Study of family history, deprivation and comorbidity in colorectal cancer

A prospective study of 1540 colorectal cancer cases aged 16 -79, diagnosed in Scotland between 3rd January 2002 and 31st December 2003 was conducted.AIMS The main aims are: Report the number and proportion of cases that perceive they have a family history risk of colorectal cancer. Compare waiting time with symptoms and behaviour after development of symptoms, between cases that perceive a family history risk and do not perceive a family history risk. Report the number and proportion of cases in this cohort with a family history of colorectal cancer that meet Scottish clinical criteria for high or moderate family history risk. A secondary aim is: Describe the average delay time in symptom presentation and the factors contributing to delay in presentation of lower gastrointestinal symptoms among cases with colorectal cancer and in particular assess the importance of deprivation and comorbidity.RESULTS The distribution of sex and age at diagnosis were similar to other published population -based colorectal cancer studies. Of the 1540 cases, 222 (14.9 %) cases perceived they had a family history of colorectal cancer. 280 (18.2 %) cases out of 1540 were at a high or moderate family history risk according to Scottish Executive Guidelines. Of these 280 cases, 133 (47.5 %) perceived they had a family history of colorectal cancer. Of these 133 cases, only 51 (18.2 %) discussed this concern with their GP and, only 12 (4.3 %) were referred to cancer genetic services. Cases that perceived a family history risk of colorectal cancer were more likely to state they have knowledge of colorectal cancer symptoms and more likely to think that the lower gastrointestinal symptoms they develop are symptoms of colorectal cancer. However, this knowledge does not prompt them to visit the GP with less delay after development of symptoms than those cases with no perception of a family history risk of colorectal cancer. There was no association found between deprivation, comorbidity and timing of presentation following development of symptoms. The more deprived group of patients were significantly more likely to report no knowledge of colorectal cancer symptoms. They were also less likely not to inspect the toilet or the toilet paper before flushing.IMPLICATIONS FOR HEALTH SERVICE Providing all health professionals with the knowledge and skills to take a family history and to follow published guidelines when assessing family history risk would share the responsibility for identification of individuals with a high or moderate family, improve the appropriateness of referrals and reduce the inequality in access to cancer genetic services. It is estimated from this study that each year there will be 49 families in the colorectal cancer population at high risk eligible for mismatch repair gene analysis and 196 of their first- degree relatives that require two - yearly colonoscopy. In addition there will be 446 at moderate risk and eligible for microsatellite testing and 1784 first- degree relatives of these cases that require a colonoscopy at age 35 and 55 years. The most deprived group of patients have the least knowledge of colorectal cancer symptoms and the design of educational material should acknowledge this fact and ensure that it is appropriate for this audience.CONCLUSION GPs do not appear to routinely use published guidelines to assess the family history of cases with colorectal cancer. The most affluent group are more likely to be aware that family history is a risk factor for colorectal cancer and those that discuss their concern of family history risk are more likely to be referred to cancer genetic services. These findings suggest that inequality in access to the cancer genetic services exists. Individuals in Scotland, that perceive a family history of colorectal cancer are not prompted by the development of lower gastrointestinal symptoms to visit their GP more quickly, nor does this knowledge change their behaviour in discussing symptoms with other people, self -treating symptoms, inspecting the toilet and toilet paper before flushing, even though they are more likely to perceive that they have colorectal cancer before visiting their GP. There appears to be little differences in presentation and development of lower gastrointestinal symptoms or association with comorbidity between the most affluent and most deprived groups suggesting that socioeconomic status and comorbidity have little effect on behaviour after development of lower gastrointestinal symptoms

Creation and Worldwide Utilisation of New COVID-19 Online Information Hub for Genetics Health Professionals, Patients and Families

The current COVID-19 pandemic has unfortunately resulted in many significant concerns for individuals with genetic disorders and their relatives, regarding the viral infection and, particularly, its specific implications and additional advisable precautions for individuals affected by genetic disorders. To address this, the resulting requirement for guidance and information for the public and for genetics professionals was discussed among colleagues nationally, on the ScotGEN Steering Committee, and internationally on the Education Committee of the European Society of Human Genetics (ESHG). It was agreed that the creation of an online hub of genetics-related COVID-19 information resources would be particularly helpful. The proposed content, divided into a web page for professionals and a page for patients, was discussed with, and approved by, genetics professionals. The hub was created and provided online at www.scotgen.org.uk and linked from the ESHG’s educational website for genetics and genomics, at www.eurogems.org. The new hub provides links, summary information and representative illustrations for a wide range of selected international resources. The resources for professionals include: COVID-19 research related hubs provided by Nature, Science, Frontiers, and PubMed; clinical guidelines; the European Centre for Disease Prevention and Control; the World Health Organisation; and molecular data sources including coronavirus 3D protein structures. The resources for patients and families include links to many accessible sources of support and relevant information. Since the launch of the pages, the website has received visits from over 50 countries worldwide. Several genetics consultants have commented on usefulness, clarity, readability, and ease of navigation. Visits have originated most frequently in the United Kingdom, Kuwait, Hong Kong, Moldova, United States, Philippines, France, and Qatar. More links have been added since the launch of the hub to include additional international public health and academic resources. In conclusion, an up-to-date online hub has been created and made freely available for healthcare professionals, patients, relatives and the public, providing categorised easily navigated links to a range of worldwide resources related to COVID-19. These pages are receiving a rapidly growing number of return visits and the authors continue to maintain and update the pages’ content, incorporating new developments in this field of enormous worldwide importance

Statin use and association with colorectal cancer survival and risk:Case control study with prescription data linkage

Background: In Scotland colorectal cancer (CRC) is the third most common cancer and a leading cause of cancer death. Epidemiological studies have reported conflicting associations between statins and CRC risk and there is one published report of the association between statins and CRC survival.Methods: Analysis was carried out on 309 cases and 294 controls from the Scottish Study of Colorectal Cancer (SOCCS). Cox's hazard and logistic regression models were applied to investigate the association between statin use and CRC risk and survival.Results: In an adjusted logistic regression model, statins were found to show a statistically significant association for three of the four statin variables and were found to not show a statistically significant association with either all-cause or CRC-specific mortality (OR 0.49; 95%CI 0.49-1.36; p-value = 0.17 and OR 0.33; 95%CI 0.08-1.35; P-value = 0.12, respectively).Conclusion: We did find a statistically significant association between statin intake and CRC risk but not statin intake and CRC-specific mortality. However, the study was insufficiently powered and larger scale studies may be advisable.</p

Medico-Legal Risk Presentation

Narrated presentation for MMB724224 CHRONIC HEART FAILURE: OPTIMISING HEALTH AND WELL BEIN

Cirrhosis Screening with a Portable Fibroscan Device in a Community Alcohol Support Service: Feasibility Study

Alcohol misuse is the major cause of the increase in deaths from liver disease in the UK,1 particularly in Scotland2 and particularly in areas of social deprivation. Liver disease usually presents late, with advanced liver disease and cirrhosis often asymptomatic.3 Patients with alcohol misuse in areas of social deprivation are a hard to reach- population. This study assessed the feasibility of using a portable Fibroscan to measure transient elastography (TE), a non-invasive method of assessing hepatic fibrosis, as a screening tool within a community alcohol support service.sch_nur7pub4746pub