Trends in colorectal cancer mortality in Europe : retrospective analysis of the WHO mortality database

Objective: To examine changes in colorectal cancermortality in 34 European countries between 1970 and 2011. Design: Retrospective trend analysis. Data source: World Health Organization mortality database. Population: Deaths from colorectal cancer between 1970and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period. Main outcomes measures: Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population. Results: From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States. Conclusion: Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, and specialised care

A framework for considering the utility of models when facing tough decisions in public health: a guideline for policy-makers

The COVID-19 pandemic has brought the combined disciplines of public health, infectious disease and policy modelling squarely into the spotlight. Never before have decisions regarding public health measures and their impacts been such a topic of international deliberation, from the level of individuals and communities through to global leaders. Nor have models-developed at rapid pace and often in the absence of complete information-ever been so central to the decision-making process. However, after nearly 3 years of experience with modelling, policy-makers need to be more confident about which models will be most helpful to support them when taking public health decisions, and modellers need to better understand the factors that will lead to successful model adoption and utilization. We present a three-stage framework for achieving these ends

What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

Funding Information: This work was supported by the University of Melbourne, Melbourne School of Population and Global Health, Human Ethics Advisory Group. Project title: “Consultation to understand international differences in bowel cancer screening participation,” ID 2057312.1 Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Engagement Research Funding from the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia. Publisher Copyright: © The Author(s) 2022.Background: Colorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation. Methods: We searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening. Results: National programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features. Conclusions: Apart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation. Impact: This screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.Peer reviewe

The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial.

BACKGROUND: Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care. METHODS: This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation. DISCUSSION: This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool. Trial results will be reported in 2020. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ACTRN12616001573448p . Registered on 14 November 2016

Female Hormonal Factors and the Risk of Endometrial Cancer in Lynch Syndrome

Apart from hysterectomy, there is no consensus recommendation for reducing endometrial cancer risk for women with a mismatch repair (MMR) gene mutation (Lynch syndrome)

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

Aspirin, Ibuprofen, and the Risk of Colorectal Cancer in Lynch Syndrome

Inheritance of a germline mutation in one of the DNA mismatch repair (MMR) genes MLH1, MSH2, MSH6, and PMS2 causes a high risk of colorectal and other cancers (Lynch Syndrome). Use of aspirin has been shown to be associated with a reduced risk of colorectal cancer for the general population as well as for MMR gene mutation carriers. The aim of this study was to determine whether use of aspirin and ibuprofen in a nontrial setting is associated with the risk of colorectal cancer risk for MMR gene mutation carriers

Colorectal cancer screening in Australia: what is the role of family history?

© 2012 Dr. Driss Ait OuakrimColorectal cancer (CRC) is the third most common cancer suffered throughout the world, with nearly one million new cases diagnosed world-wide each year and half a million deaths. Due to demographic trends, significantly more individuals will be confronted with CRC in the future. Therefore, its control has become a major public health issue for industrialised countries. Australia has one of the highest CRC incidence rate in the world. It is the second most frequently diagnosed cancer and the second largest cause of cancer deaths in Australia (14,234 new cases and 4,047 deaths in 2007). Approximately 15% to 30% of these cases occur in just the 2% of the population with a strong family history of the disease. The characteristics of colorectal cancer fulfill the conditions that make mass screening useful and beneficial for public health: strong incidence, poor prognosis, a typically long pre-symptomatic latency period, effective treatment in early stages of the disease, it is preceded by a precancerous lesion in 95% of cases and there are testing methods which are scientifically proven to be effective at reducing mortality. Screening for colorectal cancer has been shown to be an effective method to reduce both incidence and mortality, and for several years now, international scientific consensus has recognised the need for setting up mass screening initiatives for colorectal cancer. In 2006 the Australian government introduced a national bowel cancer screening programme (NBCSP) using faecal occult blood test but only for people tuning 50, 55 or 65 years of age. The latest data from the programme published in 2010 showed that only 40% of those invited to screen actually performed the test. The primary aim of my thesis was to investigate the CRC screening practices taking place outside of the current national programme based on the current screening guidelines recommendations. I conducted two systematic reviews of the literature to determine the predictors of screening for people at familial-risk of CRC and the level of screening uptake in that population. I identified a low level of screening participation among people at increased risk of CRC and that family history of CRC and physicians’ recommendation to screen were the most consistent predictors of CRC screening uptake. Overall, I found only a small number of studies investigating the screening practices of those most at risk of CRC, with important methodological shortcomings in their analyses. I investigated CRC screening practices in Australia based on the Colorectal Cancer Family Registry (ACCFR) study. 3845 participants were classified into four risk categories according to the strength of their family history of CRC based on current Australian guidelines. Among participants categorised “at or slightly above” average risk of CRC (represent 98% of the general population) eligible for screening, 90% reported never having been screened and 8% reported over-screening. Middle- aged people, those with a family history of CRC and those with a university degree were more likely to be over-screened. For participants categorised “at moderately increased-risk” or “potentially high-risk” of CRC (represents the 2% of the general population in which 15-30% of all CRC occur), 95% were underscreeners and only 5% reported guideline-defined “appropriate” screening. People of middle-age, higher education and who had resided in Australia longer were more likely to have had screening for CRC in this risk category. In a cost-effectiveness analysis of screening strategies addressed to people at increased risk of CRC due to family history, I found that biennial screening with immunochemical faecal occult blood test, colonoscopy every ten years or colonoscopy every five years reduced the number of CRC cases by 11%, 22% and 34% respectively. All three strategies had an incremental cost-effectiveness ratio (ICER) under $50,000 per life-year gained (LYG), which is regarded as the upper limit of acceptable cost-effectiveness for screening technologies in the Australian health system. At$16,924 per LYG, colonoscopy screening every five-year appears to be the most cost-effective strategy. Overall, my results show that current guidelines for CRC screening are not being implemented in the population. CRC screening participation is low across all risk categories and the vast majority of screening tests undertaken were inappropriate in terms of timing, modality or frequency. Finally, family-history-based CRC screening is a cost-effective strategy and should be considered as an option to increase participation among those most at risk of developing CRC