Browsing by Subject "colorectal neoplasms"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Reviewing the Evidence That Polypectomy Prevents Cancer
    (Elsevier, 2019-10) Kahi, Charles J.; Medicine, School of Medicine
    Colonoscopic polypectomy is fundamental to effective prevention of colorectal cancer. Polypectomy reduces colorectal cancer incidence and mortality by altering the natural history and progression of precancerous precursor polyps. Epidemiologic data from the United States, where colorectal cancer rates have been steadily declining in parallel with screening efforts, provide indisputable evidence about the effectiveness of polypectomy. Randomized controlled trials of fecal occult blood tests and flexible sigmoidoscopy, and observational colonoscopy studies, provide additional support. Longitudinal studies have shown variable levels of protection after polypectomy, highlighting the central importance of high quality and adequate surveillance of higher-risk patients.
  • Thumbnail Image
    Item
    Specificity of the Multi-Target Stool DNA Test for Colorectal Cancer Screening in Average-Risk 45–49 Year-Olds: A Cross-Sectional Study
    (AACR, 2021-04) Imperiale, Thomas F.; Kisiel, John B.; Itzkowitz, Steven H.; Scheu, Bradley; Duimstra, Emma Kate; Statz, Sandra; Berger, Barry M.; Limburg, Paul J.; Medicine, School of Medicine
    High-specificity colorectal cancer screening is desirable to triage patients <50 years for colonoscopy; however, most endorsed colorectal cancer screening tests have not been rigorously evaluated in younger populations. This prospective cross-sectional study determined the specificity of the multitarget stool DNA (mt-sDNA) test in an average-risk screening population of 45 to 49 year-olds. Specificity was the primary outcome and was measured in participants without colorectal cancer or advanced precancerous lesions [APL– advanced adenomas (AA), and sessile serrated lesions ≥10 mm], and in the subgroup of participants with negative colonoscopic findings. APL sensitivity was a secondary outcome. The evaluable cohort included those who completed the study without protocol deviations and had a usable mt-sDNA test. Of 983 enrolled participants, 816 formed the evaluable cohort, with a mean age of 47.8 (SD, 1.5) years; 47.7% were women. No participants had colorectal cancer, 49 had APL, 253 had nonadvanced adenomas (NAA), and 514 had negative colonoscopic findings. mt-sDNA test specificity was 95.2% (95% CI, 93.4–96.6) in participants with NAA or negative findings [96.3% (confidence interval (CI), 94.3%–97.8%)] in those with negative findings, and did not differ by sex (P = 0.75) or race (P = 0.36) in participants with NAA or negative findings. Sensitivity for APL was 32.7% (CI, 19.9–47.5%), with most APL (83.7%) measuring 10–19 mm and none having high-grade dysplasia. The area under the ROC curve for discriminating between APL and lesser findings was 0.72 (CI, 0.64–0.81). mt-sDNA's high specificity would help minimize risk from unnecessary diagnostic procedures in this age group. This study shows that mt-sDNA has high specificity among average-risk 45 to 49-year olds, supporting its use as a noninvasive option for colorectal cancer screening.