11 research outputs found
The effect of a supplementary ('gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial.
No full textGuided by Fuzzy Trace Theory, this study examined the impact of a 'Gist-based' leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants' numerical ability. Adults aged 45-59 years from four UK general practices were randomly assigned to receive standard information ('The Facts', n = 2,216) versus standard information plus 'The Gist' leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The 'Gist + Facts' group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest 'The Gist' leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected
Protein biomarkers in exfoliated cells collected from the human rectal mucosa: implications for colorectal disease detection and monitoring
No full textThe development and testing of a brief ('gist-based') supplementary colorectal cancer screening information leaflet.
No full textTo design and user-test a 'gist-based' colorectal cancer screening information leaflet, which promotes comprehension of the screening offer
How do people interpret information about colorectal cancer screening: observations from a think-aloud study
No full textThe English NHS Bowel Cancer Screening Programme biennially invites individuals aged 60-74 to participate in screening. The booklet, 'Bowel Cancer Screening: The Facts' accompanies this invitation. Its primary aim is to inform potential participants about the aims, advantages and disadvantages of colorectal cancer screening
Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England
No full textAbstract PR-01: Inequalities in colorectal cancer screening uptake: Results from the first 2.6 million invitations in the organized screening program in the U.K
No full textAbstract
Background: An organized, population-based colorectal cancer (CRC) screening program was initiated in England in 2006, offering biennial Fecal Occult Blood testing (FOBt) to adults aged 60 to 69 years, with abnormal results followed up by colonoscopy. Because organized programs use population records to contact all eligible adults by mail, and there are no costs associated with screening or follow-up in the UK National Health Service, barriers to access for lower SES groups should be minimized. However, socioeconomic (SES) differences have been observed across a range of early detection behaviors, making it important to monitor the implementation of a new screening program. The aim of this analysis was to identify the extent of inequalities in uptake by SES, ethnic diversity, gender, and age in the English screening program.
Methods: Between October 2006 and January 2009, over 2.6 million adults aged 60-69 years were mailed a first FOBt kit by one of the five regional “Hubs.” Area-level SES was indexed with a composite indicator (the Index of Multiple Deprivation) based on census-derived indicators of income, education, employment, environment, and housing for each postcode sector (containing an average of 3,000 addresses). Area-level ethnic diversity was based on the proportion of nonwhite residents in each postcode sector. Gender and age data were obtained from the Hubs. Screening uptake was defined as return of a test kit within 13 weeks, recorded by the Hub. We used multivariate generalized linear regression to examine variation in uptake by deprivation, ethnicity, gender, and age.
Results: Over the study period, 2,658,859 FOBt kits were mailed out, of which 54% were returned. Uptake rates showed a linear gradient across quintiles of deprivation, ranging from 35% in the most deprived quintile to 61% in the least deprived. Multivariate analyses confirmed a significant independent effect of deprivation after adjusting for ethnicity, gender, age and Hub. The association between deprivation and uptake was stronger in women and older people. The most ethnically diverse quintile of areas also had lower uptake rates (38%) than other areas (52% to 58%), independent of SES, age, gender, and Hub. Ethnic disparities were more pronounced in men but equivalent across age groups. More women than men returned a kit (56% vs. 51%). Uptake increased with age in men (49% at 60-64 years; 53% at 65-69 years) but not in women (57% vs. 56%).
Conclusion: Uptake of FOBt in the new national CRC screening program in England is encouraging, but these results demonstrate that even though organized programs provide equitable delivery of the opportunity to screen, they do not eradicate inequalities in uptake. The lower uptake associated with ethnic diversity was apparent only in the most diverse quintile, which predominantly comprised inner city areas. In contrast, SES inequalities not only meant dramatically reduced uptake in the most deprived quintile but also showed a linear gradient in uptake across the entire SES spectrum. Reducing inequalities in uptake will require understanding how SES influences screening decision making. Organized programs do not obviate the need for action to promote equality of uptake if they are to avoid creating increased inequalities in cancer mortality.
Citation Information: Cancer Prev Res 2010;3(12 Suppl):PR-01.</jats:p
The Impact of Diet-Induced Weight Loss on Biomarkers for Colorectal Cancer: An Exploratory Study (INTERCEPT)
No full textObjective: The aim of this study was to explore the potential effects of diet-induced weight loss on molecular biomarkers of colorectal cancer risk in serum and colorectal tissue. Methods: This single-arm exploratory study included 20 adults with BMI ≥ 30 kg/m2 completing an 8-week, complete, low-energy liquid diet. Pre- and postintervention anthropometric measurements, fasting blood draws, and endoscopic examinations to procure colorectal biopsies were performed. Fasting insulin, glucose, insulinlike growth factor 1 (IGF-1), C-reactive protein (CRP), and blood lipids were measured in serum, and tissue markers of apoptosis (M30), colonocyte proliferation (Ki-67), and insulin signaling (phospho-mTOR) were assessed using immunohistochemical staining. Results: Participants achieved substantial weight loss (mean = 13.56%). Mean concentrations of insulin, glucose, and cholesterol were significantly reduced (P < 0.05), but IGF-1 and CRP were not. Colorectal tissue expression of Ki-67 was significantly reduced (preintervention mean score = 7, postintervention mean score = 3.9, mean % change −43.8; P = 0.027). There were no significant changes in M30 or phospho-mTOR. Conclusions: Weight loss in individuals with obesity was associated with improvements in insulin sensitivity and blood lipid profiles and a significant reduction in tissue Ki-67 expression. This is one of the first studies to demonstrate potential cancer-relevant changes in colorectal tissue following weight loss achieved through diet
Mural Crohn disease:correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation at histologic examination--pilot study
No full textTo determine mural perfusion dynamics in Crohn disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to correlate these with histopathologic markers of inflammation and angiogenesis
NEOPRISM-CRC: Neoadjuvant pembrolizumab stratified to tumour mutation burden for high risk stage 2 or stage 3 deficient-MMR/MSI-high colorectal cancer.
No full textLBA3504 Background: The prognostic advantage of early stage deficient-MMR/MSI-High colorectal cancer (CRC) is lost after relapse. Hence, there is a clinical imperative to maximise the chance of cure in early-stage disease. Tumour mutation burden (TMB) is an emerging biomarker for response and clinical benefit to immunotherapy in the advanced setting. NEOPRISM-CRC (Neoadjuvant PembRolizumab In Stratified Medicine – ColoReCtal) is the first multicentre Phase II Trial to determine if neoadjuvant pembrolizumab is efficacious and safe, prospectively stratified to TMB. Methods: The trial population included patients (pts) with operable high-risk stage 2 or stage 3 dMMR/MSI-High CRC. Pts with tumours that were TMB high or medium (≥6 mutations/Mb on FoundationOneCDx test) received 3 cycles of pembrolizumab (200mg every 3 weeks) and underwent surgery within 4-6 weeks of last cycle. Pts with TMB low tumours (≤5 mutations/Mb) underwent surgery 4-6 weeks after 1 cycle of pembrolizumab. The primary end point was pathological complete response rate (pCR). Secondary endpoints included 3-year relapse free survival, overall survival, safety, and health-related quality of life. The trial also incorporated translational endpoints to explore relationships between possible predictive novel biomarkers and response to pembrolizumab in blood, tumour tissue and microbiome. We required 19 pts with TMB high or medium tumours to detect a pCR after 3 cycles of neoadjuvant pembrolizumab of 33% (minimum of 10%), with one-sided 5% significance level and 80% power (A’Hern single stage). The trial would be considered a success if ³5/19 of those pts achieved pCR. To achieve this number, we aimed to recruit 32 patients in total. Results: The trial opened on 20th July 2022 and 32 pts were rapidly enrolled. The pCR primary endpoint analysis was performed on 1st March 2024. The primary endpoint was exceeded with the pCR in the intent to treat pts (N=32) as well as the pCR in evaluable tumours shown in Table 1. Median TMB was 42 mutations/Mb (4-82). There was only 1 TMB low tumour and no TMB medium tumours. In the TMB high-medium cohort there were 32 evaluable resected tumours as 1 pt had 3 synchronous primaries, and 1 pt did not undergo surgery due to toxicity as well as pt choice. There were no immune-related toxicities >Grade 3. At a median follow-up of 6 months (range 2-15), no pts have had disease recurrence. Conclusions: Neoadjuvant pembrolizumab for early stage deficient-MMR/MSI-High CRC is highly efficacious and safe. Longer follow up is needed to assess relapse free survival and translational biomarker work is ongoing. Clinical trial information: NCT05197322
