Table of Contents
1
UI - 21369646
AU - Pesce A
TI -
Selections from current literature. Colorectal cancer screening.
SO - Fam Pract 2001 Aug;18(4):457-60
AD - Department of Family Medicine, Health Sciences Center, L-4, SUNY at
Stony Brook School of Medicine, Stony Brook, NY 11794, USA.
2
UI - 21436643
AU - Giorgi R; Gouvernet J; Dufour J; Degoulet P; Laugier R; Quilichini F;
TI -
Fieschi M
Elaboration and formalization of current scientific knowledge of risks
and preventive measures illustrated by colorectal cancer.
SO - Methods Inf Med 2001;40(4):323-30
AD - Laboratoire d'Enseignement et de Recherche sur le Traitement de
l'Information Medicale (LERTIM), Faculte de Medecine, Universite de la
Mediterranee, Marseille, France. rgiorgi@mail.ap-hm.fr
OBJECTIVES: Present the method used to elaborate and formalize current
scientific knowledge to provide physicians with tools available on the
Internet, that enable them to evaluate individual patient risk, give
personalized preventive recommendations or early screening measures.
METHODS: The approach suggested in this article is in line with medical
procedures based on levels of evidence (Evidence-based Medicine). A
cyclical process for developing recommendations allows us to quickly
incorporate current scientific information. At each phase, the analysis
is reevaluated by experts in the field collaborating on the project. The
information is formalized through the use of levels of evidence and
grades of recommendations. GLIF model is used to implement
recommendations for clinical practice guidelines. RESULTS: The most
current scientific evidence incorporated in a cyclical process includes
several steps: critical analysis according to the Evidence-based
Medicine method; identification of predictive factors; setting-up risk
levels; identification of prevention measures; elaboration of
personalized recommendation. The information technology implementation
of the clinical practice guideline enables physicians to quickly obtain
personalized information for their patients. Cases of colorectal
prevention illustrate our approach. CONCLUSIONS: Integration of current
scientific knowledge is an important process. The delay between the
moment new information arrives and the moment the practitioner applies
it, is thus reduced.
3
UI - 21271475
AU - Yoshinaga M; Watabe R; Yanagisawa J; Harada N; Motomura S; Nawata H;
TI -
Ikeda K
The interval between flexible sigmoidoscopy screening examinations can
be expanded beyond five years.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):437-9
AD - Department of Internal Medicine, Fukuoka Teishin Hospital, 2-6-11
Yakuin, Fukuoka 810-8798, Japan. m-yoshi@winter.try-net.or.jp
BACKGROUND/AIMS: As one of the methods for colorectal cancer screening,
asymptomatic average-risk persons aged > or = 50 years are recommended
to undergo flexible sigmoidoscopy screening every 5 years. We evaluate
whether the interval between examinations can be extended beyond 5
years. METHODOLOGY: A total of 192 asymptomatic average-risk subjects
were studied, all of whom had undergone a initial negative examination
on a flexible sigmoidoscopy screening at age > or = 50 years and a
second examination at least 3 years later. The study population was
divided into three groups according to the interval between
examinations, which was 3-5 years in Group A, 5-6 years in Group B, and
6-8 years in Group C. RESULTS: The incidence of neoplasms was compared
among the three subjects groups, and it was found to be similar: 11/96
(11.5%) in group A, 4/55 (7.3%) in group B, and 5/41 (12.2%) in group C.
All detected adenomas were less than 10 mm in diameter, and none
contained a villous component or high-grade dysplasia. No cancers were
found in the study. CONCLUSIONS: The results suggest that the interval
for screening sigmoidoscopy may be extended beyond 5 years in persons
showing negative results on an initial examination.
4
UI - 21287873
AU - Camma C; Giunta M; Andreone P; Craxi A
TI -
Interferon and prevention of hepatocellular carcinoma in viral
cirrhosis: an evidence-based approach.
SO - J Hepatol 2001 Apr;34(4):593-602
AD - Istituto Metodologie Diagnostichie Avanzate, Consiglio Nazionale delle
Ricerche, Palermo, Italy. camma@ismeda.pa.cnr.it
BACKGROUND/AIMS: To evaluate by meta-analysis of available literature
whether interferon (IFN) reduces the incidence of hepatocellular
carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C
virus (HCV)-related Child A cirrhosis. METHODS: Three randomized
controlled trials and 15 nonrandomized controlled trials, including 4614
patients and comparing IFN to no treatment, were selected. Data on the
incidence of HCC in IFN treated and untreated patients were extracted
from each study. Meta-analysis by the DerSimonian and Laird risk
difference (RD) method was used to pool observations. RESULTS: A
different incidence of HCC between treated and untreated cirrhotic
patients was observed for HCV (overall RD -12.8%; 95% CI -8.3 to -17.2%,
P < 0.0001) and HBV (overall RD -6.4%; 95% CI -2.8 to -10%, P < 0.001).
In HCV-related cirrhosis, the rate of HCC development was lower in
sustained responders to IFN than in untreated patients (overall RD
-19.1%; 95% CI -13.1 to -25.2%, P < 0.00001), with low heterogeneity
among trials (P=0.053), and also in nonresponders vs. untreated patients
(overall RD -11.8%; 95% CI -6.4 to -19.1%, P < 0.0001), although with
significant heterogeneity. Inconsistency among the studies was a major
problem, both for HCV (chi2 = 58.16 with 13 DF; P < 0.0001) and HBV
(chi2 = 26.4 with 6 DF; P = 0.0001) related cirrhosis, and also when
follow-up was shorter than 60 months. Consistent results were only
observed when assessing data from European reports: in this subgroup no
preventive effect of HCC was shown for HBV (overall RD -4.8%; 95% CI
-11.1-1.5%, P, not significant), and only a weak effect for HCV (overall
RD -10%; 95% CI -5.9 to -14.2%; P < 0.0001). CONCLUSIONS: Literature
data pooling suggests a slight preventive effect of IFN on HCC
development in patients with HCV-related cirrhosis. The magnitude of
this effect is low and the observed benefit might be due to spurious
associations. The preventive effect is more evident among sustained
responders to IFN. IFN does not seem to affect the rate of HCC in
HBV-related cirrhosis.
5
UI - 21287875
AU - Valla DC; Degos F
TI -
Chemoprevention of hepatocellular carcinoma in hepatitis C virus-related
cirrhosis: first, eliminate the virus.
SO - J Hepatol 2001 Apr;34(4):606-9
6
UI - 21381292
AU - Feldman RA
TI -
Review article: would eradication of Helicobacter pylori infection
reduce the risk of gastric cancer?
SO - Aliment Pharmacol Ther 2001 Jun;15 Suppl 1():2-5
AD - The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.
feldman@qmw.ac.uk
This article reviews the data on the epidemiology of gastric cancer, to
determine if treatment of an asymptomatic individual can be justified.
It reviews retrospective and prospective case-control studies of gastric
cancer in Italy and other countries. Mucosa-associated lymphoid tissue
lymphoma is associated with Helicobacter pylori infection. The risk of
noncardia gastric cancer is higher (4-fold or greater) in those with H.
pylori infection. Although no studies have shown prevention following
treatment, eradication of asymptomatic H. pylori infection in an
individual in the age group 40 or lower may be expected to reduce the
risk of gastric cancer.
7
UI - 21436668
AU - van Veen WA
TI -
[National colorectal carcinoma screening program deserves further study;
a report from the Dutch Health Council]
SO - Ned Tijdschr Geneeskd 2001 Aug 25;145(34):1655-7
AD - wa.van.veen@gr.nl
Each year there are about 8400 new colorectal carcinoma (CRC) cases in
the Netherlands. Despite improved treatment possibilities the mortality
rate has not shown a decline. A reduction in the mortality rate can be
achieved by screening for CRC by means of faecal occult-blood testing.
Endoscopic screening (flexible sigmoidoscopy or colonoscopy) could
reduce not only the mortality but also the incidence of CRC, but this
has yet to be conclusively demonstrated. The introduction of a national
screening programme deserves serious consideration, although various
questions need to be answered before a final decision can be taken.
These concern the optimal screening strategy, the expected degree of
participation, the follow-up under persons in whom polyps are found, the
demand on human resources and other resources, and the
cost-effectiveness.
8
UI - 21458874
AU - Okada S
TI -
Cancer chemoprevention as adjuvant therapy for hepatocellular carcinoma.
SO - Jpn J Clin Oncol 2001 Aug;31(8):357-8
9
UI - 21458875
AU - Okuno M; Sano T; Matsushima-Nishiwaki R; Adachi S; Akita K; Okano Y;
TI -
Kojima S; Moriwaki H
Apoptosis induction by acyclic retinoid: a molecular basis of 'clonal
deletion' therapy for hepatocellular carcinoma.
SO - Jpn J Clin Oncol 2001 Aug;31(8):359-62
AD - First Department of Internal Medicine, Gifu University School of
Medicine, Gifu, Japan.
We have shown previously that administration of acyclic retinoid to
cirrhotic patients who had undergone curative treatment of preceding
hepatocellular carcinoma (HCC) induced the disappearance of serum
lectin-reactive alpha-fetoprotein (AFP-L3) and subsequently reduced the
incidence of second liver cancers. AFP-L3 is a tumor marker that
indicates the presence of occult tumors below the detection limit by
diagnostic images. Therefore, we have proposed a new concept of 'clonal
deletion' therapy with acyclic retinoid for the cancer chemoprevention
against HCC. Such eradication of AFP-L3-producing latent malignant (or
premalignant) cells from the liver suggested a new strategy to prevent
HCC, which may be involved in the same category as cancer chemotherapy.
In the present series of studies, we explored the molecular mechanism of
'clonal deletion' and found a novel mechanism of apoptosis induction by
the retinoid. We have demonstrated a modification of a retinoid
receptor, RXRalpha, by mitogen-activated protein (MAP) kinase-dependent
phosphorylation, resulting in the loss of transactivating activity. This
may lead HCC cells to be resistant to natural retinoic acid. However,
acyclic retinoid restored the function of phosphorylated RXRalpha and
induced its downstream pro-apoptotic genes including tissue
transglutaminase, an enzyme that is implicated in apoptosis. Tissue
transglutaminase-dependent apoptosis in HCC cells was independent of the
activation of caspases. This novel mechanism of retinoid-induced
apoptosis may give a clue to understand the molecular mechanism of
clonal deletion.
10
UI - 21334821
AU - Burnand B; Gonvers JJ; Vader JP; Froelich F
TI -
Risk of colorectal cancer after breast cancer.
SO - Lancet 2001 Jun 23;357(9273):2057-8
11
UI - 21349663
AU - Shapiro JA; Seeff LC; Nadel MR
TI -
Colorectal cancer-screening tests and associated health behaviors.
SO - Am J Prev Med 2001 Aug;21(2):132-7
AD - Division of Cancer Prevention and Control, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, Atlanta, Georgia 30341-3717, USA.
BACKGROUND: Studies have shown that screening reduces colorectal cancer
mortality. We analyzed national survey data to determine rates of use of
fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if
these rates differ by demographic factors and other health behaviors.
METHODS: A total of 52,754 respondents aged >or=50 years were questioned
in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a
random-digit-dialing telephone survey of the non-institutionalized U.S.
population) about their use of FOBT and sigmoidoscopy. RESULTS: The
age-adjusted proportion of respondents who reported having had a
colorectal cancer screening test during the recommended time interval
(past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for
FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or
sigmoidoscopy. Rates of use of colorectal cancer screening tests were
higher for those who had other screening tests (mammography,
Papanicolaou smear, and cholesterol check). There were also differences
in rates of use of colorectal cancer screening tests according to other
health behaviors (smoking, seat belt use, fruit and vegetable intake,
and physical activity) and several demographic factors. However, none of
the subgroups that we examined reported a rate of FOBT use above 29%
within the past year or a rate of sigmoidoscopy use above 41% within the
past 5 years. CONCLUSIONS: While rates of use of FOBT and sigmoidoscopy
were higher among people who practiced other healthy behaviors, rates of
use were still quite low in all subgroups. There is a need for increased
awareness of the importance of colorectal cancer screening.
12
UI - 21454922
AU - O'Malley MS; Shaheen NJ; Crosby MA; Murray SC; Klenzak JS; Galanko JA;
TI -
Singla A; Ransohoff DF; Sandler RS; Gaither J; Paskett ED
Colorectal cancer screening in North Carolina. Community clinicians'
perspectives.
SO - N C Med J 2001 Sep-Oct;62(5):292-7
AD - UNC Lineberger Comprehensive Cancer Center, CB#7295, Chapel Hill, NC
27599-7295, USA. clover@med.unc.edu
13
UI - 21454923
AU - Conlisk E
TI -
Colorectal cancer in North Carolina. Risk factors, screening behaviors,
incidence, stage at diagnosis, and mortality.
SO - N C Med J 2001 Sep-Oct;62(5):298-303
AD - Faculty of the School of Natural Science, Hampshire College, Amherst, MA
01002, USA. econlisk@hampshire.edu
14
UI - 21459262
AU - Fitzgerald RC; Saeed IT; Khoo D; Farthing MJ; Burnham WR
TI -
Rigorous surveillance protocol increases detection of curable cancers
associated with Barrett's esophagus.
SO - Dig Dis Sci 2001 Sep;46(9):1892-8
AD - Havering Hospitals NHS Trust, Romford, Essex, UK.
Esophageal adenocarcinoma is increasing in incidence and has a high
mortality unless detected early. Barrett's esophagus is the only known
risk factor for this cancer; however, whether endoscopic surveillance
reduces morbidity and mortality is controversial. Endoscopic cancer
surveillance programes for Barrett's esophagus are not routinely
practiced in the UK, and this is the first study to examine whether a
rigorous surveillance protocol increases the detection rate of early
oesophageal cancer. All patients with a diagnosis of Barrett's esophagus
or associated adenocarcinoma attending Havering Hospitals NHS Trust
between 1992 and 1998 were included. A retrospective analysis was made
of patients undergoing informal surveillance (96 patients, 1992-1997)
and a prospective analysis was conducted following the implementation of
a rigorous protocol (108 patients, 1997-1998). Over the same time
periods Barrett's associated cancers diagnosed in patients not
undergoing surveillance were analyzed (262 patients 1992-1997, 98
patients 1997-1998). From 1992 to 1997, one case of high-grade dysplasia
was detected (N = 96, 1%). From 1997 to 1998, two cancers and three
high-grade dysplasias were detected during rigorous surveillance (N =
108, 4.6%). Three of these patients have had curative esophagectomies
(one high-grade dysplasia and two T1,N0,M0 tumors). In 1992-1997, 10
patients were found to have cancer in previously undiagnosed Barrett's
esophagus (N = 262, 3.8%). Of 3/10 cancers treated surgically, one
patient had a curative procedure (T1,N0,M0). In 1997-1998, nine patients
were found to have de novo Barrett's esophagus cancer (N = 88, 10.2%)
and three had curative resections (T1,N0,M0). Two of the patients with
T1 lesions had no endoscopic evidence of cancer but were detected as a
result of the multiple biopsy protocol. In conclusion, a rigorous biopsy
protocol increases the detection of early cancer in Barrett's esophagus.
15
UI - 21448541
AU - Wolf RL; Zybert P; Brouse CH; Neugut AI; Shea S; Gibson G; Lantigua RA;
TI -
Basch CE
Knowledge, beliefs, and barriers relevant to colorectal cancer screening
in an urban population: a pilot study.
SO - Fam Community Health 2001 Oct;24(3):34-47
AD - Department of Health and Behavior Studies, Teachers College, Columbia
University, New York, New York, USA.
A sample of 115 urban, working-class, predominantly minority men and
women was interviewed by telephone to assess knowledge, beliefs, and
barriers relevant to colorectal cancer (CRC) and CRC screening. More
than half (53.9%) were unable to name a CRC screening test.
Misconceptions were common. Dispelling inaccurate beliefs, establishing
an individual's preference for fecal occult blood tests or flexible
sigmoidoscopy, and helping individuals take a proactive role in the
receipt of CRC screening are important goals for health education
efforts aimed at increasing rates of CRC screening. Participants'
willingness to engage in detailed telephone conversations about CRC and
CRC screening was encouraging.
16
UI - 21439162
AU - Mahavni V; Sood AK
TI -
Hormone replacement therapy and cancer risk.
SO - Curr Opin Oncol 2001 Sep;13(5):384-9
AD - Division of Gynecologic Oncology, Department of Obstetrics and
Gynecology, Holden Comprehensive Cancer Center, University of Iowa
Hospitals and Clinics, Iowa City, Iowa, USA.
The advantages and disadvantages of hormone replacement therapy (HRT)
have been debated nearly as long as the treatment has been in use,
especially the relationship between HRT and risk of cancer development.
It is hoped that recently published studies will shed more light on this
complex issue. Several large population studies suggest that there may
be a small but increased risk of developing breast cancer in HRT users,
especially in estrogen and progesterone users. This risk appears most
pronounced after 5 years of HRT use. Endometrial cancer, which has long
been associated with unopposed estrogen use, can be successfully
prevented with the addition of progestins to the HRT regimen, provided
it is given for at least 10 days each month. Estrogen replacement
therapy has also been shown to significantly reduce the risk for colon
cancer but not rectal cancers. Finally, a large prospective study has
linked HRT with an increase in ovarian cancer mortality.
17
UI - 21452080
AU - Rakowski V; DeDecker L; Westendorp J
TI -
Knowing is most of the battle.
SO - Mich Health Hosp 2001 Sep-Oct;37(5):38
AD - Cancer Control, American Cancer Society, Great Lakes Division, Lansing,
USA.
Colorectal carcinoma is the fourth most frequently diagnosed cancer and
second most frequent cause of death from cancer in the United States.
Each year in Michigan, more than 5,000 people are diagnosed with
invasive colorectal cancer, and more than 2,000 persons die from this
disease.
18
UI - 21462454
AU - Morris CD; Byrne JP; Armstrong GR; Attwood SE
TI -
Prevention of the neoplastic progression of Barrett's oesophagus by
endoscopic argon beam plasma ablation.
SO - Br J Surg 2001 Oct;88(10):1357-62
AD - Department of Upper Gastrointestinal Surgery, Hope Hospital, Stott Lane,
Salford, Manchester M6 8HD, UK.
BACKGROUND: Patients with Barrett's oesophagus have a risk of
approximately 1 per 100 patient-years for the development of oesophageal
adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been
shown to lead to the regrowth of a 'neo' squamous epithelium if
gastro-oesophageal reflux is controlled, but the incidence of subsequent
tumour formation is unknown. METHODS: The follow-up of 55 patients who
underwent endoscopic ablation of Barrett's oesophagus by argon beam
plasma coagulation (ABPC) is reported. Of the 55 patients, nine had
low-grade dysplasia, nine had high-grade dysplasia and the remainder had
non-dysplastic Barrett's metaplasia. Twelve patients had reflux control
by antireflux surgery and the remainder received proton pump inhibitor
therapy. Barrett's metaplasia was ablated by ABPC to within 2 cm of the
gastro-oesophageal junction. RESULTS: To date, one patient has died and
one patient was unable to complete treatment. The remaining patients
were followed by regular endoscopic surveillance for a mean of 38.5
months to give a total follow-up of 173.5 patient-years. No malignancy
has developed in any patient during follow-up. CONCLUSION: The absence
of malignant complications in this study of prophylactic ablation of
long-segment Barrett's oesophagus strengthens the argument for
endoscopic ablation in the prevention of oesophageal adenocarcinoma.
19
UI - 21481726
AU - Standard Task Force; American Society of Colon and Rectal Surgeons;
TI -
Collaborative Group of the Americas on Inherited Colorectal Cancer
Practice parameters for the identification and testing of patients at
risk for dominantly inherited colorectal cancer.
SO - Dis Colon Rectum 2001 Oct;44(10):1403
20
UI - 21481727
AU - Church J; Lowry A; Simmang C; The Standards Task Force; American Society
TI -
of Colon and Rectal Surgeons
Practice parameters for the identification and testing of patients at
risk for dominantly inherited colorectal cancer--supporting
documentation.
SO - Dis Colon Rectum 2001 Oct;44(10):1404-12
21
UI - 21128990
AU - Ziebert JJ
TI -
Colorectal cancer screening: the old and the new.
SO - Tex Med 2001 Feb;97(2):46-8
As the second leading cancer killer of Americans, colorectal cancer
represents a serious health threat to all Americans. All health care
providers and patients should demand colorectal cancer screening, which
has been shown to decrease the incidence and mortality of the disease
through the detection and removal of the cancer's precursor lesion, the
adenomatous polyp. Colonoscopy is the most effective screening tool
because it identifies and treats more polyps than any other screening
tool available today. However, cost issues have led to considerable
controversy regarding its universal application as a screening tool.
22
UI - 96025018
AU - Smith KR; Croyle RT
TI -
Attitudes toward genetic testing for colon cancer risk.
SO - Am J Public Health 1995 Oct;85(10):1435-8
AD - Genetic Science in Society Program, University of Utah, Salt Lake City
84112, USA.
This study examined public interest regarding genetic testing for colon
cancer susceptibility. Survey data were collected from 383 adults in
Utah. Respondents were very (47.3%) or somewhat (36.6%) interested in
taking this genetic test. Nearly 95% reported that they would share
their results with others. Individuals with higher income and with a
perceived risk of getting colon cancer were the most interested in
testing. Individuals without health insurance and widowed individuals
were the least likely to share their test results. If respondents were
told that they carried a gene for colon cancer, most would be concerned
with how to reduce their risk of getting the disease.
23
UI - 21325274
AU - Ore L; Hagoel L; Lavi I; Rennert G
TI -
Screening with faecal occult blood test (FOBT) for colorectal cancer:
assessment of two methods that attempt to improve compliance.
SO - Eur J Cancer Prev 2001 Jun;10(3):251-6
AD - Department of Community Medicine and Epidemiology, Carmel Medical Center
and The Faculty of Medicine, Technion, Haifa, Israel.
Screening with the faecal occult blood test (FOBT) has been shown in
randomized control trials to be effective in reducing mortality from
colorectal cancer. Compliance to this test recommendation, however, by
the general population is usually low. To evaluate different methods of
increasing compliance with FOBT, using mailed test kits or order cards,
with or without information leaflets, subjects were randomly assigned to
receive a test kit or a kit request card. An information leaflet was
included in half of the mailings. All participants were contacted for
interview. Compliance was evaluated through the central computer system
of the study's FOBT laboratory. Self-initiated compliance with FOBT in
the year preceding the study was 0.6% of the study participants. The
overall compliance rate with the programme invitation was 17.9%, with a
somewhat higher, though non-significant response to the mailed kit
(19.9%) over the kit request card (15.9%). Women complied with the test
significantly more than men, older participants more than younger.
Compliance to FOBT is low among the Israeli population aged 50-74 who
receive a formal invitation to carry out this screening. Mailing a kit
request card within the framework of a screening programme can achieve a
substantial increase (to 17.9%) in the level of compliance for the
relatively low cost of postage. More effort is needed to study
additional means of convincing the non-responders to take part in this
potentially life saving activity.
24
UI - 21325275
AU - You WC; Chang YS; Heinrich J; Ma JL; Liu WD; Zhang L; Brown LM; Yang CS;
TI -
Gail MH; Fraumeni JF Jr; Xu GW
An intervention trial to inhibit the progression of precancerous gastric
lesions: compliance, serum micronutrients and S-allyl cysteine levels,
and toxicity.
SO - Eur J Cancer Prev 2001 Jun;10(3):257-63
AD - National Cancer Institute, Division of Cancer Epidemiology and Genetics,
Bethesda, MD 20892, USA. youw@exchange.nih.gov
Gastric cancer is the second most frequent cause of death from cancer in
the world and the leading cause of death from cancer in China. In
inhibit the progression of precancerous gastric lesions in Linqu County,
Shandong Province, an area of China with one of the world's highest
rates of gastric cancer. Treatment compliance was measured by pill
counts and quarterly serum concentrations of vitamin C, vitamin E and
S-allyl cysteine. In 1999, toxicity information was collected from each
trial participant to evaluate treatment-related side-effects during the
trial. Compliance rates were 93% and 92.9% for 39 months of treatment
with the vitamins/mineral and garlic preparation, respectively. The
means for serum concentrations of vitamins C and E were 7.2 microg/ml
and 1695 microg/dl among subjects in the active treatment groups
compared with 3.1 microg/ml and 752 microg/dl among subjects in the
placebo treatment group, respectively. No significant differences in
side-effects were observed between the placebo treatment group and the
vitamins/mineral and garlic preparation treatment groups during the
39-month trial period.
25
UI - 21455731
AU - Myers RE; Turner B; Weinberg D; Hauck WW; Hyslop T; Brigham T; Rothermel
TI -
T; Grana J; Schlackman N
Complete diagnostic evaluation in colorectal cancer screening: research
design and baseline findings.
SO - Prev Med 2001 Oct;33(4):249-60
AD - Division of Medical Oncology and Medical Genetics, Department of
Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania 19107,
USA.
BACKGROUND: While indicated by guidelines, complete diagnostic
evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy
plus barium enema X ray), is often not recommended and performed for
persons with an abnormal screening fecal occult blood test (FOBT)
result. We initiated a randomized trial to assess the impact of a
physician-oriented intervention on CDE rates in primary care practices.
METHODS: In 1998, we identified 1,184 primary care physicians (PCPs) in
584 practices whose patients received FOBTs that are mailed annually by
a managed care organization screening program. A total of 470 PCPs in
318 practices completed a baseline survey. Practices were randomly
assigned either to a Control Group (N = 198) or to an Intervention Group
(N = 120). Control Group practices received the screening program.
Intervention Group practices received the screening program and the
intervention (i.e., CDE reminder-feedback plus educational outreach).
Practice CDE recommendation and performance rates are the primary
outcomes to be measured in the study. RESULTS: Baseline CDE
recommendation and performance rates were low and were comparable in
Control and Intervention Group practices (54 to 57% and 39 to 40%,
respectively). PCPs in the practices tended to view FOBT screening and
CDE favorably, but had concerns about screening efficacy, time involved
in CDE, and patient discomfort and adherence. Control Group physicians
were more likely than Intervention Group physicians to believe that a
mail-out FOBT screening program helps in the practice of medicine.
CONCLUSIONS: We were able to enroll a high proportion of targeted
primary care practices, measure practice characteristics and CDE rates
at baseline, and develop and implement the intervention. Study outcome
analyses will take into account baseline differences in practice
characteristics. Copyright 2001 American Health Foundation and Academic
Press.
26
UI - 21487964
AU - Harewood G
TI -
Videotape-based decision aid for colon cancer screening.
SO - Ann Intern Med 2001 Oct 16;135(8 Pt 1):634-5
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