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Colorectal Cancer: Risk Increases if Colonoscopy Is Delayed After Positive Fecal Test, Study Finds

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Colorectal Cancer: Risk Increases if Colonoscopy Is Delayed After Positive Fecal Test, Study Finds

For patients with a positive fecal immunochemical test, the risk for colorectal cancer increases if diagnostic colonoscopy is delayed beyond 6 months, according to new research.

“In breast cancer, there are quality mandates from the federal government that say how quickly patients should be seen for certain tests. Colorectal cancer has not had that,” said senior investigator Douglas Corley, MD, PhD, from Kaiser Permanente in Oakland, California.

This study provides “a solid evidence-based structure” to direct patients and physicians in this follow-up and for the development of guidelines, he told Medscape Medical News.

Results from the study will be presented by Christopher Jensen, PhD, also from Kaiser Permanente in Oakland, here at Digestive Disease Week 2016.

The fecal immunochemical test is commonly used for colorectal cancer screening. Positive tests require a diagnostic colonoscopy, but little is known about the consequences of various follow-up intervals.

To evaluate time to colonoscopy and the risk for adverse outcomes, the researchers retrospectively analyzed members of the Kaiser Permanente Northern California and Southern California health plans. They identified 71,439 patients 50 to 75 years of age with positive fecal immunochemical tests.

The analyses were adjusted for demographic characteristics, body mass index, geographic location, and screening history.

The risks for any colorectal cancer and for higher-stage disease were similar when follow-up colonoscopy was done 8 to 30 days, 31 to 60 days, 61 to 90 days, or 91 to 180 after a positive test.

However, when colonoscopy was done 181 to 365 days after a positive test, the risk for higher-stage colorectal cancer was elevated, as was the risk for and any colorectal cancer.

And when colonoscopy was done beyond 365 days, the risk for higher-stage colorectal cancers more than doubled, as did the risk for any colorectal cancer.

Table. Odds Ratios for Colorectal Cancer by Time to Colonoscopy

Time From Positive TestStage IIStage IIIStage IVAny Stage
181-365 days1.981.271.851.30
>365 days2.732.644.272.21

 

For patients 61 to 75 years of age with few comorbidities, risk was elevated when the colonoscopy was done 91 to 180 days after a positive result (OR, 1.76; 95% CI, 1.04 – 2.99). This subgroup of patients has a high age-related risk for colorectal cancer and is less likely to have a false-positive result on the fecal immunochemical test.

Ideally, colonoscopy should be done in the 6 months after a positive test, said Dr Corley. And for older people, it should be done in the 3 months after a positive test.

It makes sense that patients would undergo diagnostic colonoscopy as soon as possible after a positive fecal immunochemical test, but there are many factors that contribute to delays, Dr Corley explained.

“There is wide variation in reaction to positive fecal immunochemical tests. While some patients may be alarmed, others may view the need for colonoscopy as a burden in terms of bowel prep, time off work, and so forth,” he told Medscape Medical News.

In many places, the logistics of the healthcare system can also be a burden, and multiple contact points between patients, primary care physicians, and gastroenterologists can be required, Dr Corley said.

“Each step may take days to weeks, and cumulatively, between the positive test and completion of colonoscopy, a substantial amount of time can elapse. Along the way, there is always the potential for the next step not to happen,” he pointed out.

At Kaiser Permanente, the process speeds along because the fecal immunochemical test report is sent straight to the gastroenterology division, where the appointment is initiated.

“We try to take out the intermediate steps,” Dr Corley said. “A lot of other systems don’t have such processes in place, to get patients into colonoscopy sooner, because data showing the problem with delays have been lacking.”

This “important study” addresses an information gap, said Linda Rabeneck, MD, vice president of prevention and cancer control at Cancer Care Ontario, and professor of medicine, health policy, management, and evaluation at the University of Toronto.

“The findings are important for both organized colorectal cancer screening programs, such as the one at Kaiser Permanente, and a program such as ours in Ontario,” Dr Rabeneck told Medscape Medical News.

“In organized screening, we have the opportunity to measure the time interval between an abnormal stool test (fecal immunochemical or occult blood test) and receipt of colonoscopy. We set out targets and then measure and report on our performance against the targets,” she explained.

New information from this large study provides evidence-based guidance in terms of setting the targets for completion of colonoscopy after an abnormal test, she pointed out. If targets are consistently not met, other steps (such as navigation or timed appointments) can be introduced to address the performance gap, she said.

In opportunistic screening, the importance of timely follow-up colonoscopy is clear as well, Dr Rabeneck explained. However, it can be more challenging to measure the time interval and to address any performance gaps because the necessary infrastructure to collect and report the information might be lacking.

“Endoscopists in practice may want to prioritize access to colonoscopy to those with a positive stool test,” she said.

Entrepreneur, contributor, writer, and editor of Sostre News. With a powerful new bi-lingual speaking generation by his side, Sostre News is becoming the preferred site for the latest in Politics, Entertainment, Sports, Culture, Tech, Breaking and World News.

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Woman, 24, With Cervical Cancer Given Months to Live After Docs Refused Smear Test Because She was ‘Too Young’

A WOMAN was told that she was “too young” for a smear test – only to be given months to live when docs finally discovered she had cervical cancer.

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Woman, 24, With Cervical Cancer Given Months to Live After Docs Refused Smear Test Because She was ‘Too Young’

A WOMAN was told that she was “too young” for a smear test – only to be given months to live when docs finally discovered she had cervical cancer.

Katie Bourne started to suffer from belly pains, doctors assumed she had Crohn’s disease.

Then aged 24, docs refused to give her a smear test as she was too young.

Katie was finally diagnosed with stage-three cervical cancer back in February, when she was warned that unless she started treatment immediately, she’d only have 18 months left to live.

Katie told Teesside Live that all of her symptoms had pointed towards cervical cancer but that her referrals for smears were turned down because of her age.

She said she started to experience stomach pains in July last year and went her GP in November.

“They took some swabs and said I was booked in for a smear,” she told the site.

“But when I went back they said they weren’t going to do the smear and I was diagnosed with Crohn’s Disease.

“The pain never went with the medication they gave me for that.”

In fact, after her cancer was picked up, it turned out that there was nothing wrong with her bowel at all.

In February, Katie collapsed in pain at her job at Next and spent the next three nights in hospital – where she was denied a smear again.

Symptoms of cervical cancer

The devastating thing about cervical cancer is that there are no obvious symptoms during the early stages.

But vaginal bleeding can often be a tell-tale sign – especially if it occurs after sex, in between periods or after the menopause.

Women are offered smear tests from the age of 25 which look for any abnormalities in the cervix, but if you are under the age bracket, and you notice any of the following symptoms, you’ve got to push for testing.

Other warning signs include:

  • pain and discomfort during sex
  • unusual or unpleasant vaginal discharge
  • pain in your lower back or pelvis

And if it spreads to other organs, the signs can include:

  • pain in your lower back or pelvis
  • severe pain in your side or back caused by your kidneys
  • constipation
  • peeing or pooing more than usual
  • losing control of your bladder or bowels
  • blood in your pee
  • swelling in one or both legs
  • severe vaginal bleeding

“Because of my age I was still declined a smear and when the pains went they sent me home,” she said.

“My GP had sent two gynae referrals in the December and January but both were declined. All my symptoms have always been the same.

“And when I Googled them they always brought up cervical cancer.”

A third referral was accepted and a smear and scan confirmed Katie’s worst fears.

She was told that she had stage three cancer which had spread to both sides of her pelvis.

Katie began chemo last month, but docs don’t know how well she’ll respond to it yet.

Without treatment, her prognosis is just 18 months.

Now 25, she’s already set about making a bucket list.

Top of her list is marrying her partner of four years, Leighanne Prior.

The couple had planned to get hitched in Las Vegas in the next few years but following Katie’s diagnoses, they’ve decided to get wed next month at Middlesbrough Registry Office.

And in January, they’ll be honeymooning in the Maldives.

Another thing in the bucket list is to “finish all the Real Housewives series!”

Cheers For Smears

Fabulous has partnered with cervical cancer charity Jo’s Trust to launch #CheersForSmears, a campaign aiming to ensure women across the UK attend their screenings, no matter what.

With around 3,200 women in the UK now being diagnosed with the disease every year – a number that is set to rise by around 40% within 20 years – and one in three dying from it, it’s clear we’re facing a cervical cancer time bomb.

Many say they can’t get convenient appointments to fit around their jobs.

In many surgeries, smear tests are only available at certain times or days, making it difficult for some women to book an appointment.

That’s why #CheersForSmears is calling on GPs to offer more flexible screening times and make testing available outside of office hours and at weekends.

We also want employers to play their part in helping to ensure that their female employees can attend potentially life-saving cervical screenings if they are unable to get an appointment outside of working hours.

Help get your employer involved by emailing info@jostrust.org.uk.

Remember:

  • 5,000 women’s lives are saved a year in the UK by cervical screening
  • 3,000 women are diagnosed with cervical cancer each year
  • 99.8% of cervical cancer cases are preventable
  • 870 women die every year in the UK from cervical cancer
  • 1 in 142 UK females will be diagnosed with cervical cancer in their lifetime
  • 25-29 years peak rate of cervical cancer cases

Leighanne, 30, has taken time off work to help take care of Katie.

She told Teesside Live that because the pair have a young nephew and another one on the way, Katie is worried about whether they’ll remember her.

“But most of the time, she’s so positive, she’s been amazing.”

All women and people with a cervix are invited for smear tests every three years from the age of 25 to 64.

A smear test isn’t a test for cervical cancer, but detects changes in the cells of the cervix which can be a precursor to the disease.

Finding abnormal changes early means they can be monitored or treated, so they don’t become cervical cancer.

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6 Scientific Tricks to Help you Sleep

Do you have trouble sleeping? Don’t lie in bed and stress about it. These science-proven tricks will help you get to sleep faster…

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6 Scientific Tricks to Help you Sleep - Sostre News

Do you have trouble sleeping? Don’t lie in bed and stress about it. These science-proven tricks will help you get to sleep faster.

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“The Depravity of The Human Condition”

Driven with out love and purpose we lack the necessities to sustain human life. Through eyes of apathy homelessness is normalized as a chosen way of life…

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"The Depravity of The Human Condition"

 “The Human Condition”

 

Despondency, starvation and lack cover the face of the earth

Driven with out love and purpose we lack the necessities to sustain human life.

Through eyes of apathy homelessness is normalized as a chosen way of life.

Depravity corrupts moral character diminishing compassion, and mercy.

loss of love is loss of life, people crave acceptance, support, love. interpersonal

relationships are opportunities for growth, maturity, insight and wisdom .

life experiences shape and mold character, without the proper elements to support

human life, we are susceptible to diseases both physically and spiritually.

atrocities darken the mind, and its eternal perception to see the good things

in life. destroying hope and potential, enslaving the mind to incorrect ways of

thinking. influencing the degeneration of moral conduct. impacting relationships,

creating heart ache and pain. destroying the fabric of relationships critical to our

emotional well being, drastically affecting emotional health. broken relationships

cripple our capacity to love. a closed unresponsive heart destroys inner life. making

you a slave to your own pain, causing great distress and spiritual blindness. that binds

the spirit that hinders it from expressing itself freely. erosion of love is malignant cancer

to the human soul. our heart is the core of who we are, our heart controls are thoughts

and actions. the heart most be protected and guarded in order to preserve the inner life

within us  the very essence of our spirit. we must be  careful of what we allow to enter

our hearts, music. television, the types of books we read  will mold us over time . like  water

over rocks the heart is a well spring of life’s issues, acting as a compass leading us along the

path of our destiny. the home of the higher self  created in the image of God

 

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