Colorectal Cancer Screening An Issue of Gastrointestinal Endoscopy Clinics

1st Edition, Volume 30-3 - May 22, 2020
Editor: Douglas K. Rex
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 3 3 3 8 - 0
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 3 3 3 9 - 7

Together with Consulting Editor, Dr. Charles Lightdale, Dr. Doug Rex has put together an issue of Gastrointestinal Endoscopy Clinics that provides state-of-the-art clinical… Read more

Colorectal Cancer Screening An Issue of Gastrointestinal Endoscopy Clinics

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Together with Consulting Editor, Dr. Charles Lightdale, Dr. Doug Rex has put together an issue of Gastrointestinal Endoscopy Clinics that provides state-of-the-art clinical coverage of colorectal screening. Expert authors from all over the world have contributed clinical reviews that will be a staple for all practicing endoscopists. The articles are devoted to the following topics: What is organized screening and what is its value; Screening decisions in the opportunistic setting; The National Colorectal Cancer Round Table: Past performance and current and future goals; Proven strategies for increasing screening adherence; Colorectal cancer in persons under age 50: Seeking causes and solutions; Risk stratification strategies: From logistic regression to artificial intelligence; Cost-effectiveness of current screening tests; Quality in colorectal cancer screening; Screening for the serrated pathway; FIT: The world’s colorectal cancer screening test; Fecal DNA testing: What has it accomplished and where is it headed; Is bowel preparation without complete colon clearing a viable concept: Update on flexible sigmoidoscopy, CTC, and capsule colonoscopy; Evidenced based screening strategies for a positive family history; Aspirational ADR and ideal colonoscopy performance: How long can we go between colonoscopies; and How Artificial Intelligence will impact colonoscopy and colorectal cancer screening. Readers will come away with the clinical knowledge they need to improve outcomes in colon cancer screening and prevention.

Cover image
Title page
Table of Contents
Copyright
Contributors
Gastrointestinal Endoscopy Clinics of North America
Proven Strategies for Increasing Adherence to Colorectal Cancer Screening
Key points
Introduction
Interventions to increase adherence
General categories of evidence-based interventions applicable for all screening modalities
Interventions to increase adherence, by screening modality
Fecal occult blood test
Cologuard
Computed tomographic colonography
What Is Organized Screening and What Is Its Value?
Key points
Introduction
Organized screening defined
Identifying the population at risk
How to offer screening and interventions to improve uptake of screening
Special considerations for fecal immunochemical test: adjusting cutoffs and ensuring follow-up
Assuring appropriate surveillance
Quality assurance in screening programs
Testing new screening modalities
Value of organized screening
Summary
Colorectal Cancer Screening Decisions in the Opportunistic Setting
Key points
Introduction
Frameworks for discussing screening
Overview of widely used screening tests in the United States
Flexible sigmoidoscopy
Colonoscopy
Fecal immunochemical test
Fecal immunochemical test–fecal DNA stool test
Big picture for opportunistic screening
Islands of resistance
How to maximize opportunistic screening
Risk Stratification Strategies for Colorectal Cancer Screening: From Logistic Regression to Artificial Intelligence
Key points
Introduction
Risk stratification
Selected modeling techniques for risk prediction
Barriers to use of risk prediction models
Agenda for research
Colorectal Cancer in Persons Under Age 50: Seeking Causes and Solutions
Key points
Introduction
Definitions
Epidemiology
Clinical and pathologic features
Causes of early onset colorectal cancer
Potential etiologies for the rise in early onset colorectal cancer
Approaches to addressing disease burden of early onset colorectal cancer
Summary
Colorectal Cancer Screening for the Serrated Pathway
Key points
Introduction
Summary
Cost-Effectiveness of Current Colorectal Cancer Screening Tests
Key points
Conceptual framework
What is a “cost-effective” intervention?
Effectiveness first, cost-effectiveness second
Long-term comparative effectiveness: modeling
Cost-effectiveness of established colorectal cancer screening tests
Payer perspective: commercial insurance versus Medicare in the United States
Participation rates and programmatic costs: the cost of uptake and adherence
Total budge impact
Current debate 1: average-risk screening starting at age 45 years in the United States
Current debate 2: tailored screening based on predicted colorectal cancer risk
Summary
The National Colorectal Cancer Roundtable: Past Performance, Current and Future Goals
Key points
Introduction
Creation of the National Colorectal Cancer Roundtable
Early National Colorectal Cancer Roundtable initiatives: 2002 to 2005
Building block phase: 2006 through 2012
National Colorectal Cancer Roundtable site visits
Evolution of the task groups
Establishing the foundation for a unified campaign
National Colorectal Cancer Roundtable growth and expansion: 2012 to 2018
The National Colorectal Cancer Roundtable today
Fecal Immunochemical Test: The World’s Colorectal Cancer Screening Test
Key points
Introduction
Principles of the fecal immunochemical test, including fecal immunochemical test types and performance
Application of fecal immunochemical testing from patient and program perspectives
Current use of fecal immunochemical testing in organized screening programs and estimates of effectiveness
Future of fecal immunochemical testing
Summary
The Case for High-Quality Colonoscopy Remaining a Premier Colorectal Cancer Screening Strategy in the United States
Key points
Introduction
Potential technical disruptions to screening colonoscopy
Advantages and disadvantages of colonoscopy as a screening strategy
Evidence that screening colonoscopy effectively reduces colorectal cancer and right-sided colon cancer
Potential routes to improved effectiveness and cost-effectiveness of screening colonoscopy
Summary
Quality in Colorectal Cancer Screening with Colonoscopy
Key points
Introduction
Methodology
Preprocedure indicators
Intraprocedure quality indicators for colorectal cancer screening/surveillance with colonoscopy
Postprocedure quality indicators for colorectal cancer screening/surveillance with colonoscopy
Quality indicators for colonoscopy and malpractice claims
Summary
Multitarget Stool DNA for Average Risk Colorectal Cancer Screening: Major Achievements and Future Directions
Key points
Introduction: colorectal cancer screening saves lives but is underused
Preclinical evidence and biological rationale support noninvasive screening by stool DNA
High sensitivity and specificity in screening study support US Food and Drug Administration and Centers for Medicare and Medicaid Services approval
A second screening study and favorable benefits to harms support US Preventative Services Task Force endorsement
Clinical multitarget stool DNA testing use is rapidly increasing and attracting new colorectal cancer screening participation
Multitarget stool DNA testing has a high positive predictive value in clinical practice
Discordant multitarget stool DNA testing and colonoscopy: avoid further testing
Multitarget stool DNA testing is a cost-effective test for colorectal cancer prevention
US Food and Drug Administration approval of multitarget stool DNA testing has been expanded to younger patients
Next-generation multitarget stool DNA testing shows high specificity
Summary
Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy
Key points
Introduction
Flexible sigmoidoscopy
Computed tomography colonography
Colon capsule endoscopy
Summary
How Artificial Intelligence Will Impact Colonoscopy and Colorectal Screening
Key points
Introduction
Artificial intelligence promotes value in colorectal cancer screening and surveillance
Integration into clinical processes directly affects adoption of machine learning products
Machine learning products require rigorous validation
Machine learning products face regulatory, legal, and ethical challenges
Data labeling is a key limitation to developing and maintaining machine learning products
Future directions
Evidenced-Based Screening Strategies for a Positive Family History
Key points
Introduction
Identifying high-risk patients with a positive family history
Risk in individuals with a positive family history of colorectal cancer
Additional factors that influence risk in individuals with a positive family history of colorectal cancer
Risk in individuals with a positive family history of advanced adenomas
Current screening guidelines for positive family history
Evidence that earlier screening is effective in those with a family history
International approaches to family-based colorectal cancer screening
Cost-effectiveness of screening in those with family history
Barriers to use of family cancer history in practice
Impact of family history on the increase of early-onset colorectal cancer
Future directions

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Douglas K. Rex