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Showing content from https://pubmed.ncbi.nlm.nih.gov/30001362/ below:

Is increased colorectal screening effective in preventing distant disease?

. 2018 Jul 12;13(7):e0200462. doi: 10.1371/journal.pone.0200462. eCollection 2018. Is increased colorectal screening effective in preventing distant disease?

Affiliations

¹ Cancer Biology Graduate Interdisciplinary Program, Tucson, AZ.
² University of Arizona Cancer Center, University of Arizona, Tucson, AZ, Tucson, AZ.

PMID: 30001362
PMCID: PMC6042755
DOI: 10.1371/journal.pone.0200462

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Is increased colorectal screening effective in preventing distant disease?

Gaius Julian Augustus et al. PLoS One. 2018.

. 2018 Jul 12;13(7):e0200462. doi: 10.1371/journal.pone.0200462. eCollection 2018. Affiliations

¹ Cancer Biology Graduate Interdisciplinary Program, Tucson, AZ.
² University of Arizona Cancer Center, University of Arizona, Tucson, AZ, Tucson, AZ.

PMID: 30001362
PMCID: PMC6042755
DOI: 10.1371/journal.pone.0200462

Item in Clipboard

Abstract

Background: Screening in the average risk population for colorectal cancer (CRC) is expected to reduce the incidence of distant (i.e., metastatic) CRCs at least as much as less advanced CRCs. Indeed, since 2000, during which time colonoscopy became widely used as a screening tool, the overall incidence of CRC has been reduced by 29%.

Objective: The purpose of the current study was to determine whether the reduction of incidence rates is the same for all stages of disease.

Methods: We evaluated incidence data from the Surveillance, Epidemiology, and End Results (SEER) program from 2000-2014 for Localized, Regional, and Distant disease. Joinpoint models were compared to assess parallelism of trends. Data were stratified by race, age, tumor location, and sex to determine whether these subgroupings could explain overall trends.

Results: Inconsistent with the expectations of a successful screening program, the reduction in incidence rates of distant CRCs from 2000-2014 has been slower than the reductions in incidence rates of both regional and localized CRCs. This trend is evident even when the data are stratified by age at diagnosis, sex, race, or tumor location.

Conclusions: The slower decrease in the incidence rate of distant disease is not consistent with a screening effect, that is, CRC screening may not be effective in preventing many distant CRCs. As a consequence, distant CRCs represent an increasing fraction of all CRCs, accounting for 21% of all CRCs in 2014. The analysis indicates that inadequate screening does not explain the slower decrease in incidence of distant CRCs. Consequently, we suggest that a subtype of CRC exists that advances rapidly, evading detection because screening intervals are too long to prevent it. Microsatellite unstable tumors represent a known subtype that advances more rapidly, and we suggest that another rapidly advancing subtype very likely exists that is microsatellite stable.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures
Fig 1. Model of a successful screening…

Fig 1. Model of a successful screening program.

The widely accepted concept is that colonic…

Fig 1. Model of a successful screening program.

The widely accepted concept is that colonic neoplasia progress from less advanced to more advanced stages (from adenoma to localized to regional to distant) and become more symptomatic as they progress. As screening quality is improved and more people are being screened, as has been the case in the US since 2000, we expect a screening effect that reduces the incidence rates of all stages of disease. This model predicts that a successful screening program would exert its largest reduction in incidence on distant CRC.

Fig 2. The incidence rate of distant…

Fig 2. The incidence rate of distant CRC is decreasing much more slowly than non-distant…
Fig 2. The incidence rate of distant CRC is decreasing much more slowly than non-distant disease.

Green squares, localized; yellow triangles, regional; red stars, distant. Incidence rates are expressed per 100,000.

Fig 3. Incidence rates of distant, regional,…

Fig 3. Incidence rates of distant, regional, and localized CRC by age, sex, site, and…
Fig 3. Incidence rates of distant, regional, and localized CRC by age, sex, site, and race.

Change in the incidence rates (per 100,000) of CRC by stage stratified by (A) age (<50, 50–64, 65+), (B) site (distal, proximal), (C) race (Native American/Alaskan Native, Asian or Pacific Islander, Black or African American, and White), and (D) sex. Green squares, localized; yellow triangles, regional; red stars, distant.