标,分析TEG指标与常规凝血实验检测指标的相关性。结果:两组患者输血前凝血四项和血小板计数(PLT)差异无统计学意义(P>0.05),输血后两组活化凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)均有不同程度的改善(P<0.05),TEG组PT、TT较常规凝血功能检测组低(P<0.05);输血后,TEG组患者凝血反应时间(R值)、血凝块形成时间(K值)较输血前降低,最大血凝块强度(MA值)、凝血综合指数(CI值)升高,凝血形成速率(Angle角)增大,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,R值与APTT呈正相关(P<0.05),K值与PLT呈负相关,与FIB呈正相关(P<0.05),Angle角、MA值、CI值与FIB、PLT呈正相关(P<0.05);TEG组新鲜冰冻血浆、冷沉淀输注量少于常规凝血功能检测组,差异有统计学意义(P<0.05)。结论:TEG能更好地指导食管癌手术患者各种血液成分的合理输注,有效改善凝血异常情况,减少输血用量,TEG指标与常规凝血实验检测指标存在一定的相关性。 相似文献
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目的：评价薄层液基细胞学（Thin prep cytology test,TcT）检测技术对宫颈癌前病变的诊断和宫颈癌筛查的准确性及临床价值。方法：收集分析2009年5月～2010年11月在我院妇科门诊行TCT检查的受检者7340例,以细胞学诊断为未明确意义的不典型鳞状上皮细胞（ASC—US）及以上者为阳性结果,并对阳性结果行病理组织学诊断,以组织学诊断作为金标准、,结果：液基细胞学标本满意度高,对SCC、HSIL、LSIL的准确率分别为76．8％、97.3％、100％。结论：TCT结合TBS诊断系统是目前诊断宫颈癌前病变和筛查宫颈癌的理想方法川,同时也可以作为一项宫颈癌术后随访的检测指标。ASC—US患者中存在部分年轻的高危癌前病变者。 相似文献
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Coral Díez Pérez Rosa Rodríguez Ferro Manuel Penín Álvarez 《Endocrinología y nutrición》2013,60(9):513-516
The American Diabetes Association issues annually its recommendations for diabetes mellitus screening. Although there is a high proportion of people with undiagnosed diabetes in the general population, it is suspected that many of these screening tests could be needless.An analysis was made of the number of venous blood glucose measurements that did not meet the American Diabetes Association requirements performed in 150 people seen in primary care.On average, an unnecessary venous blood glucose measurement is performed every 15 months. The number is significantly higher in people over 45 years of age, and also in women as compared to men (although with a p value slighty higher than 0.05). 相似文献
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目的:评价薄层液基细胞学(Thinprep cytologytest,TCT)检测技术对宫颈癌前病变的诊断和宫颈癌筛查的准确性及临床价值。方法:收集分析2009年5月～2010年11月在我院妇科门诊行TCT检查的受检者7340例,以细胞学诊断为未明确意义的不典型鳞状上皮细胞(ASC-US)及以上者为阳性结果,并对阳性结果行病理组织学诊断,以组织学诊断作为金标准。结果:液基细胞学标本满意度高,对SCC、HSIL、LSIL的准确率分别为76.8%、97.3%、100%。结论:TCT结合TBS诊断系统是目前诊断宫颈癌前病变和筛查宫颈癌的理想方法,同时也可以作为一项宫颈癌术后随访的检测指标。ASC-US患者中存在部分年轻的高危癌前病变者。 相似文献
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Kycler Witold Kubiak Anna Trojanowski Maciej Janowski Jakub 《Reports of Practical Oncology and Radiotherapy》2018,23(2):75-83
Colorectal cancer is the second most common type of cancer both in Europe and Poland. During the last 30 years more than a 3-fold increase has been observed in Poland due to environmental and genetic factors. Almost all colorectal malignancies are related to the formation and malignant transformation of colorectal dysplasia and adenoma. Efforts aiming to decrease the number of colorectal cancer deaths are focused on the disease early detection. Genetic diagnosis for hereditary syndromes predisposing to colorectal cancer has been developed and is a part of the routine treatment. Most cancers are sporadic. They often develop from polyps in the colon. In addition to the genetic events described in the 1990s, showing the adenoma transformation into carcinoma that has been a prime example of malignant transformation for a long time, there are also other possibilities of neoplastic transformation. The recognition of colorectal cancer risk factors make sense as their nature is lifestyle- and diet-related. In this review paper those risk factors are presented and the prevention of colorectal cancer is discussed taking into account genetic factors. 相似文献