Genome-wide interaction analysis of folate for colorectal cancer risk
Epidemiological and experimental evidence suggests that higher folate intake is associated with a decreased colorectal cancer (CRC) risk; however, the mechanisms underlying this relationship are not fully understood. Genetic variation that may have a direct or indirect impact on folate…
Brief Communication: The Contemporary Probability of Occult Colorectal Cancer in Patients with Colitis-Related Dysplasia undergoing Colectomy
Occult colorectal cancer (CRC) has historically driven recommendations for colectomy in patients with inflammatory bowel disease with dysplasia . We defined the contemporary risk of occult CRC at colectomy among 93 patients with inflammatory bowel disease with dysplasia based on…
A genetic locus within the FMN1/GREM1 gene region interacts with body mass index in colorectal cancer risk
Colorectal cancer risk can be impacted by genetic, environmental, and lifestyle factors, including diet and obesity. Gene-environment interactions (G × E) can provide biological insights into the effects of obesity on colorectal cancer risk. Here, we assessed potential genome-wide G…
Addressing Disparities in Outcomes of Screening for Colorectal Cancer in Community-Based Settings
This study will evaluate the colorectal cancer screening continuum — tests, screening quality, follow-up care, and health outcomes — over a 20-year time period that covers before, during, and after implementation of an organized colorectal cancer screening at KPNC and…
Risk of colorectal cancer and colorectal cancer mortality beginning one year after a negative fecal occult blood test, among screen-eligible 76-85-year-olds
Colorectal cancer (CRC) screening is universally recommended for adults ages 45-75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially…
Current chemoprevention approaches in Lynch syndrome and Familial adenomatous polyposis: a global clinical practice survey
International chemoprevention preferences and approaches in Lynch syndrome (LS) and APC-associated polyposis, including Familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) have not been previously explored. To describe current chemoprevention strategies for patients with LS or FAP/AFAP (referred to collectively…
Kroenke, Candyce H
Research interests include social, psychological, and lifestyle factors and breast cancer.
Corley, Douglas A.
Research interests include outcomes and epidemiologic research in gastroenterology.
CANcer Cachexia Action Network/CANCAN
This study will include 1500 patients with advanced lung, pancreatic, or colorectal cancer at high risk of cachexia for detailed measurement via biospecimen collection, remote monitoring, questionnaire, and medical record review. The aims are to: identify distinct cachexia subtypes with…
Program components and results from an organized colorectal cancer screening program using annual fecal immunochemical testing
Programmatic colorectal cancer (CRC) screening increases uptake, but the design and resources utilized for such models are not well known. We characterized program components and participation at each step in a large program that used mailed fecal immunochemical testing (FIT)…
Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps
The longitudinal risk of colorectal cancer (CRC) associated with subtypes of serrated polyps (SPs) remains incompletely understood. This community-based, case-control study included 317 178 Kaiser Permanente Northern California members who underwent their first colonoscopy during 2006-2016. Nested within this population,…
Evaluating Acceptance and Screening Yield for Early Colorectal Cancer Screening: (EASY Early CRC)
Three national guideline groups now recommend that all adults start colorectal cancer (CRC) screening at age 45. Before 2018, some guideline groups only recommended African Americans begin CRC screening at age 45. There is currently no empirical evidence of the…
Improving health outcomes and reducing healthcare costs in individuals with Helicobacter pylori infection in a large, community-based population
Optimization of Diagnosis and Surveillance of Colonic Sessile Serrated Adenomas by Pathologists and Gastroenterologists at KPNC.
Efficacy of paired tumor and germline testing in evaluation of patients with Lynch-like syndrome in a large integrated healthcare setting
Patients with mismatch repair (MMR) deficient colorectal cancer (CRC) without detectable germline pathogenic variants (PVs) or likely pathogenic variants (LPVs) in MMR genes are often labeled as Lynch-like syndrome (LLS). We sought to evaluate the efficacy of paired tumor and…
Genetic architectures of proximal and distal colorectal cancer are partly distinct
An understanding of the etiologic heterogeneity of colorectal cancer (CRC) is critical for improving precision prevention, including individualized screening recommendations and the discovery of novel drug targets and repurposable drug candidates for chemoprevention. Known differences in molecular characteristics and environmental…
Genetically predicted circulating concentrations of micronutrients and risk of colorectal cancer among individuals of European descent: a Mendelian randomization study
The literature on associations of circulating concentrations of minerals and vitamins with risk of colorectal cancer is limited and inconsistent. Evidence from randomized controlled trials (RCTs) to support the efficacy of dietary modification or nutrient supplementation for colorectal cancer prevention…
Weight stability masks changes in body composition in colorectal cancer: a retrospective cohort study
There is an emerging viewpoint that change in body weight is not sufficiently sensitive to promptly identify clinically meaningful change in body composition, such as skeletal muscle depletion. We aimed to determine whether body weight stability is associated with skeletal…
PREEMPT CRC: Prevention of Colorectal Cancer Through Multiomics Blood Testing
The primary objectives of this study are to determine the sensitivity and specificity of Freenome's test for colorectal adenocarcinoma, using screening CS with histopathology as the reference method.
Heterogeneity in colorectal cancer incidence among people recommended 3-yearly surveillance post-polypectomy: a validation study
Colonoscopy surveillance is recommended for patients at increased risk of colorectal cancer (CRC) following adenoma removal. Low-, intermediate-, and high-risk groups are defined by baseline adenoma characteristics. We previously examined intermediate-risk patients from hospital data and identified a higher-risk subgroup…
An update on the epidemiology, molecular characterization, diagnosis, and screening strategies for early-onset colorectal cancer
Rising trends in the incidence and mortality of early-onset colorectal cancer (CRC) in those who are younger than 50 years have been well established. These trends have spurred intense investigation focused on elucidating the epidemiology and characteristics of early-onset CRC,…
Identifying novel susceptibility genes for colorectal cancer risk from a transcriptome-wide association study of 125,478 subjects
Susceptibility genes and the underlying mechanisms for the majority of risk loci identified by genome-wide association studies (GWAS) for colorectal cancer (CRC) risk remain largely unknown. We conducted a transcriptome-wide association study (TWAS) to identify putative susceptibility genes. Gene-expression prediction…
Natural language processing for the accurate identification of colorectal cancer mismatch repair status in Lynch syndrome screening
Lynch syndrome (LS) is the most common type of hereditary colorectal cancer (CRC) syndrome caused by pathogenic variants in mismatch repair (MMR) genes.1 Current multisociety guidelines recommend screening all CRC tumors for LS.2,3 The most widely adopted screening method is…
Metalworking Fluids and Colon Cancer Risk: Longitudinal Targeted Minimum Loss-based Estimation
Metalworking fluids (MWFs) are a class of complex mixtures of chemicals and oils, including several known carcinogens that may pose a cancer hazard to millions of workers. Reports on the relation between MWFs and incident colon cancer have been mixed…
Association of body mass index with colorectal cancer risk by genome-wide variants
Body mass index (BMI) is a complex phenotype that may interact with genetic variants to influence colorectal cancer risk. We tested multiplicative statistical interactions between BMI (per 5 kg/m2) and approximately 2.7 million single nucleotide polymorphisms with colorectal cancer risk among…
Genetic Variants in the Regulatory T cell-Related Pathway and Colorectal Cancer Prognosis
High numbers of lymphocytes in tumor tissue, including T regulatory cells (Treg), have been associated with better colorectal cancer survival. Tregs, a subset of CD4+ T lymphocytes, are mediators of immunosuppression in cancer, and therefore variants in genes related to…
Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems
Primary care provider's (PCP) perceptions of colorectal cancer screening test effectiveness and their recommendations for testing intervals influence patient screening uptake. Few large studies have examined providers' perceptions and recommendations, including their alignment with evidence suggesting comparable test effectiveness and…
Early Screening of African Americans (45-50 Years Old) in a Fecal Immunochemical Test-based Colorectal Cancer Screening Program
Some guidelines recommend starting colorectal cancer (CRC) screening before age 50 years for African Americans, but there are few data on screening uptake and yield in this population. We performed a prospective study of fecal immunochemical test (FIT) screening among…
COVID-19 Pandemic: Impact on Colorectal Cancer Screening and Adenoma Surveillance Outcomes (PICASO)
The goal of this project is to evaluate the impact of the COVID pandemic on colorectal cancer screening and surveillance activities, and the impact on outcomes such as colorectal cancer incidence and stage.
Intake of dietary fruit, vegetables, and fiber and risk of colorectal cancer according to molecular subtypes: A pooled analysis of 9 studies
Protective associations of fruits, vegetables, and fiber intake with colorectal cancer risk have been shown in many, but not all epidemiologic studies. One possible reason for study heterogeneity is that dietary factors may have distinct effects by colorectal cancer molecular…
Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery
Given the risks of postoperative morbidity and its consequent economic burden and impairment to patients undergoing colon resection, evaluating risk factors associated with complications will allow risk stratification and the targeting of supportive interventions. Evaluation of muscle characteristics is an…
Circulating bilirubin levels and risk of colorectal cancer: serological and Mendelian randomization analyses
Bilirubin, a byproduct of hemoglobin breakdown and purported anti-oxidant, is thought to be cancer preventive. We conducted complementary serological and Mendelian randomization (MR) analyses to investigate whether alterations in circulating levels of bilirubin are associated with risk of colorectal cancer…
Genome-wide Modeling of Polygenic Risk Score in Colorectal Cancer Risk
Accurate colorectal cancer (CRC) risk prediction models are critical for identifying individuals at low and high risk of developing CRC, as they can then be offered targeted screening and interventions to address their risks of developing disease (if they are…
Postmenopausal Hormone Therapy and Colorectal Cancer Risk by Molecularly Defined Subtypes and Tumor Location
Postmenopausal hormone therapy (HT) is associated with a decreased colorectal cancer (CRC) risk. As CRC is a heterogeneous disease, we evaluated whether the association of HT and CRC differs across etiologically relevant, molecularly defined tumor subtypes and tumor location. We…
Increased Risk of Colorectal Cancer in Individuals With a History of Serrated Polyps
Serrated polyp (SPs) are precursors to 20% to 30% of cases of colorectal tumors, but patients' long-term risk after removal of SPs is poorly understood. We investigated the risk of colorectal cancer (CRC) in individuals with a history of SPs…
A Transparent and Adaptable Method to Extract Colonoscopy and Pathology Data Using Natural Language Processing
Key variables recorded as text in colonoscopy and pathology reports have been extracted using natural language processing (NLP) tools that were not easily adaptable to new settings. We aimed to develop a reliable NLP tool with broad adaptability. During 1996-2016,…
PREDICT PCCC: PREDICTing Post Colonoscopy Colorectal Cancer
We are using post-polypectomy surveillance, an increasingly common indication for colonoscopy in clinical practice at TPMG and across the United States, as a model for how we might risk-stratify patients for care. Patients and physicians desire more precise estimates of…
NRG Oncology NCORP Research Base
This is a non-inferiority trial design comparing colorectal cancer incidence in trial participants with 1-2 non-advanced adenomas randomized to recommendation for a 5- and 10-year surveillance colonoscopy exam vs. a 10-year surveillance colonoscopy exam.
Kaiser Permanente Interregional Cancer Statistics Project
A Kaiser Permanente interregional cancer statistics report will be developed to include incidence and 5-year relative survival rates for breast, colorectal, and lung cancer. The development of new mortality measures will be explored, along with improved routine capture and reporting…
Functional informed genome-wide interaction analysis of body mass index, diabetes and colorectal cancer risk
Body mass index (BMI) and diabetes are established risk factors for colorectal cancer (CRC), likely through perturbations in metabolic traits (e.g. insulin resistance and glucose homeostasis). Identification of interactions between variation in genes and these metabolic risk factors may identify…
Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the women’s health initiative
We evaluated associations between perceived social support, social integration, living alone, and colorectal cancer (CRC) outcomes in postmenopausal women. The study included 1431 women from the Women's Health Initiative who were diagnosed from 1993 through 2017 with stage I through…
Cumulative Burden of Colorectal Cancer-Associated Genetic Variants is More Strongly Associated With Early-onset vs Late-onset Cancer
Early-onset colorectal cancer (CRC, in persons younger than 50 years old) is increasing in incidence; yet, in the absence of a family history of CRC, this population lacks harmonized recommendations for prevention. We aimed to determine whether a polygenic risk…
Circulating Levels of Insulin-like Growth Factor 1 and Insulin-like Growth Factor Binding Protein 3 Associate With Risk of Colorectal Cancer Based on Serologic and Mendelian Randomization Analyses
Human studies examining associations between circulating levels of insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3) and colorectal cancer risk have reported inconsistent results. We conducted complementary serologic and Mendelian randomization (MR) analyses to determine…
The Association of Abdominal Adiposity with Mortality in Patients with Stage I-III Colorectal Cancer
The quantity and distribution of adipose tissue may be prognostic measures of mortality in colorectal cancer patients, and such associations may vary by patient sex. This cohort included 3262 stage I-III colorectal cancer patients. Visceral and subcutaneous adipose tissues were…
Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women’s Health Initiative
Dietary factors may influence colorectal cancer (CRC) survival through effects on inflammation. We examined the association between post-CRC diagnosis inflammatory potential of diet and all-cause and cancer-specific mortality in the Women's Health Initiative. The study included 463 postmenopausal women who…
D3-creatine dilution to assess skeletal muscle mass in colon cancer patients
Among colon cancer patients participating in a resistance training intervention during chemotherapy, this study will examine whether a new method to evaluate skeletal muscle mass (d3-creatine dilution) is associated with the key cancer outcomes of strength and physical function, chemotherapy…
Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population
The long-term risks of colorectal cancer (CRC) and CRC-related death following adenoma removal are uncertain. Data are needed to inform evidence-based surveillance guidelines, which vary in follow-up recommendations for some polyp types. Using data from a large, community-based integrated health…
Evaluating screening participation, follow-up and outcomes for breast, cervical and colorectal cancer in the PROSPR consortium
Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast,…
Meta-analysis of 16 studies of the association of alcohol with colorectal cancer
Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of…
DNA repair and cancer in colon and rectum: novel players in genetic susceptibility
Interindividual differences in DNA repair systems may play a role in modulating the individual risk of developing colorectal cancer. To better ascertain the role of DNA repair gene polymorphisms on colon and rectal cancer risk individually, we evaluated 15,419 single…
Effect of Sex, Age and Positivity Threshold on Fecal Immunochemical Test Accuracy: a Systematic Review and Meta-Analysis
Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex…
Morbidity and Mortality After Surgery for Nonmalignant Colorectal Polyps: A 10-Year Nationwide Analysis
Rates of surgery for nonmalignant colorectal polyps are increasing in the United States despite evidence that most polyps can be managed endoscopically. We aimed to determine nationally representative estimates and to identify predictors of in-hospital mortality and morbidity after surgery…
Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline
Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at…
Colonoscopy Indication Algorithm Performance Across Diverse Health Care Systems in the PROSPR Consortium
Despite the importance of characterizing colonoscopy indication for quality monitoring and cancer screening program evaluation, there is no standard approach to documenting colonoscopy indication in medical records. We applied two algorithms in three health care systems to assign colonoscopy indication…
Comparison of Universal Versus Age-Restricted Screening of Colorectal Tumors for Lynch Syndrome Using Mismatch Repair Immunohistochemistry: A Cohort Study
Guidelines recommend screening all patients with newly diagnosed colorectal cancer (CRC) for Lynch syndrome (LS). However, the efficiency of universal LS screening in elderly populations has not been well studied. To compare the performance of age-restricted and universal LS screening…
Colorectal Cancer Screening in People With and Without HIV in an Integrated Health Care Setting
As people with HIV (PWH) live longer, age-appropriate colorectal cancer (CRC) screening is increasingly important. Limited data exist on CRC screening and outcomes comparing PWH and persons without HIV. Large integrated health care system. This study included PWH and demographically…
Treatment patterns and survival differ between early-onset and late-onset colorectal cancer patients: the patient outcomes to advance learning network
Our objective was to describe differences in treatment patterns and survival between early-onset ( 12 lymph nodes examined (OR 1.60, CI 1.37-1.87), to receive systemic therapy (chemotherapy or immunotherapy) within 6 months of diagnosis (OR 2.84, CI 2.40-3.37), and to have a…
Body Composition and Cardiovascular Events in Patients With Colorectal Cancer: A Population-Based Retrospective Cohort Study
Patients with colorectal cancer (CRC) are up to 4-fold more likely than individuals without a history of cancer to develop cardiovascular disease. Clinical care guidelines recommend that physicians counsel patients with CRC regarding the association between obesity (defined using body…
Early outcomes of a high-resolution anoscopy-based anal cancer screening program among people with HIV enrolled in an integrated healthcare system
Few studies have examined outcomes of high-resolution anoscopy (HRA)-based screening for people with HIV infection (PWH), a population at increased risk for anal cancer. Large integrated health care system. Cohort study of 13,552 people with HIV infection, comparing incidences of…
Mendelian randomization analysis of C-reactive protein on colorectal cancer risk
Chronic inflammation is a risk factor for colorectal cancer (CRC). Circulating C-reactive protein (CRP) is also moderately associated with CRC risk. However, observational studies are susceptible to unmeasured confounding or reverse causality. Using genetic risk variants as instrumental variables, we…
Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type
The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same…
Genetic variant predictors of gene expression provide new insight into risk of colorectal cancer
Genome-wide association studies have reported 56 independently associated colorectal cancer (CRC) risk variants, most of which are non-coding and believed to exert their effects by modulating gene expression. The computational method PrediXcan uses cis-regulatory variant predictors to impute expression and…
Gene Dependent Cancer Risk and Optimal Cancer Prevention Strategies in Lynch Syndrome – DUPLICATED DO NOT ACTIVATE
As part of a K training award, and within our overall colorectal cancer research program, this award will support additional analyses regarding the identification of persons at high hereditary risk for colorectal cancer (e.g., Lynch syndrome) and their use of…
Comprehensive Translational Science Analytics Tools for the Global Health Agenda
This project builds on a previous Community Benefit grant award to examine changes in cervical and colorectal cancer screening as a result of the implementation of the Patient Protection and Affordable Care Act. It will examine impacts on colorectal cancer incidence and mortality. This will be…
The association of medical and demographic characteristics with sarcopenia and low muscle radiodensity in patients with nonmetastatic colorectal cancer
Sarcopenia and low skeletal muscle radiodensity (SMD) have been associated with adverse outcomes in patients with colorectal cancer (CRC); however, factors contributing to these 2 muscle abnormalities are unclear. The aim of this study was to investigate the association of…
Effects of Electronic Chromoendoscopy on Detection of Adenomas During Colonoscopy
I-scan is an electronic chromoendoscopy technology that improves resolution of epithelial and mucosal surfaces and vessels. We performed a randomized controlled trial to compare detection of adenomas by i-scan vs standard high-definition white-light (HDWL) colonoscopy. From February 1 through December…
Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study
The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates. Using a mixed-methods design (qualitative and quantitative), we first…
Long-term Risk of Colorectal Cancer and Related Deaths After a Colonoscopy With Normal Findings
Guidelines recommend a 10-year rescreening interval after a colonoscopy with normal findings (negative colonoscopy results), but evidence supporting this recommendation is limited. To examine the long-term risks of colorectal cancer and colorectal cancer deaths after a negative colonoscopy result, in…
Non-alcoholic fatty liver disease and colorectal cancer survival
Liver diseases including non-alcoholic fatty liver disease (NAFLD) and ensuing alterations to the micro-environment may affect development of liver metastasis. Mirroring the rise in obesity rates, prevalence of NAFLD is increasing globally. Our objective was to examine the association between…
Balancing Adherence and Expense: The Cost-Effectiveness of Two-Sample vs One-Sample Fecal Immunochemical Test
Colorectal cancer (CRC) causes more than 50,000 deaths each year in the United States but early detection through screening yields survival gains; those diagnosed with early stage disease have a 5-year survival greater than 90%, compared to 12% for those…
Novel Common Genetic Susceptibility Loci for Colorectal Cancer
Previous genome-wide association studies (GWAS) have identified 42 loci (P < 5 × 10-8) associated with risk of colorectal cancer (CRC). Expanded consortium efforts facilitating the discovery of additional susceptibility loci may capture unexplained familial risk. We conducted a GWAS in European…
Discovery of common and rare genetic risk variants for colorectal cancer
To further dissect the genetic architecture of colorectal cancer (CRC), we performed whole-genome sequencing of 1,439 cases and 720 controls, imputed discovered sequence variants and Haplotype Reference Consortium panel variants into genome-wide association study data, and tested for association in…
Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems
To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. We describe patterns of and factors associated with subsequent colonoscopy among persons with ?3 adenomas…
Modifiable Failures in the Colorectal Cancer Screening Process and Their Association with Risk of Death
Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow-up of abnormal results or when the screening test fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these…
Colorectal Cancer Screening Participation Among Asian Americans Overall and Subgroups in an Integrated Health Care Setting with Organized Screening
Screening reduces colorectal cancer deaths, but?
Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers
Postcolonoscopy colorectal cancers (PCCRCs) are defined as those detected ≤10 years after an index colonoscopy negative for cancer, but modifiable risk factors are not well established in large, community-based populations. We evaluated risk factors from the index colonoscopy for PCCRCs diagnosed…
Health care improvement and survivorship priorities of colorectal cancer survivors: findings from the PORTAL colorectal cancer cohort survey
Few population-level surveys have explored patient-centered priorities for improving colorectal cancer survivors' care. Working with patients, we designed a survey to identify care improvement and survivorship priorities. We surveyed a random sample of 4000 patients from a retrospective, population-based cohort…
Accurate Identification of Colonoscopy Quality and Polyp Findings Using Natural Language Processing
The aim of this study was to test the ability of a commercially available natural language processing (NLP) tool to accurately extract examination quality-related and large polyp information from colonoscopy reports with varying report formats. Colonoscopy quality reporting often requires…
Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. We identified adults…
Novel variant of unknown significance in MUTYH in a patient with MUTYH-associated polyposis: a case to reclassify
MUTYH-associated polyposis (MAP) is a hereditary cancer syndrome that is caused by biallelic pathogenic variants in the MUTYH gene and should be evaluated for in patients with an attenuated colonic polyposis phenotype. Monoallelic pathogenic variants in MUTYH are associated with…
Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study
The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. To identify programmatic (multitest) FIT performance characteristics and optimal…
Acceptability of high-resolution anoscopy for anal cancer screening in HIV-infected patients
HIV-infected individuals are at increased risk of anal cancer. Screening for anal cancer precursors using high-resolution anoscopy (HRA) may be clinically beneficial. In this study, we examined patient tolerability of this procedure. The acceptability of HRA was evaluated among HIV-infected…
Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large, Community-based Population
Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after…
Clinical implications of low skeletal muscle mass in early-stage breast and colorectal cancer
Although obesity has now been widely accepted to be an important risk factor for cancer survival, the associations between BMI and cancer mortality have not been consistently linear. Although morbid obesity has clearly been associated with worse survival, some studies…
Optimizing Long-Term Post-Polypectomy Surveillance for Colorectal Cancer Prevention Using a Prediction Rule Developed from a Large, Community-Based Cohort
Screening has been shown to reduce colorectal cancer incidence and mortality. However, screening has resulted in a growing cohort of patients with adenomatous polyps (adenomas), and little is known about effectively managing their post-polypectomy surveillance. With limited data available in…
Gene Dependent Cancer Risk and Optimal Cancer Prevention Strategies in Lynch Syndrome
As part of a “K” training award from the National Institutes of Health, and within the overall colorectal cancer research program at Kaiser Permanente Northern California, this project will support additional analyses regarding the identification of persons at high hereditary…
World Endoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer
Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term…
Antidepressant Use and Risk of Colorectal Cancer in The Women’s Health Initiative
Background: Some prior studies have reported reduced colorectal cancer risk among individuals using antidepressant medications, especially selective serotonin reuptake inhibitors (SSRIs). Yet most studies have not considered the potential role of depression or other confounders in their analyses.Methods: We utilized…
Associations of pre-existing co-morbidities with skeletal muscle mass and radiodensity in patients with non-metastatic colorectal cancer
Co-morbidities and computerized tomography-measured muscle abnormalities are both common in cancer patients and independently adversely influence clinical outcomes. Muscle abnormalities are also evident in other diseases, such as diabetes and obesity. This study examined for the first time the association…
Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality
Low skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time-consuming, expensive, and require training. Clinic-friendly tools to screen for low skeletal…
Beyond Body Mass Index: Bringing Body Composition into Oncology Practice
This project consists of development of electronic tools to rapidly assess body composition in colorectal cancer and breast cancer patients and present this information to clinicians. It leverages Kaiser Permanente Northern California’s electronic medical records and repository of CT images,…
Muscle radiodensity and mortality in patients with colorectal cancer
Low skeletal muscle radiodensity (SMD) is related to higher mortality in several cancers, but the association with colorectal cancer (CRC) prognosis is unclear. This observational study included 3262 men and women from the Kaiser Permanente Northern California population diagnosed between…
The TGFβ-signaling pathway and colorectal cancer: associations between dysregulated genes and miRNAs
The TGFβ-signaling pathway plays an important role in the pathogenesis of colorectal cancer (CRC). Loss of function of several genes within this pathway, such as bone morphogenetic proteins (BMPs) have been seen as key events in CRC progression. In this…
Mutation analysis of adenomas and carcinomas of the colon: early and late drivers
Colorectal cancer (CRC) accounts for about 8% of all new cancer cases diagnosed in the US. We used whole exome sequence data from triplet samples (colon carcinoma, colon adenoma, and normal tissue) from 18 individuals to assess gene mutation rates…
Influence of smoking, body mass index and other factors on the preventive effect of nonsteroidal anti-inflammatory drugs on colorectal cancer risk
Nonsteroidal anti-inflammatory drugs (NSAIDs) use has consistently been associated with lower risk of colorectal cancer (CRC); however, studies showed inconsistent results on which cohort of individuals may benefit most. We performed multivariable logistic regression analysis to systematically test for the…
The p53-signaling pathway and colorectal cancer: Interactions between downstream p53 target genes and miRNAs
We examined expression of genes in the p53-signaling pathway. We determine if genes that have significantly different expression in carcinoma tissue compared to normal mucosa also have significantly differentially expressed miRNAs. We utilize a sample of 217 CRC cases. We…
Mendelian randomisation study of age at menarche and age at menopause and the risk of colorectal cancer
Substantial evidence supports an association between use of menopausal hormone therapy and decreased colorectal cancer (CRC) risk, indicating a role of exogenous sex hormones in CRC development. However, findings on endogenous oestrogen exposure and CRC are inconsistent. We used a Mendelian…
Determining Risk of Colorectal Cancer and Starting Age of Screening Based on Lifestyle, Environmental, and Genetic Factors
Guidelines for initiating colorectal cancer (CRC) screening are based on family history but do not consider lifestyle, environmental, or genetic risk factors. We developed models to determine risk of CRC, based on lifestyle and environmental factors and genetic variants, and…
The deterioration of muscle mass and radiodensity is prognostic of poor survival in stage I-III colorectal cancer: a population-based cohort study (C-SCANS)
Muscle abnormalities such as low muscle mass and low muscle radiodensity are well known risk factors for unfavourable cancer prognosis. However, little is known in regard to the degree and impact of longitudinal changes in muscle mass and radiodensity within…
Optimizing Colorectal Cancer Screening PREcision and Outcomes in CommunIty-baSEd Populations (PRECISE)
This study is part of the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) program, which aims to enhance understanding of the implementation and effects of screening as practiced in multiple, heterogeneous health care environments in the United States. Within…
A Mixed-Effects Model for Powerful Association Tests in Integrative Functional Genomics
Genome-wide association studies (GWASs) have successfully identified thousands of genetic variants for many complex diseases; however, these variants explain only a small fraction of the heritability. Recently, genetic association studies that leverage external transcriptome data have received much attention and…
MicroRNA-messenger RNA interactions involving JAK-STAT signaling genes in colorectal cancer
JAK-STAT signaling influences many downstream processes that, unchecked, contribute to carcinogenesis and metastasis. MicroRNAs (miRNAs) are hypothesized as a mechanism to prevent uncontrolled growth from continuous JAK-STAT activation. We investigated differential expression between paired carcinoma and normal colorectal mucosa of…
A Cohort Study of Metformin and Colorectal Cancer Risk among Patients with Diabetes Mellitus
Background: Several epidemiologic studies have reported strong inverse associations between metformin use and risk of colorectal cancer, although time-related biases, such as immortal time bias, may in part explain these findings. We reexamined this association using methods to minimize these…
Patterns and predictors or repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States
Effectiveness of fecal occult blood test (FOBT) for colorectal cancer (CRC) screening depends on annual testing, but little is known about patterns of repeat stool-based screening within different settings. Our study's objective was to characterize screening patterns and identify factors…
Yield of Colonoscopy After a Positive Result From a Fecal Immunochemical Test OC-Light.
BACKGROUND & AIMS: The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about…
Dysregulated genes and miRNAs in the apoptosis pathway in colorectal cancer patients
Apoptosis is genetically regulated and involves intrinsic and extrinsic pathways. We examined 133 genes within these pathways to identify whether they are expressed differently in colorectal carcinoma (CRC) and normal tissue (N = 217) and if they are associated with similar differential…
Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps.
BACKGROUND: Prediction of histology of small polyps facilitates colonoscopic treatment. The aims of this study were: 1) to develop a simplified polyp classification, 2) to evaluate its performance in predicting polyp histology, and 3) to evaluate the reproducibility of the…
Outreach for Colorectal Cancer Screening in African Americans Aged 45 to 49
This study aims to 1) evaluate uptake of fecal immunochemical testing among African Americans aged 45 to 49 who receive outreach for such testing by mail, 2) examine the yield of screening results, including advanced adenomas and colon cancers, and…
Diagnosis of sessile serrated adenoma after educational training in a large, community-based, integrated healthcare setting
Sessile serrated adenomas (SSAs) are precursors of 15% to 30% of colorectal cancers but are frequently underdiagnosed. We sought to measure the SSA detection rate (SDR) and predictors of SSA detection after educational training for community gastroenterologists and pathologists. Colonoscopy…
The NF-κB signalling pathway in colorectal cancer: associations between dysregulated gene and miRNA expression
The nuclear factor-kappa B (NF-κB) signalling pathway is a regulator of immune response and inflammation that has been implicated in the carcinogenic process. We examined differentially expressed genes in this pathway and miRNAs to determine associations with colorectal cancer (CRC)…
The Women’s Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study: Description and Baseline Characteristics of Participants
Background: The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study offers an important opportunity to advance cancer research by extending the original WHI studies to examine survivorship in women diagnosed with cancer during their participation in WHI.Methods:…
Effect of Time to Diagnostic Testing for Breast, Cervical, and Colorectal Cancer Screening Abnormalities on Screening Efficacy: A Modeling Study
Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices.Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to…
Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study
Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of…
Expression of Wnt-signaling pathway genes and their associations with miRNAs in colorectal cancer
The Wnt-signaling pathway functions in regulating cell growth and thus is involved in the carcinogenic process of several cancers, including colorectal cancer. We tested the hypothesis that multiple genes in this signaling pathway are dysregulated and that miRNAs are associated…
Being Present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers
A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers. Mindfulness interventions can reduce distress and improve quality of life in cancer patients. However, standard mindfulness training relies on in-person instruction, which is often not…
The MAPK-Signaling Pathway in Colorectal Cancer: Dysregulated Genes and Their Association With MicroRNAs
Mitogen-activated protein kinase (MAPK) pathways regulate many cellular functions including cell proliferation and apoptosis. We examined associations of differential gene and microRNA (miRNA) expression between carcinoma and paired normal mucosa for 241 genes in the KEGG-identified MAPK-signaling pathway among 217…
Rectal Cancer Survivors’ Participation in Productive Activities
Rectal cancer and its treatment impair survivors' productivity. To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. We mailed questionnaires to 1063 survivors who were members of (Northern…
Resistance Training to Reduce Chemotoxicity in Colon Cancer
The goal of this study is to test a randomized intervention of up to six months of home-based resistance training and protein supplementation versus a waitlist control. The intervention will begin during the first month of chemotherapy and continue through…
Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives
Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN), although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung,…
Methodological considerations for disentangling a risk factor’s influence on disease incidence versus postdiagnosis survival: The example of obesity and breast and colorectal cancer mortality in the Women’s Health Initiative
Often, studies modeling an exposure's influence on time to disease-specific death from study enrollment are incorrectly interpreted as if based on time to death from disease diagnosis. We studied 151,996 postmenopausal women without breast or colorectal cancer in the Women's…
Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer
Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related to patients' post-colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) vs. primary colonoscopy screening for colorectal cancer…
Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C SCANS Study
Systemic inflammation and sarcopenia are easily evaluated, predict mortality in many cancers, and are potentially modifiable. The combination of inflammation and sarcopenia may be able to identify patients with early-stage colorectal cancer (CRC) with poor prognosis. To examine associations of…
Effectiveness of Screening for Colorectal Cancer in Average Risk Adults: Colonoscopy vs. Fecal Immunochemical Test (FIT)
This project will evaluate the effectiveness of screening fecal immunochemical testing (FIT) versus screening colonoscopy in reducing the risk of death from colorectal cancer in average risk men and women who receive their care in community settings. We will also…
Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM): Rationale for Study Design
Colorectal cancer (CRC) is preventable through screening, with colonoscopy and fecal occult blood testing comprising the two most commonly used screening tests. Given the differences in complexity, risk, and cost, it is important to understand these tests' comparative effectiveness. The…
A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening
Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two…
Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis
Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics. The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer…
The co-regulatory networks of tumor suppressor genes, oncogenes, and miRNAs in colorectal cancer
Tumor suppressor genes (TSGs) and oncogenes (OG) are involved in carcinogenesis. MiRNAs also contribute to cellular pathways leading to cancer. We use data from 217 colorectal cancer (CRC) cases to evaluate differences in TSGs and OGs expression between paired CRC…
The PI3K/AKT Signaling Pathway: associations of miRNAs with dysregulated gene expression in colorectal cancer
The PI3K/AKT-signaling pathway is one of the most frequently activated signal-transduction pathways in cancer. We examined how dysregulated gene expression is associated with miRNA expression in this pathway in colorectal cancer (CRC). We used data from 217 CRC cases to…
Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review
Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. To evaluate interventions to improve rates of follow-up colonoscopy for…
Primary care visit use after positive fecal immunochemical test for colorectal cancer screening
For some patients, positive cancer screening test results can be a stressful experience that can affect future screening compliance and increase the use of health care services unrelated to medically indicated follow-up. Among 483,216 individuals aged 50 to 75 years…
Germline variation in inflammation-related pathways and risk of Barrett’s oesophagus and oesophageal adenocarcinoma
Oesophageal adenocarcinoma (OA) incidence has risen sharply in Western countries over recent decades. Local and systemic inflammation is considered an important contributor to OA pathogenesis. Established risk factors for OA and its precursor, Barrett's oesophagus (BE), include symptomatic reflux, obesity…
Multiple Gene-Environment Interactions on the Angiogenesis Gene-Pathway Impact Rectal Cancer Risk and Survival
Characterization of gene-environment interactions (GEIs) in cancer is limited. We aimed at identifying GEIs in rectal cancer focusing on a relevant biologic process involving the angiogenesis pathway and relevant environmental exposures: cigarette smoking, alcohol consumption, and animal protein intake. We…
Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C-SCANS study
For many chemotherapy regimens dosed based on body surface area (BSA), patients experience dose reductions or delays or discontinue treatment, thereby reducing survival. Consideration of body composition may be useful in individualizing chemotherapy dosing, but to the authors' knowledge few…
Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program
Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. This was a retrospective cohort study among…
Effectiveness of Screening for Colorectal Cancer in Average Risk Adults: Colonoscopy vs. FIT
This study will evaluate the effectiveness of screening fecal immunochemical testing (FIT) versus screening colonoscopy in reducing the risk of death from colorectal cancer in average risk men and women who receive their care in community settings. We will also…
Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests…
Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study)
Background: Body composition may partially explain the U-shaped association between body mass index (BMI) and colorectal cancer survival.Methods: Muscle and adiposity at colorectal cancer diagnosis and survival were examined in a retrospective cohort using Kaplan-Meier curves, multivariable Cox regression, and…
Optimizing patient-reported outcome and risk factor reporting from cancer survivors: a randomized trial of four different survey methods among colorectal cancer survivors
The goal of this study was to determine response rates and associated costs of different survey methods among colorectal cancer (CRC) survivors. We assembled a cohort of 16,212 individuals diagnosed with CRC (2010-2014) from six health plans, and randomly selected…
Recommendations on Surveillance and Management of Biallelic Mismatch Repair Deficiency (BMMRD) Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The US Multi-Society Task Force on Colorectal Cancer, with invited experts, developed a consensus statement and recommendations to assist health care providers with appropriate management of patients with biallelic mismatch repair deficiency (BMMRD) syndrome, also called constitutional mismatch repair deficiency syndrome. This position…
Recommendations on Surveillance and Management of Biallelic Mismatch Repair Deficiency (BMMRD) Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The US Multi-Society Task Force on Colorectal Cancer, with invited experts, developed a consensus statement and recommendations to assist health care providers with appropriate management of patients with biallelic mismatch repair deficiency (BMMRD) syndrome, also called constitutional mismatch repair deficiency…
Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis
The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results require follow-up colonoscopy. However, follow-up intervals vary, which may result in neoplastic progression. To evaluate time to colonoscopy after a positive FIT result and…
Comprehensive Colorectal Cancer Risk Prediction to Inform Personalized Screening
The aims of this study are: 1) To build a comprehensive risk-prediction model for colorectal cancer and advanced adenoma in 45,000 colorectal tumors and 45,000 controls based on existing common and rare genome-wide genetic variants, demographic characteristics, and lifestyle and…
Endoscopist Fatigue Estimates and Colonoscopic Adenoma Detection in a Large Community-Based Setting
Endoscopist fatigue may impact colonoscopy quality, but prior studies conflict, and minimal data exist from community-based practices where most colonoscopies are performed. Within a large, community-based integrated healthcare system, we evaluated the associations among 4 measures of endoscopist fatigue and…
Genetic Biomarker Prevalence Is Similar in Fecal Immunochemical Test Positive and Negative Colorectal Cancer Tissue
Fecal immunochemical test (FIT) screening detects most asymptomatic colorectal cancers. Combining FIT screening with stool-based genetic biomarkers increases sensitivity for cancer, but whether DNA biomarkers (biomarkers) differ for cancers detected versus missed by FIT screening has not been evaluated in…
Colorectal Cancer Screening and Outcomes in HIV-Positive and HIV-Negative Individuals
With increasing age of HIV patients, HIV care is increasingly directed towards prevention of chronic disease, including cancer. With the exception of our recent study, prior research has not noted a higher risk of colorectal cancer in HIV patients. However,…
Novel approaches to identify sarcopenia in newly diagnosed cancer patients
This study will provide evidence on the prevalence and prognostic value of sarcopenia at diagnosis among KPNC colorectal cancer patients diagnosed from 2005-2013. Sarcopenia will be assessed through the qualitative determination of an expert radiologist using visual inspection, and validated…
Retrospective Validation of MeScore for Identification of Colorectal Cancer
The purpose of this study is to assess the efficacy of the computational method MeScore CRC in risk stratification for colorectal cancer in a seemingly healthy population (average risk).
Metabolic Phenotype and Risk of Colorectal Cancer in Normal-Weight Postmenopausal Women
The prevalence of metabolically unhealthy phenotype in normal-weight adults is 30%, and few studies have explored the association between metabolic phenotype and colorectal cancer incidence in normal-weight individuals. Our aim was to compare the risk of colorectal cancer in normal-weight…
Effectiveness of Screening Colonoscopy in Reducing Deaths from Colorectal Cancer (SCOLAR)
A case-control study to evaluate the associations between commonly performed tests (e.g. colonoscopy) and mortality from colon cancer.
Optimizing Colonoscopy and Fecal Immunochemical Tests for Community-Based Screening, COLOFIT(S)
An evaluation of the entire colorectal cancer screening process to optimize end results. The study includes evaluation of screen-failures (persons who had cancer detected outside of screening), failures of colonoscopy detection (and causes), and differences between screen detected and non-screen…
Body Composition, Weight, and Colon Cancer Survival
Using a novel state of the art meausre of lean body mass and fat mass derived from CT scans , this study will examine effects of body composition and changes in body composition among colon cancer survivors on colon cancer…
Effectiveness of Screening Colonoscopy in Reducing Deaths from Colorectal Cancer (SCOLAR) – DUPLICATED DO NOT ACTIVATE
This is a case-control study to evaluate the associations between commonly performed tests (e.g., colonoscopy) and mortality from colon cancer.
Fecal Immunochemical Test (FIT) for Colon Cancer Screening: Variable Performance with Ambient Temperature
Fecal immunochemical tests (FITs) are widely used in colorectal cancer (CRC) screening, but hemoglobin degradation, due to exposure of the collected sample to high temperatures, could reduce test sensitivity. We examined the relation of ambient temperature exposure with FIT positivity…
Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The use of the fecal occult blood test (FOBT) for colorectal cancer (CRC) screening is supported by randomized trials demonstrating effectiveness in cancer prevention and widely recommended by guidelines for this purpose. The fecal immunochemical test (FIT), as a direct…
Association of Weight Change after Colorectal Cancer Diagnosis and Outcomes in the Kaiser Permanente Northern California Population
Higher body mass index (BMI) is associated with incident colorectal cancer but not consistently with colorectal cancer survival. Whether weight gain or loss is associated with colorectal cancer survival is largely unknown. We identified 2,781 patients from Kaiser Permanente Northern…
Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. To examine the association between race/ethnicity and the receipt of CRC…
Self-reported depression and perceived financial burden among long-term rectal cancer survivors
Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among…
Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop
Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues,…
Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach
Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. To assess associations between primary care provider (PCP) visits and receipt of CRC screening and…
Consequences of Increasing Time to Colonoscopy Examination Following Positive Result From Fecal Colorectal Cancer Screening Test
Delays in diagnostic testing after a positive result from a screening test can undermine the benefits of colorectal cancer (CRC) screening, but there are few empirical data on the effects of such delays. We used microsimulation modeling to estimate the…
Harms, benefits, and the nature of interventions in pragmatic clinical trials
To produce evidence capable of informing healthcare decision making at all critical levels, pragmatic clinical trials are diverse both in terms of the type of intervention (medical, behavioral, and/or technological) and the target of intervention (patients, clinicians, and/or healthcare system…
Metabolic Dysfunction, Obesity, and Survival Among Patients With Early-Stage Colorectal Cancer
The effects of obesity and metabolic dysregulation on cancer survival are inconsistent. To identify high-risk subgroups of obese patients and to examine the joint association of metabolic syndrome (MetSyn) in combination with obesity, we categorized patients with early-stage (I to…
Relationship of pre-diagnostic body mass index with survival after colorectal cancer: Stage-specific associations
Higher body mass index (BMI) is a well-established risk factor for colorectal cancer (CRC), but is inconsistently associated with CRC survival. In 6 prospective studies participating in the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO), 2,249 non-Hispanic white CRC…
Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly
Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata,…
Analysis of Body Mass Index and Mortality in Patients With Colorectal Cancer Using Causal Diagrams
Physicians and investigators have sought to determine the relationship between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and colorectal cancer (CRC) outcomes, but methodologic limitations including sampling selection bias, reverse causality, and…
Acceptance of flexible sigmoidoscopy screening for colorectal cancer
This study was conducted in the Kaiser Permanente Medical Care Program of Northern California to identify patient characteristics that explain interest in flexible sigmoidoscopy (FS) screening. A mailed screening invitation to 6837 age-eligible patients elicited responses from 49%. Efforts to…
Participation of Asian-American women in cancer treatment research: a pilot study
Few Asian-American women participate in cancer treatment trials. In a pilot study to assess barriers to participation, we mailed surveys to 132 oncologists and interviewed 19 Asian-American women with cancer from Northern California. Forty-four oncologists responded. They reported as barriers…
Breast and cervical cancer screening: clinicians’ views on health plan guidelines and implementation efforts
BACKGROUND: Optimizing breast and cervical cancer screening rates within health plans requires clinician support for screening guidelines, an awareness of whether there are tools available and functioning to aid screening implementation, and a perception of collegial and leadership support for…
Women’s decision making about whether or not to use breast cancer chemoprevention
BACKGROUND: Minimal research is available that examines how women at high risk for breast cancer make choices about chemoprevention. We examined how women decide whether to use chemoprevention within the Study of Tamoxifen and Raloxifene (STAR), a non-placebo arm prevention…
Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors
Sexual dysfunction is a treatment sequela in survivors of rectal cancer (RC). Differences in health-related quality of life (HRQOL) can occur based on ostomy status (permanent ostomy vs anastomosis). To describe alterations in sexual function and HRQOL based on ostomy…
Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study
The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown. To assess FIT performance characteristics over 4 rounds of annual screening. Retrospective…
Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium
Primary care providers and health systems have prominent roles in guiding effective cancer screening. To characterize variation in screening abnormality rates and timely initial follow-up for common cancer screening tests. Population-based cohort undergoing screening in 2011, 2012, or 2013 at…
Recommendations for a step-wise comparative approach to the evaluation of new screening tests for colorectal cancer
New screening tests for colorectal cancer continue to emerge, but the evidence needed to justify their adoption in screening programs remains uncertain. A review of the literature and a consensus approach by experts was undertaken to provide practical guidance on…
Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer
The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the…
Factors Influencing Variation in Physician Adenoma Detection Rates: a Theory-Based Approach for Performance Improvement
Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful, and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence…
Ten-year incidence of colorectal cancer following a negative screening sigmoidoscopy: an update from the Colorectal Cancer Prevention (CoCaP) programme
To examine the rates of colorectal cancer (CRC) following a negative screening sigmoidoscopy. Cohort study. An integrated healthcare delivery organisation in California, USA. 72,483 men and women aged 50?years and above who had a negative screening sigmoidoscopy between 1994 and…
CYP24A1 variant modifies the association between use of oestrogen plus progestogen therapy and colorectal cancer risk
Menopausal hormone therapy (MHT) use has been consistently associated with a decreased risk of colorectal cancer (CRC) in women. Our aim was to use a genome-wide gene-environment interaction analysis to identify genetic modifiers of CRC risk associated with use of…
Fine-Mapping of Common Genetic Variants Associated with Colorectal Tumor Risk Identified Potential Functional Variants
Genome-wide association studies (GWAS) have identified many common single nucleotide polymorphisms (SNPs) associated with colorectal cancer risk. These SNPs may tag correlated variants with biological importance. Fine-mapping around GWAS loci can facilitate detection of functional candidates and additional independent risk…
Risk of gastric cancer, gastrointestinal cancers and other cancers: a comparison of treatment with pantoprazole and other proton pump inhibitors
Proton pump inhibitors (PPIs) have been shown to be carcinogenic in rodent studies. As part of a long-term post-marketing surveillance study requested by the US Food and Drug Administration, to compare incidence rates of gastric and other cancers after sustained…
Common Genetic Variation and Survival after Colorectal Cancer Diagnosis: A Genome-Wide Analysis
Genome-wide association studies have identified several germline single nucleotide polymorphisms (SNPs) significantly associated with colorectal cancer (CRC) incidence. Common germline genetic variation may also be related to CRC survival. We used a discovery-based approach to identify SNPs related to survival…
Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors
Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel…
Observational methods to assess the effectiveness of screening colonoscopy in reducing right colon cancer mortality risk: SCOLAR
Screening colonoscopy's effectiveness in reducing risk of death from right colon cancers remains unclear. Methodological challenges of existing observational studies addressing this issue motivated the design of 'Effectiveness of Screening for Colorectal Cancer in Average-Risk Adults (SCOLAR)'. SCOLAR is a…
METFORMIN USE AND RISK OF COLORECTAL ADENOMA AFTER POLYPECTOMY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Existing literature suggests that metformin, the most commonly used biguanide, may lower colorectal cancer risk. Because most colorectal cancers originate in precancerous adenomas, we examined whether metformin use lowered colorectal adenoma risk after polypectomy in patients with type-2 diabetes. Retrospective…
Chronic inflammation and risk of colorectal and other obesity-related cancers: The health, aging and body composition study.
Evidence of the association between chronic inflammation and the risk of colorectal cancer (CRC) and other obesity-related cancers (OBRC) remains inconsistent, possibly due to a paucity of studies examining repeated measures of inflammation. In the Health ABC prospective study of…
A Candidate-Pathway Approach to Identify Gene-Environment Interactions: Analyses of Colon Cancer Risk and Survival
Genetic association studies have traditionally focused on associations between individual single nucleotide polymorphisms (SNPs) and disease. Standard analysis ignores interactions between multiple SNPs and environmental exposures explaining a small portion of disease heritability: the often-cited issue of "missing heritability." We…
Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know.
Although colorectal cancer (CRC) is a common cause of cancer-related death, it is fortunately amenable to screening with faecal tests for occult blood and endoscopic tests. Despite the evidence for the efficacy of guaiac-based faecal occult blood tests (gFOBT), they…
An evaluation and replication of miRNAs with disease stage and colorectal cancer-specific mortality
MicroRNAs (miRNAs) have been implicated in colorectal cancer (CRC) development and associated with prognostic indicators such as disease stage and survival. Prognostic associations are often based on few individuals and imprecise. In this study, we utilize population-based data from 1,141…
Genome-wide association study of colorectal cancer identifies six new susceptibility loci
Genetic susceptibility to colorectal cancer is caused by rare pathogenic mutations and common genetic variants that contribute to familial risk. Here we report the results of a two-stage association study with 18,299 cases of colorectal cancer and 19,656 controls, with…
Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management
Improving colorectal cancer (CRC) screening rates for patients from socioeconomically disadvantaged backgrounds is a recognized public health priority. Our aim was to determine if implementation of a system-wide screening intervention could reduce disparities in the setting of improved overall screening…
Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018
The National Colorectal Cancer Roundtable, a national coalition of public, private, and voluntary organizations, has recently announced an initiative to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018. The authors evaluated the potential public…
Mendelian randomization study of body mass index and colorectal cancer risk
High body mass index (BMI) is consistently linked to increased risk of colorectal cancer for men, whereas the association is less clear for women. As risk estimates from observational studies may be biased and/or confounded, we conducted a Mendelian randomization…
Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening: A Microsimulation Model
Colonoscopy is the most commonly used colorectal cancer screening test in the United States. Its quality, as measured by adenoma detection rates (ADRs), varies widely among physicians, with unknown consequences for the cost and benefits of screening programs. To estimate…
Adjusting for Patient Demographics Has Minimal Effects on Rates of Adenoma Detection in a Large, Community-based Setting
Reliable estimates of adenoma detection rates (ADRs) are needed to inform colonoscopy quality standards, yet little is known about the contributions of patient demographics to variation in ADRs. We evaluated the effects of adjusting for patient age, race/ethnicity, and family…
Association of aspirin and NSAID use with risk of colorectal cancer according to genetic variants
Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with lower risk of colorectal cancer. To identify common genetic markers that may confer differential benefit from aspirin or NSAID chemoprevention, we tested gene?×?environment interactions between regular use of…
The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative
Inflammation is a process central to carcinogenesis and in particular to colorectal cancer (CRC). Previously, we developed a dietary inflammatory index (DII) from extensive literature review to assess the inflammatory potential of diet. In the current study, we utilized this…
Development and validation of an algorithm for classifying colonoscopy indication
Accurate determination of colonoscopy indication is required for managing clinical programs and performing research; however, existing algorithms that use available electronic databases (eg, diagnostic and procedure codes) have yielded limited accuracy. To develop and validate an algorithm for classifying colonoscopy…
Colorectal cancer deaths attributable to nonuse of screening in the United States
Screening is a major contributor to colorectal cancer (CRC) mortality reductions in the United States but is underused. We estimated the fraction of CRC deaths attributable to nonuse of screening to demonstrate the potential benefits from targeted interventions. The established…
Lack of significant association between serum inflammatory cytokine profiles and the presence of colorectal adenoma
Inflammatory cytokines in the colonic microenvironment have been shown to increase with advance colorectal cancer disease state. However, the contribution of inflammatory cytokines to pre-malignant disease, such as the formation of adenomas, is unclear. Using the Milliplex® MAP Human Cytokine/…
Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study
The one-sample fecal immunochemical test (FIT) is gaining popularity for colorectal cancer (CRC) screening of average-risk people. However, uptake and annual use remain suboptimal. In 2013, we mailed questionnaires to three groups of nonHispanic White, Black, and Latino Kaiser Permanente…
Red meat intake, NAT2, and risk of colorectal cancer: A pooled analysis of 11 studies
Red meat intake has been associated with risk of colorectal cancer, potentially mediated through heterocyclic amines. The metabolic efficiency of N-acetyltransferase 2 (NAT2) required for the metabolic activation of such amines is influenced by genetic variation. The interaction between red…
Advances in Fecal Occult Blood Tests: the FIT revolution.
There is a wide choice of fecal occult blood tests (FOBTs) for colorectal cancer screening. GOAL: To highlight the issues applicable when choosing a FOBT, in particular which FOBT is best suited to the range of screening scenarios. Four scenarios…
Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors
Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (?5 years post-diagnosis). We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City…
Assessing bowel preparation quality using the mean number of adenomas per colonoscopy
The quality of the bowel preparation directly influences colonoscopy effectiveness. Quality indicators are widely employed to monitor operator performance and to gauge colonoscopy effectiveness. Some have suggested that the enumeration of the mean number of adenomas per colonoscopy (MNA) may…
An analysis of genetic factors related to risk of inflammatory bowel disease and colon cancer
Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal cancer than the general population. Genome-wide association studies have identified and replicated several loci associated with risk of IBD; however, it is currently unknown whether these loci…
Gene-environment interaction involving recently identified colorectal cancer susceptibility loci
Genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) that are associated with risk of colorectal cancer. Prior research has evaluated the presence of gene-environment interaction involving the first 10 identified susceptibility loci, but little work has been conducted…
Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides…
Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: provides a colorectal…
Guidelines on Genetic Evaluation and Management of Lynch Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides…
Estimating the Heritability of Colorectal Cancer
A sizable fraction of colorectal cancer (CRC) is expected to be explained by heritable factors, with heritability estimates ranging from 12 to 35% twin and family studies. Genome-wide association studies (GWAS) have successfully identified a number of common single-nucleotide polymorphisms…
Multitarget stool DNA testing for colorectal-cancer screening.
To the Editor: Imperiale and colleagues evaluate the use of a single-application multitarget stool DNA test for colorectal-cancer screening and compare its performance characteristics with those of the FIT. Two important points warrant further discussion. First, the investigators used a…
The Colorectal Cancer Screening Process in Community Settings: A Conceptual Model for the Population-Based Research Optimizing Screening through Personalized Regimens Consortium
Reducing colorectal cancer mortality by promoting screening has been a national goal for two decades. The NCI's Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium is the first federal initiative to foster coordinated, transdisciplinary research evaluating the entire cancer…
From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies
The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of…
Pleiotropic effects of genetic risk variants for other cancers on colorectal cancer risk: PAGE, GECCO and CCFR consortia
Genome-wide association studies have identified a large number of single nucleotide polymorphisms (SNPs) associated with a wide array of cancer sites. Several of these variants demonstrate associations with multiple cancers, suggesting pleiotropic effects and shared biological mechanisms across some cancers…
Adenoma detection rate and risk of colorectal cancer and death
The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients' risks of a…
Multitarget Stool DNA Testing for Colorectal-Cancer Screening
An accurate, noninvasive test could improve the effectiveness of colorectal-cancer screening. We compared a noninvasive, multitarget stool DNA test with a fecal immunochemical test (FIT) in persons at average risk for colorectal cancer. The DNA test includes quantitative molecular assays…
Genome-wide diet-gene interaction analyses for risk of colorectal cancer
Dietary factors, including meat, fruits, vegetables and fiber, are associated with colorectal cancer; however, there is limited information as to whether these dietary factors interact with genetic variants to modify risk of colorectal cancer. We tested interactions between these dietary…
Challenges and possible solutions to colorectal cancer screening for the underserved
Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and…
Population Screening for Colorectal Cancer Means Getting FIT: The Past, Present, and Future of Colorectal Cancer Screening Using the Fecal Immunochemical Test for Hemoglobin (FIT)
Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this…
Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis
Performance characteristics of fecal immunochemical tests (FITs) to screen for colorectal cancer (CRC) have been inconsistent. To synthesize data about the diagnostic accuracy of FITs for CRC and identify factors affecting its performance characteristics. Online databases, including MEDLINE and EMBASE,…
Does KRAS Testing in Metastatic Colorectal Cancer Impact Overall Survival? A Comparative Effectiveness Study in a Population-Based Sample
Epidermal growth factor receptor (EGFR) inhibitors are approved for treating metastatic colorectal cancer (CRC); KRAS mutation testing is recommended prior to treatment. We conducted a non-inferiority analysis to examine whether KRAS testing has impacted survival in CRC patients. We included…
Approaches for classifying the indications for colonoscopy using detailed clinical data
Accurate indication classification is critical for obtaining unbiased estimates of colonoscopy effectiveness and quality improvement efforts, but there is a dearth of published systematic classification approaches. The objective of this study was to evaluate the effects of data-source and adjudication…
Cohort Study of Insulin Glargine and Risk of Breast, Prostate, and Colorectal Cancer Among Patients With Diabetes
To examine whether use of insulin glargine, compared with another long-acting insulin, is associated with risk of breast, prostate, colorectal cancer, or all cancers combined. Computerized health records from Kaiser Permanente Northern and Southern California regions starting in 2001 and…
Oncologists’ attitudes toward KRAS testing: a multisite study
Recent discoveries promise increasingly to help oncologists individually tailor anticancer therapy to their patients' molecular tumor characteristics. One such promising molecular diagnostic is Kirsten ras (KRAS) tumor mutation testing for metastatic colorectal cancer (mCRC) patients. In the current study, we…
Uncontrolled confounding in studies of screening effectiveness: an example of colonoscopy
To estimate the expected magnitude of error produced by uncontrolled confounding from health behaviours in observational medical record-based studies evaluating effectiveness of screening colonoscopy. We used data from the prospective National Institutes of Health American Association of Retired Persons (NIH-AARP)…
Genetic Predictors of Circulating 25-Hydroxyvitamin D and Risk of Colorectal Cancer
Experimental evidence has demonstrated an antineoplastic role for vitamin D in the colon, and higher circulating 25-hydroxyvitamin D [25(OH)D] levels are consistently associated with a lower risk of colorectal cancer. Genome-wide association studies have identified loci associated with levels of…
Health Benefits and Cost-Effectiveness of a Hybrid Screening Strategy for Colorectal Cancer
Colorectal cancer (CRC) screening guidelines recommend screening schedules for each single type of test except for concurrent sigmoidoscopy and fecal occult blood test (FOBT). We investigated the cost-effectiveness of a hybrid screening strategy that was based on a fecal immunological…
Phospholipase A2G1B polymorphisms and risk of colorectal neoplasia
Pancreatic phospholipase A2, product of PLA2G1B, catalyzes the release of fatty acids from dietary phospholipids.Diet is the ultimate source of arachidonic acid in cellular phospholipids, precursor of eicosanoid signaling molecules, linked to inflammation, cell proliferation and colorectal carcinogenesis. We evaluated…
Effectiveness and Reach of the FLU-FIT Program in an Integrated Health Care System: A Multisite Randomized Trial
OBJECTIVES: We tested the effectiveness of offering home fecal immunochemical tests (FITs) during influenza vaccination clinics to increase colorectal cancer screening (CRCS). METHODS: In a clinical trial at Kaiser Permanente Northern California influenza clinics in Redwood City, Richmond, South San…
Genetic variation in the lipoxygenase pathway and risk of colorectal neoplasia
Arachidonate lipoxygenase (ALOX) enzymes metabolize arachidonic acid to generate potent inflammatory mediators and play an important role in inflammation-associated diseases. We investigated associations between colorectal cancer risk and polymorphisms in ALOX5, FLAP, ALOX12, and ALOX15, and their interactions with nonsteroidal…
Gene-diet-interactions in folate-mediated one-carbon metabolism modify colon cancer risk
SCOPE: The importance of folate-mediated one-carbon metabolism (FOCM) in colorectal carcinogenesis is emphasized by observations that high dietary folate intake is associated with decreased risk of colon cancer (CC) and its precursors. Additionally, polymorphisms in FOCM-related genes have been repeatedly…
Identification of Genetic Susceptibility Loci for Colorectal Tumors in a Genome-Wide Meta-Analysis
BACKGROUND & AIMS: Heritable factors contribute to the development of colorectal cancer. Identifying the genetic loci associated with colorectal tumor formation could elucidate the mechanisms of pathogenesis. METHODS: We conducted a genome-wide association study that included 14 studies, 12,696 cases…
Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study
BACKGROUND: The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer. OBJECTIVE: To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC). DESIGN: Nested case-control study. SETTING: Four U.S. health…
Variation of Adenoma Prevalence by Age, Sex, Race, and Colon Location in a Large Population: Implications for Screening and Quality Programs
BACKGROUND & AIMS: Reliable community-based colorectal adenoma prevalence estimates are needed to inform colonoscopy quality standards and to estimate patient colorectal cancer risks; however, minimal data exist from populations with large numbers of diverse patients and examiners. METHODS: We evaluated…
Measurement of Colorectal Cancer Test Use With Medical Claims Data in a Safety-Net Health System
BACKGROUND:: Optimizing colorectal cancer (CRC) screening requires identification of unscreened individuals and tracking screening trends. A recent National Institutes of Health State of the Science Conference, 'Enhancing Use and Quality of CRC Screening,' cited a need for more population data…
Factors Influencing Time to Diagnosis After Abnormal Mammography Results in Diverse Women
BACKGROUND: Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. METHODS: Women aged 40-80 years, identified from lists…
KRAS Testing and Epidermal Growth Factor Receptor Inhibitor Treatment for Colorectal Cancer in Community Settings
BACKGROUND: In metastatic colorectal cancer (mCRC), mutations in the KRAS gene predict poor response to EGF receptor (EGFR) inhibitors. Clinical treatment guidelines now recommend KRAS testing if EGFR inhibitors are considered. Our study investigates the clinical uptake and utilization of…
PTGS1, PTGS2, ALOX5, ALOX12, ALOX15, and FLAP SNPs: interaction with fatty acids in colon cancer and rectal cancer
Dietary polyunsaturated fatty acids (PUFAs) can be converted to prostaglandins and leukotrienes. Oxygenation of omega-6 PUFAs generally results in the production of pro-inflammatory mediators, whereas oxygenated products of omega-3 (n-3) PUFAs generally have lower inflammatory activity. We hypothesize that elevated…
Surviving Colorectal Cancer: Long-term, Persistent Ostomy-Specific Concerns and Adaptations
The purpose of this article was to describe persistent ostomy-specific concerns and adaptations in long-term (>5 years) colorectal cancer survivors with ostomies. Thirty-three colorectal cancer survivors who participated in 8 gender- and health-related quality of life stratified focus groups and…
A pooled analysis of smoking and colorectal cancer: timing of exposure and interactions with environmental factors
BACKGROUND: Considerable evidence suggests that cigarette smoking is associated with a higher risk of colorectal cancer (CRC). What is unclear, however, is the impact of quitting smoking on risk attenuation and whether other risk factors for CRC modify this association…
Irrigation practices in long-term survivors of colorectal cancer with colostomies
For some patients diagnosed with rectal cancer, surgery will involve the creation of a temporary or permanent ostomy. When the colostomy is located in the sigmoid or descending colon, regulation of fecal output can occur through irrigation, a procedure that…
Capecitabine-induced chest pain relieved by diltiazem.
Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma were started on a 2-weeks-on, 1-week-off capecitabine dosing regimen in addition to other chemotherapeutic agents and/or radiation. Within the first few doses, patients experienced chest pain and/or dyspnea at…
Incidence and Mortality of Colorectal Adenocarcinoma in Persons with Inflammatory Bowel Disease from 1998 to 2010
BACKGROUND & AIMS: The relationship between inflammatory bowel disease (IBD) and the incidence and mortality of colorectal adenocarcinoma (CRC) has not been evaluated recently. METHODS: We calculated the incidence and standardized incidence and mortality rate ratios of CRC among adult…
Automated phone and mail population outreach to promote colorectal cancer screening
OBJECTIVES: To evaluate a population outreach program to promote screening for colorectal cancer (CRC) among average-risk insured men and women. STUDY DESIGN: In 2008, 58,440 Kaiser Permanente Colorado members unscreened for CRC received an interactive voice response (IVR) call followed…
A Proposal to Standardize Reporting Units for Fecal Immunochemical Tests for Hemoglobin
Fecal immunochemical tests for hemoglobin are replacing traditional guaiac fecal occult blood tests in population screening programs for many reasons. However, the many available fecal immunochemical test devices use a range of sampling methods, differ with regard to hemoglobin stability,…
Glutathione peroxidase tagSNPs: Associations with rectal cancer but not with colon cancer
Glutathione peroxidases (GPXs) are selenium-dependent enzymes that reduce and, thus, detoxify hydrogen peroxide and a wide variety of lipid hydroperoxides. We investigated tagSNPs in GPX1-4 in relation to colorectal neoplasia in three independent study populations capturing the range of colorectal…
Genetic Variation in the Transforming Growth Factor-beta-Signaling Pathway, Lifestyle Factors, and Risk of Colon or Rectal Cancer
BACKGROUND: The transforming growth factor-beta-signaling pathway has been identified as being involved in colorectal cancer. OBJECTIVE: The aim of this study was to determine how diet and lifestyle factors in combination with genetic variation in the transforming growth factor-beta-signaling pathway…
Characterization of gene-environment interactions for colorectal cancer susceptibility loci
Genome-wide association studies (GWAS) have identified more than a dozen loci associated with colorectal cancer (CRC) risk. Here, we examined potential effect-modification between single-nucleotide polymorphisms (SNP) at 10 of these loci and probable or established environmental risk factors for CRC…
Genetic variability in IL23R and risk of colorectal adenoma and colorectal cancer
Inflammatory processes, including, specifically, the inflammatory conditions Crohn's disease (CD) and ulcerative colitis (UC) predispose to colorectal cancer. Interleukin-23 is involved in pro-inflammatory signaling; genetic variation in the interleukin-23 receptor (IL23R) has been consistently associated with CD and UC risk…
Meta-analysis of new genome-wide association studies of colorectal cancer risk
Colorectal cancer is the second leading cause of cancer death in developed countries. Genome-wide association studies (GWAS) have successfully identified novel susceptibility loci for colorectal cancer. To follow up on these findings, and try to identify novel colorectal cancer susceptibility…
Editorial: Taking FIT to the People: Out of the Office and Into the Mail
Colorectal cancer (CRC) screening is most commonly performed in the United States using an opportunistic approach: patients coming to a physician's office for other unrelated reasons are offered screening with either fecal occult blood tests or, more commonly, a referral…
Genome-wide search for gene-gene interactions in colorectal cancer
Genome-wide association studies (GWAS) have successfully identified a number of single-nucleotide polymorphisms (SNPs) associated with colorectal cancer (CRC) risk. However, these susceptibility loci known today explain only a small fraction of the genetic risk. Gene-gene interaction (GxG) is considered to…
Genetic variability in EGFR, Src and HER2 and risk of colorectal adenoma and cancer
The EGFR signaling pathway is involved in carcinogenesis at multiple sites, particularly colorectal cancer, and is a target of colorectal cancer chemotherapy. EGFR signaling is linked to pro-carcinogenic mechanisms, including cell proliferation, survival, angiogenesis, and more recently prostaglandin synthesis. Genetic…
Is Diabetes Mellitus an Independent Risk Factor for Colon Cancer and Rectal Cancer?
OBJECTIVES: Diabetes mellitus (DM) has been associated with an increased risk of colorectal cancer (CRC). The American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 recommend that clinicians be aware of an increased CRC risk in patients with smoking…
Genetic variation in the transforming growth factor-beta signaling pathway and survival after diagnosis with colon and rectal cancer
BACKGROUND: The transforming growth factor-beta (TGF-beta) signaling pathway is involved in many aspects of tumorigenesis, including angiogenesis and metastasis. The authors evaluated this pathway in association with survival after a diagnosis of colon or rectal cancer. METHODS: The study included…
Colon Cancer Survival With Herbal Medicine and Vitamins Combined With Standard Therapy in a Whole-Systems Approach: Ten-Year Follow-up Data Analyzed With Marginal Structural Models and Propensity Score Methods
Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal…
Gender differences in quality of life among long-term colorectal cancer survivors with ostomies
PURPOSE/OBJECTIVES: To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies. DESIGN: Qualitative study using content analysis of focus group content. SETTING: Oregon, southwestern Washington, and northern California. SAMPLE:…
Cost-effectiveness of a mailed educational reminder to increase colorectal cancer screening.
BACKGROUND: Colorectal cancer (CRC) screening rates are low in many areas and cost-effective interventions to promote CRC screening are needed. Recently in a randomized controlled trial, a mailed educational reminder increased CRC screening rates by 16.2% among U.S. Veterans. The…
Ethical and practical challenges of sharing data from genome-wide association studies: the eMERGE Consortium experience
In 2007, the National Human Genome Research Institute (NHGRI) established the Electronic MEdical Records and GEnomics (eMERGE) Consortium (www.gwas.net) to develop, disseminate, and apply approaches to research that combine DNA biorepositories with electronic medical record (EMR) systems for large-scale, high-throughput…
Variation in the CYP19A1 gene and risk of colon and rectal cancer
CYP19A1, or aromatase, influences estrogen-metabolizing enzymes and may influence cancer risk. We examine variation in the CYP19A1 gene and risk of colorectal cancer using data from population-based case-control studies (colon n = 1,574 cases, 1,970 controls; rectal n = 791…
Molecular Prognostic and Predictive Markers in Colorectal Cancer: Current Status.
In parallel with our growing understanding of the molecular pathways underlying colorectal neoplasia, significant advances have been made in the treatment of colorectal cancer (CRC). For the past few decades, 5-fluorouracil-based therapy has been the cornerstone of adjuvant therapy. More…
Genetic variation in C-reactive protein in relation to colon and rectal cancer risk and survival
C-reactive protein (CRP), a biomarker of inflammation, has been shown to be influenced by genetic variation in the CRP gene. In this study, we test the hypothesis that genetic variation in CRP influences both the risk of developing colon and…
Complications among colorectal cancer survivors: SF-6D preference-weighted quality of life scores
BACKGROUND: Societal preference-weighted health-related quality of life (HRQOL) scores enable comparing multidimensional health states across diseases and treatments for research and policy. OBJECTIVE: To assess the effects of living with a permanent intestinal stoma, compared with a major bowel resection,…
Associations between genetic variation in RUNX1, RUNX2, RUNX3, MAPK1 and eIF4E and riskof colon and rectal cancer: additional support for a TGF-beta-signaling pathway
The Runt-related transcription factors (RUNX), mitogen-activated protein kinase (MAPK) 1 and eukaryotic translation initiation factor 4E (eIF4E) are potentially involved in tumorigenesis. We evaluated genetic variation in RUNX1 (40 tagSNPs), RUNX2 (19 tagSNPs), RUNX3 (9 tagSNPs), MAPK1 (6 tagSNPs), eIF4E…
Genetic variation in bone morphogenetic protein and colon and rectal cancer
Bone morphogenetic proteins (BMP) are part of the TGF-beta-signaling pathway; genetic variation in these genes may be involved in colorectal cancer. In this study, we evaluated the association between genetic variation in BMP1 (11 tagSNPs), BMP2 (5 tagSNPs), BMP4 (3…
The FLU-FIT program: an effective colorectal cancer screening program for high volume flu shot clinics
OBJECTIVE: To determine whether offering home fecal immunochemical tests (FITs) to eligible patients during a high volume influenza vaccination clinic could lead to increased colorectal cancer screening (CRCS) rates in a managed care setting. STUDY DESIGN: Observational study. METHODS: During…
Candidate pathway polymorphisms in one-carbon metabolism and risk of rectal tumor mutations
We examined candidate polymorphisms in genes involved in the folate-mediated, one-carbon metabolism pathway, DNMT1 1311V, MTHFD1 R134K and R653Q, MTHFR R594Q, MTR D919G, MTRR H595Y and I22M, SHMT1 L474F, SLC19A1 H27R, and TDG G199S, and associations with rectal tumor characteristics…
Organized colorectal cancer screening in integrated health care systems
Colorectal cancer (CRC) is an ideal target for early detection and prevention through screening. Noninvasive screening options are the guaiac fecal occult blood test and the fecal immunochemical test. Organized screening offers the promise of uniformly delivering screening to all…
Lack of association between insulin sensitivity and colorectal adenoma risk
Insulin resistance is thought to mediate the association between obesity and colorectal neoplasia, but no prior studies have assessed stimulated insulin sensitivity as a risk factor for colorectal neoplasia. This prospective study examined the association between insulin sensitivity measured directly…
Nutrients in folate-mediated, one-carbon metabolism and the risk of rectal tumors in men and women
In an investigation of rectal tumors characterized by CpG island methylator phenotype (CIMP), KRAS2 mutation, and TP53 mutation, we examined associations with dietary and supplemental folate, riboflavin, vitamins B(6) and B(12), and methionine, nutrients involved in folate-mediated 1-carbon metabolism. We…
Characterization of 9p24 risk locus and colorectal adenoma and cancer: gene-environment interaction and meta-analysis
BACKGROUND: A potential susceptibility locus for colorectal cancer on chromosome 9p24 (rs719725) was initially identified through a genome-wide association study, though replication attempts have been inconclusive. METHODS: We genotyped this locus and explored interactions with known risk factors as potential…
Prevalence of colorectal cancer surveillance for ulcerative colitis in an integrated health care delivery system
BACKGROUND & AIMS: The absence of grade A supporting evidence for surveillance colonoscopy in patients with ulcerative colitis (UC) has led to controversy regarding its benefit, yet it is routinely recommended in practice guidelines. Limited data are available on rates…
Evidence for an hMSH3 defect in familial hamartomatous polyps.
BACKGROUND: Patients with hamartomatous polyposis syndromes have increased risk for colorectal cancer (CRC). Although progression of polyps to carcinoma is observed, pathogenic mechanisms remain unknown. The authors examined whether familial hamartomatous polyps harbor defects in DNA mismatch repair (MMR), and…
Physicians’ approaches to recommending colorectal cancer screening: a qualitative study
Little is known about strategies that physicians use to encourage receipt of colorectal cancer screening (CRCS). This study conducted focus groups with physicians. Twenty-seven physicians participated in four focus groups. Physicians described four categories of approaches: (1) why screening is…
FIT: a valuable but underutilized screening test for colorectal cancer-it’s time for a change
Although fecal immunochemical tests (FITs) have been used for colorectal cancer (CRC) screening in several countries for years, this has not been the case in the United States. The reasons for this are multifactorial, but if the United States hopes…
Diet, physical activity, and body size associations with rectal tumor mutations and epigenetic changes
Diet and lifestyle factors have been inconsistently associated with rectal tumors. It is possible that evaluation of specific tumor markers with these factors may help clarify these associations. In this study, we examine energy contributing nutrients, dietary fiber, BMI (kg/m2),…
Alcohol consumption and rectal tumor mutations and epigenetic changes
PURPOSE: An association between alcohol and rectal cancer has been reported in the epidemiological literature. In this study we further explore the association by examining specific tumor markers with alcohol consumption as well as types of alcoholic beverages consumed. METHODS:…
Increased risk of colon cancer associated with a genetic polymorphism of SMAD7
Genome-wide association studies (GWAS) have identified SMAD7 on 8q21 as being associated with colorectal cancer. We evaluated single nucleotide polymorphisms (SNP) in the SMAD7 gene, including rs4939827, rs12953717, and rs4464148, previously identified from GWAS in a large population-based case-control study…
Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis
PURPOSE: Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life. BACKGROUND: The incidence and effects of complications…
Red wine consumption not associated with reduced risk of colorectal cancer
Red wine contains polyphenol antioxidants that inhibit colorectal cancer (CRC) development in animal studies. We investigated the effect of red wine intake on risk of CRC in the California Men's Health Study (CMHS). CMHS is a prospective, multiethnic cohort of…
Characterization of the association between 8q24 and colon cancer: gene-environment exploration and meta-analysis
BACKGROUND: Genome-wide association studies and subsequent replication studies have shown that single nucleotide polymorphisms (SNPs) in the chromosomal region 8q24 are associated with colorectal cancer susceptibility. METHODS: We examined 11 SNP markers in the 8q24 region between 128.47 and 128.54…
Calcium, vitamin D, VDR genotypes, and epigenetic and genetic changes in rectal tumors
Calcium, vitamin D, exposure to sunshine, and vitamin D receptor (VDR) genotypes have been associated rectal cancer. We used data from 750 rectal tumors and 1,205 population-based controls examine associations with TP53, KRAS2, and CpG Island methylator phenotype (CIMP) markers…
Activin signaling in microsatellite stable colon cancers is disrupted by a combination of genetic and epigenetic mechanisms.
BACKGROUND: Activin receptor 2 (ACVR2) is commonly mutated in microsatellite unstable (MSI) colon cancers, leading to protein loss, signaling disruption, and larger tumors. Here, we examined activin signaling disruption in microsatellite stable (MSS) colon cancers.METHODS: Fifty-one population-based MSS colon cancers…
Assessing tumor mutations to gain insight into base excision repair sequence polymorphisms and smoking in colon cancer
DNA repair enzymes function in major pathways to reverse DNA damage, including base excision repair (BER). Missense polymorphisms in BER repair genes may contribute to differences in DNA repair capacity, specific mutations, and susceptibility to cancer in the presence of…
MSH6 G39E polymorphism and CpG island methylator phenotype in colon cancer
The MSH6 G39E germline polymorphism is not associated with an increased risk of either microsatellite stable or unstable sporadic colorectal cancer. Other than microsatellite instability, however, most genetic and epigenetic changes of tumors associated with this common variant have not…
Microsatellite instability and survival in rectal cancer
OBJECTIVE: High levels of microsatellite instability (MSI-H) have been associated in many studies with improved prognosis in colon cancer. Very few studies have evaluated the effect of MSI-H on rectal cancer survival. We assessed MSI-H and other genetic and epigenetic…
Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex
PURPOSE: Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL)…
Tumor markers and rectal cancer: support for an inflammation-related pathway
Inflammation may be a key element in the etiology of colorectal cancer. In our study, we examine associations between factors related to inflammation and specific rectal cancer mutations. A population-based study of 750 rectal cancer cases with interview and tumor…
Improving fecal occult blood testing compliance using a mailed educational reminder.
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT…
Vitamin D related genes, CYP24A1 and CYP27B1, and colon cancer risk
Genetic association studies investigating the role of vitamin D in colon cancer have primarily focused on the vitamin D receptor (VDR), with limited data available for other genes in the vitamin D pathway, including vitamin D activating enzyme 1-alpha hydroxylase…
Screening for colorectal cancer in a safety-net health care system: access to care is critical and has implications for screening policy
BACKGROUND: Data on the number of individuals eligible for screening, and rates of screening, are necessary to assess national colorectal cancer screening efforts. Such data are sparse for safety-net health systems. METHODS: A retrospective cohort study of individuals ages 50…
Statin use and risk of colorectal cancer in a cohort of middle-aged men in the US: a prospective cohort study
BACKGROUND: Numerous modifiable factors have been associated with a reduced risk of colorectal cancer, including the chronic use of NSAIDs. Thus, it is biologically plausible that HMG-CoA reductase inhibitors (statins), therapeutic agents that also possess anti-inflammatory effects, are also associated…
Somatic alterations, metabolizing genes and smoking in rectal cancer
Cigarette smoking has been identified as a risk factor for rectal cancer. Our investigation evaluates associations between active and passive smoking and TP53, KRAS2, and BRAF V600E mutations, microsatellite instability (MSI), and CpG Island Methylator Phenotype (CIMP) in rectal tumors…
Considering culture in physician– patient communication during colorectal cancer screening
Racial and ethnic disparities exist in both incidence and stage detection of colorectal cancer (CRC). We hypothesized that cultural practices (i.e., communication norms and expectations) influence patients' and their physicians' understanding and talk about CRC screening. We examined 44 videotaped…
Editorial: It’s time to make organized colorectal cancer screening convenient and easy for patients
Colorectal cancer (CRC) screening is widely recommended, but underused. To increase screening rates, we need to implement organized and population-based systems to promote CRC screening among people in a single region, health plan, or health system. This is ideally accomplished…
Exploring household income as a predictor of psychological well-being among long-term colorectal cancer survivors
PURPOSE: The purpose of this analysis was to determine the unique contribution of household income to the variance explained in psychological well-being (PWB) among a sample of colorectal cancer (CRC) survivors. METHODS: This study is a secondary analysis of data…
Colon tumor mutations and epigenetic changes associated with genetic polymorphism: insight into disease pathways
Variation in genes associated with serum levels of proteins may be useful for examining specific disease pathways. Using data from a large study of colon cancer, we examine genetic variants in insulin, inflammation, estrogen, metabolizing enzymes, and energy homeostasis genes…
Oncogenetic tree model of somatic mutations and DNA methylation in colon tumors
Our understanding of somatic alterations in colon cancer has evolved from a concept of a series of events taking place in a single sequence to a recognition of multiple pathways. An oncogenetic tree is a model intended to describe the…
Thiazolidinedione therapy is not associated with increased colonic neoplasia risk in patients with diabetes mellitus
BACKGROUND & AIMS: Thiazolidinedione ligands for peroxisome proliferator-activated receptor gamma (PPARgamma), are used to treat diabetes. PPARgamma is highly expressed in the colon, and exposure to thiazolidinediones has been proposed to affect the risk for colorectal neoplasia. In vitro models…
Stool DNA and occult blood testing for screen detection of colorectal neoplasia
BACKGROUND: Stool DNA testing is a new approach to colorectal cancer detection. Few data are available from the screening setting. OBJECTIVE: To compare stool DNA and fecal blood testing for detection of screen-relevant neoplasia (curable-stage cancer, high-grade dysplasia, or adenomas…
Genetic variation in calcium-sensing receptor and risk for colon cancer
BACKGROUND: Experimental and epidemiologic studies have suggested that high calcium intake is associated with decreased colon cancer risk, yet very limited data are available for candidate genes in the calcium-vitamin D pathway and colon cancer risk. To address this, we…
The MLH1 -93 G>A promoter polymorphism and genetic and epigenetic alterations in colon cancer
The MLH1 -93 G>A promoter polymorphism has been reported to be associated with an increased risk of microsatellite unstable colorectal cancer. Other than microsatellite instability, however, the genetic and most epigenetic changes of tumors associated with this polymorphism have not…
Evidence for colorectal sarcomatoid carcinoma arising from tubulovillous adenoma.
Sarcomatoid carcinomas of the colorectum are rare tumors that display both malignant epithelial and stromal components. Clinically, they are aggressive tumors with early metastasis. Due to their infrequent occurrence, the pathogenesis is poorly understood. We report a case of a…
The health-related quality of life in long-term colorectal cancer survivors study: objectives, methods and patient sample
OBJECTIVES: The objective of this paper is to describe the complex mixed-methods design of a study conducted to assess health-related quality of life (HRQOL) outcomes and ostomy-related obstacles and adjustments among long-term (>5 years) colorectal cancer (CRC) survivors with ostomies…
Dietary flavonoids and colorectal adenoma recurrence in the Polyp Prevention Trial
Two recent case-control studies suggested that some flavonoid subgroups may play a role in preventing colorectal cancer. Previous prospective cohort studies generally reported no association; however, only a small subset of flavonoids was evaluated and partial flavonoid databases were used…
Transcription factor 7-like 2 polymorphism and colon cancer
Polymorphisms of the transcription factor 7-like 2 (TCF7L2) gene have been associated with insulin sensitivity and diabetes, and the TCF7L2 gene is involved in the Wnt/beta-catenin signaling pathway, all factors thought to be important in the etiology of colon cancer…
Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years
BACKGROUND: Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. OBJECTIVE: To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined…
Low-fat dietary pattern and cancer incidence in the Women’s Health Initiative Dietary Modification Randomized Controlled Trial
BACKGROUND: The Women's Health Initiative Dietary Modification (DM) Randomized Controlled Trial evaluated the effects of a low-fat dietary pattern on chronic disease incidence, with breast cancer and colorectal cancer as primary outcomes. The trial protocol also listed ovarian cancer and…
Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics
BACKGROUND: One type of fecal occult blood test (FOBT), the unrehydrated guaiac fecal occult blood test (GT), is recommended by the United States Preventive Services Task Force and the Institute of Medicine for use in screening programs, but it has…
Genetic polymorphisms in one-carbon metabolism: associations with CpG island methylator phenotype (CIMP) in colon cancer and the modifying effects of diet
This study investigated associations between CpG island methylator phenotype (CIMP) colon cancer and genetic polymorphisms relevant to one-carbon metabolism and thus, potentially the provision of methyl groups and risk of colon cancer. Data from a large, population-based case-control study (916…
Dealing with uncertainty: surveillance colonoscopy after polypectomy
Post-polypectomy surveillance is often done sooner than guideline recommendations. This practice is driven by physician intolerance of uncertainty. The accompanying article by Brenner et al. supports the recommendation to wait 5 years or longer following adenoma removal before performing surveillance…
Correlates of screening sigmoidoscopy use among men in a large nonprofit health plan
BACKGROUND: As the majority of patients diagnosed with colorectal cancer have no known risk factors, regular screening is strongly recommended. The authors examined factors associated with screening sigmoidoscopy use among participants in the California Men's Health Study (CMHS). METHODS: The…
Thymidylate synthase polymorphisms and colon cancer: associations with tumor stage, tumor characteristics and survival
Thymidylate synthase (TS) is a key enzyme in folate metabolism, a pathway that is important in colorectal carcinogenesis. We investigated the role of functional polymorphisms in the TS 5'-UTR promoter enhancer region (TSER, 3 or 2 repeats of a 28-bp…
Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable
BACKGROUND: Standardized reporting systems for diagnostic and screening tests facilitate quality improvement programs and clear communication among health care providers. Although colonoscopy is commonly used for screening, diagnosis, and therapy, no standardized reporting system for this procedure currently exists. The…
Dietary intake of folate and co-factors in folate metabolism, MTHFR polymorphisms, and reduced rectal cancer
Little is known about the contribution of polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR) and the folate metabolism pathway in rectal cancer alone. Data were from participants in a case-control study conducted in Northern California and Utah (751 cases and…
Change in body size and the risk of colorectal adenomas
Adiposity has been recognized as a risk factor for colorectal adenoma, but the influence of weight gain, adipose tissue distribution, and possible differences between ethnic/racial and gender groups remains unanswered. The aim of this prospective study was to examine the…
Racial differences in tumor stage and survival for colorectal cancer in an insured population
BACKGROUND: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients. METHODS: This study was conducted among patients who were diagnosed…
Diet and lifestyle factor associations with CpG island methylator phenotype and BRAF mutations in colon cancer
It has been proposed that dietary factors such as folate, alcohol and methionine may be associated with colon cancer because of their involvement in DNA methylation processes. Data from a large population-based case-control study of incident colon cancer were used…
Complications of colonoscopy in an integrated health care delivery system
BACKGROUND: Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited. OBJECTIVE: To quantify the magnitude and severity of colonoscopy complications. DESIGN: Retrospective cohort. SETTING: Kaiser Permanente of Northern California. PATIENTS: 16, 318 members 40 years of age or older undergoing…
Association of smoking, CpG island methylator phenotype, and V600E BRAF mutations in colon cancer
BACKGROUND: Cigarette smoking has been associated with microsatellite instability in sporadic colon cancer. Most microsatellite-unstable colon cancers have widespread methylation of CpG islands (i.e., the CpG island methylator phenotype [CIMP]), and many of these tumors harbor the V600E BRAF mutation…
The association between aspirin use and the incidence of colorectal cancer in women
The purpose of this study was to test the hypothesis that aspirin use is associated with a decreased risk of incident colorectal cancer. From the Women's Health Initiative, 91,574 participants between the ages of 50 and 79 years at baseline…
High dry bean intake and reduced risk of advanced colorectal adenoma recurrence among participants in the polyp prevention trial
Adequate fruit and vegetable intake was suggested to protect against colorectal cancer and colorectal adenomas; however, several recent prospective studies reported no association. We examined the association between fruits and vegetables and adenomatous polyp recurrence in the Polyp Prevention Trial…
Interactions between CYP2C9 and UGT1A6 polymorphisms and nonsteroidal anti-inflammatory drugs in colorectal cancer prevention
BACKGROUND AND AIMS: Variant genotypes of uridine diphosphate glucuronsyltransferase isoenzyme 1A6 (UGT1A6) associated with decreased metabolic activity have been associated with an enhanced protective effect of aspirin on the development of colorectal adenomas. However, interactions between UGT1A6 variants or variants…
Associations between vitamin D, vitamin D receptor gene and the androgen receptor gene with colon and rectal cancer
The transcriptional activity of the vitamin D receptor (VDR) gene is regulated, at least in part, by the androgen receptor (AR) gene. We evaluate how the number of polyglutamine (CAG) repeats of the AR gene influence colorectal cancer in conjunction…
Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer
BACKGROUND: Several factors may contribute to poorer prognosis for obese breast cancer patients, including unfavorable disease features, the influence of fat on estrogen availability, co-morbidity, and socio-demographic factors. Both obesity and estrogen receptor negative (ER-) tumors are more prevalent in…
Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer
Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer addresses only the use…
Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society
Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect…
PPARgamma and colon and rectal cancer: associations with specific tumor mutations, aspirin, ibuprofen and insulin-related genes (United States)
We hypothesize that the peroxisome proliferator-activated receptor-gamma (PPARgamma) is associated with colorectal cancer given its association with insulin, diabetes, obesity, and inflammation. In this study, we evaluated the association between colorectal cancer and specific tumor mutations and the Pro12Ala (P12A)…
Haplotype analysis of common vitamin D receptor variants and colon and rectal cancers
Inherited variants of the vitamin D receptor (VDR) gene may influence cancer risk by altering the effect of vitamin D on cell growth and homeostasis. Studies have examined genotypes for common VDR polymorphisms, including a single nucleotide polymorphism (SNP) detected…
Calcium plus vitamin D supplementation and the risk of colorectal cancer
BACKGROUND: Higher intake of calcium and vitamin D has been associated with a reduced risk of colorectal cancer in epidemiologic studies and polyp recurrence in polyp-prevention trials. However, randomized-trial evidence that calcium with vitamin D supplementation is beneficial in the…
Low-fat dietary pattern and risk of colorectal cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial
CONTEXT: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. OBJECTIVE: To evaluate the effects of a low-fat eating pattern on risk…
Vitamin D receptor gene polymorphisms, dietary promotion of insulin resistance, and colon and rectal cancer
Modifiable risk factors in colorectal cancer etiology and their interactions with genetic susceptibility are of particular interest. Functional vitamin D receptor (VDR) gene polymorphisms may influence carcinogenesis through modification of cell growth, protection from oxidative stress, cell-cell matrix effects, or…
Shared decision making and the experience of partnership in primary care
PURPOSE: Communication has been researched either as a set of behaviors or as a facet of the patient-physician relationship, often leading to conflicting results. To determine the relationship between these perspectives, we examined shared decision making (SDM) and the subjective…
Breast cancer risk reduction options: awareness, discussion, and use among women from four ethnic groups
BACKGROUND: With recent advances in breast cancer risk reduction practices, it is increasingly important to assess both the breadth of and disparities in use across different racial/ethnic groups. METHODS: We conducted telephone interviews with 1,700 women ages 40 to 74,…
Participation of Asian-American women in cancer chemoprevention research: physician perspectives
To the authors' knowledge, little is known regarding the participation of Asian Americans in cancer prevention research. In 2002, the authors mailed surveys to primary care physicians in Northern California to assess their knowledge, attitudes, behaviors, and barriers concerning the…
Associations between ERalpha, ERbeta, and AR genotypes and colon and rectal cancer
Estrogen and androgens are thought to be involved in the etiology of colorectal cancer. We evaluate genetic variants of the estrogen receptor genes (ERalpha and ERbeta) and the androgen receptor gene (AR). We use data from two large case-control studies…
The association between cigarette smoking and colorectal polyp recurrence (United States)
OBJECTIVE: Although evidence exists linking smoking to precancerous colorectal adenomatous polyps, few studies have examined the association between cigarette smoking and recurrence of colorectal polyps. This association was investigated prospectively with data from the Polyp Prevention Trial. METHODS: Cigarette smoking…
Polymorphisms in the reduced folate carrier, thymidylate synthase, or methionine synthase and risk of colon cancer
Folate metabolism supports the synthesis of nucleotides as well as the transfer of methyl groups. Polymorphisms in folate-metabolizing enzymes have been shown to affect risk of colorectal neoplasia and other malignancies. Using data from a population-based incident case-control study (1,600…
MTHFR variants reduce the risk of G:C->A:T transition mutations within the p53 tumor suppressor gene in colon tumors
5,10-Methylene-tetrahydrofolate reductase (MTHFR) is a key enzyme in folate-mediated 1-carbon metabolism. Reduced MTHFR activity has been associated with genomic DNA hypomethylation. Methylated cytosines at CpG sites are easily mutated and have been implicated in G:C-->A:T transitions in the p53 tumor…
Evaluation of a large, population-based sample supports a CpG island methylator phenotype in colon cancer
BACKGROUND & AIMS: The concept of a CpG island methylator phenotype (CIMP), especially in microsatellite stable colon cancer, is not accepted universally. We therefore evaluated a large population-based sample of individuals with colon cancer and used univariate and multivariate analyses…
Recommendations for care related to follow-up of abnormal cancer screening tests: accuracy of patient report
When using patient self-report of processes of care as part of measuring quality performance, validity and reliability are important considerations. In this study, the congruence of patient report of recommendations of screening follow-up care was compared with record audit data…
Incomplete screening flexible sigmoidoscopy associated with female sex, age, and increased risk of colorectal cancer
BACKGROUND: Several previous studies have found that females and older individuals are at greater risk of having incomplete flexible sigmoidoscopy. However, no prior study has reported the subsequent risk of colorectal cancer (CRC) following incomplete sigmoidoscopy. METHODS: Using data from…
Associations between apoE genotype and colon and rectal cancer
Apolipoprotein E (apoE) plays a major role in the metabolism of bile acids, cholesterol and triglycerides, and has recently been proposed as being involved in the carcinogenic process. Given the potential role of bile acids in colorectal cancer etiology, it…
Energy balance, insulin-related genes and risk of colon and rectal cancer
Energy balance, or the ability to maintain body weight by balancing energy intake with energy expenditure, appears to be important in the etiology of colon cancer. One possible mechanism whereby energy balance may be associated with colorectal cancer is through…
Interactions of peroxisome proliferator-activated receptor {gamma} and diet in etiology of colorectal cancer
The peroxisome proliferator-activated receptor gamma (PPARgamma) is one of a group of ligand-activated nuclear receptors responsible for regulation of glucose, lipid homeostasis, cell differentiation, and apoptosis. The 12 proline-to-alanine (Pro12Ala) substitution polymorphism in PPARgamma produces proteins with lower activity. Variation…
Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography?
OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was…
The CYP1A1 genotype may alter the association of meat consumption patterns and preparation with the risk of colorectal cancer in men and women
We hypothesized that the risk of colorectal cancer associated with meat preparation methods producing heterocyclic amines or polycyclic aromatic hydrocarbons is modified by the CYP1A1 genotype alone or in combination with the GSTM1 genotype or the NAT2 imputed phenotype. A…
PPARgamma, energy balance, and associations with colon and rectal cancer
Peroxisome proliferator-activated receptor-gamma (PPARgamma) has been hypothesized as being involved in colorectal cancer given its role in adipocyte development and insulin resistance. In this study we evaluated the association between the Pro12Ala (P12A) PPARgamma polymorphism and body mass index (BMI),…
Associations between BMI, energy intake, energy expenditure, VDR genotype and colon and rectal cancers (United States)
Components of energy balance are important elements associated with colorectal cancer risk. In this study we examine the association between VDR genotypes, BMI, physical activity, and energy intake and risk of colorectal cancer. Data from a population-based case-control study of…
Local services and amenities, neighborhood social capital, and health
Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects…
The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population
BACKGROUND: Access and satisfaction are determinants of preventive service use, but few studies have evaluated their role in breast and cervical cancer screening in multiethnic populations. OBJECTIVES: We sought to investigate the relationship between race/ethnicity, access, satisfaction, and regular mammogram…
The incidence of colorectal cancer following a negative screening sigmoidoscopy: implications for screening interval
BACKGROUND & AIMS: Current guidelines recommend a 5-year interval for colorectal cancer (CRC) screening by sigmoidoscopy. However, the optimal screening interval is uncertain. We estimated the annual incidence of distal and proximal CRC in the first 5 years following a…
The evolution to stool DNA testing for colorectal cancer
Despite a variety of screening strategies and recent trends showing death rate stabilization, colorectal cancer still remains the second leading cause of overall cancer death. Current screening tools suffer from performance limitations, low patient acceptability, and marginal reliable access within…
Meat consumption patterns and preparation, genetic variants of metabolic enzymes, and their association with rectal cancer in men and women
Meat consumption, particularly of red and processed meat, is one of the most thoroughly studied dietary factors in relation to colon cancer. However, it is not clear whether meat, red meat, heterocyclic amines (HCA), or polycyclic aromatic hydrocarbons (PAH) are…
Estrogen plus progestin and colorectal cancer in postmenopausal women
BACKGROUND: Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use of estrogen plus progestin was associated with a significant decrease…
Low energy reporting may increase in intervention participants enrolled in dietary intervention trials
OBJECTIVE: To examine differences in low energy intake reporting between intervention and control groups during a dietary intervention trial. DESIGN: Retrospective data analysis from a subcohort of participants in the Polyp Prevention Trial (PPT), a 4-year, multisite, randomized, controlled dietary…
Factors associated with colorectal cancer screening in a population-based study: the impact of gender, health care source, and time
INTRODUCTION: The effectiveness of colorectal cancer screening in reducing incident colorectal cancer and the risk of death has been shown. Despite campaigns to promote the benefits of and use of colorectal cancer screening, most people are not participating in screening…
MTHFR C677T and A1298C polymorphisms: diet, estrogen, and risk of colon cancer
5,10-methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in folate metabolism, diverting metabolites toward methylation reactions or nucleotide synthesis. Using data from an incident case-control study (1608 cases and 1972 controls) we investigated two polymorphisms in the MTHFR gene, C677T and…
Antioxidants, carotenoids, and risk of rectal cancer
Numerous properties suggest that antioxidants and carotenoids may be valuable chemopreventive agents. A population-based case-control study of 952 rectal cancer cases and 1,205 controls from Northern California and Utah was conducted between September 1997 and February 2002. Detailed diet history,…
Family history and colorectal cancer: predictors of risk
INTRODUCTION: While the association between family history of colorectal cancer in first-degree relatives and risk of developing colon cancer has been well defined, the association with rectal cancer is much less clear. The purpose of this study is to define…
Implementation of systems strategies for breast and cervical cancer screening services in health maintenance organizations
OBJECTIVE: To describe the systems strategies used to reduce failures in delivery of breast and cervical cancer screening services in HMOs with high performance rates for these services. STUDY DESIGN: Multiple case study. PARTICIPANTS AND METHODS: Seven HMOs participated in…
Guidelines for breast and ovarian cancer genetic counseling referral: adoption and implementation in HMOs
PURPOSE: To describe referral guidelines for hereditary breast and ovarian cancer (HBOC) counseling among a group of Health Maintenance Organizations (HMOs) and awareness of such among primary care clinicians. METHODS: An organizational assessment of plan policies and a primary care…
Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence
We have updated guidelines for screening for colorectal cancer. The original guidelines were prepared by a panel convened by the U.S. Agency for Health Care Policy and Research and published in 1997 under the sponsorship of a consortium of gastroenterology…
Body mass index and colon cancer: an evaluation of the modifying effects of estrogen (United States)
OBJECTIVE: The association between body mass index (BMI) and colon cancer has been reported to be different for men and women. No prior literature has examined if estrogen influences these differences. METHODS: Using data from an incident population-based case (n…
Flexible sigmoidoscopy for colorectal cancer screening: valid approach or short-sighted?
Flexible sigmoidoscopy is a safe, effective test that may be delivered feasibly on a large scale for mass colorectal cancer screening. Flexible sigmoidoscopy is 67% to 80% as sensitive as colonoscopy in a screening population, but is probably 10 to…
Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population
BACKGROUND: Screening mammogram and Pap smear rates are lower for women in underserved racial and ethnic groups, yet may be overestimated due to reliance on patients' self-reports. The purpose of this study was to determine accuracy of self-reports of mammograms…
Adenomatous polyp recurrence and physical activity in the Polyp Prevention Trial (United States)
OBJECTIVE: To examine prospectively the association between physical activity and adenomatous polyp recurrence. METHODS: Information on past year total physical activity was collected annually through an interview-administered questionnaire from the 1905 men and women enrolled in a randomized dietary intervention…
Hereditary nonpolyposis colorectal cancer in young colorectal cancer patients: high-risk clinic versus population-based registry
BACKGROUND & AIMS: Early onset colorectal cancer (CRC) is an important feature of hereditary nonpolyposis colorectal cancer (HNPCC). We sought to compare rates of genetically defined HNPCC among individuals with early onset CRC drawn from a high-risk clinic and a…
Eating frequency and the risk of colon cancer
Eating frequency has been found in most previous studies to have a positive association or no association with colon cancer. We report data from a large case-control study to determine the effect of eating frequency on colon cancer risk. Data…
Correlates of breast cancer screening among low-income, low-education Latinas
INTRODUCTION: This paper discusses the factors associated with breast cancer screening among low-education, low-income Latinas. BACKGROUND: These data were collected as part of a breast cancer educational intervention study aimed at this population. The objective of the larger study was…
Interplay between dietary inducers of GST and the GSTM-1 genotype in colon cancer
The purpose of this study is to determine if cruciferous vegetables and coffee, two dietary inducers of glutatione-S-transferases, interact with GSTM-1 genotype to alter risk of colon cancer. Data were available on 1579 incident cases of adenocarcinoma of the colon…
Colon cancer screening, lifestyle, and risk of colon cancer
OBJECTIVES: Sigmoidoscopy screening and fecal occult blood (FOB) tests have been demonstrated as effective ways to reduce mortality from colorectal cancer. However, most studies of colorectal cancer screening and cancer mortality have not taken into consideration lifestyle factors that could…
Calcium, vitamin D, sunshine exposure, dairy products and colon cancer risk (United States)
OBJECTIVE: Epidemiologic studies on calcium, vitamin D and colon cancer are inconsistent, whereas experimental studies more regularly show a protective effect. To evaluate potential sources of inconsistencies, data from a large case-control study were analyzed, stratifying on potential effect modifiers…
Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group
BACKGROUND: We tested the hypothesis that dietary intervention can inhibit the development of recurrent colorectal adenomas, which are precursors of most large-bowel cancers. METHODS: We randomly assigned 2079 men and women who were 35 years of age or older and…
Western diet, family history of colorectal cancer, NAT2, GSTM-1 and risk of colon cancer
OBJECTIVE: In this study we examine the combined effects of Western diet, age at diagnosis, and genetic susceptibility. METHODS: We use data collected as part of an incident case-control study of colon cancer. Family history of colorectal cancer, N-acetyltransferase (NAT2),…
Does nutritionist review of a self-administered food frequency questionnaire improve data quality?
OBJECTIVE: This study sought to evaluate the benefit of utilizing a nutritionist review of a self-administered food frequency questionnaire (FFQ), to determine whether accuracy could be improved beyond that produced by the self-administered questionnaire alone. DESIGN: Participants randomized into a…
Lifestyle and colon cancer: an assessment of factors associated with risk
Studies of the etiology of colon cancer indicate that it is strongly associated with diet and lifestyle factors. The authors use data from a population-based study conducted in northern California, Utah, and Minnesota in 1991-1995 to determine lifestyle patterns and…
Colorectal cancer screening: new opportunities
Colorectal cancer is the third most common cancer among men and women in the United States, and the third leading cause of cancer death. Strategies currently available to screen for colorectal cancer include fecal occult blood tests, sigmoidoscopy, or both…
Hormone replacement therapy and improved survival among postmenopausal women diagnosed with colon cancer (USA)
OBJECTIVES: Hormone replacement therapy (HRT) has been inversely associated with colon cancer incidence in several epidemiologic studies. In this study we used data from a population-based incident case-control study of colon cancer to evaluate the role of HRT use in…
Survival and treatment for colorectal cancer Medicare patients in two group/staff health maintenance organizations and the fee-for-service setting
The current study compares treatment use and long-term survival in colorectal cancer patients between Medicare beneficiaries enrolled in two large prepaid group/staff health maintenance organizations (HMOs) and the fee-for-service (FFS) setting. The study is based on 15,352 colorectal cancer cases…
Cholecystectomy and the risk of colon cancer
OBJECTIVE: The relationship between cholecystectomy and the occurrence of subsequent colon cancer has been controversial. Using data collected as part of an incident case-control study of colon cancer conducted in northern California, Minnesota, and Utah, we evaluated this association. METHODS:…
Comparison of the Block and the Willett self-administered semiquantitative food frequency questionnaires with an interviewer-administered dietary history
The performances of two commonly used diet instruments, the Block and the Willett food frequency questionnaires, were compared with a longer, interviewer-administered diet history. Participants in a case-control study on diet and colon cancer were interviewed between 1990 and 1994…
Screening mammography in an integrated health care system: the Kaiser permanente experience
In this paper, we describe the attributes of a comprehensive approach to breast cancer screening possible in an integrated health care system. We define an integrated health care system as one in which comprehensive preventive and medical care is provided…
Drugs and colon cancer
In a case-control study of colon cancer conducted in three geographic regions of the United States, 1993 case subjects and 2410 control subjects were interviewed. In addition to queries regarding other known or suspected risk factors, subjects were asked about…
Body size and the risk of colon cancer in a large case-control study
OBJECTIVE: To investigate the risks of height, weight and body fat distribution associated with colon cancer in subcategories of gender, age and site in the colon. Interaction with family history of colorectal cancer is also examined. DESIGN: Case-control study of…
A comparison of fecal occult-blood tests for colorectal-cancer screening.
BACKGROUND: Hemoccult II, a widely used guaiac test for fecal occult blood, has a low sensitivity for detecting colorectal neoplasms in asymptomatic patients at average risk. In such patients, the performance characteristics of screening tests developed to improve on Hemoccult…
Cancer of the large bowel after cholecystectomy
The possibility that cholecystectomy may increase the risk of developing cancer of the large bowel has been a matter of concern for several years. The association has biological plausibility because of the effects of cholecystectomy on the formation of secondary…
Sigmoidoscopy and mortality from colorectal cancer: the Kaiser Permanente Multiphasic Evaluation Study
The Kaiser Permanente Multiphasic Evaluation Study is often cited as evidence from a randomized trial that screening sigmoidoscopy reduces mortality from colorectal cancer. To examine the role of sigmoidoscopy in this reduction, we reviewed the 110 incident cases of colorectal…
Cholecystectomy and large bowel cancer
The records of 5898 patients with colorectal cancer and 27,687 controls were examined for previous cholecystectomy. The estimated relative risks (and 95% confidence intervals) of development of any cancer of the large bowel and cancer of the right colon after…
