Cost-effectiveness of Novel Noninvasive Screening Tests for Colorectal Neoplasia.

Background & Aims: This study assessed the economic and health impact of colorectal cancer (CRC) screening programs for average-risk individuals aged 45 years and older.

Methods: A 10-year Markov model simulated disease progression, comparing multitarget stool RNA test (mt-sRNA, ColoSense), two mt-sDNA tests (Cologuard and Cologuard Plus), a blood-based test (cfDNA, Shield), and a fecal immunochemical test (FIT). Clinical inputs leveraged age-weighted sensitivity and specificity from independent studies.

Clinical Validation of a Circulating Tumor DNA-Based Blood Test to Screen for Colorectal Cancer.

Importance: Colorectal cancer screening is widely recommended but underused. Blood-based screening offers the potential for higher adherence compared with endoscopy or stool-based testing but must first be clinically validated in a screening population.

Objective: To evaluate the clinical performance of an investigational blood-based circulating tumor DNA test for colorectal cancer detection in an average-risk population using colonoscopy with histopathology as the reference method.

Discrepancy in Metabolic Dysfunction-Associated Steatotic Liver Disease Prevalence in a Large Northern California Cohort.

Background And Aims: The estimated prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in US adults is 31.3%. However, little is known about MASLD diagnosis rates in clinical practice.

Oakland score to identify low-risk patients with lower gastrointestinal bleeding performs well among emergency department patients.

Background: The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit (Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding, including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission with further LGIB within 28 days.

Rebound in Fecal Testing, Colonoscopy Utilization, and Colorectal Neoplasia Detection During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic reduced colorectal cancer (CRC) screening, but the rebound in testing and outcomes after the pandemic has not been widely reported. We evaluated CRC test utilization and colorectal neoplasia detection among screening eligible patients in a large health system in 2020 and 2021, compared with 2019 (prepandemic).

Methods: Using a retrospective cohort study design, fecal immunochemical test (FIT) and colonoscopy utilization, FIT positivity, and neoplasia detection were evaluated annually in 2019-2021 among Kaiser Permanente Northern California patients aged 50-75 years overall and by sex, age, race and ethnicity, and spoken language preference.

Colorectal Cancer Screening and Social Needs.

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. While patient-reported barriers have been previously described, few studies have analyzed how patients' social needs affect screening rates.

Methods: This cross-sectional study includes 3,443 Kaiser Permanente (KP) patients ages 50 to 75 years who completed the 2020 KP National Social Needs Survey.

Incidence of Serious Complications following Screening Colonoscopy in Adults Ages 76 to 85 Years.

Background: Screening colonoscopy harm data are limited for adults ages 76 to 85 years.

Methods: We conducted a retrospective cohort study of screening colonoscopies versus fecal immunochemical tests (FIT) and general population matched comparators ages 76 to 85 years within three integrated healthcare systems (2010-2019). The primary outcome was death or overnight hospitalization within 30 days.

Colorectal Cancer Screening Completion and Yield in Patients Aged 45 to 50 Years : An Observational Study.

Background: Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years.

Objective: To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years.

Design: Retrospective cohort study.

Development and External Validation of a Prediction Model for Colorectal Cancer Among Patients Awaiting Surveillance Colonoscopy Following Polypectomy.

Background And Aims: Demand for surveillance colonoscopy can sometimes exceed capacity, such as during and following the coronavirus disease 2019 pandemic, yet no tools exist to prioritize the patients most likely to be diagnosed with colorectal cancer (CRC) among those awaiting surveillance colonoscopy. We developed a multivariable prediction model for CRC at surveillance comparing performance to a model that assigned patients as low or high risk based solely on polyp characteristics (guideline-based model).

Methods: Logistic regression was used for model development among patients receiving surveillance colonoscopy in 2014-2019.

Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death.

Importance: The fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening, but evidence of its effectiveness is limited.

Objective: To evaluate whether FIT screening is associated with a lower risk of dying from CRC overall, according to cancer location, and within demographic groups.

Design, Setting, And Participants: This nested case-control study in a cohort of screening-eligible people was conducted in 2 large, integrated health systems of racially, ethnically, and socioeconomically diverse members with long-term programs of mailed FIT screening outreach.

Hepatocellular Carcinoma in Metabolic Dysfunction-Associated Steatotic Liver Disease.

Importance: In the US, hepatocellular carcinoma (HCC) has been the most rapidly increasing cancer since 1980, and metabolic dysfunction-associated steatotic liver disease (MASLD) is expected to soon become the leading cause of HCC.

Objective: To develop a prediction model for HCC incidence in a cohort of patients with MASLD.

Design, Setting, And Participants: This prognostic study was conducted among patients aged at least 18 years with MASLD, identified using diagnosis of MASLD using International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes; natural language processing of radiology imaging report text, which identified patients who had imaging evidence of MASLD but had not been formally diagnosed; or the Dallas Steatosis Index, a risk equation that identifies individuals likely to have MASLD with good precision.

Patterns of Care Following a Positive Fecal Blood Test for Colorectal Cancer: A Mixed Methods Study.

Background/objective: Multilevel barriers to colonoscopy after a positive fecal blood test for colorectal cancer (CRC) are well-documented. A less-explored barrier to appropriate follow-up is repeat fecal testing after a positive test. We investigated this phenomenon using mixed methods.

Colorectal Cancer Screening After Sequential Outreach Components in a Demographically Diverse Cohort.

Importance: Organized screening outreach can reduce differences in colorectal cancer (CRC) incidence and mortality between demographic subgroups. Outcomes associated with additional outreach, beyond universal outreach, are not well known.

Objective: To compare CRC screening completion by race and ethnicity, age, and sex after universal automated outreach and additional personalized outreach.

Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas.

Importance: Postpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population.

Objective: To estimate surveillance colonoscopy yields in older adults.

Design, Setting, And Participants: This population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance.

Predicting Risk of Colorectal Cancer After Adenoma Removal in a Large Community-Based Setting.

Introduction: Colonoscopy surveillance guidelines categorize individuals as high or low risk for future colorectal cancer (CRC) based primarily on their prior polyp characteristics, but this approach is imprecise, and consideration of other risk factors may improve postpolypectomy risk stratification.

Methods: Among patients who underwent a baseline colonoscopy with removal of a conventional adenoma in 2004-2016, we compared the performance for postpolypectomy CRC risk prediction (through 2020) of a comprehensive model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and prior polyp findings (i.e.

Randomized Trial of Patient Outreach Approaches to De-implement Outdated Colonoscopy Surveillance Intervals.

Background And Aims: Guidelines now recommend patients with low-risk adenomas receive colonoscopy surveillance in 7-10 years and those with the previously recommended 5-year interval be re-evaluated. We tested 3 outreach approaches for transitioning patients to the 10-year interval recommendation.

Methods: This was a 3-arm pragmatic randomized trial comparing telephone, secure messaging, and mailed letter outreach.

Unsatisfactory Fecal Immunochemical Tests for Colorectal Cancer Screening: Prevalence, Reasons, and Subsequent Testing.

Background: Fecal immunochemical test (FIT) is an effective colorectal cancer screening modality. Little is known about prevalence, reasons, and testing after unsatisfactory FIT, or a FIT that cannot be processed by the laboratory due to inadequate stool specimen or incomplete labeling.

Methods: Our retrospective cohort study examined unsatisfactory FIT among average-risk individuals aged 50-74 years in a large, integrated, safety-net health system who completed an index FIT from 2010 to 2019.