Targeted colorectal cancer screening in type 2 diabetes patients and high cardiovascular risk patients – first interim results of a multicenter prospective study
Štěpán Suchánek Orcid.org 1, Ondřej Májek Orcid.org 2, Ondřej Ngo3,4, Petra Mináriková Orcid.org 5, Nagyija Brogyuk1, Bohumil Seifert Orcid.org 6, Ladislav Dušek Orcid.org 3,2, Miroslav Zavoral Orcid.org 1, Tomáš Grega Orcid.org 7
+ Affiliation
Summary
The National Colorectal Cancer (CRC) Screening Program has been running in the Czech Republic (CR) since 2000 and is focused on asymptomatic individuals with an average risk of this malignancy. However, according to some studies, there is evi-dence of a higher CRC risk in patients with metabolic diseases. Therefore, the Czech multicenter prospective study was launched in 2013 to verify this hypothesis. This text presents the first interim results, focusing on a sub-study on bowel preparation. The main aim of the study is to verify the assumption that people with increased cardiovascular risk with SCORE > 10% (ischemic heart disease – IHD) and diabetes mellitus type 2 (DM2) in the Czech population bear a higher risk of colorectal neoplasia (cancer; advanced adenoma – size ≥ 10 mm, high grade dysplasia, villous character). The secondary aim is to compare the effectiveness of different types of bowel preparation before colonoscopy. Initially, a pilot project evaluating the efficacy of sulfate salt solution (product Eziclen) was performed. Material and methods: The study will be running from 2013 to 2015. The project will involve 2,000 individuals (1,000 in the control group and 1,000 in the target group). All patients (aged 45–75 years) meet the condition of the "screening" population (asymptomatic, without family or personal history of colorectal neoplasia) and are examined by colonoscopy at eight centers for colonoscopy screening. The primary outcome is the prevalence of colorectal neoplasia in the target and the control group. In the bowel preparation pilot project, the effectiveness of bowel cleansing (4-point scale A–D) and its safety (changes in clinical biochemical values) was assessed. Results: 640 individuals have been enrolled in the main study so far. In 44% of them (281 individuals; 167 men – 59%; 114 women – 41%; mean age 59 years) the complete data have been already recorded. The observed prevalence of adenomas was higher in the target group than in the control group (41 vs 29%, p = 0,034), both for men (45 vs 37%) and women (33 vs 21%); however, comparisons stratified by sex did not reach statistical significance. In the case of advanced adenomas and carcinomas the differences were not statistically significant. In the target group, more adenomas and advanced adenomas were diagnosed in patients with a combination of IHD and DM2 (55, i.e. 13%), than in patients with isolated ischemic heart disease (40, i.e. 12%) or DM2 (32, i.e. 5%). In the bowel preparation pilot project, 100 individuals were enrolled. Excellent (grade A) or adequate (grade A + B) bowel preparation was reached in 65% and 90% of the individuals, respectively. The level of bowel cleansing was significantly increased by using split dose regime. High detection of adenomas (57%) was recorded. No significant clinical changes in blood mineral levels before and after colonoscopy were observed. Conclusion: According to the interim study results, patients with a higher metabolic risk (cardiovascular; diabetes mellitus type 2) have a statistically significantly higher risk of adenomatous polyps; however, the study results are inconclusive and final conclusions will only be available after enrolling the total planned number of patients. The new bowel preparation method using sulfate salts solution is safe and effective, particularly when the split dose regime is used.
Keywords
adenoma, type 2 diabetes mellitus, coronary heart disease, colorectal cancer, metabolic risk, screening, bowel preparation, sulfate salts solutionTo read this article in full, please register for free on this website.
Benefits for subscribers
Benefits for logged users
Literature
1. Dušek L, Mužík J, Pavlík T et al. Epidemiologie zhoubných nádorů trávicího traktu v České republice – současný stav a predikce. Gastroent Hepatol 2012; 66(5): 331–339.
2. Zavoral M, Suchanek S, Majek O et al.Colorectal cancer screening: 20 years of development and recent progress. World J Gastroenterol 2014; 20(14): 3825–3834. doi: 10.3748/wjg.v20.i14.3825.
3. Suchanek S, Majek O, Vojtechova G et al. Colorectal cancer prevention in the Czech Republic: time trends in performance indicators and current situation after 10 years of screening. Eur J Cancer Prev 2014; 23(1): 18–26. doi: 10.1097/ CEJ.0b013e328364f203.
4. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst 2005; 97(22): 1679–1687.
5. Hu FB, Manson JE, Liu S et al. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst 1999; 91(6): 542–547.
6. Will JC, Galuska DA, Vinicor F et al. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol 1998; 147(9): 816–825.
7. Yang SY, Kim YS, Chung SJ et al. Association between colorectal adenoma and coronary atherosclerosis detected by CT coronary angiography in Korean men; a cross-sectional study. J Gastroenterol Hepatol 2010; 25(11): 1795–1799. doi: 10.1111/j.1440-1746.2010.06330.x.
8. Valori R, Rey JF, Atkin WS et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – quality assurance in endoscopy in colorectal cancer screening and diagnosis. Endoscopy 2012; 44 (Suppl 3): SE88–SE105.
9. Hassan C, Bretthauer M, Kaminski MF et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45(2): 142–150. doi: 10.1055/s-0032-1326186.
10. Di Palma JA, Rodriguez R, McGowan J et al. A randomized clinical study evaluating the safety and efficacy of a new, reduced- volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol 2009; 104(9): 2275–2284. doi: 10.1038/ajg.2009.389.
11. Rex DK, Di Palma JA, Rodriguez R et al. A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free elektrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc 2010; 72(2): 328–336. doi: 10.1016/j.gie.2010.03.1054.
12. Rex DK, DiPalma JA, McGowan J et al. A comparison of oral sulfate solution with sodium picosulfate: magnesium citrate in split doses as bowel preparation for colonoscopy. Gastrointest Endosc 2014. doi: 10.1016/j.gie.2014.05.329.