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.
"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). "
[Show abstract][Hide abstract] 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 · 4.82 Impact Factor
"Our results mirror those reported by other Canadian studies. For example, in 2005, 77% of surveyed Ontarians 50 years of age and over without CRC had never been screened for CRC, and close to 80% of screen-eligible Ontario beneficiaries failed to receive CRC screening during a 6 year follow-up period. "
[Show abstract][Hide abstract] ABSTRACT: To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians.
2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.
Of the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).
Healthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.
[Show abstract][Hide abstract] 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 · 1.92 Impact Factor
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