Evidence-Based Guidelines for Precision Risk Stratification-Based Screening (PRSBS) for Colorectal Cancer: Lessons Learned from the US Armed Forces: Consensus and Future Directions

2. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
Journal of Cancer (Impact Factor: 3.27). 03/2013; 4(3):172-92. DOI: 10.7150/jca.5834
Source: PubMed


Colorectal cancer (CRC) is the third most common cause of cancer-related death in the United States (U.S.), with estimates of 143,460 new cases and 51,690 deaths for the year 2012. Numerous organizations have published guidelines for CRC screening; however, these numerical estimates of incidence and disease-specific mortality have remained stable from years prior. Technological, genetic profiling, molecular and surgical advances in our modern era should allow us to improve risk stratification of patients with CRC and identify those who may benefit from preventive measures, early aggressive treatment, alternative treatment strategies, and/or frequent surveillance for the early detection of disease recurrence. To better negotiate future economic constraints and enhance patient outcomes, ultimately, we propose to apply the principals of personalized and precise cancer care to risk-stratify patients for CRC screening (Precision Risk Stratification-Based Screening, PRSBS). We believe that genetic, molecular, ethnic and socioeconomic disparities impact oncological outcomes in general, those related to CRC, in particular. This document highlights evidence-based screening recommendations and risk stratification methods in response to our CRC working group private-public consensus meeting held in March 2012. Our aim was to address how we could improve CRC risk stratification-based screening, and to provide a vision for the future to achieving superior survival rates for patients diagnosed with CRC.

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Available from: Björn L.D.M. Brücher,
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    • "In fact, 10%-20% of patients with Stage II colorectal cancer (theoretically cured by a proper oncological operation), and 30%-40% of those with Stage III colorectal cancer, develop recurrence.16 Where the “blame” lies in this is controversial; however, factors such as inadequate surgical margins or lymph node extraction, insufficient pathological examination (i.e., under-staging), and tumor biology have all been reported to play a role in recurrent disease.17 In the realm of colorectal cancer, microarray technology has been used to investigate gene expression profiles, yet no established signature has been found that is reliably useful for clinical practice. "
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    ABSTRACT: The disproportionately higher incidence of and mortality from colorectal cancer (CRC) among African Americans (AA) led the American College of Gastroenterology to recommend screening starting at age 45 in 2005. The purpose of this study was to determine the prevalence of colorectal neoplasia among 40-49-year-old inner city AA and Hispanic Americans (HA). We reviewed the medical records of 2,435 inner city AA and HA who underwent colonoscopy regardless of indication and compared the prevalence of colorectal neoplasia between AA and HA patients. We used logistic regression models to calculate odds ratios (OR) and 95 % confidence intervals (CI). There were 2,163 AAs and 272 HA. There were 57 % women in both groups. A total of 158 (7 %) AA and 9 (3 %) HA (P = 0.014) underwent the procedures for CRC screening. When compared to HAs, AAs had higher prevalence of any polyp (35 vs. 18 %, OR = 2.53; 95 % CI 1.82-3.52). Overall, AA had higher prevalence of colorectal neoplasia (adenoma and cancer) when compared to HAs (16 vs. 10 %; OR = 1.68; 95 % CI 1.10-2.56). We observed a higher frequency of colorectal neoplasia among 40-49-year-old AAs as compared to HAs suggesting an increased susceptibility to CRC risk in this population.
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    ABSTRACT: Background A federally funded demonstration project (Project SCOPE) was conducted to develop a model for delivering screening colonoscopy to underinsured patients in Suffolk County, NY. The recruitment model featured collaboration between Stony Brook University Medical Center and the Suffolk County Department of Health Services’ network of community health centers; bilingual patient navigators, and reimbursement of physicians and the hospital at Medicare rates. Methods We conducted a retrospective analysis of all (11,752) colonoscopies performed at Stony Brook Medicine, during the pre-SCOPE time period (2003–2004), during SCOPE period (2007–2008), and post-SCOPE (2010–2011), to measure the impact of SCOPE on reducing racial and ethnic disparities. Multiple logistic regression models were used to compare the likelihood of a patient being Hispanic or African American after adjusting for potential covariates. Results The numbers of Hispanics undergoing colonoscopies were 146 (4.3 %), 506 (12.3 %), and 262 (6 %) during the pre-SCOPE, SCOPE, and post-SCOPE time periods. The numbers of African Americans were 166 (5.1 %), 298 (7.2 %), and 255 (5.8 %). The odds ratio (OR = 1.4, 95 % CI = 1.06–1.83, p = 0.014) of a screening colonoscopy patient being Hispanic during the Project SCOPE period compared to the post-SCOPE period remained significant after taking into consideration the other covariates, such as diabetes, smoking, and insurance status. Conclusions Project SCOPE had a significant impact on increasing the proportion of Hispanics undergoing screening colonoscopies. Factors such as bilingual patient navigators, in addition to removing financial barriers, may have contributed to the increase.
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