Association between subject factors and colorectal cancer screening participation in Ontario, Canada
ABSTRACT Colorectal cancer screening reduces colorectal cancer incidence and mortality. This population-based study was conducted to evaluate (i) the association between subject factors and colorectal screening participation and (ii) the lifetime prevalence of colorectal screening among the general population of Ontario, Canada. Population-based controls were recruited by the Ontario Familial Colorectal Cancer Registry during 1998-2000. The 1944 persons completed an epidemiologic questionnaire. Descriptive statistics were computed and step-wise multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Overall, 23% of persons greater than 50 years of age reported ever having had colorectal cancer screening; 17% reported fecal occult blood test (FOBT), 6% sigmoidoscopy, and 4% colonoscopy. Family history of colorectal cancer, increased age, higher household income, and use of hormone replacement therapy (among women) were all significantly associated with ever having had colorectal cancer screening. The low prevalence of colorectal cancer screening among the target population suggests the need for an increased awareness of the public health importance of colorectal cancer screening.
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- "Second, it is possible that an adjunctive profiling tool based on genomic information might increase the uptake of existing screening methods. For example, population-based studies have shown that the likelihood of participating in CRC screening is positively associated with having a family history of the disease (Slattery et al. 2000, 2004; Mandelson et al. 2000; Madlensky et al. 2003; Ramji et al. 2005). In a study of patient and physician preferences for various types of tests to detect CRC, both patients and physicians stated that they considered accuracy as the most important feature in deciding on which test they would choose; thus, improved efficacy through an adjunctive test might also lead to higher uptake (Ling et al. 2001). "
ABSTRACT: Despite the fact that colorectal cancer (CRC) is a highly treatable form of cancer if detected early, a very low proportion of the eligible population undergoes screening for this form of cancer. Integrating a genomic screening profile as a component of existing screening programs for CRC could potentially improve the effectiveness of population screening by allowing the assignment of individuals to different types and intensities of screening and also by potentially increasing the uptake of existing screening programs. We evaluated the utility and predictive value of genomic profiling as applied to CRC, and as a potential component of a population-based cancer screening program. We generated simulated data representing a typical North American population including a variety of genetic profiles, with a range of relative risks and prevalences for individual risk genes. We then used these data to estimate parameters characterizing the predictive value of a logistic regression model built on genetic markers for CRC. Meta-analyses of genetic associations with CRC were used in building science to inform the simulation work, and to select genetic variants to include in logistic regression model-building using data from the ARCTIC study in Ontario, which included 1,200 CRC cases and a similar number of cancer-free population-based controls. Our simulations demonstrate that for reasonable assumptions involving modest relative risks for individual genetic variants, that substantial predictive power can be achieved when risk variants are common (e.g., prevalence > 20%) and data for enough risk variants are available (e.g., approximately 140-160). Pilot work in population data shows modest, but statistically significant predictive utility for a small collection of risk variants, smaller in effect than age and gender alone in predicting an individual's CRC risk. Further genotyping and many more samples will be required, and indeed the discovery of many more risk loci associated with CRC before the question of the potential utility of germline genomic profiling can be definitively answered.Human Genetics 07/2010; 128(1):89-101. DOI:10.1007/s00439-010-0828-1 · 4.52 Impact Factor
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ABSTRACT: Although, the study of human development--from fertilized egg to mature embryo--is extremely important, the early differentiation of human tissues remains an enigma. Moreover, the relatively high percentage of unexplained pregnancy loss--a major concern of human embryologists and gynaecologists--emphasizes the need for an appropriate model for studying early human development. The availability of human pluripotent stem cells might allow us to study previously inaccessible basic processes that occur during human embryogenesis, such as gastrulation and organogenesis.Bailliè re s Best Practice and Research in Clinical Obstetrics and Gynaecology 01/2005; 18(6):929-40. DOI:10.1016/j.bpobgyn.2004.06.005 · 3.00 Impact Factor
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ABSTRACT: The health benefits of the Human Genome Project have been widely anticipated. Experts predict a new era of individ- ualized disease prevention based on testing for genetic susceptibilities,1andsafer,moreeffectiveuseofdrugsbasedon pharmacogenomic testing.2 Genomic research is also pre- dicted to improve disease classification and generate innova- tive therapies, targeted more precisely to the molecular mech- anisms of disease.3 Early breakthroughs support this promise. Genetic testing can identify women at high risk for breast and ovarian cancer who may benefit from interventions such as breast screening by MRI and prophylactic oophorectomy.4 Pharmacogenomic testing offers a potential means to increase the safety of drugs with narrow therapeutic indices, such as mercapotopurines5 and warfarin.6,7 Genetic analysis of disease processes such asGenetics in Medicine 08/2006; 8(7):451-8. DOI:10.1097/01.gim.0000228213.72256.8c · 6.44 Impact Factor