|
1
|
Tan WY, Sharma A, Das P, Ahuja N. Early Detection of Cancers in the Era of Precision Oncology. Curr Opin Oncol 2023; 35:115-124. [PMID: 36721896 DOI: 10.1097/cco.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The increasing global incidence of cancer demands innovative cancer detection modalities. The current population-based early cancer detection approaches focus on several major types of cancers (breast, prostate, cervical, lung and colon) at their early stages, however, they generally do not target high-risk individuals at precancerous stages. RECENT FINDINGS Some cancers, such as pancreatic cancer, are challenging to detect in their early stages. Therefore, there is a pressing need for improved, accessible, noninvasive, and cost-effective early detection methods. Harnessing cell-free-based biomarker-driven strategies paves a new era of precision diagnosis for multicancer early detection. The majority of these tests are in the early stages and expensive, but these approaches are expected to become cost sensitive in the near future. SUMMARY This review provides an overview of early cancer detection strategies, highlighting the methods, challenges, and issues to be addressed to revolutionize and improve global early cancer detection.
Collapse
Affiliation(s)
| | - Anup Sharma
- Yale School of Medicine, Department of Surgery
| | | | - Nita Ahuja
- Yale School of Medicine, Department of Surgery
- Yale School of Medicine, Department of Pathology
- Yale School of Medicine, Biological and Biomedical Sciences Program (BBS), Yale University, New Haven, Connecticut, USA
| |
Collapse
|
|
2
|
Schauer C, Plant A, Vandal AC, Claydon A. Outcomes Of Patients with Delayed Surveillance Colonoscopy. Intern Med J 2020; 52:1061-1069. [PMID: 33280217 DOI: 10.1111/imj.15146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surveillance colonoscopy has been shown to be an effective tool for prevention of CRC in high-risk populations, if adhered to. We aimed to discover the sequelae of late surveillance in a cohort of patient's overdue for colonoscopy, in particular the development of colorectal cancer (CRC) or advanced adenoma (AA) within surveillance subgroups. METHOD We conducted a retrospective cohort study on all patients from the Bay of Plenty District Health Board region, New Zealand, placed on the colonoscopy surveillance waitlist from 2006 onwards who had their procedure completed between 1 November 2016 and 31 January 2018, when the total surveillance list was declared up-to-date. Patients with overdue surveillance, defined as done later than 90 days after the recommended due date were compared to patients who were done either early, or on time. RESULTS 786 patients were recorded as overdue for surveillance colonoscopy, and 386 were completed early or on time. The median time overdue was 22 months. Three cases (0.4%) of CRC were found in overdue patients compared to 4 cases (1%) for those done on time (adjusted p=0.24). There were 86 (11%) AA in patient's overdue compared to 27 (7%) in those not overdue (odds ratio (OR) 1.6, 95% confidence interval (CI) [1.0,2.5], p=0.04). Overdue status increased the expected risk of AA by approximately 60% (adjusted; 95% CI [1%,253%], p=0.04) or 19% per year overdue (95% CI [7%,32%], p=0.002). Surveillance of 248 low-risk post-polypectomy patients demonstrated 26/211 with AA in overdue patients compared to 2/37 (12.3% vs 5.4%, unadjusted p=0.23) for those done on time. Surveillance of 180 high-risk post-polypectomy patients identified 2 CRC's and 8/43 AA in those overdue, as compared to no CRC and 9/137 AA (18.6% vs 6.6%, OR 1.79 (95% CI [1.07,2.0], unadjusted p=0.03) in those done on time. CONCLUSION Whilst overdue surveillance is not predictive of increased CRC, it is associated with an increase in expected number of AA, particularly in patients having surveillance for previous high-risk polypectomy. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - A Plant
- Gastroenterology Department, Tauranga Hospital, Bay of Plenty, District Health Board, Tauranga, New Zealand
| | - A C Vandal
- Ko Awatea, Counties Manukau District Health Board; Associate Professor, Faculty of Health and Environmental Sciences, Auckland University
| | - A Claydon
- Gastroenterology Department, Tauranga Hospital, Bay of Plenty, District Health Board, Tauranga, New Zealand
| |
Collapse
|
|
3
|
Streptococcus anginosus pyogenic liver abscess following a screening colonoscopy. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:e45-6. [PMID: 24421818 DOI: 10.1155/2013/802545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A previously healthy 58-year-old man presented with a septic thrombosis of the right hepatic vein and a pyogenic liver abscess (PLA) one week after undergoing a screening colonoscopy. Blood cultures and a radiological drainage specimen were both positive for Streptococcus anginosus. Evolution was favourable after six weeks of antibiotherapy. To the authors' knowledge, the present report is the first to describe a PLA following a screening colonoscopy with no intervention. The authors hypothesize that silent microperforations during colonoscopy contributed to the infection. Although 20% to 40% of reported PLA cases are cryptogenic in the literature, it may be because of failure to recognize and report a precipitating factor such as colonoscopy. As more cases similar to the present case are reported, the number of cryptogenic cases may decrease.
Collapse
|
|
4
|
Stock C, Holleczek B, Hoffmeister M, Stolz T, Stegmaier C, Brenner H. Adherence to physician recommendations for surveillance in opportunistic colorectal cancer screening: the necessity of organized surveillance. PLoS One 2013; 8:e82676. [PMID: 24324821 PMCID: PMC3855836 DOI: 10.1371/journal.pone.0082676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/26/2013] [Indexed: 01/07/2023] Open
Abstract
Background Limited evidence exists on the utilization of surveillance colonoscopy in colorectal cancer (CRC) screening programs. We assessed adherence to physician recommendations for surveillance in opportunistic CRC screening in Germany. Methods A follow-up study of screening colonoscopy participants in 2007-2009 in Saarland, Germany, was conducted using health insurance claims data. Utilization of additional colonoscopies through to 2011 was ascertained. Adherence to surveillance intervals of 3, 6, 12 and 36 months, defined as having had colonoscopy at 2.5 to 4, 5 to 8, 10.5 to 16 and 33 to 48 months, respectively (i.e., tolerating a delay of 33% of each interval) was assessed. Potential predictors of non-adherence were investigated using logistic regression analysis. Results A total of 20,058 screening colonoscopy participants were included in the study. Of those with recommended surveillance intervals of 3, 6, 12 and 36 months, 46.5% (95%-confidence interval [CI]: 37.3-55.7%), 38.5% (95%-CI: 29.6-47.3%), 25.4% (95%-CI: 21.2-29.6%) and 28.0% (95%-CI: 25.5-30.5%), respectively, had a subsequent colonoscopy within the specified margins. Old age, longer recommended surveillance interval, not having had polypectomy at screening and negative colonoscopy were statistically significant predictors of non-adherence. Conclusion This study suggests frequent non-adherence to physician recommendations for surveillance colonoscopy in community practice. Increased efforts to improve adherence, including introduction of more elements of an organized screening program, seem necessary to assure a high-quality CRC screening process.
Collapse
Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | | | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Stolz
- Gastroenterologische Schwerpunktpraxis Völklingen, Kreppstraße 3-5, Völklingen, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
|
5
|
Tiong LU, Jalleh R, Travers EJ, Paxton T, Innes-Wong C, Barreto SG, Williams R. Screening for colorectal neoplastic lesions following acute diverticulitis: Would a sigmoidoscopy suffice? World J Surg Proced 2013; 3:13. [DOI: 10.5412/wjsp.v3.i2.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/24/2013] [Accepted: 06/06/2013] [Indexed: 02/06/2023] Open
|
|
6
|
Rostirolla RA, Pereira-Lima JC, Teixeira CR, Schuch AW, Perazzoli C, Saul C. [Development of colorectal advanced neoplasia/adenomas in the long-term follow-up of patients submitted to colonoscopy with polipectomy]. ARQUIVOS DE GASTROENTEROLOGIA 2010; 46:167-72. [PMID: 19918680 DOI: 10.1590/s0004-28032009000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 10/03/2008] [Indexed: 11/22/2022]
Abstract
CONTEXT Colonoscopy with polypectomy reduces the incidence of colorectal cancer and its associated mortality. The ideal interval between surveillance examinations is determined by clinical features and endoscopic findings considered as risk factors to the development of advanced colonic neoplasias. OBJECTIVE To determine the development rate of advanced neoplasia in patients submitted to surveillance colonoscopy in a tertiary referral center. METHODS Three hundred and ninety two patients who underwent two or more complete colonoscopies between 1995 and 2005, and who have at least one diagnosed colorectal adenoma entered into the study. The endoscopic findings of the first and subsequent colonoscopies of each patient were analysed, considering advanced neoplasia as the main outcome. The patients enrolled were divided in accordance to the first colonoscopy findings in groups 1 or high risk; 2 or low risk; and 3 or without adenoma at the first colonoscopy. The development of advanced colorectal neoplasia and the period of surveillance until the outcome were analysed and compared among groups. RESULTS Twenty eight per cent of patients had advanced adenomas at index colonoscopy; 57.8% presented with low grade dysplasia neoplastic lesions and 14.1% had no adenoma at the first examination. The mean age was 59.54 +/- 11.74 years. Twenty six point four per cent of subjects from group 1 presented with advanced neoplasia during the surveillance period, while this outcome occurred in 10.9% and 5.3% of patients from groups 2 and 3, respectively (P<0,05). The mean period of surveillance was 123.35 months, and the mean time between the first examination and the one which presented with the outcome statistically differed among group 1 and the others, being 104.02, 115.31 and 120.61 months, respectively. CONCLUSIONS Patients with advanced neoplasia at index colonoscopy presented with a higher probability of harbouring this condition during the follow-up when compared with other two groups. These lesions also occur earlier in this patients than in the ones without these lesions at the first examination.
Collapse
|
|
7
|
Nusko G, Hahn EG, Mansmann U. Characteristics of metachronous colorectal adenomas found during long-term follow-up: analysis of four subsequent generations of adenoma recurrence. Scand J Gastroenterol 2009; 44:736-44. [PMID: 19277927 DOI: 10.1080/00365520902770078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Because of the high recurrence rates of colorectal adenomas, regular surveillance by colonoscopy has been recommended, but there is still a dearth of information on the long-term results of follow-up colonoscopy after polypectomy. The aims of this study were to determine the differences between initial adenomas and metachronous lesions, to evaluate the effect of long-term surveillance and to describe the hypothetical origin of the colorectal adenoma-carcinoma sequence. MATERIAL AND METHODS Between 1978 and 2003 a total of 1091 patients undergoing periodic surveillance examinations were prospectively documented at the Erlangen Registry of Colorectal Polyps. Differences between initial and metachronous lesions found during long-term follow-up were studied. Statistical analysis using chi(2) testing of adenoma characteristics found in four subsequent recurrence periods was carried out, and the relative risk (RR) for the development of metachronous adenomas of advanced pathology was calculated. RESULTS In comparison with the initial findings, metachronous adenomas are generally significantly smaller lesions (p<0.00001), usually tubular in shape (p<0.00001) and bearing high-grade dysplasia less often (p<0.00001) and are usually located in the right colon (p<0.00001). These differences are found between the initial and four subsequent generations of metachronous adenomas. The number of synchronous adenomas is reduced only in the first recurrence (p<0.001); in the further generations equal proportions of multiplicity are found, as in the baseline examination. Patients with adenomas of advanced pathology, i.e. large, tubulovillous or villous adenomas at baseline, have a significantly higher risk for large (RR 2.73; 95% CI 1.77-4.20), tubulovillous or villous (RR 1.55; 95% CI 1.06-2.25) or multiple (RR 2.45; 95% CI 1.83-3.29) metachronous adenomas at the first recurrence. CONCLUSIONS Metachronous adenomas show the uniform characteristics of being small tubular lesions rarely bearing high-grade dysplasia, usually located in the right colon. Thus regular follow-up colonoscopy can provide sufficient colorectal carcinoma prevention.
Collapse
Affiliation(s)
- Gerhard Nusko
- Department of Internal Medicine, University of Erlangen, Erlangen, Germany.
| | | | | |
Collapse
|
|
8
|
Nusko G, Hahn EG, Mansmann U. Risk of advanced metachronous colorectal adenoma during long-term follow-up. Int J Colorectal Dis 2008; 23:1065-71. [PMID: 18597098 DOI: 10.1007/s00384-008-0508-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND According to the adenoma-carcinoma concept, all colorectal adenomas are to be removed and all patients have to undergo regular surveillance examinations. But there is still shortage on information on the long-term results of follow-up colonoscopy after polypectomy. METHODS Between 1978 and 2003, more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps. A total of 1,091 patients undergoing periodic surveillance examinations are studied for differences between initial and metachronous lesions of the colorectum. Statistical analysis using chi (2)-testing of adenoma characteristics found in four subsequent recurrence periods and calculation of the relative risk (RR) for the development of metachronous adenomas of advanced pathology was performed. RESULTS In comparison with the initial findings, metachronous adenomas are, in general, significantly smaller ones (p < 0.00001), more frequently tubular lesions (p < 0.00001) and bearing less often high-grade dysplasia (p < 0.00001). Adenomas of advanced pathology were significantly less often found during follow-up than at baseline examination (p < 0.0001). These differences are found between the initial and four subsequent generations of metachronous adenomas. Patients with adenomas of advanced pathology at baseline have a significantly higher risk for metachronous adenomas of advanced pathology (RR 1.51; 95%CI 1.04-1.93) at the first recurrence. CONCLUSIONS Metachronous adenomas show uniform characteristics of being small tubular lesions rarely bearing high-grade dysplasia. Thus, regular surveillance examinations can provide sufficient colorectal carcinoma prevention.
Collapse
Affiliation(s)
- G Nusko
- Department of Internal Medicine, Erkenbrechtallee 45, 91438 Bad Windsheim, Germany.
| | | | | |
Collapse
|
|
9
|
Mansmann U, Crispin A, Henschel V, Adrion C, Augustin V, Birkner B, Munte A. Epidemiology and quality control of 245 000 outpatient colonoscopies. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:434-40. [PMID: 19626186 PMCID: PMC2696904 DOI: 10.3238/arztebl.2008.0434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 05/09/2008] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Screening colonoscopy is an effective means for early detection of colorectal carcinoma. Any exhaustive evaluation of the method must take further factors into account: epidemiology of colorectal adenomas and carcinomas in the target population, acceptance by the patients, structure, process, and outcome quality, and health economics. METHODS The internet-based colonoscopy database of the Bavarian Association of Statutory Health Insurance Physicians (ASHIP) for the year 2006 includes data on 86.05% of all outpatient colonoscopies performed in Bavarian ASHIP patients, or a total of 245 263 documented examinations. RESULTS The rate of participation in preventive colonoscopies was low (1.5%) and showed considerable geographical variation. The rate of detection of histologically confirmed colorectal neoplasia in symptom-free screened individuals was almost 26.0%. Some 1.3% of those screened had colorectal carcinoma. In 76.31% of the participants a completely clean gut was achieved. The incidence of bleeding, perforation, and cardiorespiratory complications was 0.22%, 0.03%, and 0.06%, respectively. DISCUSSION The complication rate of outpatient colonoscopy is on the order of tenths of a percent, while the process quality is high. The rate of detection of colorectal adenoma and carcinoma is high and the projected benefits for public health are considerable, but the rate of participation is too low.
Collapse
Affiliation(s)
- Ulrich Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|