Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death.
Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death.
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结直肠癌筛查过程中可改变的失败及其与死亡风险的关联。
DOI：
10.1053/j.gastro.2018.09.040
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发表时间：
2019-01
期刊：
影响因子：
29.4
通讯作者：
Corley DA
中科院分区：
文献类型：
--
作者：
Doubeni CA;Fedewa SA;Levin TR;Jensen CD;Saia C;Zebrowski AM;Quinn VP;Rendle KA;Zauber AG;Becerra-Culqui TA;Mehta SJ;Fletcher RH;Schottinger J;Corley DA
结直肠癌（CRC）死亡发生在患者没有接受筛查或对异常结果随访不足，或筛查试验本身失败时。我们几乎没有关于每种因素对CRC相关死亡或与这些事件相关的因素的贡献的数据。我们对Kaiser Permanente北方和南加州系统（55-90岁）2006年至2012年死于CRC且诊断前入组时间≥5年的患者进行了一项回顾性队列研究。我们在同一系统中比较了来自患者与匹配的无癌症患者队列的数据。从电子数据库和图表审核中获得诊断前10年内CRC检查的接收、结果、适应症和随访。在1750例CRC死亡中，75.9%（n=1328）发生在筛选时未更新的患者中，24.1%（n=422）发生在筛选时更新的患者中。筛查失败与初级保健医生的就诊次数减少有关。在3486名无癌症患者中，44.6%的患者在筛查中保持最新状态。在筛选中及时更新的患者CRC死亡风险降低（比值比[OR]，0.38; 95%CI，0.33-0.44）。67.8%死于结直肠癌的患者未能进行筛查或未能在适当的时间间隔内进行筛查，而53.2%的无癌患者未进行筛查; 8.1%死于结直肠癌的患者未能对异常结果进行随访，而2.2%的无癌患者未进行随访。CRC死亡与未能筛查或未能在适当的时间间隔内筛查（OR，2.40; 95%CI，2.07-2.77）和未能对异常结果进行随访（OR，7.26; 95%CI，5.26-10.03）的几率较高相关。及时进行筛查可大大降低CRC死亡的风险。在2个筛查率高的医疗保健系统中，大多数死于CRC的人在筛查过程中失败，可以纠正，例如未能随访异常结果;这些显著增加了CRC死亡的风险。
Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow up of abnormal results, or when the screening test itself fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these events. We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55–90 years old) who died from CRC from 2006 through 2012 and had ≥5 years of enrollment prior to diagnosis. We compared data from patients with a matched cohort of cancer-free patients in the same system. Receipt, results, indications, and follow up of CRC tests in the 10-year period prior to diagnosis were obtained from electronic databases and chart audits. Among 1750 CRC deaths, 75.9% (n=1328) occurred in patients who were not up to date in screening and 24.1% (n=422) occurred in patients who were up to date. Failure to screen was associated with fewer visits to primary care physicians. Among 3486 cancer-free patients, 44.6% were up to date on their screening. Patients who were up to date in their screening had reduced risk of CRC death (odds ratio [OR], 0.38; 95% CI, 0.33–0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died from CRC vs 53.2% of cancer-free patients; failure to follow up on abnormal results occurred in 8.1% of patients who died from CRC vs 2.2% of cancer-free patients. CRC death was associated with higher odds of failure to screen or failure to screen at appropriate intervals (OR, 2.40; 95% CI, 2.07–2.77) and failure to follow up on abnormal results (OR, 7.26; 95% CI, 5.26–10.03). Being up to date on screening substantially reduces risk of CRC death. In 2 healthcare systems with high rates of screening, most people who died from CRC had failures in the screening process that could be rectified, such as failure to follow up on abnormal findings; these significantly increased risk for CRC death.
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影响因子：
24.5
作者：
Doubeni CA;Corley DA;Quinn VP;Jensen CD;Zauber AG;Goodman M;Johnson JR;Mehta SJ;Becerra TA;Zhao WK;Schottinger J;Doria-Rose VP;Levin TR;Weiss NS;Fletcher RH
通讯作者：
Fletcher RH
DOI：
10.1158/1055-9965.epi-15-0470
发表时间：
2016-02
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Chubak J;Garcia MP;Burnett-Hartman AN;Zheng Y;Corley DA;Halm EA;Singal AG;Klabunde CN;Doubeni CA;Kamineni A;Levin TR;Schottinger JE;Green BB;Quinn VP;Rutter CM;PROSPR consortium
通讯作者：
PROSPR consortium
DOI：
10.3122/jabfm.2016.06.160060
发表时间：
2016-11-12
期刊：
Journal of the American Board of Family Medicine : JABFM
影响因子：
--
作者：
Doubeni CA;Jensen CD;Fedewa SA;Quinn VP;Zauber AG;Schottinger JE;Corley DA;Levin TR
通讯作者：
Levin TR
DOI：
10.3322/caac.21452
发表时间：
2018-05
期刊：
CA: a cancer journal for clinicians
影响因子：
--
作者：
Doubeni CA;Gabler NB;Wheeler CM;McCarthy AM;Castle PE;Halm EA;Schnall MD;Skinner CS;Tosteson ANA;Weaver DL;Vachani A;Mehta SJ;Rendle KA;Fedewa SA;Corley DA;Armstrong K
通讯作者：
Armstrong K
影响因子：
120.7
作者：
Corley, Douglas A.;Jensen, Christopher D.;Levin, Theodore R.
通讯作者：
Levin, Theodore R.