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4. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication

Author

Von Karsa, L, Patnick, J, Segnan, N, Atkin, W, Halloran, S, Lansdorp Vogelaar, I, Malila, N, Minozzi, S, Moss, S, Quirke, P, Steele, Rj, Vieth, M, Aabakken, L, Altenhofen, L, Ancelle Park, R, Antoljak, N, Anttila, A, Armaroli, P, Arrossi, S, Austoker, J, Banzi, R, Bellisario, C, Blom, J, Brenner, H, Bretthauer, M, Camargo Cancela, M, Costamagna, Guido, Cuzick, J, Dai, M, Daniel, J, Dekker, E, Delicata, N, Ducarroz, S, Erfkamp, H, Espinàs, Ja, Faivre, J, Faulds Wood, L, Flugelman, A, Frkovic Grazio, S, Geller, B, Giordano, L, Grazzini, G, Green, J, Hamashima, C, Herrmann, C, Hewitson, P, Hoff, G, Holten, I, Jover, R, Kaminski, Mf, Kuipers, Ej, Kurtinaitis, J, Lambert, R, Launoy, G, Lee, W, Leicester, R, Leja, M, Lieberman, D, Lignini, T, Lucas, E, Lynge, E, Mádai, S, Marinho, J, Maučec Zakotnik, J, Minoli, G, Monk, C, Morais, A, Muwonge, R, Nadel, M, Neamtiu, L, Peris Tuser, M, Pignone, M, Pox, C, Primic Zakelj, M, Psaila, J, Rabeneck, L, Ransohoff, D, Rasmussen, M, Regula, J, Ren, J, Rennert, G, Rey, J, Riddell, Rh, Risio, M, Rodrigues, V, Saito, H, Sauvaget, C, Scharpantgen, A, Schmiegel, W, Senore, C, Siddiqi, M, Sighoko, D, Smith, R, Smith, S, Suchanek, S, Suonio, E, Tong, W, Törnberg, S, Villain, P, Van Cutsem, E., Costamagna, Guido (ORCID:0000-0002-8100-2731), Von Karsa, L, Patnick, J, Segnan, N, Atkin, W, Halloran, S, Lansdorp Vogelaar, I, Malila, N, Minozzi, S, Moss, S, Quirke, P, Steele, Rj, Vieth, M, Aabakken, L, Altenhofen, L, Ancelle Park, R, Antoljak, N, Anttila, A, Armaroli, P, Arrossi, S, Austoker, J, Banzi, R, Bellisario, C, Blom, J, Brenner, H, Bretthauer, M, Camargo Cancela, M, Costamagna, Guido, Cuzick, J, Dai, M, Daniel, J, Dekker, E, Delicata, N, Ducarroz, S, Erfkamp, H, Espinàs, Ja, Faivre, J, Faulds Wood, L, Flugelman, A, Frkovic Grazio, S, Geller, B, Giordano, L, Grazzini, G, Green, J, Hamashima, C, Herrmann, C, Hewitson, P, Hoff, G, Holten, I, Jover, R, Kaminski, Mf, Kuipers, Ej, Kurtinaitis, J, Lambert, R, Launoy, G, Lee, W, Leicester, R, Leja, M, Lieberman, D, Lignini, T, Lucas, E, Lynge, E, Mádai, S, Marinho, J, Maučec Zakotnik, J, Minoli, G, Monk, C, Morais, A, Muwonge, R, Nadel, M, Neamtiu, L, Peris Tuser, M, Pignone, M, Pox, C, Primic Zakelj, M, Psaila, J, Rabeneck, L, Ransohoff, D, Rasmussen, M, Regula, J, Ren, J, Rennert, G, Rey, J, Riddell, Rh, Risio, M, Rodrigues, V, Saito, H, Sauvaget, C, Scharpantgen, A, Schmiegel, W, Senore, C, Siddiqi, M, Sighoko, D, Smith, R, Smith, S, Suchanek, S, Suonio, E, Tong, W, Törnberg, S, Villain, P, Van Cutsem, E., and Costamagna, Guido (ORCID:0000-0002-8100-2731)

Abstract

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

Published
2013

5. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Author

Von Karsa, L., Patnick, J., Segnan, N., Atkin, W., Halloran, S., Lansdorp_Vogelaar, Iris, Malila, N., Minozzi, S., Moss, S., Quirke, P., Steele, R., Vieth, M., Aabakken, L., Altenhofen, L., Ancelle-Park, R., Antoljak, N., Anttila, A., Armaroli, P., Arrossi, S., Austoker, J., Banzi, R., Bellisario, C., Blom, J., Brenner, H., Bretthauer, M., Cancela, M., Costamagna, G., Cuzick, J., Dai, M., Daniel, J., Dekker, E., Delicata, N., Ducarroz, S., Erfkamp, H., Espinàs, J., Faivre, J., Wood, L., Flugelman, A., Frkovic-Grazio, S., Geller, B., Giordano, L., Grazzini, G., Green, J., Hamashima, C., Herrmann, C., Hewitson, P., Hoff, G., Holten, I., Jover, R., Kaminski, M., Kuipers, E., Kurtinaitis, J., Lambert, R., Launoy, G., Lee, W., Leicester, R., Leja, M., Lieberman, D., Lignini, T., Lucas, E., Lynge, E., Mádai, S., Marinho, J., Zakotnik, J., Minoli, G., Monk, C., Morais, A., Muwonge, R., Nadel, M., Neamtiu, L., Tuser, M., Pignone, M., Pox, C., Primic-Zakelj, M., Psaila, J., Rabeneck, L., Ransohoff, D., Rasmussen, M., Regula, J., Ren, J., Rennert, G., Rey, J., Riddell, R., Risio, M., Rodrigues, V., Saito, H., Sauvaget, C., Scharpantgen, A., Schmiegel, W., Senore, C., Siddiqi, M., Sighoko, D., Von Karsa, L., Patnick, J., Segnan, N., Atkin, W., Halloran, S., Lansdorp_Vogelaar, Iris, Malila, N., Minozzi, S., Moss, S., Quirke, P., Steele, R., Vieth, M., Aabakken, L., Altenhofen, L., Ancelle-Park, R., Antoljak, N., Anttila, A., Armaroli, P., Arrossi, S., Austoker, J., Banzi, R., Bellisario, C., Blom, J., Brenner, H., Bretthauer, M., Cancela, M., Costamagna, G., Cuzick, J., Dai, M., Daniel, J., Dekker, E., Delicata, N., Ducarroz, S., Erfkamp, H., Espinàs, J., Faivre, J., Wood, L., Flugelman, A., Frkovic-Grazio, S., Geller, B., Giordano, L., Grazzini, G., Green, J., Hamashima, C., Herrmann, C., Hewitson, P., Hoff, G., Holten, I., Jover, R., Kaminski, M., Kuipers, E., Kurtinaitis, J., Lambert, R., Launoy, G., Lee, W., Leicester, R., Leja, M., Lieberman, D., Lignini, T., Lucas, E., Lynge, E., Mádai, S., Marinho, J., Zakotnik, J., Minoli, G., Monk, C., Morais, A., Muwonge, R., Nadel, M., Neamtiu, L., Tuser, M., Pignone, M., Pox, C., Primic-Zakelj, M., Psaila, J., Rabeneck, L., Ransohoff, D., Rasmussen, M., Regula, J., Ren, J., Rennert, G., Rey, J., Riddell, R., Risio, M., Rodrigues, V., Saito, H., Sauvaget, C., Scharpantgen, A., Schmiegel, W., Senore, C., Siddiqi, M., and Sighoko, D.

Abstract

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. © Georg Thieme Verlag KG Stuttgart · New York.

Published
2013

6. alpha-Glucosidase inhibition (acarbose) fails to enhance secretion of glucagon-like peptide 1 (7-36 amide) and to delay gastric emptying in Type 2 diabetic patients

Author

Hücking, K, Kostic, Z, Pox, C, Ritzel, R, Holst, Jens Juul, Schmiegel, W, Nauck, M A, Hücking, K, Kostic, Z, Pox, C, Ritzel, R, Holst, Jens Juul, Schmiegel, W, and Nauck, M A

Abstract

AIM: Acarbose is able to enhance GLP-1 release and delay gastric emptying in normal subjects. The effect of alpha-glucosidase inhibition on GLP-1 has been less evident in Type 2 diabetic patients. The aim of this study was to investigate the possible influence of acarbose on GLP-1 release and gastric emptying in Type 2 diabetic patients after a mixed test meal.PATIENTS AND METHODS: Ten Type 2 diabetic patients were tested with 100 mg acarbose or placebo served with a mixed meal that was labelled with 100 mg 13C-octanoic acid. Plasma concentrations of glucose, insulin, C-peptide, glucagon, GLP-1 and GIP were determined over 6 h. Gastric emptying was measured by determining breath 13CO2 using infrared absorptiometry. Statistics repeated-measures anova.RESULTS: Gastric emptying rates (t1/2: 162 +/- 45 vs. 163 +/- 62 min, P = 0.65) and plasma concentrations (increasing from approximately 12 to approximately 25 pmol/l, P = 0.37) and integrated responses of GLP-1 (P = 0.37) were not changed significantly by acarbose treatment. Postprandial plasma glucose concentrations (P < 0.0001) and their integrated responses were lowered by acarbose (by 64%; P = 0.016). The plasma concentrations of insulin and C-peptide were reduced (P = 0.007 and 0.057, respectively) by acarbose, while glucagon was not changed (P = 0.96). GIP plasma concentrations (increasing with placebo from approximately 10 to approximately 85 pmol/l and with acarbose to approximately 55 pmol/l (P < 0.0001) and their integrated responses were significantly lowered (by 43%) by acarbose (P = 0.021). After 2 weeks of acarbose treatment (50 mg t.i.d. for the first and 100 mg t.i.d. for the second week, n = 6), similar results were found.CONCLUSIONS: In hyperglycaemic Type 2 diabetic patients, ingestion of acarbose with a mixed test meal failed to enhance GLP-1 release and did not influence gastric emptying.

Published
2005

9. Colorectal carcinoma [corrected] [published erratum appears in DTSCH ARZTEBL INT 2010 Feb 5;107(5):74].

Author

Schmiegel W, Pox C, Arnold D, Porschen R, Rödel C, and Reinacher-Schick A

Abstract

Background: Colorectal carcinoma (CRC) is the second most common type of cancer in Germany. In view of recent major changes in the diagnosis and treatment of CRC, the S3 guideline for CRC published in its full version in 2004 was partially updated in 2008 and again in 2009. Method: The literature was systematically searched for all articles published from 2004 onward concerning polyp management, (neo-)adjuvant treatment, and treatment of metastatic disease. Evidence-based recommendations were developed in a consensus conference. Results: For some patients who have undergone polypectomy, the time to follow-up with colonoscopy can be lengthened. In UICC stage III colon cancer, adjuvant chemotherapy with an oxaliplatin-based regimen is -recommended. In stage II colon cancer, adjuvant chemotherapy should be considered mainly when risk factors are present. In stages II and III, neo-adjuvant therapy should be given before resection in rectal cancer. In patients with metastatic disease, the use of all possible treatment options results in a median overall survival time of 24 months. In some patients with primarily non-resectable liver metastases, systemic treatment may enable a secondary, potentially curative resection. Therapeutic agents are chosen individually on the basis of clinical -factors including the goal of treatment, the patient's general condition, and tumor molecular markers. Conclusion: The S3 guideline contains evidence-based recommendations for the diagnosis and treatment of -colorectal carcinoma. Broad implementation of the guideline will be essential for improved patient care. [ABSTRACT FROM AUTHOR]

Published
2009
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10. Original article polymorphisms in CTNNBL1 in relation to colorectal cancer with evolutionary implications

Author

Huhn, S., Ingelfinger, D., Bermejo, J. L., Bevier, M., Pardini, B., Alessio Naccarati, Steinke, V., Rahner, N., Holinski-Feder, E., Morak, M., Schackert, H. K., Görgens, H., Pox, C. P., Goecke, T., Kloor, M., Loeffler, M., Büttner, R., Vodickova, L., Novotny, J., Demir, K., Cruciat, C. -M, Renneberg, R., Huber, W., Niehrs, C., Boutros, M., Propping, P., Vodička, P., Hemminki, K., and Försti, A.

Subjects
Selective pressure, Ancestral-susceptibility model, Case-control study, Colorectal cancer, CTNNBL1

11. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020

Author

Jaroslaw Regula, Antonio Z. Gimeno-García, Cesare Hassan, Enrique Quintero, Jeanin E. van Hooft, Jean-Marc Dumonceau, Stanislas Chaussade, Luigi Ricciardiello, Lise Mørkved Helsingen, Monika Ferlitsch, Arne Bleijenberg, Carlo Senore, Mette Kalager, Mário Dinis-Ribeiro, Matthew D. Rutter, Michael Bretthauer, Evelien Dekker, Giulio Antonelli, Rodrigo Jover, Maria Pellise, Christian Pox, Hassan C., Antonelli G., Dumonceau J.-M., Regula J., Bretthauer M., Chaussade S., Dekker E., Ferlitsch M., Gimeno-Garcia A., Jover R., Kalager M., Pellise M., Pox C., Ricciardiello L., Rutter M., Helsingen L.M., Bleijenberg A., Senore C., Van Hooft J.E., Dinis-Ribeiro M., and Quintero E.

Subjects
Adenoma, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Colonoscopy, Colonic Polyps, Endoscopy, Gastrointestinal, 03 medical and health sciences, 0302 clinical medicine, polypectomy, colonoscopy, colon cancer, adenomatous polyps, Medicine, Humans, Gastrointestinal endoscopy, medicine.diagnostic_test, business.industry, General surgery, Gastroenterology, Guideline, medicine.disease, Polypectomy, Endoscopy, Dysplasia, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business
Abstract

Main RecommendationsThe following recommendations for post-polypectomy colonoscopic surveillance apply to all patients who had one or more polyps that were completely removed during a high quality baseline colonoscopy. 1 ESGE recommends that patients with complete removal of 1 – 4 Strong recommendation, moderate quality evidence.If organized screening is not available, repetition of colonoscopy 10 years after the index procedure is recommended.Strong recommendation, moderate quality evidence. 2 ESGE recommends surveillance colonoscopy after 3 years for patients with complete removal of at least 1 adenoma ≥ 10 mm or with high grade dysplasia, or ≥ 5 adenomas, or any serrated polyp ≥ 10 mm or with dysplasia. Strong recommendation, moderate quality evidence. 3 ESGE recommends a 3 – 6-month early repeat colonoscopy following piecemeal endoscopic resection of polyps ≥ 20 mm.Strong recommendation, moderate quality evidence. A first surveillance colonoscopy 12 months after the repeat colonoscopy is recommended to detect late recurrence.Strong recommendation, high quality evidence. 4 If no polyps requiring surveillance are detected at the first surveillance colonoscopy, ESGE suggests to perform a second surveillance colonoscopy after 5 years. Weak recommendation, low quality evidence.After that, if no polyps requiring surveillance are detected, patients can be returned to screening. 5 ESGE suggests that, if polyps requiring surveillance are detected at first or subsequent surveillance examinations, surveillance colonoscopy may be performed at 3 years. Weak recommendation, low quality evidence.A flowchart showing the recommended surveillance intervals is provided (Fig. 1).

Published
2020

12. Colorectal Cancer After Screening Colonoscopy: 10-Year Incidence by Site and Detection Rate at First Repeat Colonoscopy.

Author

Schwarz S, Hornschuch M, Pox C, and Haug U

Subjects
Male, Humans, Female, Middle Aged, Aged, Incidence, Early Detection of Cancer, Colonoscopy, Mass Screening, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology
Abstract

Introduction: We aimed to describe cumulative colorectal cancer (CRC) incidence after screening colonoscopy stratified by tumor location, age, and sex as well as CRC detection rate at first repeat colonoscopy., Methods: Using the German Pharmacoepidemiological Research Database, we included persons with screening colonoscopy and assessed cumulative CRC incidence after baseline screening colonoscopy with snare polypectomy (cohort 1) and without polypectomy (cohort 2). We also determined the CRC detection rate at first repeat colonoscopy by time since screening colonoscopy., Results: Overall, 1,095,381 persons were included. The 10-year cumulative CRC incidence was 1.5% in cohort 1 and 0.6% in cohort 2. The proportion of proximal CRC increased with age: In women of cohort 1, 47% of CRCs in the age group 55-64 years were proximal (men: 42%) while in the age group 65-74 years, this proportion was 55% (men: 49%). In cohort 2, similar patterns were observed. In cohort 1, the CRC detection rate at first repeat colonoscopy among persons examined within 6-8 years after screening colonoscopy was more than twice as high compared with those examined within 4-6 years (1.7% vs 0.8%)., Discussion: Among persons followed up after screening colonoscopy, we observed a steadily increasing predominance of proximal CRC, and this shift showed distinct patterns by age and sex. Because our study suggests higher CRC detection rates among persons with a later repeat colonoscopy, the role of delayed surveillance and the benefit of a reminder system should be explored., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Published
2023
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13. Evidence-Based Follow-up for Adults With Cancer.

Author

Dührsen U, Deppermann KM, Pox C, and Holstege A

Subjects
Adult, Follow-Up Studies, Humans, Treatment Outcome, Neoplasms therapy
Abstract

Background: The objectives of follow-up care for cancer patients include psycho- social assistance and the detection of health problems. The concept of follow-up care rests on the assumption that the early detection of cancer recurrences and disease- or treatment-related complications is beneficial to patients. In this article, we provide an overview of the scientific evidence supporting current recommen- dations for the follow-up care of patients with colorectal cancer, lung cancer, and lymphoma., Methods: This review is based on pertinent publications that were retrieved by a selective search in PubMed, supplemented by the authors' own experience in patient care and guideline creation., Results: As recurrences usually arise soon after initial treatment, the recommended follow-up interval is shorter in the first two years (3-6 months) and longer thereafter (6-12 months). The question of which particular follow-up studies should be per- formed has only been systematically analyzed in a few cases. For patients with colorectal cancer, colonoscopy is the most important study. Intensive follow-up care is associated with a statistically non-significant increase in the survival rate compared to minimal follow-up care (77.5% versus 75.8%). Intensive diagnostic follow-up studies have been found to lead to a doubling of the frequency of operations for recurrence with curative intent, yet without any effect on the average survival time. The findings in lung cancer are similar. However, after tumor resection with curative intent, regularly repeated CT scanning leads to a survival advantage. In lymphoma patients, the longer the interval from primary treatment, the greater the likelihood of treatment-related secondary illnesses. It is not yet known how follow-up care should be provided to these patients in order to help them best., Conclusion: The evidence supporting the efficacy of currently recommended modalities of follow-up care for cancer patients is weak. Until more data from clinical studies become available, the current guidelines should be followed.

Published
2019
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14. Risk of Malignancy in Adenomas Detected During Screening Colonoscopy.

Author

Rösch T, Altenhofen L, Kretschmann J, Hagen B, Brenner H, Pox C, Schmiegel W, Theilmeier A, Aschenbeck J, Tannapfel A, von Stillfried D, Zimmermann-Fraedrich K, and Wegscheider K

Subjects
Aged, Aged, 80 and over, Disease Progression, Female, Germany epidemiology, Histocytochemistry, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Assessment, Adenoma pathology, Colonic Neoplasms pathology, Colonoscopy, Early Detection of Cancer, Neoplasms epidemiology
Abstract

Background & Aims: A higher incidence of proximal interval cancers after colonoscopy has been reported in several follow-up studies. One possible explanation for this might be that proximally located adenomas have greater malignant potential. The aim of the present study was to assess the risk of malignancy in proximal versus distal adenomas in patients included in a large screening colonoscopy database; adenoma shape and the patients' age and sex distribution were also analyzed., Methods: Data for 2007-2012 from the German National Screening Colonoscopy Registry, including 594,614 adenomas identified during 2,532,298 screening colonoscopies, were analyzed retrospectively. The main outcome measure was the rate of high-grade dysplasia (HGD) in adenomas, used as a surrogate marker for the risk of malignancy. Odds ratios (ORs) for the rate of HGD found in adenomas were analyzed in relation to patient- and adenoma-related factors using multivariate analysis., Results: HGD histology was noted in 20,873 adenomas (3.5%). Proximal adenoma locations were not associated with a higher HGD rate. The most significant risk factor for HGD was adenoma size (OR 10.36 ≥1 cm vs <1 cm), followed by patient age (OR 1.26 and 1.46 for age groups 65-74 and 75-84 vs 55-64 years) and sex (OR 1.15 male vs female). In comparison with flat adenomas as a reference lesion, sessile lesions had a similar HGD rate (OR 1.02) and pedunculated adenomas had a higher rate (OR 1.23). All associations were statistically significant (P ≤ .05)., Conclusions: In this large screening database, it was found that the rates of adenomas with HGD are similar in the proximal and distal colon. The presence of HGD as a risk marker alone does not explain higher rates of proximal interval colorectal cancer. We suggest that certain lesions (flat, serrated lesions) may be missed in the proximal colon and may acquire a more aggressive biology over time. A combination of endoscopy-related factors and biology may therefore account for higher rates of proximal versus distal interval colorectal cancer., (Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2018
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15. Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program.

Author

Brenner H, Altenhofen L, Kretschmann J, Rösch T, Pox C, Stock C, and Hoffmeister M

Subjects
Adenoma diagnosis, Adenoma pathology, Age Factors, Aged, Aged, 80 and over, Arabidopsis Proteins, Colorectal Neoplasms diagnosis, Early Detection of Cancer methods, Early Detection of Cancer statistics & numerical data, Female, Germany epidemiology, Humans, Male, Mass Screening methods, Mass Screening statistics & numerical data, Middle Aged, Nuclear Proteins, Prevalence, Risk Factors, Sex Factors, Time Factors, Adenoma epidemiology, Colonoscopy, Colorectal Neoplasms epidemiology, Early Detection of Cancer trends, Mass Screening trends
Abstract

Background & Aims: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program., Methods: We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry., Results: We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively., Conclusions: We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2015
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16. Colorectal carcinoma: the management of polyps, (neo)adjuvant therapy, and the treatment of metastases.

Author

Schmiegel W, Pox C, Arnold D, Porschen R, Rödel C, and Reinacher-Schick A

Subjects
Colorectal Neoplasms diagnosis, Colorectal Neoplasms secondary, Colorectal Neoplasms therapy, Germany, Humans, Colonic Polyps diagnosis, Colonic Polyps therapy, Medical Oncology standards, Neoadjuvant Therapy standards
Abstract

Background: Colorectal carcinoma (CRC) is the second most common type of cancer in Germany. In view of recent major changes in the diagnosis and treatment of CRC, the S3 guideline for CRC published in its full version in 2004 was partially updated in 2008 and again in 2009., Method: The literature was systematically searched for all articles published from 2004 onward concerning polyp management, (neo-)adjuvant treatment, and treatment of metastatic disease. Evidence-based recommendations were developed in a consensus conference., Results: For some patients who have undergone polypectomy, the time to follow-up with colonoscopy can be lengthened. In UICC stage III colon cancer, adjuvant chemotherapy with an oxaliplatin-based regimen is recommended. In stage II colon cancer, adjuvant chemotherapy should be considered mainly when risk factors are present. In stages II and III, neo-adjuvant therapy should be given before resection in rectal cancer. In patients with metastatic disease, the use of all possible treatment options results in a median overall survival time of 24 months. In some patients with primarily non-resectable liver metastases, systemic treatment may enable a secondary, potentially curative resection. Therapeutic agents are chosen individually on the basis of clinical factors including the goal of treatment, the patient's general condition, and tumor molecular markers., Conclusion: The S3 guideline contains evidence-based recommendations for the diagnosis and treatment of colorectal carcinoma. Broad implementation of the guideline will be essential for improved patient care.

Published
2009
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