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01-03-2020 | Colonoscopy | Original Article

Colorectal cancer-screening program improves both short- and long-term outcomes: a single-center experience in Trieste

Authors: Pasquale Losurdo, Massimo Giacca, Alan Biloslavo, Stefano Fracon, Elisabetta Sereni, Fabiola Giudici, Daniele Generali, Nicolo’ de Manzini

Published in: Updates in Surgery | Issue 1/2020

Abstract

Screening programs (SC) have been proven to reduce both incidence and mortality of CRC. We retrospectively analyzed patients who underwent surgical treatment for CRC between 01/2011 and 01/2017. The current screening program in our region collects patients aged from 50 to 69. For this reason, out of a total of 600 patients, we compared 125 patients with CRC founded during the SC to 162 patients who presented with symptoms and were diagnosed between 50–69 years old (NO-SC). 45% patients in the SC group were diagnosed as AJCC stage I vs 27% patients in the NO-SC group; 14% vs 20% were stage II, 14% vs 26% were stage III, and 3% vs 14% were stage IV (p 0.002). We found a significant difference in surgical approach: 89% SC vs 56% NO-SC patients had laparoscopic surgery (p 0.002). In the NO-SC group, 16% patients underwent resection in an emergency setting. Only 5% patients in the SC group had postoperative complications vs 14% patients in the NO-SC group (p 0.03). We had a 2-year OS of 86%, being 95% in the SC group and 80% in the NO-SC group (p 0.002). Likewise, the whole 2-year DFS was 77%, whereas it was 90% in the SC group and 66% in the NO-SC group (p 0.002). Screening significantly improves early diagnosis and accelerated surgical treatment. We obtained earlier stages at diagnosis, a less invasive surgical approach, and lower rates of complications and emergency surgery, all this leading to an improvement in both OS and DFS.

Noone AM, Cronin KA, Altekruse SF et al (2017) Cancer incidence and survival trends by subtype using data from the surveillance epidemiology and end results program, 1992–2013. Cancer Epidemiol Biomark Prev 26(4):632–641CrossRef

Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66(4):683–691CrossRefPubMed

Allemani C, Weir HK, Carreira H et al (2015) Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385(9972):977–1010CrossRefPubMed

Shaukat A, Lehenbauer KP (2017) Screening for colorectal neoplasia. N Engl J Med 376(16):1599PubMed

Whitlock EP, Lin JS, Liles E, Beil TL, Fu R (2008) Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task Force. Ann Intern Med 149(9):638–658CrossRefPubMed

Force USPST, Bibbins-Domingo K, Grossman DC et al (2016) Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA 315(23):2564–2575CrossRef

Berger BM, Parton MA, Levin B (2016) USPSTF colorectal cancer screening guidelines: an extended look at multi-year interval testing. Am J Managed Care 22(2):e77–e81

Schreuders EH, Ruco A, Rabeneck L et al (2015) Colorectal cancer screening: a global overview of existing programmes. Gut 64(10):1637–1649CrossRefPubMed

Carrozzi G, Sampaolo L, Bolognesi L et al (2015) Economic difficulties keep on influencing early diagnosis of colorectal cancer. Epidemiol Prev 39(3):210PubMed

10.

Honein-AbouHaidar GN, Kastner M, Vuong V et al (2016) Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening. Cancer Epidemiol 25(6):907–917CrossRef

11.

Imperiale TF, Ransohoff DF (2017) Screening for colorectal neoplasia. N Engl J Med 376(16):1598–1599CrossRefPubMed

12.

Burch JA, Soares-Weiser K, St John DJ et al (2007) Diagnostic accuracy of faecal occult blood tests used in screening for colorectal cancer: a systematic review. J Med Screen 14(3):132–137CrossRefPubMed

13.

Lee JK, Liles EG, Bent S, Levin TR, Corley DA (2014) Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med 160(3):171CrossRefPubMedPubMedCentral

14.

Bray C, Bell LN, Liang H, Collins D, Yale SH (2017) Colorectal cancer screening. WMJ 116(1):27–33PubMed

15.

Coin CG, Wollett FC, Coin JT, Rowland M, DeRamos RK, Dandrea R (1983) Computerized radiology of the colon: a potential screening technique. Comput Radiol 7(4):215–221CrossRefPubMed

16.

Mead R, Duku M, Bhandari P, Cree IA (2011) Circulating tumour markers can define patients with normal colons, benign polyps, and cancers. Br J Cancer 105(2):239–245CrossRefPubMedPubMedCentral

17.

Church TR, Wandell M, Lofton-Day C et al (2014) Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut 63(2):317–325CrossRefPubMed

18.

Kroijer R, Kobaek-Larsen M, Qvist N, Knudsen T, Baatrup G (2019) Colon capsule endoscopy for colonic surveillance. Colorectal Dis 21:532–537CrossRefPubMed

19.

Imperiale TF, Ransohoff DF, Itzkowitz SH (2014) Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 371(2):187–188PubMed

20.

Altomare DF, Di Lena M, Porcelli F et al (2013) Exhaled volatile organic compounds identify patients with colorectal cancer. Br J Surg 100(1):144–150CrossRefPubMed

21.

Ouyang DL, Chen JJ, Getzenberg RH, Schoen RE (2005) Noninvasive testing for colorectal cancer: a review. Am J Gastroenterol 100(6):1393–1403CrossRefPubMed

22.

Hari DM, Leung AM, Lee JH et al (2013) AJCC Cancer staging manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 217(2):181–190CrossRefPubMedPubMedCentral

23.

Mandel JS, Bond JH, Church TR et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota colon cancer control study. N Engl J Med 328(19):1365–1371CrossRefPubMed

24.

Hardcastle JD, Chamberlain JO, Robinson MH et al (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348(9040):1472–1477CrossRefPubMed

25.

Scholefield JH, Moss SM, Mangham CM, Whynes DK, Hardcastle JD (2012) Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut 61(7):1036–1040CrossRefPubMed

26.

Shaukat A, Mongin SJ, Geisser MS et al (2013) Long-term mortality after screening for colorectal cancer. N Engl J Med 369(12):1106–1114CrossRefPubMed

27.

Mandel JS, Church TR, Bond JH et al (2000) The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 343(22):1603–1607CrossRefPubMed

28.

Allison JE, Fraser CG, Halloran SP, Young GP (2014) Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver 8(2):117–130CrossRefPubMedPubMedCentral

29.

Allison JE, Sakoda LC, Levin TR et al (2007) Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst 99(19):1462–1470CrossRefPubMed

30.

Ventura L, Mantellini P, Grazzini G et al (2014) The impact of immunochemical faecal occult blood testing on colorectal cancer incidence. Dig Liver Dis 46(1):82–86CrossRefPubMed

31.

Lieberman DA (2009) Clinical practice. Screening for colorectal cancer. N Engl J Med 361(12):1179–1187CrossRefPubMed

32.

Kahi CJ, Imperiale TF, Juliar BE, Rex DK (2009) Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol 7(7):770–775 (quiz 711) CrossRef

33.

Neugut AI, Lebwohl B (2010) Colonoscopy vs sigmoidoscopy screening: getting it right. JAMA 304(4):461–462CrossRefPubMed

34.

Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M (2011) Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 154(1):22–30CrossRefPubMed

35.

Jorgensen OD, Kronborg O, Fenger C, Rasmussen M (2007) Influence of long-term colonoscopic surveillance on incidence of colorectal cancer and death from the disease in patients with precursors (adenomas). Acta Oncol 46(3):355–360CrossRefPubMed

36.

Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN (2010) The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 139(4):1128–1137CrossRefPubMed

37.

Sandler RS (2010) Editorial: colonoscopy and colorectal cancer mortality: strong beliefs or strong facts? Am J Gastroenterol 105(7):1633–1635CrossRefPubMed

38.

Castells A, Quintero E (2015) Programmatic screening for colorectal cancer: the COLONPREV study. Dig Dis Sci 60(3):672–680CrossRefPubMed

39.

Kaminski MF, Bretthauer M, Zauber AG et al (2012) The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 44(7):695–702CrossRefPubMed

40.

Bretthauer M, Kaminski MF, Loberg M et al (2016) Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial. JAMA Intern Med 176(7):894–902CrossRefPubMedPubMedCentral

41.

Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348(9040):1467–1471CrossRefPubMed

42.

Rex DK, Johnson DA, Anderson JC et al (2009) American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 104(3):739–750CrossRefPubMed

43.

Sabatino SA, White MC, Thompson TD, Klabunde CN, Centers for Disease C (2015) Prevention: Cancer screening test use—United States, 2013. MMWR 64(17):464–468PubMedPubMedCentral

44.

Brenner AT, Ko LK, Janz N, Gupta S, Inadomi J (2015) Race/ethnicity and primary language: health beliefs about colorectal cancer screening in a diverse, low-income population. J Health Care Poor Underserved 26(3):824–838CrossRefPubMedPubMedCentral

45.

Doubeni CA, Corley DA, Zauber AG (2016) Colorectal cancer health disparities and the role of US law and health policy. Gastroenterology 150(5):1052–1055CrossRefPubMed

46.

Lo SH, Halloran S, Snowball J, Seaman H, Wardle J, von Wagner C (2015) Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut 64(2):282–291CrossRefPubMed

47.

Duncan A, Turnbull D, Wilson C et al (2014) Behavioural and demographic predictors of adherence to three consecutive faecal occult blood test screening opportunities: a population study. BMC Public Health 14:238CrossRefPubMedPubMedCentral

48.

Adler A, Geiger S, Keil A et al (2014) Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany. BMC Gastroenterol 14:183CrossRefPubMedPubMedCentral

49.

deVos T, Tetzner R, Model F et al (2009) Circulating methylated SEPT9 DNA in plasma is a biomarker for colorectal cancer. Clin Chem 55(7):1337–1346CrossRefPubMed

50.

Grutzmann R, Molnar B, Pilarsky C et al (2008) Sensitive detection of colorectal cancer in peripheral blood by septin 9 DNA methylation assay. PLoS One 3(11):e3759CrossRefPubMedPubMedCentral

51.

Wang C, Ke C, Wang X et al (2014) Noninvasive detection of colorectal cancer by analysis of exhaled breath. Anal Bioanal Chem 406(19):4757–4763CrossRefPubMed

52.

European guidelines for quality assurance in colorectal cancer screening and diagnosis—First petitiën (chapter 1: 1–31) European Commission, 2010. https://doi.org/10.2772/15379(Electronic version)

53.

Tappenden P, Chilcott J, Eggington S et al (2007) Option appraisal of population-based colorectal cancer screening programmes in England. Gut 56(5):677–684CrossRefPubMed

54.

Lairson DR, DiCarlo M, Myers RE et al (2008) Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use. Cancer 112(4):779–788CrossRefPubMed

55.

Maciosek MV, Solberg LI, Coffield AB et al (2006) Colo-rectal cancer screening: health impact and cost effectiveness. Am J Prev Med 31(1):80–89CrossRefPubMed

56.

Berchi C, Bouvier V, Reaud JM, Launoy G (2004) Cost-effectiveness analysis of two strategies for mass screening for colorectal cancer in France. Health Econ 13(3):227–238CrossRefPubMed

57.

Rossi PG, Camilloni L, Cogo C et al (2012) Methods to increase participation in cancer screening programmes. Epidemiol Prev 36(1):1–104

58.

Shankaran V, Luu TH, Nonzee N et al (2009) Costs and cost effectiveness of a health care provider-directed intervention to promote colorectal cancer screening. J Clin Oncol 27(32):5370–5375CrossRefPubMedPubMedCentral

59.

Idigoras Rubio I, Arana-Arri E, Portillo I et al (2019) Participation in a population-based screening for colorectal cancer using the faecal immunochemical test decreases mortality in 5 years. Eur J Gastroenterol Hepatol 31(2):197–204CrossRefPubMed

Title: Colorectal cancer-screening program improves both short- and long-term outcomes: a single-center experience in Trieste
Authors: Pasquale Losurdo
Massimo Giacca
Alan Biloslavo
Stefano Fracon
Elisabetta Sereni
Fabiola Giudici
Daniele Generali
Nicolo’ de Manzini
Publication date: 01-03-2020
Publisher: Springer International Publishing
Keywords: Colonoscopy
Colorectal Cancer
Colorectal Cancer
Published in: Updates in Surgery / Issue 1/2020
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00703-y

At a glance: The STEP trials

Springer Medicine

Colorectal cancer-screening program improves both short- and long-term outcomes: a single-center experience in Trieste

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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