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Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening.

ABSTRACT: A multicentre randomised controlled trial to evaluate screening by "once only" flexible sigmoidoscopy (FS) for prevention of bowel cancer is in progress.To pilot the trial protocol examining rates of attendance, yield of neoplasia, and adverse effects.A total of 3540 subjects aged 55-64 years in Welwyn Garden City (WGC) and 19,706 in Leicester (LE).Subjects responding positively to an "interest in screening" questionnaire were randomised to invitation for screening or control arms. Small polyps were removed during screening. Colonoscopy was undertaken for high risk polyps (more than two adenomas, size at least 1 cm, villous histology, severe dysplasia, or malignancy). The remainder were discharged.In WGC and LE respectively, 59% and 61% indicated an interest in screening, of which 74% and 75% attended. Adenomas were detected in 10% and 9%, respectively, and cancers in 7 per 1000 (in both centres), 55% at Dukes's stage A. The colonoscopy referral rate was 6% in both centres. Mild, short lived bleeding occurred in 3%. One person died following surgery.Compliance rates, yield of adenomas, and referral rate for colonoscopy were as expected, but cancer detection rates were higher. Adverse effects following sigmoidoscopy or colonoscopy were mild and transient, but there was one postoperative death. A randomised trial is necessary to evaluate fully the risks and benefits of this intervention.

SUBMITTER: Atkin WS

PROVIDER: S-EPMC1727083 | biostudies-other | 1998 Apr

REPOSITORIES: biostudies-other

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Project description:Background and study aims?Uptake of flexible sigmoidoscopy screening in the English Bowel Scope Screening (BSS) Programme is low. The aim of this study was to test the impact of a nonparticipant reminder and theory-based leaflet to promote uptake among former nonresponders (previously did not confirm their appointment) and nonattenders (previously confirmed their appointment but did not attend). Patients and methods?Eligible adults were men and women in London who had not attended a BSS appointment within 12 months of their invitation. Individuals were randomized (1:1:1) to receive no reminder (control), a 12-month reminder plus standard information booklet (TMR-SIB), or a 12-month reminder plus bespoke theory-based leaflet (TMR-TBL) designed to address barriers to screening. The primary outcome of the study was the proportion of individuals screened within each group 12 weeks after the delivery of the reminder. Results?A total of 1383 men and women were randomized and analyzed as allocated (n?=?461 per trial arm). Uptake was 0.2?% (n?=?1), 10.4?% (n?=?48), and 15.2?% (n?=?70) in the control, TMR-SIB, and TMR-TBL groups, respectively. Individuals in the TMR-SIB and TMR-TBL groups were significantly more likely to attend screening than individuals in the control group (adjusted odds ratio [OR] 53.7, 95?% confidence interval [CI] 7.4?-?391.4, P?<?0.001 and OR 89.0, 95?%CIs 12.3?-?645.4, P?<?0.01, respectively). Individuals in the TMR-TBL group were also significantly more likely to attend screening than individuals in the TMR-SIB group (OR 1.7, 95?%CIs 1.1?-?2.5, P?=?0.01). Across all groups, former nonattenders were more likely to participate in screening than former nonresponders (uptake was 14.2?% and 8.0?%, respectively; OR 2.5, 95?%CIs 1.4?-?4.4, P?<?0.01). The adenoma detection rate among screened adults was 7.6?%, which is comparable to the rate in initial attenders. Conclusions?Reminders targeting former nonparticipants can improve uptake and are effective for both former nonresponders and nonattenders. Theory-based information designed to target barriers to screening added significantly to this strategy.

Project description:BackgroundColorectal cancer is the third most common cancer worldwide. Previous analyses have only reported follow-up after flexible sigmoidoscopy for a maximum of 12 years. We aimed to examine colorectal cancer incidence and mortality after a single flexible sigmoidoscopy screening and 17 years of follow-up.MethodsIn this multicentre randomised trial (UK Flexible Sigmoidoscopy Screening Trial), done between Nov 14, 1994, and March 30, 1999, 170 432 eligible men and women, who had indicated on a previous questionnaire that they would probably attend screening if invited, were randomly assigned (1:2) to an intervention group (offered flexible sigmoidoscopy screening) or a control group (not contacted). Randomisation was done centrally in blocks of 12, and stratified by trial centre, general practice, and household type. The nature of the intervention did not allow the staff to be masked to arm of the trial; however, randomisation was done in batches so that the control group and participants not yet randomised were unaware of their allocation status. The primary outcomes were incidence and mortality of colorectal cancer. Hazard ratios (HRs) and 95% CIs for colorectal cancer incidence and mortality were estimated for intention-to-treat and per-protocol analyses. The trial is registered with ISRCTN, number 28352761.FindingsOur cohort analysis included 170 034 people: 112 936 in the control group and 57 098 in the intervention group, 40 621 (71%) of whom were screened and 16 477 (29%) were not screened. During screening and a median of 17·1 years' follow-up, colorectal cancer was diagnosed in 1230 individuals in the intervention group and 3253 in the control group, and 353 individuals in the intervention group versus 996 individuals in the control group died from colorectal cancer. In intention-to-treat analyses, colorectal cancer incidence was reduced by 26% (HR 0·74 [95% CI 0·70-0·80]; p<0·0001) in the intervention group versus the control group and colorectal cancer mortality was reduced by 30% (0·70 [0·62-0·79]; p<0·0001) in the intervention group versus the control group. In per-protocol analyses, adjusted for non-compliance, colorectal cancer incidence and mortality were 35% (HR 0·65 [95% CI 0·59-0·71]) and 41% (0·59 [0·49-0·70]) lower in the screened group.InterpretationA single flexible sigmoidoscopy continues to provide substantial protection from colorectal cancer diagnosis and death, with protection lasting at least 17 years.FundingNational Institute for Health Research Efficacy and Mechanism Evaluation.

Project description:ObjectiveTo determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment.DesignA single-stage phase II trial.SettingSouth Tyneside District Hospital, Tyne and Wear, England, UK.ParticipantsIndividuals invited for BSS at South Tyneside District Hospital during the 6-month recruitment period were invited to participate in the study.InterventionConsenting individuals were randomly assigned to either the PN intervention or usual care group in a 4:1 ratio. The intervention involved BSS non-attenders receiving a phone call from an SSP to elicit their reasons for non-attendance and offer educational, practical and emotional support as required. If requested by the patient, another BSS appointment was then scheduled.Primary outcome measureThe number of non-attenders in the intervention group who were navigated and then rebooked and attended their new BSS appointment.Secondary outcome measuresBarriers to BSS attendance, patient-reported outcomes including informed choice and satisfaction with BSS and the PN intervention, reasons for study non-participation, SSPs' evaluation of the PN process and a cost analysis.ResultsOf those invited to take part (n=1050), 152 (14.5%) were randomised into the study: PN intervention=109; usual care=43. Most participants attended their BSS appointment (PN: 79.8%; control: 79.1%) leaving 22 eligible for PN: only two were successfully contacted. SSPs were confident in delivering PN, but were concerned that low BSS awareness and information overload may have deterred patients from taking part in the study. Difficulty contacting patients was reported as a burden to their workload.ConclusionsPN, as implemented, was not a feasible intervention to increase BSS uptake in South Tyneside. Interventions to increase BSS awareness may be better suited to this population.Trial registration numberISRCTN13314752; Results.

Project description:Enhancing maize lodging resistance with plant growth retardants (PGRs) is common in maize production. However, the underlying mechanisms of yield formation as affected by PGRs are still poorly understood. A field experiment contained PGR application (a mixture of ethephon and cycocel, EC) with normal (T1) and double (T2) doses and water control (CK) was conducted at four maize plant densities (4.5, 6.0, 7.5, and 9.0 plants m-2) in 2020 and 2021. In this two-year study, the grain yield and kernel number per ear (KNE) of EC treatments were reduced by 4.8-9.0% and 3.3-12.2%, respectively, compared with CK under densities of 4.5, 6.0, and 7.5 plants m-2 without lodging. However, under the density of 9.0 plants m-2, EC treatments had no pronounced effects on grain yield and yield components. Across all densities, EC significantly decreased the leaf area index (LAI), and the lowest LAI was recorded in T2. The concentrations of nonstructural carbohydrates (NSCs; starch and soluble sugar) in the stem were significantly decreased by 9.9-10.2% in T2 averaged all densities. The sucrose and starch concentrations in grains also declined in the EC treatments. The key enzymes (cell wall acid invertase, sucrose synthase, and adenosine diphosphate pyrophosphorylase) and grain polyamine concentrations showed a slight downward trend under EC treatments compared to CK. NSCs in stems and grains, kernel enzyme activities, and polyamines in grains presented significant positive correlations with KNE. Additionally, structural carbohydrate (SC; including cellulose, hemicellulose, and lignin) concentrations in stems were improved with enhanced lodging resistance by spraying EC. Significant negative relationships were observed between SC with kernel number m-2 (KNM) and yield, suggesting that improved SC in stems might affect the availability of NSCs for kernel set. Although the lowest kernel weight and KNE were obtained at 9.0 plant m-2, relatively high LAI still ensured high KNM and high yield. Collectively, EC treatment increased SC in stems, enhanced lodging resistance of maize and reduced NSC availability for kernels, ultimately presenting adverse effects on maize kernel number and yield under relative low density.

Project description:Background and study aims Bowel (or colorectal) cancer is one of the most common types of cancer. If a person is suspected to have colorectal cancer, they may undergo a colonoscopy, an examination of the bowel using a device called a colonoscope. A colonoscope is a flexible tube that is attached to a camera and a light. It is inserted into the bowel though the rectum. The tube is pushed through the entire length of the bowel and is then slowly taken out again (withdrawn). The bowel is examined for signs of cancer (the presence of adenomas and polyps) during withdrawal. The EndoRings is a flexible silicone rubber device that can be attached to the end of a colonoscope. It has circular wings that stretch the walls of the colon and flatten them. This, in turn, increases how much of the colon that can be seen during a colonoscopy. Previous studies have shown that EndoRings colonoscopy is more likely to detect adenomas and polyps and are less likely to miss them (miss rate) than standard colonoscopy. This study is comparing the diagnostic yield (that is, how many patients are diagnosed with bowel cancer) and the number of adenomas and polyps are missed (the miss rate) of EndoRings colonoscopy with standard colonoscopy. Who can participate? Adults that have tested positive in respect to a immunochemical fecal test as part of a screening program to detect bowel cancer. What does the study involve? Participants are randomly assigned to one of four groups. Those in group 1 are given a standard colonoscopy. Those in group 2 are given a EndoRings colonoscopy. Those in group 3 are given a standard colonoscopy followed by a EndoRings colonoscopy (one immediately after the other). Those in group 4 are given a EndoRings colonoscopy followed immediately by a standard colonoscopy. If any adenomas or polyps are identified during the procedures they are removed and analysed if appropriate. All patients are then called 30 days after the examination and asked about their experience.

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Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening.

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