• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9801-9804
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• 2014

Background: Colorectal cancer is currently the third most common cancer in Indonesia, yet colonoscopy - the most accepted mode of screening to date - is not done routinely and national data are still lacking. Objective: To determine the detection rate of colorectal cancers and adenomas in unselected patients undergoing colonoscopy for various large bowel symptoms at the Digestive Disease and GI Oncology Centre, Medistra Hospital in Jakarta, Indonesia. Materials and Methods: Colonoscopy data from January 2009 to December 2012 were reviewed. New patients referred for colonoscopy were included. Data collected were patient demographic and significant colonoscopy findings such as the presence of hemorrhoids, colonic polyps, colonic diverticula, inflammation, and tumor mass. Histopathological data were obtained for specimens taken by biopsy. Associations between categorical variables were analyzed using chi-square test, while mean differences were tested using the t-test. Results: A total of, 1659 cases were included in this study, 889 (53.6%) of them being men. Polyps or masses were found in 495 (29.8%) patients while malignancy was confirmed in 74 (4.5%). Patients with a polyp or mass were significantly older (60.2 vs 50.8 years; p<0.001; t-test) and their presence was significantly associated with male gender (35.0% vs 23.9%; prevalent ratio [PR] 1.71; 95% confidence interval [CI] 1.38-2.12; p<0.001) and age >50 years (39.6% vs 16.6%; PR 3.29; 95% CI 2.59-4.12; p<0.001). Neoplastic lesions was found in 257 (16.1%), comprising 180 (11.3%) adenomas, 10 (0.6%) in situ carcinomas, and 67 (4.2%) carcinomas. Conclusions: Polyps or masses were found in 30% of colonoscopy patients and malignancies in 16.1%. These figures do not represent the nation-wide demographic status of colorectal cancer, but may reflect a potentially increasing major health problem with colorectal cancer in Indonesia.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.10
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• pp.4229-4235
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• 2015

Background: Colorectal cancer (CRC is increasingly becoming a major cause of cancer morbidity and mortality in Jordan. However the population's level of awareness about CRC, CRC screening test preferences and willingness to embrace screening are not known. The aim of this study was to assess the level of CRC awareness and screening preferences among Jordanian patients. Materials and Methods: A survey assessing the CRC knowledge levels was distributed among patients attending outpatient gastroenterology clinics in public hospitals throughout Jordan. A total of 800 surveys were distributed and of these 713 (89.1%) were returned. Results: Only 22% of the participants correctly judged CRC among the choices provided as the commonest cause of cancer related deaths. The majority of participants (68.3%) underestimated their risk for CRC. Only 26.8% correctly judged their life time risk while 5% overestimated their risk. Two thirds of participants (66%) were willing to pay 500 Jordanian Dinars (equivalent to 706 US$) in order to get a prompt colonoscopy if recommended by their physician, while 25.5% reported that they would rather wait for 6 months in order to get a free colonoscopy. Conclusions: Although the participants tended to underestimate their risk for CRC, they were mostly aware of CRC as a major cause of mortality and were willing to embrace the concept of CRC screening and bear the related financial costs. These findings about CRC awareness and propensity for screening provide a good foundation as the Jordanian health system moves forward with initiatives to promote CRC screening and prevention.

• Parasites, Hosts and Diseases
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• v.52 no.1
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• pp.85-87
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• 2014

We encountered a patient with heavy Hymenolepis nana infection. The patient was a 44-year-old Korean man who had suffered from chronic hepatitis (type B) for 15 years. A large number of H. nana adult worms were found during colonoscopy that was performed as a part of routine health screening. The parasites were scattered throughout the colon, as well as in the terminal ileum, although the patient was immunocompetent. Based on this study, colonoscopy may be helpful for diagnosis of asymptomatic H. nana infections.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9649-9654
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• 2014

Background: Polyps are common lesions in the gastrointestinal (GI) tract. Colon cancer is mostly a result of progression from polyps. The present study aimed to evaluate demographic, clinical, and histological characteristics of colorectal polyps in Iran, particularly neoplastic and advanced types. Materials and Methods: Over a period of 10 years, specimens of all colorectal polyps obtained from colonoscopy were studied. The variables subjected to statistical analysis were age, sex, and the chief clinical complaint of the patients who underwent colonoscopy, their motivation, and the site, size, and histological types of detected polyps. The level of significance was set at p value <0.05. Results: Data were obtained from a total of 352 patients. No difference was seen between male and female patients regarding histological types. Only in nine patients was screening the reason for colonoscopy. Almost two-thirds (66.2%) of the polyps were neoplastic. Familial polyposis syndrome and inflammatory bowel disease were seen in 4.3% and 3.0% of the patients with neoplastic polyps, respectively. Sites of polyps were the sigmoid, rectum, and descending colon in 40.1%, 34.5%, and 17% of the cases, respectively. The advanced type made up 58.8% of neoplastic polyps. Only 3.6% of the patients undergoing colonoscopy in the study period had biopsied polyps. Discussion: No difference was observed between male and female patients in terms of overall incidence of polyps, histological and anatomical profiles, and mean age distribution. Anatomical and histological profiles agreed with the studies performed in areas with a low risk of colon cancer. The findings show that colonoscopy was not performed when it was necessary. A meaningful increase in the number polyp biopsy cases and a corresponding decrease in polyp size in the last few years of the study can be associated with the presence of more GI specialist clinicians in hospital centers, and this holds out much hope for the further improvement of the situation in the future.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3179-3183
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• 2016

The aim of this study was to assess the rate of uptake of a customised annual Colorectal Cancer Awareness, Screening and Treatment Project (CCASTP) using faecal immunohistochemical test (FIT) kits in low income communities in Malaysia. The immediate objectives were (1) to evaluate the level of adherence of CRC screening among low-income groups, (2) to assess the knowledge and awareness of the screened population and (3) to assess the accuracy of FIT kits. A total of 1,581 FIT kits were distributed between years 2010 to 2015 to healthy asymptomatic participants of the annual CCASTP organized by Empowered - the Cancer Advocacy Society of Malaysia. Data for socio-demographic characteristics, critical health and lifestyle information of the registered subjects were collected. Findings for use of the FIT kits were collected when they were returned for stool analyses. Those testingd positive were invited to undergo a colonoscopy examination. A total of 1,436 (90.8%) of the subjects retuned the FIT-kits, showing high compliance. Among the 129 subjects with positive FIT results, 92 (71.3%) underwent colonoscopy. Six cases (6.5%) of CRC were found. Based on the data collected, the level of awareness of stool examination and knowledge about CRC was poor amongst the participants. Gender, age group, ethnicity and risk factors (i.e. smoking, lack of exercise and low consumption of fresh fruits) were associated with positive FIT-kit results. In conclusion, CRC screening can be performed in the community with a single FIT-kit. Although CRC knowledge and awareness is poor in low-income communities, the average return rate of the FIT kits and rate of colonoscopy examination were 91.2% and 70.3%, respectively.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6605-6608
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• 2015

Background: Colorectal cancer is a major cause of morbidity and mortality throughout the world. Colorectal cancer screening is an optimal way for reducing of morbidity and mortality and a clinical decision support system (CDSS) plays an important role in predicting success of screening processes. DSS is a computer-based information system that improves the delivery of preventive care services. The aim of this article was to detail engineering of information requirements and work flow design of CDSS for a colorectal cancer screening program. Materials and Methods: In the first stage a screening minimum data set was determined. Developed and developing countries were analyzed for identifying this data set. Then information deficiencies and gaps were determined by check list. The second stage was a qualitative survey with a semi-structured interview as the study tool. A total of 15 users and stakeholders' perspectives about workflow of CDSS were studied. Finally workflow of DSS of control program was designed by standard clinical practice guidelines and perspectives. Results: Screening minimum data set of national colorectal cancer screening program was defined in five sections, including colonoscopy data set, surgery, pathology, genetics and pedigree data set. Deficiencies and information gaps were analyzed. Then we designed a work process standard of screening. Finally workflow of DSS and entry stage were determined. Conclusions: A CDSS facilitates complex decision making for screening and has key roles in designing optimal interactions between colonoscopy, pathology and laboratory departments. Also workflow analysis is useful to identify data reconciliation strategies to address documentation gaps. Following recommendations of CDSS should improve quality of colorectal cancer screening.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.10
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• pp.5125-5129
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• 2012

Economic decision models are being increasingly used to assess medical interventions. Advances in this field are mainly due to enhanced processing capacity of computers, availability of specific software to perform the necessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness of ten strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs and quality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening by each test. In this paper, we tested the model with data from the Ministry of Health and published literature. We considered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rial being converted into US dollars. We focused on three tests for the 10 strategies considered currently being used for population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran): low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening. These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY (quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of various scales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis. Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical and cost-effective over conventional levels of WTP8.

• Journal of Radiation Protection and Research
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• v.38 no.4
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• pp.214-227
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• 2013

Computed tomographic scan as a screening procedures in asymptomatic individuals has seen a steady increase with the introduction of multiple-raw detector CT scanners. This report provides a brief review of the current controversy surrounding CT cancer screening, with a focus on the radiation induced cancer risks and clinical efficacy. 1. A large study of patients at high risk of lung cancer(the National Lung Screening Trial[NLST]) showed that CT screening reduced cancer deaths by 20%(1.33% in those screened compared with 1.67% in those not screened). The rate of positive screening tests was 24.2% and 96.4% of the positive screening results in the low-dose CT group were false-positive. Radiation induced lung cancer risk was estimated the most important in screening population because ERR of radiation induced lung cancer does not show the decrease with increasing age and synergistic connection between smoking and radiation risk. Therefore, the radiation risk may be on the same order of magnitude as the benefit observed in the NLST. Optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation. 2. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but significantly less sensitive and specific for smaller lesions and disadvantageous for subsequent therapeutic optical colonoscopy if polyps are detected. The average effective dose from CT colonography was estimated 8-10 $mS{\nu}$, which could be a significant dose if administered routinely within the population over many years. CT colonography should a) achieve at least 90% sensitivity and specificity in the size category from 6 and 10 mm, b) offer non-cathartic bowl preparation and c) be optimized and standardized CT parameters if it is to be used for mass screening. 3. There is little evidence that demonstrates, for whole-body scanning, the benefit outweighs the detriment. This test found large portion of patient(86~90.8%) had at least one abnormal finding, whereas only 2% were estimated to have clinically significant disease. Annual scans from ages 45 to 75 years would accrue an estimated lifetime cancer mortality risk of 1.9%. There is no group within the medical community that recommends whole-body CT. No good studies indicate the accuracy of screening CT, at this time. The benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established. These areas need further research. Therefore wild screening should be avoided.

• Clinical Endoscopy
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• v.51 no.6
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• pp.534-540
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• 2018

From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

• Parasites, Hosts and Diseases
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• v.57 no.4
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• pp.411-416
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• 2019

To analyze the clinical and endoscopic features of colonic anisakiasis. A retrospective chart review of 20 patients with colonic anisakiasis, who were diagnosed by colonoscopy at 8 hospitals between January 2002 and December 2011, was performed. Patients' mean age was $53.6{\pm}10.74years$. Seventy percent patients were men. Acute abdominal pain was a common symptom that mostly developed within 48 hr after the ingestion of raw fish, and which lasted for 1-28 days. Sixty percent patients had ingested raw fish before the diagnosis of colonic anisakiasis and 40% patients were incidentally found to have colonic anisakiasis during the screening colonoscopies. Leukocytosis and eosinophilia were each found in 20% of the patients. In all patients who underwent colonoscopy, the worms were removed with biopsy forceps, except in 1 case, and a definite diagnosis of anisakiasis was made. In some cases of colonic anisakiasis, colonoscopy may be helpful in the diagnosis and treatment to avoid surgical intervention.