Faculty Bibliography
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89
Assessing the impact of lowering the colorectal cancer screening age to 45 years
PMID: 32416860
ISSN: 2468-1253
CID: 4446602
Cumulative Burden of Colorectal Cancer-Associated Genetic Variants is More Strongly Associated With Early-onset vs Late-onset Cancer
BACKGROUND & AIMS/OBJECTIVE:Early-onset colorectal cancer (CRC, in persons younger than 50 years old) is increasing in incidence; yet, in the absence of a family history of CRC, this population lacks harmonized recommendations for prevention. We aimed to determine whether a polygenic risk score (PRS) developed from 95 CRC-associated common genetic risk variants was associated with risk for early-onset CRC. METHODS:We studied risk for CRC associated with a weighted PRS in 12,197 participants younger than 50 years old vs 95,865 participants 50 years or older. PRS was calculated based on single-nucleotide polymorphisms associated with CRC in a large-scale genome-wide association study as of January 2019. Participants were pooled from 3 large consortia that provided clinical and genotyping data: the Colon Cancer Family Registry, the Colorectal Transdisciplinary study, and the Genetics and Epidemiology of Colorectal Cancer Consortium and were all of genetically defined European descent. Findings were replicated in an independent cohort of 72,573 participants. RESULTS:). When we compared the highest with the lowest quartiles in this group, risk increased 4.3-fold for early-onset CRC (95% CI, 3.61-5.01) vs 2.9-fold for late-onset CRC (95% CI, 2.70-3.00). Sensitivity analyses were consistent with these findings. CONCLUSIONS:In an analysis of associations with CRC per standard deviation of PRS, we found the cumulative burden of CRC-associated common genetic variants to associate with early-onset cancer, and to be more strongly associated with early-onset than late-onset cancer-particularly in the absence of CRC family history. Analyses of PRS, along with environmental and lifestyle risk factors, might identify younger individuals who would benefit from preventative measures.
PMID: 31866242
ISSN: 1528-0012
CID: 4243992
Cancer prevention research (Philadelphia, Pa.). 2020:13(4):395-402.DOI: 10.1158/1940-6207.CAPR-19-0440
Low colorectal cancer screening uptake and persistent disparities in an underserved urban population
Colorectal cancer (CRC) screening has increased substantially in New York City in recent years. However, screening uptake measured by telephone surveys may not fully capture rates among underserved populations. We measured screening completion within one year of a primary care visit among previously unscreened patients in a large urban safety-net hospital and identified sociodemographic and health-related predictors of screening. We identified 21,256 patients aged 50-75 who were seen by primary care providers (PCPs) in 2014, of whom 14,425 (67.9%) were not up-to-date with screening. Since PCPs facilitate the majority of screening, we compared patients who received screening within one year of an initial PCP visit to those who remained unscreened using multivariable logistic regression. Among patients not up-to-date with screening at study outset, 11.5% (1,658 patients) completed screening within one year of a PCP visit. Asian race, more PCP visits, and higher area-level income were associated with higher screening completion. Factors associated with remaining unscreened included morbid obesity, ever smoking, Elixhauser comorbidity index of 0, and having Medicaid/Medicare insurance. Age, sex, language, and travel time to the hospital were not associated with screening status. Overall, 39.9% of patients were up-to-date with screening by 2015. In an underserved urban population, CRC screening disparities remain, and overall screening uptake was low. Since more PCP visits were associated with modestly higher screening completion at one year, additional community-level education and outreach may be crucial to increase CRC screening in underserved populations.
PMID: 32015094
ISSN: 1940-6215
CID: 4301272
Artificial Intelligence and Polyp Detection
PURPOSE OF REVIEW/OBJECTIVE:This review highlights the history, recent advances, and ongoing challenges of artificial intelligence (AI) technology in colonic polyp detection. RECENT FINDINGS/RESULTS:Hand-crafted AI algorithms have recently given way to convolutional neural networks with the ability to detect polyps in real-time. The first randomized controlled trial comparing an AI system to standard colonoscopy found a 9% increase in adenoma detection rate, but the improvement was restricted to polyps smaller than 10Â mm and the results need validation. As this field rapidly evolves, important issues to consider include standardization of outcomes, dataset availability, real-world applications, and regulatory approval. AI has shown great potential for improving colonic polyp detection while requiring minimal training for endoscopists. The question of when AI will enter endoscopic practice depends on whether the technology can be integrated into existing hardware and an assessment of its added value for patient care.
PMID: 31960282
ISSN: 1092-8472
CID: 4273832
Trends in Sociodemographic Disparities in Colorectal Cancer Staging and Survival: A SEER-Medicare Analysis
INTRODUCTION/BACKGROUND:Race, ethnicity, and socioeconomic status are known to influence staging and survival in colorectal cancer (CRC). It is unclear how these relationships are affected by geographic factors and changes in insurance coverage for CRC screening. We examined the temporal trends in the association between sociodemographic and geographic factors and staging and survival among Medicare beneficiaries. METHODS:We identified patients 65 years or older with CRC using the 1991-2010 Surveillance, Epidemiology, and End Results-Medicare database and extracted area-level sociogeographic data. We constructed multinomial logistic regression models and the Cox proportional hazards models to assess factors associated with CRC stage and survival in 4 periods with evolving reimbursement and screening practices: (i) 1991-1997, (ii) 1998-June 2001, (iii) July 2001-2005, and (iv) 2006-2010. RESULTS:We observed 327,504 cases and 102,421 CRC deaths. Blacks were 24%-39% more likely to present with distant disease than whites. High-income areas had 7%-12% reduction in distant disease. Compared with whites, blacks had 16%-21% increased mortality, Asians had 32% lower mortality from 1991 to 1997 but only 13% lower mortality from 2006 to 2010, and Hispanics had 20% reduced mortality only from 1991 to 1997. High-education areas had 9%-12% lower mortality, and high-income areas had 5%-6% lower mortality after Medicare began coverage for screening colonoscopy. No consistent temporal trends were observed for the associations between geographic factors and CRC survival. DISCUSSION/CONCLUSIONS:Disparities in CRC staging and survival persisted over time for blacks and residents from areas of low socioeconomic status. Over time, staging and survival benefits have decreased for Asians and disappeared for Hispanics.
PMCID:7145046
PMID: 32352722
ISSN: 2155-384x
CID: 4438612
Interventions to ensure follow-up of positive fecal immunochemical tests: An international survey of screening programs
PMID: 32054392
ISSN: 1475-5793
CID: 4304572
A Theory-based Educational Pamphlet With Low-residue Diet Improves Colonoscopy Attendance and Bowel Preparation Quality
GOALS/BACKGROUND/OBJECTIVE:Patients who "no-show" for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examinations for colorectal cancer (CRC) screening. Using the Health Belief Model, we modified an existing patient education pamphlet and evaluated its effect on nonattendance rates and bowel preparation quality. STUDY/METHODS:We implemented a color patient education pamphlet to target individual perceptions about CRC and changed bowel preparation instructions to include a low-residue diet instead of the previous clear liquid diet. We compared the nonattendance rate over a 2-month period before and after the introduction of the pamphlet, allowing for a washout period during which pamphlet use was inconsistent. We compared the Boston Bowel Preparation Scale (BBPS) in 100 consecutive patients who underwent colonoscopy during each of the 2 periods. RESULTS:Baseline characteristics between the 2 groups were similar, although patients who received the pamphlet were younger (P=0.03). The nonattendance rate was significantly lower in patients who received the pamphlet (13% vs. 21%, P=0.01). The percentage of patients with adequate bowel preparation increased from 82% to 86% after introduction of the pamphlet, although this was not statistically significant (P=0.44). The proportion of patients with a BBPS score of 9 was significantly higher in the pamphlet group (41% vs. 27%, P=0.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after pamphlet implementation. CONCLUSIONS:After implementing a theory-based patient education intervention with a low-residue diet, our absolute rate for colonoscopy nonattendance decreased by 8% and the proportion of patients with a BBPS score of 9 increased by 14%. The Health Belief Model appears to be a useful construct for CRC screening interventions.
PMID: 30439762
ISSN: 1539-2031
CID: 3457682
Low-residue diet for colonoscopy in veterans: Risk factors for inadequate bowel preparation and patient satisfaction and compliance
Bowel preparation with low-residue diet (LRD) has resulted in higher patient satisfaction and similar polyp detection rates compared to conventional clear liquid diet. However, there is limited experience with LRD in veterans, in whom conditions associated with poor bowel preparation are more prevalent than the general population. To examine risk factors associated with inadequate bowel preparation, we conducted a chart review of outpatient colonoscopies at the Manhattan VA Medical Center from February 2017 to April 2018. To examine patient satisfaction and compliance, we administered an anonymous questionnaire to patients undergoing outpatient colonoscopy from March to August 2018. Patients assessed by chart review (n = 660) were 92% male with a mean age of 64 years. An adequate Boston Bowel Preparation Scale score ≥2 in each colonic segment was achieved in 94% of procedures. Higher BMI, diabetes, prior inadequate bowel preparation, bowel preparation duration of two days, and opioid use were associated with inadequate bowel preparation on univariable analysis. On multiple logistic regression, only higher BMI remained a predictor, with every one-unit increase associated with a 6% increased odds of poor bowel preparation. Questionnaire responses showed 84% of patients were willing to repeat LRD bowel preparation, 85% found the process easy or acceptable, and 78% reported full adherence to LRD. These findings demonstrate that bowel preparation quality, patient satisfaction, and compliance were all high among veterans using LRD.
PMID: 32437378
ISSN: 1932-6203
CID: 4446982
American journal of gastroenterology. 2019:Conference:(2019).DOI: 10.14309/01.ajg.0000590732.75569.00
Predictors of colonoscopy use among Chinese Americans: An analysis of The New York City community health survey (2003-2016) [Meeting Abstract]
INTRODUCTION: Colorectal cancer (CRC) is a leading cause of cancer death among Asian Americans, who also have one of lowest rates of CRC screening. Chinese Americans are the largest Asian American subgroup in the United States (US), but there is a paucity of data examining predictors of CRC screening in this population. We used the New York City Community Health Survey (NYCCHS) to study factors associated with up-to-date colonoscopy use among Chinese Americans.
METHOD(S): The NYCCHS is an annual population-based telephone survey. For this analysis, we included all Chinese Americans aged >=50 years who participated in the survey from 2003-2016. We calculated up-to-date CRC screening uptake by colonoscopy, defined as colonoscopy within the last 10 years. To evaluate sociodemographic and medical predictors of colonoscopy use over four consecutive time periods, we entered age, sex, and any additional factors with P< 0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection.
RESULT(S): During the study period, 2,577 Chinese Americans were surveyed and 62.4% had received a colonoscopy within 10 years. On multivariable analysis, receiving a flu shot was the only consistent positive predictor of up-to-date colonoscopy use from 2009-2016 (OR 2.06-2.36, Table 1). Individuals without a primary care provider were less likely to have received a colonoscopy from 2003-2012 (OR 0.25-0.42), and the risk estimate remained consistent but was no longer statistically significant from 2015-2016. Similarly, being born outside of the US was associated with lower colonoscopy uptake from 2009-2014 (OR 0.06-0.22). Compared to never smokers, current but not former smokers were significantly less likely to have received up-to-date colonoscopy (OR 0.37 in 2003-2008; OR 0.16 in 2013-2014). Age, sex, borough of residence, and exercise activity were not consistent predictors of up-to-date colonoscopy uptake.
CONCLUSION(S): Among Chinese Americans older than age 50 living in NYC, those who had a primary care provider and received annual flu shots were most likely to be up-to-date with colonoscopy. Foreign-born Chinese Americans and current smokers were less likely to have received colonoscopy. These findings highlight the importance of primary care for CRC prevention and provide insight into the vulnerable populations within the Chinese American community
METHOD(S): The NYCCHS is an annual population-based telephone survey. For this analysis, we included all Chinese Americans aged >=50 years who participated in the survey from 2003-2016. We calculated up-to-date CRC screening uptake by colonoscopy, defined as colonoscopy within the last 10 years. To evaluate sociodemographic and medical predictors of colonoscopy use over four consecutive time periods, we entered age, sex, and any additional factors with P< 0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection.
RESULT(S): During the study period, 2,577 Chinese Americans were surveyed and 62.4% had received a colonoscopy within 10 years. On multivariable analysis, receiving a flu shot was the only consistent positive predictor of up-to-date colonoscopy use from 2009-2016 (OR 2.06-2.36, Table 1). Individuals without a primary care provider were less likely to have received a colonoscopy from 2003-2012 (OR 0.25-0.42), and the risk estimate remained consistent but was no longer statistically significant from 2015-2016. Similarly, being born outside of the US was associated with lower colonoscopy uptake from 2009-2014 (OR 0.06-0.22). Compared to never smokers, current but not former smokers were significantly less likely to have received up-to-date colonoscopy (OR 0.37 in 2003-2008; OR 0.16 in 2013-2014). Age, sex, borough of residence, and exercise activity were not consistent predictors of up-to-date colonoscopy uptake.
CONCLUSION(S): Among Chinese Americans older than age 50 living in NYC, those who had a primary care provider and received annual flu shots were most likely to be up-to-date with colonoscopy. Foreign-born Chinese Americans and current smokers were less likely to have received colonoscopy. These findings highlight the importance of primary care for CRC prevention and provide insight into the vulnerable populations within the Chinese American community
EMBASE:630841168
ISSN: 1572-0241
CID: 4314232
American journal of gastroenterology. 2019:Conference:(2019):S172-S174.DOI: 10.14309/01.ajg.0000590716.78248.56
Antibiotic use and risk of colorectal neoplasia: A systematic review and meta-analysis [Meeting Abstract]
INTRODUCTION: Colorectal cancer (CRC) is the third most prevalent cancer and the third leading cause of cancer death for women and men in the United States. There is emerging evidence that the gut microbiome plays a role in CRC development, and antibiotics are one of the most common exposures that can alter the gut microbiome. We performed a systematic review and meta-analysis to characterize the association between antibiotic use and colorectal neoplasia risk.
METHOD(S): We searched Pubmed, EMBASE, and Web of Science for articles describing the relationship between antibiotic exposure and colorectal neoplasia (cancer or adenoma) through October 2018. A total of 5342 citations were identified, which were reviewed independently by two investigators. After screening, we evaluated 15 articles and included 5 in the final analysis. We assessed the association between any antibiotic use as well as intensity of antibiotic use (defined as number of courses or duration of therapy) and colorectal neoplasia risk. Random effects metaanalysis was performed.
RESULT(S): Four studies provided five estimates for the association between any antibiotic use and risk of colorectal neoplasia. There was a 4% increased risk of neoplasia among individuals exposed to antibiotics (RR 1.04, 95% CI 1.02-1.07, Figure 1), with no evidence of heterogeneity (P=0.96, I2=0%). Five studies provided 13 estimates of the association between antibiotic intensity and colorectal neoplasia. Individuals with the highest intensity of antibiotic exposure had a 13% higher risk of colorectal neoplasia than those with lowest exposure (RR 1.13, 95% CI 1.06-1.21, Figure 2). However, significant heterogeneity was observed (P=0.04, I2=45%). Given the small number of studies, subgroup analyses on antibiotic class could not be performed.
CONCLUSION(S): Antibiotic exposure is associated with a subsequent increased risk of colorectal neoplasia. Furthermore, this relationship appears to be dose-dependent. Given the widespread use of antibiotics in childhood and early adulthood, additional research to further characterize this relationship is needed. (Figure Presented)
METHOD(S): We searched Pubmed, EMBASE, and Web of Science for articles describing the relationship between antibiotic exposure and colorectal neoplasia (cancer or adenoma) through October 2018. A total of 5342 citations were identified, which were reviewed independently by two investigators. After screening, we evaluated 15 articles and included 5 in the final analysis. We assessed the association between any antibiotic use as well as intensity of antibiotic use (defined as number of courses or duration of therapy) and colorectal neoplasia risk. Random effects metaanalysis was performed.
RESULT(S): Four studies provided five estimates for the association between any antibiotic use and risk of colorectal neoplasia. There was a 4% increased risk of neoplasia among individuals exposed to antibiotics (RR 1.04, 95% CI 1.02-1.07, Figure 1), with no evidence of heterogeneity (P=0.96, I2=0%). Five studies provided 13 estimates of the association between antibiotic intensity and colorectal neoplasia. Individuals with the highest intensity of antibiotic exposure had a 13% higher risk of colorectal neoplasia than those with lowest exposure (RR 1.13, 95% CI 1.06-1.21, Figure 2). However, significant heterogeneity was observed (P=0.04, I2=45%). Given the small number of studies, subgroup analyses on antibiotic class could not be performed.
CONCLUSION(S): Antibiotic exposure is associated with a subsequent increased risk of colorectal neoplasia. Furthermore, this relationship appears to be dose-dependent. Given the widespread use of antibiotics in childhood and early adulthood, additional research to further characterize this relationship is needed. (Figure Presented)
EMBASE:630840448
ISSN: 1572-0241
CID: 4314342
