Do faecal test-based colorectal cancer screening pilots provide data that are reflected in subsequent programmes? Evidence from interval cancer proportions

OBJECTIVE: Guidelines on colorectal cancer (CRC) screening with guaiac faecal occult blood tests (gFOBTs) and faecal immunochemical tests (FITs) include the need for a pilot before a programme is introduced. Interval cancers (ICs), cancers arising after a negative screening test result but before the next scheduled invite, are important indicators of programme quality. Our aim was to compare IC in the gFOBT-based Scottish Bowel Screening Programme (SBoSP), a FIT-based pilot, and the FIT-based SBoSP, to assess if the pilot provided data that was reflected in the subsequent programme. DESIGN: The IC proportions (ICPs) data ([IC/(IC + screen detected CRC)] x 100) from the penultimate year of the gFOBT-based SBoSP, the 6-month pilot and the first year of the FIT-based SBoSP were compared. To ensure appropriate comparison, these data were only from the two pilot NHS Boards. RESULTS: For all participants, and females and males, the ICPs were very similar in the gFOBT-based SBoSP and the pilot. The faecal haemoglobin concentration (f-Hb) threshold for the pilot was set at ≥80 μg Hb/g faeces. However, in marked contrast, in the FIT-based SBoSP, at the same threshold, the ICPs were lower. In all three groups, the ICPs were higher in females than in males. CONCLUSIONS: Data on variables in pilots, including ICP, can be informative, but only if variables such as FIT system are held consistent between pilot and programme. Lowering the f-Hb threshold for females to give the same ICP as males might be a strategy to minimise sex inequality

Awareness of lifestyle and colorectal cancer risk:findings from the BeWEL study

It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.Additional co-author: The BeWEL team. The BeWEL Team consists of Shaun Treweek, Fergus Daly, Jill Belch, Jackie Rodger, Alison Kirk, Anne Ludbrook, Petra Rauchhaus, Patricia Norwood, Joyce Thompson, and Jane Wardle

The isotope geochemistry of Ni

In the writing of this review TE was supported by the ERC (AdG 321209 ISONEB) and RCJS by ETH.Nickel is an iron-peak element with 5 stable isotopes (see Table 1) which is both cosmochemically abundant and rich in the information carried in its isotopic signature. Significantly, 60Ni is the radiogenic daughter of 60Fe, a short-lived nuclide (t1/2 = 2.62 Ma; Rugel et al. 2009) of a major element. 60Fe has the potential to be both an important heat source and chronometer in the early solar system. 60Ni abundances serve to document the prior importance 60Fe and this is a topic of on-going debate (see Extinct 60Fe and radiogenic 60Ni). The four other stable Ni nuclides span a sizeable relative mass range of ~10%, including the notably neutron-rich nuclide 64Ni. The relative abundances of these isotopes vary with diverse stellar formation environments and provide a valuable record of the nucleosynthetic heritage of Ni in the solar system (see Nucleosynthetic Ni isotopic variations). Ni occurs widely as both elemental and divalent cationic species, substituting for Fe and Mg in common silicate structures and forming Fe/Ni metal alloys. The Ni isotope chemistry of all the major planetary reservoirs and fractionations between them can thus be characterized (see Mass-Dependent Ni isotopic Variability). Ni is also a bio-essential element and its fractionation during low-temperature biogeochemical cycling is a topic that has attracted recent attention (see Mass-Dependent Ni isotopic Variability).PostprintPeer reviewe

Comparison with first round findings of faecal haemoglobin concentrations and clinical outcomes in the second round of a biennial faecal immunochemical test based colorectal cancer screening programme

OBJECTIVE: How faecal haemoglobin concentrations (f-Hb) vary from one round to the next in a colorectal cancer (CRC) screening programme, and relate to colonoscopy findings, are unknown. Our aim was to use data from the first two rounds of the faecal immunochemical test (FIT) based Scottish Bowel Screening Programme (SBoSP) to explore these issues. METHODS: Faecal haemoglobin concentration (f-Hb) percentiles in the second round were compared with those in the first when the first round yielded a negative FIT result (<80 µg Hb/g faeces), a positive FIT but no colonoscopy, CRC, all adenoma, and a negative colonoscopy. In addition, the outcomes in the first and second rounds were compared. RESULTS: The profiles of f-Hb in the first and second rounds differed in (a) those who had had a negative FIT result in the first round and (b) those in whom neoplastic pathology had been found. In contrast, the pattern of difference between profiles in those who had had a negative colonoscopy was very similar to that in those in whom an adenoma had been found. In addition, the risk of CRC being diagnosed in the second round after a negative colonoscopy in the first was 3.0%, not very different to that after a negative test result (4.9%). CONCLUSIONS: Adenomas may be rarely the cause of a positive FIT result. An alternative explanation as to why these are detected using FIT is required. In addition, a negative colonoscopy for a positive FIT result does not rule out the finding of significant neoplastic pathology in the next round

Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials : a case study of the BeWEL trial

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