Joanne M. Osborne

Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program

Objective: To assess the impact of the National Bowel Cancer Screening Program (NBCSP) in South Australia.

Gender differences in faecal haemoglobin concentration

In his valuable summary, Professor Fraser notes that the distribution of haemoglobin levels within a population may be useful in matching positivity thresholds to regional health service capacity. We further explored the effect of gender on faecal haemoglobin levels by analysing these concentrations in single sample faecal immunochemical tests (FIT, OC Sensor, Eiken Chemical Company, Japan) completed within two weeks prior to scheduled colonoscopy (for any indication, n ¼ 2009). Gender differences were similar to those in our recent publication. 1 We therefore investigated: (1) the baseline faecal haemoglobin level of males and females who had been found at colonoscopy to have a normal colon; and (2) the sensitivity of the same haemoglobin cut-off in males and females to detect advanced neoplasia (colorectal cancer or advanced adenoma). Among people with no colorectal disease at colonoscopy, a statistically significant difference between sexes in faecal haemoglobin concentration was evident. The median level in males was 1.0mg Hb/g faeces (25th–75th percentile: 0 – 3.2mg Hb/g faeces, n ¼ 179) and in females 0.6mg Hb/g faeces (25th–75th percentile: 0 – 1.4mg Hb/g faeces, n ¼ 219; p < 0.001). We then assessed whether these differences would also exist in cases of advanced neoplasia, among 234 males (21% of colonoscopy findings) and 150 (14%) females. Using the positivity cut-off of 10mg Hb/g faeces in a FIT, 50% (118/234) of males, but only 43% (64/150) of females were positive. To enable detection of the same proportion of advanced neoplasia in females in our study would require the positivity cut-off of 5.4mg Hb/g. The difference in sensitivity (50% vs 43%) is not statistically significant in this population (Chi-squared test p ¼ 0.14), but the same positivity cut-off, applied to nation-wide screening programmes, may lead to more missed cancers and adenomas in females. This is a potential factor in the higher rate of female FIT-negative interval cancers. 2 When establishing positivity thresholds for quantitative FIT in screening programmes, differing faecal haemoglobin levels between males and females, or between different age bands, influence the effectiveness of screening. Furthermore, regional differences may necessitate different thresholds to achieve equivalent advanced neoplasia detection rates. However, decreasing test positivity cut-off, while increasing neoplasia sensitivity, can also increase false positive rate. Further work is needed to establish the best screening strategy to maximise neoplasia detection in all groups of the community to improve equity of screening, while taking into consideration colonoscopy capacity.

The impact of sample type and procedural attributes on relative acceptability of different colorectal cancer screening regimens

Objective In Australia and other countries, participation in colorectal cancer (CRC) screening using fecal occult blood testing is low. Previous research suggests that fecal sampling induces disgust, so approaches not involving feces may increase participation. This study aimed to determine population preferences for CRC screening tests that utilize different sample collections (stool, blood, and saliva) and the extent to which specific attributes (convenience, performance, and cost) impact this preference. Materials and methods People aged 50–74 years completed a survey. Preference for screening for CRC through stool, blood, and saliva was judged through ranking of preference and attributes critical to preference and confirmed via a discrete choice experiment (DCE) where test attributes were described as varying by performance, cost, and sample type. Participants also completed a measure of aversion to sample type. Results A total of 1,282 people participated in the survey. The DCE and ranking exercise confirmed that all test attributes had a statistically significant impact on respondents’ preferences (P < 0.001). Blood and saliva were equally preferred over stool; however, test performance was the most influential attribute. In multivariable analyses, those who preferred blood to stool collection exhibited higher aversion to fecal (OR = 1.17; P ≤ 0.001) and saliva (OR = 1.06; P ≤ 0.05) sampling and perceived that they had less time for home sample collection (OR = 0.72, P ≤ 0.001). Those who preferred saliva to stool had higher aversion to fecal (OR = 1.15; P ≤ 0.001) and blood (OR = 1.06, P ≤ 0.01) sampling and less time for home sample collection (OR = 0.81, P ≤ 0.5). Conclusion Aversion to sample type and perceived inconvenience of sample collection are significant drivers of screening preference. While blood and saliva sampling were the most preferred methods, test performance was the most important attribute of a screening test, regardless of sample type. Efforts to increase CRC screening participation should focus on a test, or combination of tests, that combines the attributes of high performance, low aversion, and convenience of use.

The relationship between participant evaluations of faecal occult blood tests (FOBT) and re-participation in screening

Are socioeconomic position, work stress, and work complexity associated to mobility after retirement?Abstracts from the ICBM 2014 Meetings from the ICBM 2014 MeetingIntroduction: Attitudinal ambivalence occurs when individuals endorse both positive and negative attitudes toward the same target object. Ambivalent attitudes are particularly relevant for addictive behaviours, as these behaviours may have both positive and negative evaluations associated with them. For example, drinking alcohol may make someone relaxed but can also produce feelings of nausea. Despite this, the majority of research focused on attitudes toward addictive behaviours assume that these attitudes are either positive or negative, not positive and negative. By assessing ambivalence toward addictive behaviours, a greater understanding of the nature of attitudes underlying these behaviours can be realised. Method: A total of 247 participants (M= 28.76 years) took part in this study. A measure of potential ambivalence, which asks participants to indicate their positive and negative evaluations on split semantic differential scales, was completed for five different health behaviours: drinking on a weekday and a weekend, exercising, increasing fruit and vegetable intake and smoking. Results: Attitudes toward alcohol consumption were found to be the most ambivalent. When examining drinking behaviour, a pattern emerged suggesting that the greater the quantity of alcohol consumed, the more ambivalent participants were toward drinking. Similar patterns were found for smoking. Conclusions: The results suggest that attitudinal ambivalence is an important aspect of addictive behaviours, as participants engaging in greater levels of these behaviours also reported higher levels of ambivalence. This indicates that individuals are aware of the positives and negatives of addictive behaviours but continue to perform them anyway.Salivary cortisol and alpha-amylase (sAA) that reflect hypothalamopituitary-adrenal axis (HPA-axis) activity and sympathetic activity within the autonomic nervous system (ANS) respectively, are bio ...Introduction: Previous research has developed an 11-item self-report measure assessing activation and pressure stress among adolescents. However, the biological correlates of this measure are uncle ...

Mo1200 Demographic and Behavioural Predictors of Ongoing Adherence to Faecal Occult Blood Test Screening for Colorectal Cancer

cancers as those diagnosed in patients with colonoscopy between 6-36 months previously, and all others to have detected cancers. The presence of diverticulosis was identified through diagnosis codes during the previous three years. We compared the prevalence of diverticulosis in interval and detected cancers according to tumor location. The independent association of diverticulosis was then evaluated in a logistic model with generalized estimating equations accounting for clustering by endoscopists and stratified by tumor location. The model adjusted for demographics, comorbidity and endoscopist characteristics. Results: We identified 57,839 patients, including 53,647 with detected cancers and 4,192 (7.2%) with interval cancers. A previous diagnosis of diverticulosis was documented in 69.3% of interval cancers and 26.9% of detected cancers (p,0.001). In all segments of the colon, the prevalence of a diverticulosis diagnosis was higher in interval cancers than in detected cancers (Table) (p,0.001 for all comparisons). In the multivariable analysis, diverticulosis was strongly associated with interval cancer risk in both the proximal colon (cecum to splenic flexure) (Adjusted Odds Ratio (AOR) 5.43, 95% CI 4.98-5.93) and distal colon (descending, sigmoid) (AOR 6.59, CI 5.65-7.69). Conclusions: A previous diagnosis of diverticulosis is a strong risk factor for interval colon cancer regardless of tumor location. Given the greater prevalence and extent of diverticulosis in the left colon, it suggests that factors other than impaired visualization of neoplasia between diverticuli are involved in the pathogenesis of interval cancer. Prevalence of Diverticulosis

Su1083 Predictors of Outcome At Surveillance Colonoscopy Following a Diagnosis of Colorectal Adenoma

Background. Post polypectomy surveillance colonoscopies are a huge burden on healthcare systems. Improved risk assessment could result in reduced colonoscopy use. Our aim was to identify patient, polyp and program factors associated with incidence of new neoplasia at first surveillance colonoscopy following an initial diagnosis of colorectal adenomaMethods. We reviewed colorectal cancer (CRC) surveillance outcome data contained in a colonoscopy recall database. Findings at first surveillance colonoscopy in people who had been diagnosed with advanced (high risk, HRA) adenoma ( ≥ 3 polyps, size ≥10mm, villous component, serration, high grade dysplasia) at diagnostic colonoscopy were compared to those with non-advanced (low risk, LRA) adenomas at diagnosis. Data included patient age and sex, polyp features and location, and interval between colonoscopies. Outcomes were compared using bivariate (Fishers exact) and multivariate (multinomial logistic regression) analyses. Results. Among 457 eligible patients, 266 (58%) were males, and mean age at diagnostic colonoscopy was 63 years. Mean time between diagnostic and surveillance colonoscopy were 43 and 31 months (median 40 and 35 months) for HRA and LRA respectively. There was a significant difference between groups for outcome at surveillance (Table, p=0.014). At the multivariate level, significant associations between outcome at surveillance and polyp features at diagnosis were limited. Controlling for age, gender and colonoscopy interval, those with LRA at diagnosis were more likely to have LRA at surveillance (RRR=1.91, p= 0.023, 95% CI 1.09-3.34). There was a non-significant trend towards increased risk for advanced neoplasia (HRA plus cancers) at surveillance in those originally diagnosed with HRA (RRR=1.31). Age and sex were significant predictors of adenoma incidence at surveillance. Relative risk ratios for HRA increased with each year of age for both males (RRR 1.04, p=0.007, 95% CI 1.01-1.07) and females (RRR 1.04, p=0.019, 95% CI 1.01-1.07), while the relative risk ratio for LRA increased significantly per year of age for males only (RRR 1.03, p=0.007, 95% CI 1.01-1.06). Conclusions: While features of polyps at diagnostic colonoscopies remain key predictors of findings at surveillance, age and sex are additional variables that predict worse outcome. Reduced risk of LRA at surveillance in patients previously diagnosed with HRA may reflect a more conscientious approach by proceduralists at diagnosis. Post polypectomy surveillance could focus more towards older patients. Table. Surveillance outcomes following a diagnosis of low or high risk adenoma.