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dc.contributor.authorAugustus, Gaius Julian
dc.contributor.authorRoe, Denise J.
dc.contributor.authorJacobs, Elizabeth T.
dc.contributor.authorLance, Peter
dc.contributor.authorEllis, Nathan A.
dc.date.accessioned2018-11-26T22:52:25Z
dc.date.available2018-11-26T22:52:25Z
dc.date.issued2018-07-12
dc.identifier.citationAugustus 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.0200462en_US
dc.identifier.issn1932-6203
dc.identifier.pmid30001362
dc.identifier.doi10.1371/journal.pone.0200462
dc.identifier.doi10.1371/journal.pone.0200462.g001
dc.identifier.doi10.1371/journal.pone.0200462.g002
dc.identifier.doi10.1371/journal.pone.0200462.g003
dc.identifier.doi10.1371/journal.pone.0200462.t001
dc.identifier.doi10.1371/journal.pone.0200462.t002
dc.identifier.urihttp://hdl.handle.net/10150/631058
dc.description.abstractBackground 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.en_US
dc.description.sponsorshipNational Cancer Institute [U01 CA153060, P30 CA023074]; Cancer Biology Training Grant [T32 CA009213]en_US
dc.language.isoenen_US
dc.publisherPUBLIC LIBRARY SCIENCEen_US
dc.relation.urlhttps://dx.plos.org/10.1371/journal.pone.0200462en_US
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0200462.g001en_US
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0200462.g002en_US
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0200462.g003en_US
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0200462.t001en_US
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0200462.t002en_US
dc.rights© 2018 Augustus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.en_US
dc.titleIs increased colorectal screening effective in preventing distant disease?en_US
dc.typeArticleen_US
dc.contributor.departmentUniv Arizona, Canc Ctren_US
dc.identifier.journalPLOS ONEen_US
dc.description.noteOpen access journal.en_US
dc.description.collectioninformationThis 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.en_US
dc.eprint.versionFinal published versionen_US
dc.source.journaltitlePLOS ONE
dc.source.volume13
dc.source.issue7
dc.source.beginpagee0200462
refterms.dateFOA2018-11-26T22:52:25Z


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