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Background: During the pandemic there has been an impact on the number of patients entering the cancer pathway, because of changes in patients presenting and GP referral behaviours. The aim was to understand whether different groups in our society have been disproportionately affected by the pandemic in terms of the care they have received for their cancer. Method(s): The study looked specifically at elective admissions from the Hospital Episode Statistics data for all cancers combined and separately for breast, bowel, lung, and prostate cancers to investigate the number of patients admitted for cancer surgery over time. The ONS Mortality Dataset was used to investigate the place of death for patients who had died from cancer. Mortality rates were calculated to identify whether there was a rise in in-hospital mortality during the pandemic. Deaths were defined as an in-hospital death for a patient admitted with a primary diagnosis of cancer. Age-standardised mortality rates were created across the last five years, broken down by cancer type, sex and deprivation quintile. Result(s): The analysis shows a decrease in patients undergoing surgery at the start of the pandemic for all demographic groups. At the start of the pandemic, the largest decreases for all cancers combined by ethnicity could be seen in White (42.6%) and Asian or Asian British (44.6%). While by age, the largest decrease was seen in women aged 40-49. For lung cancer surgery, there were differences by deprivation quintile during the recovery period, showing a 42.0% increase in the least deprived compared to a 27.6% increase in the most deprived. However, changes at the beginning of the pandemic were similar across all quintiles. Age standardised mortality rates showed an increase in in-hospital deaths following the start of the pandemic. Conclusion(s): While we know that there are inequalities in access to cancer surgery, particularly by age, for the most part, the results of our analysis indicate that the recovery period of the COVID-19 pandemic has not exacerbated these inequalities. However, it is difficult to understand the extent to which any variation in access to cancer services is unwarranted.Copyright © 2023
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Background. Small intestine cancer is extremely rare cancer worldwide with an incidence of less than 1.0 per 100,000 population. In 2020, 1,711 cases of small intestine cancer were recorded in Russia, including 781 cases among the male population, and 930 among the female population. It should be noted that in Russia, despite the decrease in the total number of new cancer cases associated with the coronavirus epidemic, the number of patients with small intestine cancer increased by 4.14 % from 2019 to 2020. In the Northwestern Federal District of the Russian Federation, 216 patients with newly diagnosed small intestine cancer were registered in 2020, (29 more patients than in the previous year). The purpose of the study was to analyze the efficiency of small intestine cancer care provision based on of the database of the Population Cancer Registry (DB PCR) of the Northwestern Federal District of the Russian Federation, with an assessment of one-and five-year survival rates. Material and Methods. To calculate the survival rates for patients with small intestine cancer, we selected 1922 patients from the database of the PCR of the Northwestern Federal District of the Russian Federation, for the period from 2000 to 2018. Standard methods for calculating survival rates according to the Eurocare program were used. Results. The one-year survival rate of small intestine cancer patients increased from 50.0 % to 61.1 % from 2000 to 2018, and the five-year survival rate remained almost unchanged. The relative one-year survival rate of patients was 2.0 % higher. The five-year survival rate for five-year cohorts indicates defects in staging of small intestine cancer rather than an improvement in patient care;although this rate increased from 31.5 to 32.9 %. The histological detail of small intestine cancer according to the ICD-10 was investigated. Conclusion. The study confirmed the high mortality rates and modest survival benefits in survival rates in patients with small intestine cancer. Defects in the distribution of patients by disease stages were revealed. The most common histological types of small intestine cancer with calculations of patient survival were identified. Copyright © 2022, Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved.
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Background: Lynch syndrome (LS) is an inherited disorder characterized by pathogenic variants within mismatch repair genes resulting in an increased risk of colorectal cancer (CRC). In England, the fecal immunochemical test for Haemoglobin (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. Herein, we report results from a national emergency clinical service implemented during the COVID-19 pandemic which used FIT to prioritize colonoscopy in LS patients while endoscopy services were limited. Methods: Regional genetic and endoscopy services across England were invited to participate. Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 March 2021. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub's Research Laboratory in Surrey. The Hub sent patients a FIT kit (OC-Sensor? (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Lab reports with feecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥10mg of Haemoglobin (Hb)/g (mg/g) faeces: triaged for colonoscopy via an urgent two-week wait (2WW) pathway, (2) f-Hb ≤10mg/g: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits. Results: Fifteen centers across England participated in the clinical service from 9th June 2020 to 31st March 2021. An uptake rate of 64% was observed from this cohort (375/588 invites), though 21 cases were removed from analysis due to repeat FITs, insufficient sample, missing clinical data, or FIT completed after colonoscopy. Of the remaining 354 patients analyzed, 269 patients (76%) had a f-Hb of <6mg/g. 6% (n=23) of patients had a f-Hb that was at or between greater than the limit of detection of the assay (≥6mg/g) yet below 10mg/g.18% (n=62) had FIT results of ≥10mg/g and met criteria for urgent colonoscopy triage via the 2WW pathway. Of the 62 urgently triaged patients, 22 had detectable adenomas, 6 had advanced adenomas (AAs), and 4 were diagnosed with CRC (table). Conclusions: The utility of FIT during the pandemic has demonstrated clinical value for LS patients requiring CRC surveillance. Further longitudinal investigation on the efficacy of FIT in people with LS is warranted and will be examined as part of the multi-center prospective research study “FIT for Lynch Syndrome” (ISRCTN15740250) which is presently recruiting patients in the UK.
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Introduction Waiting lists in Northern Ireland are the worst in the UK, representing a growing problem and one exacerbated by the Covid-19 pandemic. Those currently awaiting diagnostic services in NI total 147,543 including 31,313 endoscopy investigations (60% of which are waiting >26 weeks). By applying recent BSG/ACPGBI/PHE Guidelines for post-polypectomy surveillance, this study aimed to reduce the numbers of those awaiting planned colonoscopy within our Trust. The Guidelines suggest patients with polyps and high-risk findings should receive a one-off surveillance colonoscopy at 3 years, compared to previous 1-year interval advice. Patients who previously required follow up endoscopy at 5 years may be safely discharged with invitation to screening if no high risk features. Methods Validation of the waiting list was undertaken by consultants and nurse endoscopists with reference made to the current Guidelines. Patient records were reviewed using the Unisoft GI Reporting Tool v14.40.10 and the NI Electronic Care Record. Those relevant to polyp surveillance were identified (n=2001). Each request was categorised to either 'Remove', 'Proceed' or 'Defer'. Outcomes were recorded in an Excel spreadsheet. Patients were informed by letter of any change to their management plan, reasons for removal from the waiting list and given advice on seeking new referral if further symptoms developed. Participation in the Bowel Cancer Screening Programme (BCSP) was encouraged. The NHS England 2021-22 National Tariff for colonoscopy with biopsy (£548) was referenced in calculation of potential cost savings. Results A total of 5403 requests were on the endoscopy waiting list. 84 patients were deceased and were removed from the list. 1964 related to polyp surveillance and 37 to polyp site check. Following validation of 2001 tests, 1286 (64%) were categorised as 'Remove', 588 (29%) 'Proceed' and 127 (6%) 'Defer'. Reasons for removal included no high-risk features, age over 75 or life expectancy less than 10 years. Potential cost savings following removal of 1286 requests totalled £704,728.00. Conclusion Validation of the waiting list, considering updated or incorrect adherence to the current surveillance guidelines, achieved almost two thirds reduction. If applied nationally, this may greatly reduce the burden of outstanding endoscopy procedures and improve access to these services. Current guidelines state that patients >10 years younger than the BCSP who have polyps without high-risk features should be considered for colonoscopy at 5 or 10 years. In Northern Ireland, the BCSP lower age limit is 60 years. If this were reduced in line with England's 50 years, this may further reduce some surveillance burden allowing suitable patients to be invited to the Screening pathway rather than repeat endoscopy.
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Introduction Uptake rates and pathology detection has increased significantly with integration of faecal immunochemical testing (FIT) in the English Bowel Cancer Screening Programme (BCSP). However a proportion of patients do not uptake diagnostic tests after positive FIT tests. We compared pre and peri-COVID cohorts to identify current barriers to uptake of diagnostic tests within a single, large BCSP centre. Methods Two patient cohorts were analysed from the Wolverhampton BCSP Centre (September 2019-February 2020 (Group A, pre-Covid) and April-July 2021 (Group B, peri- Covid)). Patients with a positive FIT were assessed by either a face-to-face (F2F) consultation (Group A) or a telephone consultation (TC) (Group B) by a specialist screening practitioner (SSP) and offered information and diagnostic tests. Total overall numbers were recorded and cases not proceeding with diagnostic tests reviewed. Statistical analysis utilised Fisher's exact test where appropriate. Results In group A, 26293/42545 (61.8%) patients returned a FIT test compared with, 30214/45538 (66.3%) in group B (p<0.00001) with similar positivity rates (2.1% (A) vs. 2.2% (B), p=NS). The peri-COVID era shows an increase in patients not proceeding with diagnostic tests after positive FIT tests (Group A 90/633 (14.2%) Vs. Group B 144/655 (22%), p=0.0003). Table 1 expands the reasons for this. Conclusion FIT sample return rates have increased in the peri- COVID era but proportions of patients not proceeding with diagnostic investigations following positive FIT testing have risen. Patient choice is a notable barrier to uptake and other barriers which have significantly increased during this current period are patients being assessed as clinically unsuitable due to health reasons, declining initial telephone appointments and DNA tests. Whilst informed patient choice is key in national screening programmes, cancer and polyp detection in FIT positive patients in BCSP are notable. Understanding patient's perspectives on tests, preferences over TC or F2F and SSP education on health assessment for colonoscopy may improve uptake of diagnostic tests within the BCSP.
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Angiotensin converting enzyme II (ACE2) is the cellular receptor of SARS-CoV-2. At present, ACE2 receptor is considered to be the key component in the SARS-CoV-2 infection and transmitting in the host. Among the cancer patients with COVID-19, the gastrointestinal cancer is the second most prevalent. The MethyLight and QASM assays were used to evaluated the genomic DNA 5mC methylation, while the CviAII enzyme-based 6mA-RE-qPCR was applied to determine motif-specific DNA 6mA methylation. The 6mA and 5mC methylation analyses of the long interspersed nuclear elements 1 (LINE1) were used to evaluate the global level of genomic 6mA and 5mC methylations, respectively. To investigate the role of ACE2 DNA methylation in regulating ACE2 expression, we performed a genome-wide methylation analysis in colorectal cancer samples collected at the Sixth Affiliated Hospital of Sun Yat-sen University. The DNA 5mC methylation of ACE2 promoter in tumor tissues were significantly lower than that in normal tissues, while the DNA 6mA methylation of ACE2 promoter in tumor tissues was significantly higher than that in normal tissues. In addition, the mRNA and protein expression of ACE2 in tumor tissues were lower than that in normal tissues. To explore the epigenetic regulation on ACE2 expression, we treated colon cancer cell lines with 5-Azacytidine and found ACE2 expression was upregulated after lowering the DNA 5mC methylation. The correlation analysis in patient cohort samples showed that ACE2 mRNA expression was positively correlated with DNA 5mC and negatively associated with DNA 6mA methylation. Next, a novel CRISPR-based tool was developed for sequence-specific 6mA editing on ACE2 promoter region, and it was applied in HCT116 cell to further confirm the regulatory role of DNA 6mA methylation in ACE2 mRNA expression. This tool was proved to be reliable with our findings that the CRISPR/dCas9-METTL3 tool could dramatically upregulate DNA 6mA methylation in ACE2 promoter, while the global level of genomic 6mA methylation remained unchanged. Both the mRNA and protein expression of ACE2 were significantly increased following a sequence-specific DNA 6mA editing in ACE2 promoter. In conclusion, we revealed the aberrant DNA 5mC and 6mA methylations in colorectal cancer, which upregulate ACE2 expression in colorectal cancer cells that may confer the susceptibility to SARS-CoV-2 infection. We developed a novel CRISPR-based tool that could realize site-directed 6mA methylation editing. Notably, the epigenetic regulation of DNA 6mA methylation on ACE2 expression provides an insight into the intersection of the biology of cancer, SARS-CoV-2 infection and organ-specific complication in COVID-19. Aberrant ACE2 methylation may serve as a biomarker and treatment target in these patients.
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Introduction: Approximately, 10-15% of breast cancers may be hereditary. Early identification of elevated genetic risk may decrease morbidly and mortality associated with breast cancer for this population by enabling timely implantation of optimized screening techniques. Reaching out to women with breast cancer risk assessment at the time of mammography may provide an opportunity to connect risk perception with risk reduction action. We hypothesized that women receiving a high-risk assessment at the time of mammography would facilitate entry to genetic counseling. Methods: In September 2019, Jefferson Health New Jersey (JHNJ) started utilizing a tool to screen individuals for an increased risk for hereditary breast cancer syndromes (family history screening 7;FHS-7) to all women presenting for mammography at its three breast imaging centers. The FHS-7 tool was embedded into the electronic medical record system and would generate a score based on 7 questions related to a patient's family history of breast, ovarian and bowel cancer. Women who were identified at elevated risk (FHS-7 scores ≥1) were asked by the mammography technician prior to performing the screening mammogram for their permission to be contacted by a high-risk counselor for a formal high-risk assessment and potential genetic counseling/testing. In March 2020, nearly all cancer screening services shut down with the COVID-19 pandemic. Services re-opened in June 2020. We report on our experience in three-time frames: September 2019-February 2020;March 2020-May 2020, and June 2020-present. Results: From September 2019-February 2020: 3, 169 mammograms and FHS-7 screenings were performed. 44 had scores ≥1 (1.4%). 4 (9%) agreed to be contacted for an appointment with a high-risk counselor. Of these, 2 had previously met with genetics. No additional appointments were scheduled. From March 2020-May 2020, 576 mammograms and FHS-7 screenings were performed. 9 had scores ≥1 (1.6%). None agreed to be contacted for an appointment with a high-risk counselor. Two appointments had previously been completed. From June 2020-June 2021, 9, 131 mammogramsand FHS-7 screenings were performed. 240 had scores ≥1 (2.6%). 22 (9%) agreed to be contacted for an appointment with genetics. 11 appointments had previously been completed. 8 (73%) were completed as a consequence of this direct outreach. Conclusion: Although our work was interrupted by the COVID-19 pandemic, screening for hereditary risk at the time of mammography may be an effective way of facilitating referrals for genetic counseling/testing for high-risk patients. Consent to be contacted for a formal high-risk assessment was consistent at 9% pre-mammography closure and post-mammography re-opening. Consent to be contacted for genetics is likely to be associated with breast cancer risk perception. Future Directions: We are planning an educational intervention regarding the FSH-7 risk assessment tool and a positive score's association with the risk of hereditary breast cancer syndromes, as well as the benefits of optimized screening techniques depending on a patient's life-time risk of developing breast cancer. We anticipate that this will likely result in greater acceptance of a formal high-risk assessment for this at-risk population.
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Introduction: FIT is a quantitative, highly specific test to detect blood in stool for malignant and non-malignant colorectal diagnoses. Incidence of normal colonoscopy following positive FIT is not widely reported. We conducted a retrospective audit to analyse this patient cohort to evaluate diagnostic accuracy and reporting standards of colonoscopy. Method: FIT-positive was defined as>10μgHb/g faeces. Using FIT value, patients were separated into Groups 1, 2 and 3: 10-99, 100-200 and >200μgHb/g faeces respectively. Normal colonoscopy was defined as no neoplastic or benign findings reported. Patients referred in the 2WWpathway after introduction of FIT-testing in October 2019 to the onset of COVID-19 pandemic in March 2020 were included. Data on age, gender, comorbidities and additional investigations were collected. Results: There were 1072 referrals in the study period;405 had FIT done, 265 were FIT-positive and had colonoscopy referral. Four patients were excluded after further investigations showed diverticulosis and gastritis. FIT-stratified normal-colonoscopy rate was 13.3% (28/210) overall, and 14.1% (23/163), 16.7% (2/12) and 8.6% (3/35) for Group 1, 2 and 3 respectively. Conclusions: Our study was limited by the onset of COVID-19 pandemic. In the short study period, 13.3% FIT-positive patients had normal colonoscopy. There are no comparative data in literature for this parameter. Higher FIT-values were associated with lower normal colonoscopy incidence. It is possible that some endoscopists failed to record positive, non-clinically significant findings. We are currently studying larger patient cohorts and in parallel, looking at Bowel Cancer Screening Programme (BCSP) patients.
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Small bowel malignant tumours make only 2% of all gastrointestinal (GI) malignancies. Small bowel leiomyosarcoma (LMS) is further rare, accounts for only 0.1%-3% fraction of these tumours. These cases can present as asymptomatic intra-abdominal mass, anaemia due to GI bleed or acute abdomen such as perforation peritonitis, intussusception and bowel ischaemia. Standard of care is surgical resection. Our case presented as large lobulated exophytic ileal LMS measuring 10.8×11×14.7 cm involving multiple small bowel loops and abutting right iliac vessels and uterus. Patient's clinical course was complicated with COVID-19 positivity, deep vein thrombosis and pulmonary thromboembolism. She was managed by preoperative anticoagulation followed by resection of the tumour with end ileostomy.