Colorectal Cancer Screening: Theory and Practical Application

Foreword
Preface
Contents
1: Epidemiological Trends and Risk Factors of Colorectal Cancer: Implications for Population-Based Organized Service Screening
	1.1	 Introduction
		1.1.1	 Role of Population-Based Screening in Reducing Disease Burden of Colorectal Cancer
		1.1.2	 Decomposition of Epidemiologic Indicators for the Disease Burden of Colorectal Cancer
	1.2	 Socioeconomic Status and CRC
	1.3	 Colorectal Cancer in Asian Countries
	1.4	 Risk Factors for CRC
	1.5	 Family History of Colorectal Cancer
	1.6	 Lifestyle and Exposures
		1.6.1	 Cigarette Smoking
		1.6.2	 Obesity
		1.6.3	 Physical Activity
	1.7	 Metabolic Syndrome and Components Associated with CRC
	References
2: Population-Based Organized Service Screening for Colorectal Cancer
	2.1	 Evidence-Based for Population-Based CRC Screening
	2.2	 Opportunistic Versus Organized Screening
	2.3	 Existing Screening Programs Worldwide
	2.4	 Periodical Population-Based Organized Service Screening for CRC
	2.5	 Basic Elements in a Population-Based CRC Organized Service Screening
		2.5.1	 National Health Policy
		2.5.2	 Financial Support
		2.5.3	 Health Care Resources
		2.5.4	 Community Resources
		2.5.5	 Supporting System Outside Ordinary Health Care System
		2.5.6	 Information System
		2.5.7	 Evidence-Based Evaluation
	References
3: Options of Colorectal Cancer Screening: An Overview
	3.1	 Introduction
	3.2	 Stool-Based Tests for Screening
		3.2.1	 The Fecal Occult Blood Test
		3.2.2	 The Role of Fecal Hemoglobin Concentration
		3.2.3	 Stool DNA Test
		3.2.4	 Fecal Microbiota as a Potential Biomarker for CRC Screening
	3.3	 Blood-Based Tests for Screening
		3.3.1	 Plasmic Methylated Septin-9
	3.4	 Estimation of CRC Risk Based on Screening Test Results
	3.5	 Direct Visualizing Examinations for CRC Screening
		3.5.1	 Double-Contrast Barium Enema
		3.5.2	 Computed Tomographic Colonography
		3.5.3	 Colon Capsule Endoscopy
		3.5.4	 Flexible Sigmoidoscopy
		3.5.5	 Colonoscopy
	3.6	 Options for CRC Screening in Primary Care Setting
	3.7	 Summary
	References
4: Endoscopy-Based Colorectal Cancer Screening
	4.1	 Introduction
	4.2	 Effectiveness of Lower Endoscopy Screening
		4.2.1	 Colonoscopy
		4.2.2	 Flexible Sigmoidoscopy
	4.3	 Safety of Screening Lower Endoscopy
		4.3.1	 Colonoscopy
		4.3.2	 Flexible Sigmoidoscopy
	4.4	 Current Situation and Future Perspectives on the Global Implementation of Screening Colonoscopy
	4.5	 Methods to Increase Effectiveness of Screening Colonoscopy
		4.5.1	 Add-on Devices
		4.5.2	 Image-Enhanced Endoscopy
		4.5.3	 Bowel Cleansing
	4.6	 Conclusions
	References
5: Noninvasive Screening Test
	5.1	 Introduction
	5.2	 Stool-Based Tests
		5.2.1	 Guaiac FOBT
		5.2.2	 Fecal Immunochemical Test
		5.2.3	 Multi-target Stool DNA Test
		5.2.4	 Other Stool Biomarkers
	5.3	 Blood-Based Tests
	References
6: Health Information System in Population-Based Organized Service Screening for Colorectal Cancer
	6.1	 Integrated Information System for CRC Screening
	6.2	 Infrastructure and Workflow of Building up Information System
		6.2.1	 Pre-screening Phase
		6.2.2	 Screening Phase
		6.2.3	 Post-screening Phase
	6.3	 Fundamental Indicators and Databases for Supporting Implementation and Evaluation of CRC Screening
		6.3.1	 Pre-screening Phase
		6.3.2	 Screening Phase
		6.3.3	 Post-screening Phase
	References
7: Quality Assurance in Colorectal Cancer Screening Program
	7.1	 Overview
	7.2	 Fecal Immunochemical Test-Related Quality Issues
	7.3	 Colonoscopy-Related Quality Issues
		7.3.1	 Timely Referral (In FIT Program)
		7.3.2	 Bowel Preparation
		7.3.3	 Cecal Intubation Rate or Complete Colonoscopy Rate
		7.3.4	 Adenoma Detection Rate
		7.3.5	 Colonoscopy-Related Complications
		7.3.6	 Polyp Resection
		7.3.7	 Other Colonoscopy-Related Quality Issues
	7.4	 Important Infrastructures for Quality Assurance
	References
8: Basic Theory of Screening for Short-Term Evaluation of Population-Based Screening for Colorectal Cancer
	8.1	 Disease Progression and Mean Sojourn Time Observed in Cancer Screening
	8.2	 Mean Sojourn Time in Screening Program
		8.2.1	 The Concept of Prevalence Pool under the Context of Screen Theory
		8.2.2	 Applying the Prevalence Pool Method to the UK Trial on FOBT Screening
	8.3	 Test Sensitivity, Program Sensitivity, and Disease Natural History
	8.4	 Sensitivity and Specificity in Screening Program
		8.4.1	 Estimate the Sensitivity in the Screening Program
		8.4.2	 Mathematical Formula for Interval Cancer
		8.4.3	 Positive and Negative Predictive Values
	8.5	 Application of Basic Screening Theory to Fecal Immunochemical Test-based Colorectal Cancer Screening in Taiwan
		8.5.1	 Sensitivity of Fecal Immunochemical Test with Varying Cutoff
		8.5.2	 FIT Sensitivity for CRC Screening in KCIS, Taiwan
		8.5.3	 Sensitivity of National Colorectal Cancer Screening Program in Taiwan
	References
9: Evaluating Population-Based Colorectal Cancer Screening Beyond a Randomized Controlled Trial: A Mathematical Modelling Approach
	9.1	 Rationales for Evaluating a Population-Based Colorectal Cancer Screening Program beyond Randomized Controlled Trials
	9.2	 Design, Data, and Conventional Analysis for Evaluation
		9.2.1	 Quasi-experimental Study Design
			9.2.1.1	 Data Sources for Evaluation
			9.2.1.2	 Computer-aided System of Evaluation of a Screening Program
	9.3	 A Modelling Approach to Evaluating Colorectal Cancer Screening
		9.3.1	 Multistate Process of CRC with the Homogeneous Markov Model
		9.3.2	 The Nonhomogeneous Stochastic Processes
		9.3.3	 Heterogeneity Between Individuals
	9.4	 Several Applications to Subsidiary Issues of Population-Based Screening for CRC
		9.4.1	 Case-cohort Design with Multistate Disease Process
		9.4.2	 Efficacy of Reducing Malignant Transformation
		9.4.3	 Efficacy of population-based Screening by Various Screening Regimes
		9.4.4	 Decision Analysis of Population-based Screening for CRC
		9.4.5	 Health Economic Decision Model
		9.4.6	 Evaluation of Multiple Screening Modalities
	References
10: Cost-Effectiveness Analysis of Colorectal Cancer Screening
	10.1	 Economic Evaluation of Population-Based Cancer Screening
		10.1.1	 Factors Affecting the Effectiveness of Colorectal Cancer Screening
		10.1.2	 Cost Considerations in Population-Based Organized Service Screening
		10.1.3	 Framework of the Economic Evaluation of Population-Based CRC Screening
		10.1.4	 Formal Economic Analysis
	10.2	 Current Evidence on Cost-Effectiveness Analysis of Colorectal Cancer Screening
	10.3	 A Case Study of a Cost-Effectiveness Analysis of Colorectal Cancer Screening with Fecal Immunochemical Test (FIT) in Taiwan
	10.4	 Empirical Community-Based Screening Data
		10.4.1	 Screened Population
		10.4.2	 Screening Protocol and Referrals
		10.4.3	 Cost-Effectiveness Analysis with the Markov Decision Model
			10.4.3.1	 The Disease Natural History of CRC
			10.4.3.2	 Analytical Markov Decision Model
			10.4.3.3	 Computer Simulation
			10.4.3.4	 Key Assumptions
	10.5	 Results
		10.5.1	 FIT Screening by Inter-Screening Interval
	10.6	 Discussion
	Supplementary Table 10.1 Literatures of Cost-Effectiveness Analysis for Colorectal Cancer
	References
11: Future of Colorectal Cancer Screening: Screening in the Big Data Era and Personalized Screening Strategy
	11.1	 Introduction
		11.1.1	 Personalized Screening Strategy for Colorectal Cancer
		11.1.2	 State-Specific Multistate Natural History of Colorectal Neoplasm
	11.2	 Materials and Methods
		11.2.1	 Study Procedure
		11.2.2	 Cost-Effectiveness Analysis of Universal and Personalized Colorectal Cancer Screening with FIT
	11.3	 Results
		11.3.1	 The Multistate And Multifactorial Model
		11.3.2	 Risk Classification
		11.3.3	 Mean Sojourn Time for Large Adenoma
		11.3.4	 Association Between f-Hb Level and Risk Percentile
		11.3.5	 Effectiveness of Personalized CRC Screening
		11.3.6	 Cost-Effectiveness Analysis of Universal and Personalized Screening with FIT
	11.4	 Discussion
	References