Is increased colorectal screening effective in preventing distant disease?
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journal.pone.0200462.pdf
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Augustus GJ, Roe DJ, Jacobs ET, Lance P, Ellis NA (2018) Is increased colorectal screening effective in preventing distant disease? PLoS ONE 13(7): e0200462. https://doi.org/10.1371/journal.pone.0200462Journal
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© 2018 Augustus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.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 161 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.Note
Open access journal.ISSN
1932-6203PubMed ID
30001362DOI
10.1371/journal.pone.020046210.1371/journal.pone.0200462.g001
10.1371/journal.pone.0200462.g002
10.1371/journal.pone.0200462.g003
10.1371/journal.pone.0200462.t001
10.1371/journal.pone.0200462.t002
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Final published versionSponsors
National Cancer Institute [U01 CA153060, P30 CA023074]; Cancer Biology Training Grant [T32 CA009213]Additional Links
https://dx.plos.org/10.1371/journal.pone.0200462http://dx.plos.org/10.1371/journal.pone.0200462.g001
http://dx.plos.org/10.1371/journal.pone.0200462.g002
http://dx.plos.org/10.1371/journal.pone.0200462.g003
http://dx.plos.org/10.1371/journal.pone.0200462.t001
http://dx.plos.org/10.1371/journal.pone.0200462.t002
ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0200462
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Except where otherwise noted, this item's license is described as © 2018 Augustus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.
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