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Introduction: Colorectal cancer (CRC) is the third most-diagnosed cancer among men and women in the US. This study aimed to evaluate the influence of an interactive inflatable colon exhibit on CRC knowledge and screening intent among men attending state fairs in 2 midwestern states. Methods: At the 2023 state fairs in 2 midwestern states, eligible participants (men aged 18-75 y who could speak and read English and resided in 1 of the 2 states) completed a presurvey, an unguided tour of the inflatable Super Colon, and a postsurvey. Primary outcomes were changes in knowledge (actual and perceived) and CRC screening intent from presurvey to postsurvey. We used χ2 tests to examine differences in survey results between the 2 sites and the association between demographic characteristics and behaviors (knowledge and intentions) before entering the Super Colon exhibit. We used the McNemar test to examine differences in presurvey to postsurvey distributions. Results: The study sample (N = 940) comprised 572 men at site A (60.8%) and 368 men at site B (39.2%). Except for 1 question, baseline CRC knowledge was relatively high. Greater perceived knowledge was inversely associated with greater actual knowledge. After touring the Super Colon, participants improved their actual knowledge of CRC prevention and self-perceived CRC knowledge. Most participants (95.4%) agreed that the Super Colon was effective for teaching people about CRC. Conclusion: These findings emphasize the role of community-based educational initiatives in encouraging CRC screening uptake and increasing research participation among men and affirm that the inflatable colon is as an effective educational tool for increasing CRC knowledge and encouraging early-detection screening behavior among men.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Persona de Mediana Edad , Adulto , Anciano , Adulto Joven , Adolescente , Intención , Medio Oeste de Estados Unidos , Encuestas y Cuestionarios , Tamizaje MasivoRESUMEN
BACKGROUND: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. METHODS: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. RESULTS: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. CONCLUSIONS: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.
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Detección Precoz del Cáncer , Humanos , Masculino , Femenino , Persona de Mediana Edad , Australia , Estudios Transversales , Anciano , Servicios Postales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Entrevistas como Asunto , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicologíaRESUMEN
Polyphenols are plant metabolites with potential anti-inflammatory and anti-proliferative effects, which may be advantageous for disorders like colorectal cancer (CRC). Despite promising in vitro and in vivo evidence, human clinical trials have yielded mixed results. The present study aimed to evaluate the clinical evidence of polyphenols for CRC prevention or treatment. A systematic review was performed according to PRISMA. Based on a PROSPERO registered protocol (CRD42024560044), online databases (PubMed and COCHRANE) were utilized for the literature search. A total of 100 studies articles were initially identified. After reviewing, 12 studies with a low risk of bias were selected, examining the effect of a variety of compounds. Curcumin demonstrated promise in various trials, mainly decreasing inflammatory cytokines, though results varied, and it did not lower intestinal adenomas or improve outcomes after chemotherapy. Neither epigallocatechin gallate nor artepillin C reduced the incidence of adenomas. Finally, fisetin seemed to improve the inflammatory status of patients under chemotherapy (5-fluorouracil). In summary, although certain polyphenols appear to exert some effect, their role in the prevention or treatment of CRC is inconclusive, and more clinical studies under more controlled conditions are needed.
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Neoplasias Colorrectales , Polifenoles , Humanos , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/tratamiento farmacológico , Polifenoles/farmacología , Curcumina/farmacología , Curcumina/uso terapéutico , Adenoma/prevención & control , Adenoma/tratamiento farmacológicoRESUMEN
The intricate relationship between the gastrointestinal (GI) microbiome and the progression of chronic non-communicable diseases underscores the significance of developing strategies to modulate the GI microbiota for promoting human health. The administration of probiotics and prebiotics represents a good strategy that enhances the population of beneficial bacteria in the intestinal lumen post-consumption, which has a positive impact on human health. In addition, dietary fibers serve as a significant energy source for bacteria inhabiting the cecum and colon. Research articles and reviews sourced from various global databases were systematically analyzed using specific phrases and keywords to investigate these relationships. There is a clear association between dietary fiber intake and improved colon function, gut motility, and reduced colorectal cancer (CRC) risk. Moreover, the state of health is reflected in the reciprocal and bidirectional relationships among food, dietary antioxidants, inflammation, and body composition. They are known for their antioxidant properties and their ability to inhibit angiogenesis, metastasis, and cell proliferation. Additionally, they promote cell survival, modulate immune and inflammatory responses, and inactivate pro-carcinogens. These actions collectively contribute to their role in cancer prevention. In different investigations, antioxidant supplements containing vitamins have been shown to lower the risk of specific cancer types. In contrast, some evidence suggests that taking antioxidant supplements can increase the risk of developing cancer. Ultimately, collaborative efforts among immunologists, clinicians, nutritionists, and dietitians are imperative for designing well-structured nutritional trials to corroborate the clinical efficacy of dietary therapy in managing inflammation and preventing carcinogenesis. This review seeks to explore the interrelationships among dietary antioxidants, dietary fiber, and the gut microbiome, with a particular focus on their potential implications in inflammation and cancer.
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Antioxidantes , Fibras de la Dieta , Microbioma Gastrointestinal , Inflamación , Neoplasias , Humanos , Fibras de la Dieta/metabolismo , Microbioma Gastrointestinal/efectos de los fármacos , Inflamación/metabolismo , Neoplasias/prevención & control , Neoplasias/etiología , Neoplasias/microbiología , Animales , Probióticos/administración & dosificación , Suplementos Dietéticos , Neoplasias Colorrectales/microbiología , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/metabolismoRESUMEN
SIGNIFICANCE: This study on the relationship between early life high BMI and the development of CRC reveals the role of high BMI during childhood and adolescence in the occurrence and progression of CRC. It suggests the importance of restoring normal weight or reducing weight in individuals with high BMI early in life for the prevention of colorectal cancer.
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Índice de Masa Corporal , Neoplasias Colorrectales , Humanos , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/patología , Femenino , Masculino , Adolescente , Adulto , Niño , Factores de Riesgo , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. METHODS: This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. RESULTS: This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. CONCLUSIONS: The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.
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Neoplasias Colorrectales , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/terapia , China , Detección Precoz del Cáncer/métodosRESUMEN
OBJECTIVE: Endogenous and exogenous hormonal factors have been associated with female breast, genital, and colorectal cancer risk. The aim of the present study is to conduct an evidence-based evaluation of the fraction of cancers attributable to and prevented by exogenous hormonal (i.e., combined oral contraceptives [COC] and combined estrogen-progestogen menopausal therapy [CEPMT]) and reproductive factors (i.e., parity and breastfeeding) in Italy. STUDY DESIGN: We calculated the population attributable and prevented fractions combining relative risks and prevalence of exposure in Italian women. Italian cancer incidence and mortality data were extracted from national sources and used to estimate the number of cancer cases and deaths attributable to reproductive factors and exogenous hormones in Italy in 2020. For long-term effects, a 20-year latency period was considered. RESULTS: COC were responsible for 4.4 % of breast and 10.9 % of cervical cancers in women aged 15-44, but also avoided 6.4 % of endometrial, 5.6 % of ovarian, and 2.9 % of colorectal cancers in women of all ages. Overall, COC use prevented 1174 cancer diagnoses and 577 cancer deaths. CEPMT caused 0.4 % of breast cancers at age 45-69. Low parity accounted for 8.1 %, 11.8 % and 15.5 % of breast, endometrial and ovarian cancers, respectively (6267 cases, 1796 deaths). Breastfeeding avoided 6.4 % of breast cancers (3775 cases, 897 deaths). CONCLUSIONS: Our analysis quantified the complex effects of hormonal and reproductive factors on cancer burden in Italian women.
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Neoplasias de la Mama , Humanos , Femenino , Italia/epidemiología , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Adulto Joven , Anticonceptivos Orales Combinados , Paridad , Lactancia Materna/estadística & datos numéricos , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/prevención & control , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Incidencia , Neoplasias/epidemiología , Neoplasias/prevención & control , Terapia de Reemplazo de Estrógeno/estadística & datos numéricos , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/prevención & control , Factores de Riesgo , Embarazo , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/prevención & controlRESUMEN
BACKGROUND: Raloxifene and bazedoxifene are selective estrogen receptor modulators (SERMs) used to prevent and treat osteoporosis in postmenopausal women. Raloxifene is also known for its preventive effect against invasive breast cancer; however, its effect on other cancer types is unclear. This study investigated the incidence of various cancers in osteoporosis patients receiving SERM therapy to determine its association with the risk of developing specific cancer types. METHODS: This retrospective cohort study examined the association between SERM use and the incidence of cervical, endometrial, ovarian, and colorectal cancers in postmenopausal women using data from the Korean National Health Insurance Service. Propensity score matching ensured group comparability by analyzing 95,513 participants. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the cancer risk associated with SERM therapy, differentiating between the effects of raloxifene and bazedoxifene. RESULTS: SERM therapy was associated with a reduced risk of cervical (adjusted HR = 0.47, 95% CI = 0.31-0.71), ovarian (adjusted HR = 0.61, 95% CI = 0.42-0.88), and colorectal cancer (adjusted HR = 0.49, 95% CI = 0.42-0.57). No significant risk reduction was observed for endometrial cancer (adjusted HR = 1.05, 95% CI = 0.70-1.59). A comparison between raloxifene and bazedoxifene revealed no significant differences in their cancer prevention effects. CONCLUSION: SERM therapy administration is associated with a decreased incidence of cervical, ovarian, and colorectal cancers. Notably, the effects of raloxifene and bazedoxifene were consistent. Further investigations are crucial to elucidate the mechanisms underlying these observations and their clinical implications.
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Neoplasias de la Mama , Moduladores Selectivos de los Receptores de Estrógeno , Humanos , Femenino , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Persona de Mediana Edad , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/prevención & control , Estudios Retrospectivos , Clorhidrato de Raloxifeno/uso terapéutico , Incidencia , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/prevención & control , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/prevención & control , Indoles/uso terapéuticoRESUMEN
BACKGROUND: Colorectal cancer (CRC) is a significant public health problem, including Morocco. The Mediterranean Diet (MD) has demonstrated potential anticancerogenic effects toward CRC in Northern Mediterranean countries. Using a Modified Mediterranean Diet (MMD) score adapted to southern countries, we investigated the relationship between adherence to the MD and the risk of CRC among the Moroccan population. MATERIAL AND METHODS: During the study, we recruited 395 cases matched with 395 controls by sex and age (± 3 years). Using an adapted Food Frequency Questionnaire, we assessed the dietary intakes of participants to calculate the MMD score. We estimated the odds ratio and 95% confidence interval for both basic and adjusted models to evaluate the relationship between adherence to the MD and the risk of CRC. RESULT: We observed a significant inverse association between adherence to the MD and CRC risk. In the adjusted model, moderate adherence to the MD was associated with 52% lower risk of CRC [odds ratio (OR*): 0.48 and 95% confidence interval (95% CI): 0.37-0.69], while high adherence to the MD was associated with 61% lower risk of CRC compared to the lowest category. When stratified by sex, both moderate [OR*: 0.36 (CI95%: 0.27-0.55)] and high [OR*: 0.43 (CI95%:0.27-0.74)] adherence were inversely correlated with CRC risk for women, while for men, only high adherence was inversely correlated with the risk of CRC [OR*: 0.3 (CI95%:0.19-0.5)]. CONCLUSION: Adherence to MD is associated with a decreased risk of CRC, an association that may be influenced by tumor location, sex, and age. Despite certain differences between northern and southern countries, the MD can be an effective preventative measure against CRC for populations in the Southern Mediterranean region.
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Neoplasias Colorrectales , Dieta Mediterránea , Humanos , Masculino , Femenino , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Estudios de Casos y Controles , Persona de Mediana Edad , Marruecos/epidemiología , Factores de Riesgo , Estudios de Seguimiento , Pronóstico , Adulto , Cooperación del Paciente/estadística & datos numéricos , AncianoRESUMEN
INTRODUCTION: Colorectal cancer (CRC) constitutes the third most frequently diagnosed cancer in Oman. This study report the result of a community based screening campaign to promote the early detection and explore the associated risk factors of CRC amongst Omani population. METHODS: We launched a colorectal cancer awareness campaign in Oman's South Ash Sharqiyah Governorate between January and March, 2023. We conducted a stratified random study including 688 adult Omani participants aged over 40 years old. Local Health Centers collected the questionnaire forms. Fecal occult blood tests (FOBTs) were carried out at Local Health Centers; while medical professionals performed the colonoscopy examination in Sur University Hospital. RESULTS: Overall, the screening response rate was 68.8%. The data indicated that 8.1% of the total sample yielded positive FOBTs; of whom, 85.7% were aged 40-59 years old and 67.9% were obese or overweight. Abnormal colonoscopy was reported in 7 participants. One participant had a confirmed CRC of stage I. CONCLUSION: Screening and early detection campaign can have effect and increase the rate of early detection among population in Oman.
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Colonoscopía , Neoplasias Colorrectales , Detección Precoz del Cáncer , Sangre Oculta , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Masculino , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Persona de Mediana Edad , Femenino , Omán/epidemiología , Adulto , Colonoscopía/estadística & datos numéricos , Factores de Riesgo , Tamizaje Masivo/métodos , Conocimientos, Actitudes y Práctica en Salud , Pronóstico , Anciano , Estudios de Seguimiento , Encuestas y Cuestionarios , Promoción de la Salud/métodosRESUMEN
The human microbiome interacts with the host mainly in the intestinal lumen, where putrefactive bacteria are suggested to promote colorectal cancer (CRC). In contrast, probiotics and their isolated components and secreted substances, display anti-tumor properties due to their ability to modulate gut microbiota composition, promote apoptosis, enhance immunity, resist oxidation and alter metabolism. Probiotics help to form a solid intestinal barrier against damaging agents via altering the gut microbiota and preventing harmful microbes from colonization. Probiotic strains that specifically target essential proteins involved in the process of apoptosis can overcome CRC resistance to apoptosis. They can increase the production of anti-inflammatory cytokines, essential in preventing carcinogenesis, and eliminate cancer cells by activating T cell-mediated immune responses. There is a clear indication that probiotics optimize the antioxidant system, decrease radical generation, and detect and degrade potential carcinogens. In this review, the pathogenic mechanisms of pathogens in CRC and the recent insights into the mechanism of probiotics in CRC prevention and therapy are discussed to provide a reference for the actual application of probiotics in CRC.
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Neoplasias Colorrectales , Microbioma Gastrointestinal , Probióticos , Probióticos/uso terapéutico , Humanos , Neoplasias Colorrectales/microbiología , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/terapia , Apoptosis , Animales , Bacterias/metabolismoRESUMEN
BACKGROUND: Determining the effect of dietary factors on cancer is a crucial issue when accounting for the effect of other major risks, such as smoking and drinking. METHOD: A total of 15,563 adults from the Korean National Cancer Center Community Cohort were analyzed to determine and to compare the effect of dietary factors on stomach and colorectal cancer in overall and in the subgroup of non-smokers (or urinary cotinine concentrations <5 ng/mg) and non-drinkers with Cox proportional-hazard models. RESULTS: During the mean follow-up (13.7 years), 469 and 299 cases of stomach and colorectal cancer were identified, respectively. The preventive effect of vegetable, fish, and soybean/tofu intake on colorectal cancer was found in women after adjustment for smoking, drinking, BMI, and sociodemographic factors. In the subgroup analysis of non-smokers and non-drinkers, the effect on colorectal cancer was increased in women (≥1 time/week vs. almost never, vegetables: hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.13-0.69; fish: HR 0.46, 95% CI 0.26-0.83), and the fresh fish intake effect on stomach cancer was newly identified in men (HR 0.36, 95% CI 0.15-0.86). These effects were more pronounced and additionally shown in other dietary factors such as soybean or tofu in women and vegetables and fish in men, when subjects with <5 ng/mg urinary cotinine concentrations applied. CONCLUSION: The protective effect of healthy eating on the risk of stomach and colorectal cancer were different by smoking and drinking status. Rigorous control of smoking and drinking effects is necessary when measuring the effect of dietary factors on cancer, properly.
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Consumo de Bebidas Alcohólicas , Neoplasias Colorrectales , Dieta Saludable , Fumar , Neoplasias Gástricas , Humanos , Femenino , Masculino , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/prevención & control , Neoplasias Gástricas/etiología , Persona de Mediana Edad , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/etiología , República de Corea/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , Fumar/epidemiología , Fumar/efectos adversos , Fumar/orina , Adulto , Anciano , Factores de Riesgo , Estudios de Cohortes , Modelos de Riesgos ProporcionalesRESUMEN
Young-onset colorectal cancer is an increasing concern worldwide due to the growing prevalence of Westernized lifestyles in childhood and adolescence. Environmental factors during early life, particularly early-life nutrition, significantly contribute to the increasing incidence. Recently, there have been reports of beneficial effects, including anti-inflammation and anti-cancer, of a unique fungus (Antrodia camphorate, AC) native to Taiwan. The objective of this study is to investigate the impact of AC supplementation in early life on the development of young-onset intestinal tumorigenesis. APC1638N mice were fed with a high-fat diet (HF) at 4-12 weeks of age, which is equivalent to human childhood/adolescence, before switching to a normal maintenance diet for an additional 12 weeks up to 24 weeks of age, which is equivalent to young to middle adulthood in humans. Our results showed that the body weight in the HF groups significantly increased after 8 weeks of feeding (p < 0.05). Following a switch to a normal maintenance diet, the change in body weight persisted. AC supplementation significantly suppressed tumor incidence and multiplicity in females (p < 0.05) and reduced IGF-1 and Wnt/ß-catenin signaling (p < 0.05). Moreover, it altered the gut microbiota, suppressed inflammatory responses, and created a microenvironment towards suppressing tumorigenesis later in life.
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Carcinogénesis , Dieta Alta en Grasa , Suplementos Dietéticos , Microbioma Gastrointestinal , Animales , Microbioma Gastrointestinal/efectos de los fármacos , Femenino , Ratones , Masculino , Dieta Alta en Grasa/efectos adversos , Carcinogénesis/efectos de los fármacos , Polyporales , Ratones Endogámicos C57BL , Vía de Señalización Wnt/efectos de los fármacos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Neoplasias Colorrectales/prevención & control , Modelos Animales de Enfermedad , Proteína de la Poliposis Adenomatosa del Colon/genéticaRESUMEN
The resistance of colorectal cancer (CRC) to conventional therapeutic modalities, such as radiation therapy and chemotherapy, along with the associated side effects, significantly limits effective anticancer strategies. Numerous epigenetic investigations have unveiled that naturally occurring stilbenes can modify or reverse abnormal epigenetic alterations, particularly aberrant DNA methylation status, offering potential avenues for preventing or treating CRC. By modulating the activity of the DNA methylation machinery components, phytochemicals may influence the various stages of CRC carcinogenesis through multiple molecular mechanisms. Several epigenetic studies, especially preclinical research, have highlighted the effective DNA methylation modulatory effects of stilbenes with minimal adverse effects on organisms, particularly in combination therapies for CRC. However, the available preclinical and clinical data regarding the effects of commonly encountered stilbenes against CRC are currently limited. Therefore, additional epigenetic research is warranted to explore the preventive potential of these phytochemicals in CRC development and to validate their therapeutic application in the prevention and treatment of CRC. This review aims to provide an overview of selected bioactive stilbenes as potential chemopreventive agents for CRC with a focus on their modulatory mechanisms of action, especially in targeting alterations in DNA methylation machinery in CRC.
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Neoplasias Colorrectales , Metilación de ADN , Estilbenos , Humanos , Metilación de ADN/efectos de los fármacos , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/genética , Estilbenos/farmacología , Epigénesis Genética , Animales , Fitoquímicos/farmacología , Fitoquímicos/uso terapéuticoAsunto(s)
Neoplasias Colorrectales , Sigmoidoscopía , Humanos , Masculino , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer/métodos , Conducta de Reducción del Riesgo , Persona de Mediana EdadRESUMEN
BACKGROUND: Persons with diabetes have 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from priority health disparities populations. Federally qualified health centers (FQHCs) struggle to implement CRC screening programs for average risk patients. Strategies to effectively prioritize and optimize CRC screening for patients with diabetes in the primary care safety-net are needed. METHODS: Guided by the Exploration, Preparation, Implementation and Sustainment Framework, we conducted a stakeholder-engaged process to identify multi-level change objectives for implementing optimized CRC screening for patients with diabetes in FQHCs. To identify change objectives, an implementation planning group of stakeholders from FQHCs, safety-net screening programs, and policy implementers were assembled and met over a 7-month period. Depth interviews (n = 18-20) with key implementation actors were conducted to identify and refine the materials, methods and strategies needed to support an implementation plan across different FQHC contexts. The planning group endorsed the following multi-component implementation strategies: identifying clinic champions, development/distribution of patient educational materials, developing and implementing quality monitoring systems, and convening clinical meetings. To support clinic champions during the initial implementation phase, two learning collaboratives and bi-weekly virtual facilitation will be provided. In single group, hybrid type 2 effectiveness-implementation trial, we will implement and evaluate these strategies in a in six safety net clinics (n = 30 patients with diabetes per site). The primary clinical outcomes are: (1) clinic-level colonoscopy uptake and (2) overall CRC screening rates for patients with diabetes assessed at baseline and 12-months post-implementation. Implementation outcomes include provider and staff fidelity to the implementation plan, patient acceptability, and feasibility will be assessed at baseline and 12-months post-implementation. DISCUSSION: Study findings are poised to inform development of evidence-based implementation strategies to be tested for scalability and sustainability in a future hybrid 2 effectiveness-implementation clinical trial. The research protocol can be adapted as a model to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT05785780) on March 27, 2023 (last updated October 21, 2023).
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Neoplasias Colorrectales , Diabetes Mellitus , Detección Precoz del Cáncer , Proveedores de Redes de Seguridad , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer/métodos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Atención Primaria de Salud , Estados Unidos/epidemiologíaRESUMEN
Objectives. To identify nationwide census tractâlevel areas where improving colorectal cancer (CRC) screening uptake via targeted local preventive intervention may benefit Hispanic or Latino/a (H/L) groups defined by region or country of origin. Methods. Using 2021 Centers for Disease Control and Prevention PLACES and American Community Survey data, we applied geographically weighted regression and Getis-Ord Gi* hot spot procedures to identify CRC screening priority zones for H/L groups in the United States. Priority zones can be conceptualized as census tracts with strong inverse associations between percentage of a particular H/L group in the population and CRC screening rate, after adjusting for socioeconomic deprivation and lack of insurance. Results. We identified 6519, 3477, 3522, 1069, and 1424 census tract CRC screening priority zones for H/L communities of Mexican, Puerto Rican, Central/South American, Dominican, and Cuban heritage, respectively. Priority zones for H/L groups had strong spatial heterogeneity, and overlap of geographic patterns among H/L groups varied by region. Conclusions. Our findings and interactive web map may serve as a translational tool for public health authorities, policymakers, clinicians, and other stakeholders to target investment and interventions to increase guideline-concordant CRC screening uptake benefitting specific H/L communities in the United States. (Am J Public Health. 2024;114(S6):S515-S524. https://doi.org/10.2105/AJPH.2024.307733) [Formula: see text].
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Hispánicos o Latinos , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/etnología , Hispánicos o Latinos/estadística & datos numéricos , Estados Unidos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Factores Socioeconómicos , Tamizaje Masivo/estadística & datos numéricosRESUMEN
In this editorial, we comment on the article entitled "Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?" by Agatsuma et al. Colorectal cancer (CRC) is emerging as an important health issue as its incidence continues to rise globally, adversely affecting the quality of life. Although the public has become more aware of CRC prevention, most patients lack screening awareness. Some poor lifestyle practices can lead to CRC and symptoms can appear in the early stages of CRC. However, due to the lack of awareness of the disease, most of the CRC patients are diagnosed already at an advanced stage and have a poor prognosis.
Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer/métodos , Calidad de Vida , Estadificación de Neoplasias , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Pronóstico , Colonoscopía , Incidencia , Conocimientos, Actitudes y Práctica en Salud , Estilo de VidaRESUMEN
In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology. They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.
Asunto(s)
Colonoscopía , Neoplasias Colorrectales , Detección Precoz del Cáncer , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/sangre , Sangre Oculta , Heces/química , Adenoma/diagnóstico , Adenoma/prevención & controlRESUMEN
After five years of deployment, the participation rate in the Vaud colorectal cancer (CRC) screening program remains below projected targets. It was found that the communication tools made available to the population did not provide explicit recommendations regarding how to participate. To this end, Unisanté led a project between 2022 and 2023 to increase awareness and widely disseminate tools specifically designed with the target population. The intention was to provide decision-support tools (I decide to participate) and guidance in the system (in what way) to improve participation by the population targeted by the Vaud CRC screening program. This project incorporated the principles of proportionate universalism, that is to say, adapting screening methods to the specific needs of population sub-groups, such as those in a disadvantaged socio-economic position with low or very low levels of health literacy.
À l'issue de cinq années de déploiement, le taux de participation de la population au programme vaudois de dépistage du cancer colorectal (CCR) s'est révélé en dessous des objectifs souhaités Afin de faciliter une décision de participation, un projet global a été conçu par Unisanté entre 2022 et 2023, dont la finalité était de déployer des actions spécifiques de sensibilisation et de mettre à disposition de la population cible des informations d'une très large accessibilité. L'intention était de disposer d'outils d'aide à la décision (je décide à participer) et d'orientation dans le dispositif (de quelle manière) permettant d'amplifier la participation de la population ciblée par le programme vaudois de dépistage du CCR. Ce projet a permis d'adapter la sensibilisation sur les modalités de dépistage aux populations avec un niveau de littératie en santé faible, voire très faible.