Evelien Dekker

Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdamo, North Holland, Netherlands

Are you Evelien Dekker?

Claim your profile

Publications (276)2129.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Research has shown that ethnic minority groups are less likely to participate in colorectal cancer (CRC) screening than the majority population and hence less likely to be diagnosed at an early stage when treatment is potentially more successful. Objective: To explore knowledge, attitudes and beliefs regarding CRC and CRC screening among ethnic minority groups in the Netherlands. Design: We conducted qualitative interviews with 30 first-generation immigrants born in Turkey, Morocco and Surinam. We based the topic guide on the health belief model. Framework analysis was used to analyse our data. Results: Although knowledge of CRC and CRC screening was limited, all respondents felt susceptible to CRC. CRC screening was perceived to mainly benefit those individuals with poor health and symptoms. Although most respondents had a positive attitude towards CRC screening, knowledge about its potential harms was limited and self-efficacy to participate was low. Adult children acted as important mediators in providing access to information. The language barrier and low literacy formed serious barriers to informed participation in CRC screening. Conclusion: To ensure that all eligible individuals, including ethnic minority groups, have equal opportunities to informed participation in screening, targeted communication strategies should be developed, such as oral and visual channels, and face-to-face communication in the mother tongue. This will help ethnic minority groups to make an informed decision about participation in CRC screening.
    Health expectations: an international journal of public participation in health care and health policy 11/2015; DOI:10.1111/hex.12428 · 3.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening. Material and methods: In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield. Results: Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to initial screening CTC yield significantly increased the advanced neoplasia yield per 100 CTC participants (6.1 to 8.6; p < 0.001) and per 100 invitees (2.1 to 2.9; p < 0.001). Conclusion: Surveillance CTC for 6-9 mm polyps has a substantial yield of advanced adenomas and significantly increased the CTC yield in population screening. Key points: • The participation rate in surveillance CT colonography (CTC) is 86 %. • Advanced adenoma prevalence in a 6-9 mm CTC surveillance population is high. • Surveillance CTC significantly increases the yield of population screening by CTC. • Surveillance CTC for 6-9 mm polyps is a safe strategy. • Surveillance CTC is unlikely to yield new important extracolonic findings.
    European Radiology 11/2015; DOI:10.1007/s00330-015-4081-9 · 4.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and aims: The flexible endoscope is used as a platform for minimally invasive interventions. However, control of the conventional endoscope and multiple instruments is difficult. Robotic assistance could provide a solution and better control for a single operator. A novel platform should also enable interventions in areas that are currently difficult to reach. This study evaluates the safety and efficacy of a robotic platform that guides a conventional endoscope through the large bowel. Methods: In this feasibility study, adult patients scheduled for routine diagnostic colonoscopy were included. The endoscope was introduced using a robotic add-on to provide tip bending and air/water actuation. The endoscopist directly controlled the scope shaft. Upon cecal intubation, the add-on was detached and the procedure continued using conventional control. Primary evaluation parameters were the number of serious adverse events and the percentage of successful cecal intubations. Results: The procedure was performed in 22 consecutive patients who all gave informed consent. There were no serious adverse events. Cecal intubation was successful in 15 patients (68%) using the robotic add-on. Six cases were completed after conversion to conventional control: 3 cases were converted to pass sharp angulation in the flexures and 3 cases were converted after technical difficulties. One case was not successful with either technique due to severe diverticulosis. Conclusions: The robotic add-on steering module allows safe endoscope intubation to reach intervention sites throughout the large bowel. The next step is to clinically evaluate complementary instrument and shaft guiding modules in therapeutic procedures.
    Gastrointestinal endoscopy 11/2015; DOI:10.1016/j.gie.2015.10.046 · 5.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6-9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth. Methods: In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6-9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology. Results: Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of 3.3 years (s.d. 0.3; range 3.0-4.6 years). In all, 33 (35%) of 95 polyps progressed, 36 (38%) remained stable, and 26 (27%) regressed, including an apparent resolution in 13 (14%) polyps. In 68 (83%) of the 82 polyps at surveillance, histopathology was obtained; 15 (47%) of 32 progressing polyps were advanced adenomas, 6 (21%) of 28 stable polyps, and none of the regressing polyps. Conclusions: The majority of 6-9 mm polyps will not progress to advanced neoplasia within 3 years. Those that do progress to advanced status can in particular be found among the lesions that increased in size on surveillance CTC.Am J Gastroenterol advance online publication, 20 October 2015; doi:10.1038/ajg.2015.340.
    The American Journal of Gastroenterology 10/2015; DOI:10.1038/ajg.2015.340 · 10.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Specific genes, such as BCAT1 and IKZF1, are methylated with high frequency in colorectal cancer (CRC) tissue compared to normal colon tissue specimens. Such DNA may leak into blood and be present as cell-free circulating DNA. We have evaluated the accuracy of a novel blood test for these two markers across the spectrum of benign and neoplastic conditions encountered in the colon and rectum. Methods: Circulating DNA was extracted from plasma obtained from volunteers scheduled for colonoscopy for any reason, or for colonic surgery, at Australian and Dutch hospitals. The extracted DNA was bisulphite converted and analysed by methylation specific real-time quantitative PCR (qPCR). A specimen was deemed positive if one or more qPCR replicates were positive for either methylated BCAT1 or IKZF1 DNA. Sensitivity and specificity for CRC were estimated as the primary outcome measures. Results: Plasma samples were collected from 2105 enrolled volunteers (mean age 62 years, 54 % male), including 26 additional samples taken after surgical removal of cancers. The two-marker blood test was run successfully on 2127 samples. The test identified 85 of 129 CRC cases (sensitivity of 66 %, 95 % CI: 57-74). For CRC stages I-IV, respective positivity rates were 38 % (95 % CI: 21-58), 69 % (95 % CI: 53-82), 73 % (95 % CI: 56-85) and 94 % (95 % CI: 70-100). A positive trend was observed between positivity rate and degree of invasiveness. The colonic location of cancer did not influence assay positivity rates. Gender, age, smoking and family history were not significant predictors of marker positivity. Twelve methylation-positive cancer cases with paired pre- and post-surgery plasma showed reduction in methylation signal after surgery, with complete disappearance of signal in 10 subjects. Sensitivity for advanced adenoma (n = 338) was 6 % (95 % CI: 4-9). Specificity was 94 % (95 % CI: 92-95) in all 838 non-neoplastic pathology cases and 95 % (95 % CI: 92-97) in those with no colonic pathology detected (n = 450). Conclusions: The sensitivity for cancer of this two-marker blood test justifies prospective evaluation in a true screening population relative to a proven screening test. Given the high rate of marker disappearance after cancer resection, this blood test might also be useful to monitor tumour recurrence. Trial registration: ACTRN12611000318987 .
    BMC Cancer 10/2015; 15(1):654. DOI:10.1186/s12885-015-1674-2 · 3.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and aims: Patients with longstanding colitis have an increased risk for developing CRC. Although the risk for ulcerative colitis is well established, for Crohn's disease data are contradictory. This study aims to determine the number Crohn's patients with dysplasia undergoing surveillance, and assess the diagnostic accuracy of chromoendoscopy (CE) combined with integrated confocal laser endomicroscopy (iCLE) for differentiating dysplastic versus non-dysplastic lesions. Methods: Patients with longstanding Crohn's colitis undergoing surveillance colonoscopy were included in this multicenter, prospective, cohort study. Surveillance was performed with CE and lesions were assessed with iCLE for differentiation. All lesions were removed and send in for pathology as reference standard. Results: Between 2010 and 2014, 61 Crohn's patients were included in 5 centers. Seventy-two lesions, of which 7 dysplastic, were detected in 6 patients (dysplasia detection rate: 9.8%), none included high-grade dysplasia or cancer. Combined CE with iCLE for differentiating neoplastic from non-neoplastic lesions, had an accuracy of 86.7% (95% CI, 78.1-95.3), sensitivity of 42.9% (95% CI, 11.8-79.8) and specificity of 92.4% (95% CI, 80.9-97.6). For CE alone this was 80.3% (95% CI, 70.7-89.9), 28.6% (95% CI, 5.1-69.7) and 86.4% (95% CI, 80.9-97.6). The study terminated early due to frequent failure of the endoscopic equipment. Conclusion: This study shows a low incidence of dysplastic lesions found during surveillance colonoscopy in longstanding extensive Crohn's colitis. The accuracy of both CE alone and in combination with iCLE was relatively good, although the sensitivity for both was poor. Due to frequent failure iCLE has limited applicability in daily practice as a surveillance strategy.
    Gastrointestinal endoscopy 09/2015; DOI:10.1016/j.gie.2015.09.001 · 5.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Implementation of nationwide screening programs aims to decrease the disease burden of colorectal cancer (CRC) in the general population. Globally, most population screening programs for CRC are performed by either fecal occult blood test, flexible sigmoidoscopy or colonoscopy. For screening programs with colonoscopy as primary method, only circumstantial evidence from observational studies is available to prove its effectiveness, suggesting that colonoscopy effectively reduces CRC incidence and mortality. Currently, large randomized trials are being conducted to corroborate these findings. Besides the direct effect of a screening program for CRC, its protective effect is further enhanced by enrolment of patients that underwent polypectomy in surveillance programs. However, despite CRC screening and surveillance colonoscopies, interval CRCs still occur. Those are predominantly located in the right-sided colon and potential explanations, besides unfavorable tumor characteristics, are preventable operator-dependent factors relating to the quality of the colonoscopy procedure. In an effort to reduce differences in endoscopists' performance and thereby the occurrence of interval CRCs, quality indicators of colonoscopy have been introduced. In addition, emerging advanced colonoscopy techniques might contribute to the improvement in polyp detection and removal. The meticulous inspection of the colonic mucosa not only results in the detection of advanced and relevant lesions, but also in the removal of many diminutive and small lesions leading to an increasing number of surveillance colonoscopies, known as the "high-detection paradox". More data on the cost-effectiveness of high quality colonoscopy as a primary screening method and surveillance programs with intervals based on optimal risk-stratification are eagerly awaited. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Digestive Endoscopy 08/2015; DOI:10.1111/den.12533 · 2.06 Impact Factor
  • Evelien Dekker · Monique E van Leerdam ·

    Gastrointestinal endoscopy 08/2015; 82(2):334-336. DOI:10.1016/j.gie.2015.03.1903 · 5.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Randomized trials demonstrated that chromoendoscopy is superior to white light endoscopy with random biopsy sampling (WLE) for the detection of dysplasia in patients with inflammatory bowel disease (IBD). Whether implementing chromoendoscopy can increase the detection of dysplasia in clinical practice is unknown. Methods: Patients with ulcerative colitis (UC) and Crohn's disease (CD) undergoing colonoscopic surveillance between January 2000 and November 2013 in three referral centers were identified using the patients' medical records. In recent years, the use of high-definition chromoendoscopy was adopted in all three centers using segmental pancolonic spraying of 0.1% methylene blue or 0.3% indigo carmine (chromoendoscopy group). Previously, surveillance was performed employing WLE with random biopsies every 10 cm (WLE group). The percentage of colonoscopies with dysplasia was compared between both groups. Results: A total of 440 colonoscopies in 401 patients were performed using chromoendoscopy and 1,802 colonoscopies in 772 patients using WLE. Except for a higher number of CD patients with extensive disease and more patients with a first-degree relative with colorectal cancer (CRC) in the chromoendoscopy group, the known risk factors for IBD-associated CRC were comparable between both groups. Dysplasia was detected during 48 surveillance procedures (11%) in the chromoendoscopy group as compared with 189 procedures (10%) in the WLE group (P=0.80). Targeted biopsies yielded 59 dysplastic lesions in the chromoendoscopy group, comparable to the 211 dysplastic lesions detected in the WLE group (P=0.30). Conclusions: Despite compelling evidence from randomized trials, implementation of chromoendoscopy for IBD surveillance did not increase dysplasia detection compared with WLE with targeted and random biopsies.
    The American Journal of Gastroenterology 07/2015; 110(7):1014-1021. DOI:10.1038/ajg.2015.63 · 10.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and study aims: Fecal immunochemical tests (FIT) are used to detect blood in feces, which might indicate the presence of colorectal neoplasia. The aim of this study was to investigate whether FIT results vary depending on the characteristics of colonic lesions. Patients and methods: This was a retrospective analysis of lesions detected in a cohort of asymptomatic individuals (aged 50 - 75 years) who were invited to participate in a FIT-based screening pilot in The Netherlands. The mean FIT result was compared across subgroups of individuals defined by histopathology of the most advanced lesion detected. In addition, the results were compared with data from a primary colonoscopy screening trial, in which participants also completed a FIT. Results: In three rounds of FIT-based screening, a total of 877 FIT-positive individuals underwent colonoscopy. Higher mean FIT results (hemoglobin [Hb]/g feces) were observed in individuals with carcinomas (199 μg Hb/g) and advanced adenomas (87 μg Hb/g) compared with participants with nonadvanced adenomas (50 μg Hb/g) or those with serrated lesions (46 μg Hb/g) (P < 0.001). In the primary colonoscopy trial, 1256 participants completed a FIT test and underwent colonoscopy. The number of participants with nonadvanced adenomas as the most advanced lesion was comparable between this group and the FIT-based screening group (20 % vs. 22 %). Conclusion: In FIT-based screening, the mean FIT results varied depending on the characteristics of the most advanced colonic lesion. The proportion of participants with a nonadvanced adenoma as the most advanced lesion was similar in the FIT-based screening group and in the primary colonoscopy screening group, suggesting that these lesions are coincidental findings rather than FIT-detected findings. www.trialregister.nl number NTR2755. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 06/2015; DOI:10.1055/s-0034-1392412 · 5.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and study aims: The most frequently cited prevalence for serrated polyposis syndrome (SPS) is 1 in every 3000 people screened, but this value is debated. Additionally, changes in 2010 in the World Health Organization (WHO) diagnostic criteria for SPS might affect reported prevalence. An updated estimate of SPS prevalence is necessary to predict the number of cases in screening programs. Patients and methods: A systematic literature search was conducted in the PubMed, EMBASE, and Web of Science databases up to February 2014. Studies reporting the prevalence of SPS, as defined by WHO criteria, in screening populations were selected. Results: Six studies reported prevalence of SPS in screening populations, varying from 0 to 0.66 %. The highest prevalences (0.34 % and 0.66 %) were seen in studies from screening programs with patients pre-selected by fecal blood test. Primary colonoscopy-based screening programs, that have the lowest risk of bias, reported SPS prevalences ranging from 0 to 0.09 %. Across studies, 56 patients were diagnosed with SPS of whom 3 presented with synchronous colorectal cancer at index endoscopy. Conclusion: The true prevalence of SPS is unclear because of the risk of bias across studies, but is likely to be below 0.09 % as derived from primary colonoscopy screening programs. The prevalence in pre-selected screening populations after positive fecal testing is higher, with reported values of 0.34 % and 0.66 %. Large and high quality primary colonoscopy screening studies, reporting SPS prevalence in adequately described populations, are necessary for better estimation of the true prevalence of SPS in average-risk patients. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 06/2015; DOI:10.1055/s-0034-1392411 · 5.05 Impact Factor
  • J.L.A. Vleugels · J.E.G. IJspeert · E. Dekker ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Conventional adenomas were traditionally thought to be the only precursors to colorectal cancer (CRC). Nowadays, also serrated polyps are acknowledged as precursor lesions for CRC, responsible for up to 30% of all CRCs and probably a larger percentage of interval CRCs after colonoscopy. In recent years, much research is being done to unravel the serrated neoplasia pathway. Endoscopic detection of serrated polyps is still a challenge for gastroenterologists, which is illustrated by large variations in detection rates of serrated polyps in the proximal colon. Clinical practice is further inhibited by poor optical differentiation of SSA/Ps from conventional adenomas and HPs and difficult delineation of those lesions, resulting in incomplete resection. The main focus of this review is to highlight recent advancements in endoscopic imaging techniques with regards to detection, differentiation and resection of serrated polyps.
    Baillière&#x027 s Best Practice and Research in Clinical Gastroenterology 06/2015; 29(4). DOI:10.1016/j.bpg.2015.05.009 · 3.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study explored individuals' preferences for genetic testing for colorectal cancer (CRC) in a screening situation and their willingness to participate in genetic testing for Lynch syndrome, familial adenomatous polyposis (FAP), and familial colorectal cancer (FCC). For that purpose, 532 respondents aged 55-65 years completed a Discrete Choice Experiment. Using panel latent class models, the preferences for two screening situation characteristics (the probability of being genetically predisposed and the probability of developing CRC) and screening test characteristics (the frequency of preventive colonoscopies and CRC survival) were estimated. Based on these preferences, respondents' willingness to participate in the three screening initiatives was estimated. Lower-educated respondents and respondents who express serious anxiety and worries found colonoscopy frequency and the probability of developing CRC relatively more important and survival relatively less important compared with higher-educated respondents and respondents who express no anxiety and worries. These differences in preferences resulted in opposite preferences for participation in FCC and FAP screening. In conclusion, the general population is willing to participate in genetic screening for CRC. If individuals are suspected of genetic or familial CRC, they should at least be informed about their increased risk of being genetically predisposed and about the importance of participating in all preventive follow-up colonoscopies in order to maximize survival.European Journal of Human Genetics advance online publication, 3 June 2015; doi:10.1038/ejhg.2015.117.
    European journal of human genetics: EJHG 06/2015; DOI:10.1038/ejhg.2015.117 · 4.35 Impact Factor

  • Gut 06/2015; 64(Suppl 1):A52. DOI:10.1136/gutjnl-2015-309861.105 · 14.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) is considered a heterogeneous disease, both regarding pathogenesis and clinical behaviour. Four decades ago, the adenoma-carcinoma pathway was presented as the main pathway towards CRC, a conclusion that was largely based on evidence from observational morphological studies. This concept was later substantiated at the genomic level. Over the past decade, evidence has been generated for alternative routes in which CRC might develop, in particular the serrated neoplasia pathway. Providing indisputable evidence for the neoplastic potential of serrated polyps has been difficult. Reasons include the absence of reliable longitudinal observations on individual serrated lesions that progress to cancer, a shortage of available animal models for serrated lesions and challenging culture conditions when generating organoids of serrated lesions for in vitro studies. However, a growing body of circumstantial evidence has been accumulated, which indicates that ≥15% of CRCs might arise through the serrated neoplasia pathway. An even larger amount of post-colonoscopy colorectal carcinomas (carcinomas occurring within the surveillance interval after a complete colonoscopy) have been suggested to originate from serrated polyps. The aim of this Review is to assess the current status of the serrated neoplasia pathway in CRC and highlight clinical implications.
    Nature Reviews Gastroenterology &#38 Hepatology 05/2015; 12(7). DOI:10.1038/nrgastro.2015.73 · 12.61 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB208. DOI:10.1016/j.gie.2015.03.193 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB326-AB327. DOI:10.1016/j.gie.2015.03.1453 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB145. DOI:10.1016/j.gie.2015.03.1231 · 5.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The adenoma detection rate (ADR) is the most important surrogate quality parameter for colorectal cancer (CRC) prevention. However, serrated polyps also are precursors of CRC. Large, prospective studies comparing the detection rate of serrated polyps among endoscopists in an era of awareness about the malignant potential of serrated polyps have not yet been performed. We aimed to compare the proximal serrated polyp (PSP) detection rate and the clinically relevant serrated polyp (RSP) detection rate among endoscopists and to analyze the association between these parameters and the ADR. Colonoscopy data were retrieved in one expert center between January 2011 and July 2014 by using a structured reporting system, enabling prospective and automatic quality assessment. Endoscopists who performed at least 50 colonoscopies within the timeframe were included for analysis. Multivariate logistic regression was used to compare the ADR, PSP detection rate, and RSP detection rate among endoscopists. The association among these parameters was calculated by using the Pearson r correlation coefficient. All lesions were assessed by an expert pathologist. In total, 16 endoscopists and 2088 colonoscopies were included for analysis. The PSP detection rate ranged from 2.9% to 18.6% (mean 10.4%) among endoscopists. Corrected for confounders, the odds ratio to detect ≥1 PSP, compared with endoscopists with the highest detection rate, ranged from 0.79 (95% confidence interval [CI], 0.41-1.52) to 0.12 (95% CI, 0.03-0.55). The PSP detection rate was highly correlated with the RSP detection rate (ρ 0.94; P < .001), ranging from 4.3% to 20.9% (mean 13.9%). The PSP detection rate moderately correlated with the ADR (0.55; P = .03), which ranged from 23.2% to 49.2% (mean 35.2%). The PSP detection rate is widely variable among endoscopists, strongly correlated with the RSP detection rate, and moderately correlated with the ADR. These results suggest a high miss rate of RSPs among endoscopists with low rates of PSP detection. Future research should determine the association between endoscopists' PSP detection rates and the risk of interval cancer. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal endoscopy 04/2015; DOI:10.1016/j.gie.2015.02.044 · 5.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The effectiveness of colorectal cancer screening programs based on the fecal immunochemical test (FIT) is influenced by program adherence during consecutive screening rounds. We aimed to evaluate the participation rate, yield, and interval cancers in a third round of biennial CRC screening using FIT and to compare those with the first and the second screening round. A total of 3566 average-risk individuals aged 50-75 years were invited to participate in a third round of biennial FIT-based CRC screening. All FIT positives were recommended to undergo colonoscopy. We merged our data with the national cancer registry in the Netherlands to identify all non-screen-detected cancers in our cohort. Of the invitees, 2142 (60%) returned the FIT in this third screening round, compared to 56% in the second round and 57% in the first round. Overall, 153 of the third-round participants (7.1%) had a positive FIT result, versus 7.9% in the second round and 8.1% in the first round (P=0.05). Of all FIT positives, 123 (80%) underwent colonoscopy. Within this group, 33 persons had advanced neoplasia. The predictive value of FIT positivity for advanced neoplasia was 27% (33/123), compared to 42% in the second round and 54% in the first round - a significant decline (P<0.01). In an FIT-based screening program, participation rates remained stable over consecutive biennial screening rounds, while the FIT positivity rate and positive predictive value for advanced neoplasia gradually declined. Cancers in non-participants are significantly more advanced in staging than cancers in participants in the first round of screening. Copyright © 2015 Elsevier Ltd. All rights reserved.
    04/2015; 39(3). DOI:10.1016/j.canep.2015.03.012

Publication Stats

4k Citations
2,129.09 Total Impact Points


  • 2006-2015
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Gastroenterology and Hepatology
      • • Academic Medical Center
      Amsterdamo, North Holland, Netherlands
  • 2004-2015
    • University of Amsterdam
      • Department of Gastroenterology and Hepatology
      Amsterdamo, North Holland, Netherlands
  • 2012
    • Pontifical Catholic University of Chile
      CiudadSantiago, Santiago Metropolitan, Chile
    • Lyell McEwin Hospital
      Tarndarnya, South Australia, Australia
    • VU University Medical Center
      • Department of Gastroenterology and Hepatology
      Amsterdamo, North Holland, Netherlands
  • 2011
    • Technische Universität München
      München, Bavaria, Germany
  • 2009
    • Imperial College London
      Londinium, England, United Kingdom