Junjie Huang

Lower Relative Contribution of Positive Family History to Colorectal Cancer Risk with Increasing Age: A Systematic Review and Meta-Analysis of 9.28 Million Individuals

OBJECTIVES: Existing algorithms predicting the risk of colorectal cancer (CRC) assign a fixed score for family history of CRC. Whether the increased CRC risk attributed to family history of CRC was higher in younger patients remains inconclusive. We examined the risk of CRC associated with family history of CRC in first‐degree relative (FDR) according to the age of index subjects (<40 vs. ≥40; <50 vs. ≥50; and <60 vs. ≥60 years). METHODS: Ovid Medline, EMBASE, and gray literature from the reference lists of all identified studies were searched from their inception to March 2017. We included case‐control/cohort studies that investigated the relationship between family history of CRC in FDR and prevalence of CRC. Two reviewers independently selected articles according to the PRISMA guideline. A random effects meta‐analysis pooled relative risks (RR). RESULTS: We analyzed 9.28 million subjects from 63 studies. A family history of CRC in FDR confers a higher risk of CRC (RR = 1.76, 95% CI = 1.57‐1.97, p < 0.001). This increased risk was higher in younger individuals (RR = 3.29, 95% CI = 1.67‐6.49 for <40 years versus RR = 1.42, 95% CI = 1.24‐1.62 for ≥40 years, p = 0.017; RR = 2.81, 95% CI = 1.94‐4.07 for <50 years versus RR = 1.47, 95% CI = 1.28‐1.69 for ≥50 years, p = 0.001). No publication bias was identified, and the findings are robust in subgroup analyses. CONCLUSIONS: The increase in relative risk of CRC attributed to family history was found to be higher in younger individuals. Family history of CRC could be assigned a higher score for younger subjects in CRC risk prediction algorithms. Future studies should examine if such approach may improve their predictive capability.

The adoption of hypertension reference framework: An investigation among primary care physicians of Hong Kong

Background The Hong Kong Government released a Reference Framework (RF-HT) for Hypertension Care for Adults in Primary Care Settings since 2010. No studies have evaluated its adoption by primary care physicians (PCPs) since its release. Aim We aimed to evaluate the level of PCPs’ adoption of the RF-HT and the potential barriers of its use in family practice. Design and setting A cross-sectional study was conducted by a self-administered validated survey among all PCPs in Hong Kong through various means. Methods We assessed the level of and factors associated with its adoption by multivariate logistic regression modelling. Result A total of 3,857 invitation episodes were sent to 2,297 PCPs in 2014–2015. We received 383 completed questionnaires. The average score of adoption was 3.43 out of 4.00, and 47.5% of PCPs highly adopted RF-HT in their daily consultations. Male practitioners (adjusted odds ratio [aOR] = 0.524, 95% CI = 0.290–0.948, p = 0.033) and PCPs of public sector (aOR = 0.524, 95% CI = 0.292–0.940, p = 0.030) were significantly less likely to adopt the RF-HT. PCPs with higher training completion or being academic fellow are more likely to adopt RF-HT than those who were “nil to basic training completion” (aOR = 0.479, 95% CI = 0.269–0.853, p = 0.012) or “higher trainee” (aOR = 0.302, 95% CI = 0.093–0.979, p = 0.046). Three most-supported suggestions on RF-HT improvement were simplification of RF-HT, provision of pocket version and promoting in patients. Conclusion Among PCP respondents, the adoption level of the RF-HT was high. These findings also highlighted some factors associated with its adoption that could inform targeted interventions for enhancing its use in clinical practice.

The changing epidemiology of liver diseases in the Asia–Pacific region

This Review presents current epidemiological trends of the most common liver diseases in Asia–Pacific countries. Hepatitis B virus (HBV) remains the primary cause of cirrhosis; despite declining prevalence in most Asian nations, this virus still poses a severe threat in some territories and regions. Mortality resulting from HBV infection is declining as a result of preventive measures and antiviral treatments. The epidemiological transition of hepatitis C virus (HCV) infection has varied in the region in the past few decades, but the medical burden of infection and the prevalence of its related cancers are increasing. The lack of licensed HCV vaccines highlights the need for novel treatment strategies. The prevalence of nonalcoholic fatty liver disease (NAFLD) has risen in the past decade, mostly owing to increasingly urbanized lifestyles and dietary changes. Alternative herbal medicine and dietary supplements are major causes of drug-induced liver injury (DILI) in some countries. Complications arising from these chronic liver diseases, including cirrhosis and liver cancer, are therefore emerging threats in the Asia–Pacific region. Key strategies to control these liver diseases include monitoring of at-risk populations, implementation of national guidelines and increasing public and physician awareness, in concert with improving access to health care.Liver diseases exert a substantial disease burden across the Asia–Pacific region. In this Review, the authors explore the epidemiological trends in the most common liver diseases in the region, including HBV infection, HCV infection and nonalcoholic fatty liver disease, and discuss implications for preventive measures.Key pointsIn the Asia–Pacific region, HBV, HCV, excessive alcohol consumption, the metabolic syndrome and concomitant liver diseases are the major factors resulting in chronic liver injury and end-stage liver pathology.The expanding implementation of HBV vaccination has been effective in reducing thexa0incidence of liver cancer, especially in countries like China.Further effort is required to tackle the rising prevalence of HCV infection, for which axa0vaccine is not available.Nonalcoholic fatty liver disease (NAFLD) prevalence is increasing owing to increasingly urbanized lifestyles and dietary changes; as a result, the rising trend ofxa0NAFLD is becoming comparable to that of Western countries.As NAFLD is associated with the development of cardiovascular and kidney diseases, patients with this disease should receive tailor-made advice and continuous support for lifestyle modification.Liver cancer is prevalent, particularly in China, Vietnam, North Korea and Thailand.

Capability of four sigmoidoscopy-based screening strategies to predict proximal neoplasia in an asymptomatic Chinese population: Prediction of proximal neoplasia

A proper colonoscopy referral criterion is essential for flexible sigmoidoscopy‐based colorectal cancer screening. We aimed to compare the predictive capability of four existing criteria to detect proximal neoplasia (PN) and advanced proximal neoplasia (APN) in a Chinese population.

The growing burden of liver cirrhosis: implications for preventive measures

Liver cirrhosis has become one of the major causes of morbidity and mortality. The Global Burden of Disease (GBD) reported that over one million people died due to cirrhosis in 2010 worldwide, compared with 676,000 deaths in 1980. Since the survival rate of cirrhosis is relatively low, data on the incidence of geographical variations are essential to prevent its related disability and mortality. However, the heavy burden of this medical condition might be even greater, as relevant data in 58/187 (31%) of countries were not available in the report [1]. Existing evidence showed that the burden of liver cirrhosis is growing in both the West and the East. The number of deaths caused by liver cirrhosis in the Caribbean, Latin America, Asia, Oceania, Africa and Europe had increased significantly from 1980 to 2010. Especially for the Caribbean, the mortality rate increased rapidly from 600,000 to 1 million. Egypt had the highest age-standardized mortality rate for cirrhosis, while Mexican had the greatest number of deaths in the Latin Americans. In Asia, the highest incidence of liver cirrhosis was observed in Thailand [2]. The growing prevalence of liver cirrhosis is due to the increasing burden of its risk factors. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the two major causes of liver cirrhosis. Globally, 257 million people were infected with chronic HBV in 2015. Asia and Africa were the two highest endemic continents, with an overall prevalence of over 8%. The rising prevalence of HCV is also an emerging issue for health in many regions. There were about 71 million people with HCV in 2015. The prevalence in highly endemic regions, for example, Central Asia and the Mediterranean, was over 3.5% [3]. Apart from hepatitis infection, alcohol is another important risk factor for liver cirrhosis. From 2005 to 2015, the global agestandardised prevalence of liver cirrhosis due to alcohol has increased by 16.1%, compared with HBV (11.9%), HCV (14.2%) and others (9.9%) [4]. Liver cirrhosis is the end-stage of different chronic liver diseases, and is often neglected until complications, such as variceal haemorrhage, spontaneous bacterial peritonitis, ascites, or hepatic encephalopathy occur. [5] More than half of all patients diagnosed with liver cancer have liver cirrhosis. In 2012, the prevalence of liver cancer ranked the fifth among all cancers, making up 9.1% of all cancer deaths worldwide. A significant number of years of life lost were induced by its aggressive history and low survival. The highest incidence mortality was observed in Eastern Asia, South-Eastern Asia and Northern Africa [6]. Cirrhosis was also found to be associated with other diseases, including non-alcoholic fatty liver disease (NAFLD), colorectal cancer, and metabolic syndrome [7, 8]. A recent review has highlighted the changing epidemiology of liver diseases in the Asia Pacific region [3]. In this issue of the Journal, Chung et al. [9] performed an eight-year, prospective cohort study using data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database to compare the mortality between cirrhosis and five major cancers, including lung, colorectal, stomach, liver, and breast cancers. There occurred 2609 cases of liver cirrhosis and 4852 cases of the investigated cancers. The mortality was 46.9/1000 person-years for liver cirrhosis and 41.1/1000 person-years for the five cancers. At the end of eight-year follow-up, the survival probability was 69.5 and 73% for liver cirrhosis and cancers, respectively. From Cox Proportional hazards models, they found that the hazard ratio of cirrhosis for mortality was greater than the five major cancers by a magnitude of 13–87%. The fact that 16.7% of the liver cirrhosis patients had coexisting & Junjie Huang junjie_huang@link.cuhk.edu.hk