Breaking News
January 23, 2019 - Risk for Uninsurance in AMI Patients Reduced With Medicaid Expansion
January 23, 2019 - Readmissions reduction program may be associated with increase in patient-level mortality
January 23, 2019 - Fostering translation and communication in medicine and beyond
January 23, 2019 - To Fight Fatty Liver, Avoid Sugary Foods and Drinks
January 23, 2019 - TPU scientists develop new implants that double the rate of bone lengthening in kids
January 23, 2019 - New sessions at Pittcon 2019
January 23, 2019 - Insilico to present latest findings in AI for Drug Discovery at 3rd Annual SABPA FTD Forum
January 23, 2019 - Opioid overdose patients can be safely discharged an hour after administration of naloxone
January 23, 2019 - Scientists find bacterial extracellular vesicles in human blood
January 23, 2019 - Researchers gain new insights into development of necrotizing enterocolitis in preemies
January 23, 2019 - Medical expert advises people with epilepsy not to stockpile medicines
January 23, 2019 - Bedfont to exhibit NObreath FeNO monitor at Arab Health 2019
January 23, 2019 - Nicotinamide riboside supplementation confers significant physiological benefits to mothers and offspring
January 23, 2019 - Increasing temperatures may help preserve crop nutrition
January 23, 2019 - Many Oncologists in the Dark About LGBTQ Health Needs
January 23, 2019 - Epigenetic change causes fruit fly babies to inherit diet-induced heart disease
January 23, 2019 - Erasing memories could reduce relapse rates among drug addicts
January 23, 2019 - African Americans who smoke cigarettes are more likely to develop peripheral artery disease
January 23, 2019 - Unique data combination helps FinnGen researchers to fund links between genetic factors and health
January 23, 2019 - Parents’ mental health problems associated with reactive attachment disorder in children
January 23, 2019 - Graphene Flagship project studies impact of graphene and related materials on our health
January 23, 2019 - The connection between the Pope and contraceptive pills
January 23, 2019 - Prior dengue infection could protect children from symptomatic Zika
January 23, 2019 - Previous dengue virus infection associated with protection from symptomatic Zika
January 23, 2019 - VISTA checkpoint implicated in pancreatic cancer immunotherapy resistance
January 23, 2019 - The Tiny Camera That Could Revolutionize Cardiovascular Surgery
January 23, 2019 - Peptide isolated from soil fungi has antitumor and antibacterial properties
January 23, 2019 - TGen identifies polio-like virus as potential cause of Acute Flaccid Myelitis outbreak
January 23, 2019 - Migrants and refugees do not bring disease and are at greater health risk themselves says WHO
January 23, 2019 - Examing the effects of menopause in workplace
January 23, 2019 - Enemy number 1 – Air pollution and climate change top of WHO agenda
January 23, 2019 - Two Positive Phase III studies of Tafenoquine for the Radical Cure of Plasmodium vivax Malaria Published in The New England Journal of Medicine
January 23, 2019 - World Trade Center responders at increased risk for head and neck cancers
January 23, 2019 - Low-sugar diet leads to significant improvement in nonalcoholic fatty liver disease in boys
January 23, 2019 - Chaos in bodily regulation can optimize our immune system, finds study
January 23, 2019 - Short, text-based exercises can increase happiness for adults recovering from substance use disorders
January 23, 2019 - Body size may have greater influence on women’s lifespan than men
January 23, 2019 - Groundbreaking tool helps visualize neuronal activity with near-infrared light
January 23, 2019 - Prior dengue immunity in children may be protective against symptomatic Zika
January 23, 2019 - Holocaust survivors with PTSD and their offspring exhibit more unhealthy behavior patterns
January 23, 2019 - Scientists discover new genetic mutations causing inherited deaf-blindness
January 23, 2019 - UC team designs new naloxone-dispensing smart device
January 23, 2019 - Torrent Pharmaceuticals Limited Issues Voluntary Nationwide Recall of Losartan Potassium Tablets, USP and Losartan Potassium and Hydrochlorothiazide Tablets, USP
January 23, 2019 - Brain activity shows development of visual sensitivity in autism
January 23, 2019 - Two hour gap between dinner and sleep is overrated says Japanese research
January 23, 2019 - Fear and embarrassment are causing smear test numbers to plummet
January 23, 2019 - Protein-secreting device implanted in epileptic rats reduces seizures, improves cognition
January 23, 2019 - Reintroduction project recovers current wild population of green turtle in Cayman Islands
January 23, 2019 - Cancer survivors face greater financial burden related to medical bills
January 23, 2019 - PSA screening reduces prostate cancer deaths by 30%
January 23, 2019 - LSTM receives grant to help improve health of people living in informal settlements
January 23, 2019 - Hemochromatosis Mutation Linked to Other Morbidity
January 23, 2019 - Why early diagnosis of autism should lead to early intervention
January 23, 2019 - Aspirin May Lower Stroke Risk in Women with History of Preeclampsia
January 23, 2019 - Exposure to certain chemicals may be linked to decrease in blood pressure during pregnancy
January 23, 2019 - Bowel cancer on the rise among younger Australians
January 23, 2019 - Scientists have reversed memory loss in a mouse model of Alzheimer’s
January 23, 2019 - Defective molecular master switch could lead to age-related macular degeneration
January 23, 2019 - Researchers identify how concussions may contribute to seizures
January 23, 2019 - Short interval between last meal of the day and bedtime may not affect blood glucose levels
January 23, 2019 - Still Too Many Highway Deaths Tied to Speeding
January 23, 2019 - Prenatal valproate exposure linked to increased ADHD risk
January 23, 2019 - Compound identified that may help treat heart failure
January 23, 2019 - Undiagnosed Asthma in Urban Adolescents May Be Common
January 23, 2019 - Study describes metabolism of intestinal microbiota in babies for the first time
January 22, 2019 - Study links concussions to development of epilepsy
January 22, 2019 - Specialist-led hospital bereavement service may help restrain legal action after difficult deaths
January 22, 2019 - Genetic study reveals possible new routes to treating osteoarthritis
January 22, 2019 - Blood test may detect early signs of lung-transplant rejection
January 22, 2019 - Blood marker could aid in early prediction of Alzheimer’s progression
January 22, 2019 - Orthodontic treatment does not guarantee future dental health
January 22, 2019 - Rutgers researchers discover cause of bone loss in people with joint replacements
January 22, 2019 - Diversity among rural Africans extends to their gut microbiomes
January 22, 2019 - Newly developed biological system lets cells to create self-curving cornea
January 22, 2019 - VTv Therapeutics Announces Publication of Comprehensive Data in Science Translational Medicine Detailing the Discovery and Clinical Development of TTP399, including Results of Phase 2 AGATA Study
January 22, 2019 - about one in three adults with prediabetes has arthritis
January 22, 2019 - A look at how data is democratizing health care
January 22, 2019 - Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
January 22, 2019 - Researchers identify new genes linked with age-related macular degeneration
January 22, 2019 - MPFI researchers identify synaptic logic for connections between two brain hemispheres
Regenstrief scientist calls for precision surveillance for colon cancer screening

Regenstrief scientist calls for precision surveillance for colon cancer screening

image_pdfDownload PDFimage_print

The interval at which an individual undergoes a repeat colonoscopy because of previous pre-cancerous polyps — a practice known as “surveillance” — should be tailored to the individual and not simply be determined by the results of prior colonoscopies, according to Regenstrief Institute research scientist Thomas F. Imperiale, M.D. In an editorial in the American Journal of Gastroenterology, he calls for “precision surveillance,” a phrase he has coined to echo the personalized, targeted focus of precision medicine and the application of these concepts to colon cancer screening and surveillance.

“The goal of colorectal cancer surveillance is to reduce incidence and death from colorectal cancer,” said Dr. Imperiale. “The only factor we currently consider for whether and when to do a surveillance colonoscopy is the number and size of precancerous polyps found on a previous colonoscopy screening. No other factors are considered; this practice does not always make good clinical sense.

“Precision surveillance goes beyond that one element (what’s in the colon) and considers the patient’s phenotype – personal characters such as age, personal medical history, BMI (body mass index), and health habits such as smoking. And when the data become more widely available, consideration of when to rescope should include the skill of the colonoscopists who performed the previous colonoscopies.”

Dr. Imperiale says that his editorial, “Thinking Big About Small Adenomas: Moving Towards ‘Precision Surveillance'” is a small step toward advancing surveillance colonoscopy by expanding the proportion of persons considered “low-risk” from one or two small, precancerous polyps to up to four such polyps. The giant leap, he says, would be to employ precision surveillance and make screening recommendations truly personalized and based on the patient, their polyps, and their colonoscopist.

Although studies suggest that the smaller the precancerous lesions are, the longer it takes for them to become cancerous, scientists do not have an accurate picture of the natural history of these lesions because they are removed upon discovery. It is known that most do not become cancerous.

“While we want to keep an eye on those individuals who have shown they can grow precancerous polyps, we need to balance being appropriately aggressive in those with whom we should be, with backing off from intense treatment for people who don’t require it ,” said Dr. Imperiale. “Precision surveillance starts to get at that issue.”

As an example, he contrasts two hypothetical patients — a healthy 55-year-old and a 70-year-old on home oxygen or dialysis. Each is found to have one or two small precancerous polyps. Current guidelines call for the same five- to ten-year interval for a repeat colonoscopy; most colonoscopists would re-scope at five years. Dr. Imperiale says that colonoscopists need to use their judgment and discuss with each patient when and even if to repeat the colonoscopy.

For the 55-year-old he would recommend a repeat colonoscopy in five to ten years or sooner if symptoms appear or other concerns arise. For the 70-year-old with significant health issues he would discuss with the individual and relevant family whether the best course might be to forego further colonoscopy simply to look for any new polyps.

“To provide the best care to patients and use healthcare resources responsibly, we need to be more thoughtful about certain factors in addition to the results of previous colonoscopies,” said Dr. Imperiale. “We need to screen and re-examine those who need it most and not those people who won’t benefit. Precision screening and surveillance may help achieve that goal.”

Source:

https://www.regenstrief.org/article/moving-towards-precision-surveillance/

About author

Related Articles