programas cribado cancer

Nota bibliográfica cribado c colorrectal 2014-07/08

Honein-AbouHaidar GN, Rabeneck L, Paszat LF, Sutradhar R, Tinmouth J, Baxter NN. Evaluating the impact of public health initiatives on trends in fecal occult blood test participation in Ontario.BMC Cancer. 2014;14(1):537. Available from:  doi: 10.1186/1471-2407-14-537. PMID: 25062552.

CONCLUSION: Although observed increases in FOBT participation cannot be definitively attributed to the various initiatives, the results of the two statistical approaches suggest a causal association between the observed increases in FOBT participation and most of these initiatives.

Cubiella J, Castro I, Hernandez V, Gonzalez-Mao MC, Rivera C, Iglesias F, et al. Characteristics of Adenomas Detected by Fecal Immunochemical Test in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-13-1346.

CONCLUSIONS: European guidelines classification and adenoma location coORelates with the likelihood of a positive FIT result. IMPACT: This information allows us to understand the FIT impact in colorectal cancer prevention. Likewise, it should be taken into account in the development of new colorectal adenomas biomarkers.

Hoffman MD, MPH RM. In persons at average risk, stool DNA tests had higher sensitivity than FIT for detecting colorectal cancer. Ann Intern Med. Philadelphia; 2014;161(2). Available from:  

 Hoffman remarks on Imperiale et al’s study that determined whether a noninvasive, multitarget stool DNA test accurately detects colorectal cancer in persons at average risk, and how it compares with a fecal immunochemical test (FIT). The DNA tests had over twice as many abnormal results as FIT, with a higher rate of false-positive results. This means that more colonoscopies would need to be performed to detect an advanced neoplasm with DNA testing than with FIT testing. However, interpreting false-positive results is complicated because colonoscopy is an imperfect gold standard and DNA testing can detect molecular abnormalities potentially arising from extracolonic neoplasia. Further diagnostic testing could increase the costs and risks of screening. Having unexplained positive DNA test results might also be stressful to patients. DNA testing is a marvelous example of translational research, but it doesn't seem ready for prime time.

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Incidence of colorectal adenomas: Birth cohort analysis among 4.3 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-14-0367.

CONCLUSIONS. Annual incidence rates of colorectal adenomas are below 2.5% and 2% among men and women, respectively, and show little variation by age. IMPACT. Risk of clinically manifest colorectal cancer is expected to be very small within 10 years and beyond after negative colonoscopy for men and women at all ages. The use of re-screening after a negative screening colonoscopy above 60 years of age may be very limited.

Shah R, Jones E, Vidart V, Kuppen PJK, Conti JA, Francis NK. Biomarkers for Early Detection of Colorectal Cancer and Polyps: Systematic Review. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-14-0412.
Combinations of fecal and serum biomarkers produce higher sensitivities, specificities and PPVs for early detection of CRC and adenomas. Further research is required to validate these biomarkers in a well-structured population-based study.
Brett, AS. Flexible sigmoidoscopy for colorectal cancer screening: More evidence, persistent ironies. JAMA. 2014;312(6):601–2. Available from:

Holme Ø, Løberg M, Kalager M, Al E. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: A randomized clinical trial. JAMA. 2014;312(6):606–15. Available from:

There was no difference between the flexible sigmoidoscopy only vs the flexible sigmoidoscopy and FOBT screening groups.Conclusions and Relevance In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence…

Blom J, Kilpeläinen S, Hultcrantz R, Törnberg S. Five-year experience of organized colorectal cancer screening in a Swedish population - increased compliance with age, female gender, and subsequent screening round. J Med Screen. 2014;21(3):144–50. Available from:  doi: 10.1177/0969141314545555. PMID: 25070434.

CONCLUSION: The strong organization of the programme contributed to a high compliance rate, that increased by screening round. The lower participation rate among men and among individuals at younger ages needs further attention.

Løberg M, Kalager M, Holme Ø, Hoff G, Adami H-O, Bretthauer M. Long-Term Colorectal-Cancer Mortality after Adenoma Removal. N Engl J Med. 2014;371(9):799–807. Available from:  doi: 10.1056/NEJMoa1315870.

Levy BT, Bay C, Xu Y, Daly JM, Bergus G, Dunkelberg J, et al. Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy. J Med Screen. 2014;21(3):133–43. Available from:  doi: 10.1177/0969141314541109.

Conclusions The sensitivity of a single-sample FIT for advanced adenomas or cancer was low. Individuals with distal adenomas had a higher odds of testing positive than those with proximal lesions or no lesions.

Kapidzic A, Grobbee EJ, Hol L, van Roon AHC, van Vuuren AJ, Spijker W, et al. Attendance and Yield Over Three Rounds of Population-Based Fecal Immunochemical Test Screening. Am J Gastroenterol. 2014;109(8):1257–64. Available from:  doi: 10.1038/ajg.2014.168.

CONCLUSIONS: Repeated biennial FIT screening is acceptable with increased participation in successive screening rounds, and >70% of all eligible subjects participating at least once over three rounds. The decline in screen-detected AN over three screening rounds is compatible with a decreased prevalence of AN as a result of repeated FIT screening. These findings provide strong evidence for the effectiveness of FIT screening and stress the importance of ongoing research over multiple screening rounds.

Clark BT, Rustagi T, Laine L. What Level of Bowel Prep Quality Requires Early Repeat Colonoscopy: Systematic Review and Meta-Analysis of the Impact of Preparation Quality on Adenoma Detection Rate. Am J Gastroenterol. 2014; Available from:  

CONCLUSIONS: ADR is not significantly different with intermediate-quality vs. high-quality bowel preparation. Our results confirm the need for early repeat colonoscopy with low-quality bowel preparation, but suggest that patients with intermediate/fair preparation quality may be followed up at standard guideline-recommended surveillance intervals without significantly affecting quality as measured by ADR.

Kaminski MF, Polkowski M, Kraszewska E, Rupinski M, Butruk E, Regula J. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014;63(7):1112–9. Available from:  doi: 10.1136/gutjnl-2013-304965. PMID: 24385598.

CONCLUSIONS: Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.

Wong MCS, Lam TYT, Tsoi KKF, Hirai HW, Chan VCW, Ching JYL, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects. Gut. 2014;63(7):1130–6. Available from:  doi: 10.1136/gutjnl-2013-305639. PMID: 24045331.

CONCLUSIONS: The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia
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