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The effect of race and gender on colorectal cancer screening among older veterans
Submit responseTo the editor:
We read carefully the study by Walter LC and his collegues [1]. They made a conclusion that advancing age was inversely associated with colorectal cancer screening, whereas comorbidity was a weaker predictor. Since they were studying veterans, the patients were predominantly men (96%), and extrapolation of their findings to women must be done with caution. In addition, 87% of the subjects were white. Could the authors comment on the effect of race on colorectal cancer screening among older veterans?
References
1 Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150:465-73.
Conflict of Interest:
None declared
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Colon Cancer Oncological Terrain-Dependent Inherited Real Risk
Submit responseThe paper's conclusions were that advancing age was inversely associated with colorectal cancer screening, whereas comorbidity was a weaker predictor. More attention to comorbidity is needed, to better target screening for older patients with substantial life expectancies and avoid screening older patients with limited life expectancies. I fear that neither the Editors of Annals of Internal Medicine nor the authors know that Oncological Terrain as well as Colon Cancer Oncological Terrain- Dependent Inherited Real Risk, conditio sine qua non of colon cancer, do really exist. Why do doctors have to prescribe colon cancer screening if these congenital pathological conditions, recognized since birth, are absent? (1-7).
References. 1. Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. www.travelfactory.it
2. Stagnaro S. Newborn-pathological Endoarteriolar Blocking Devices in Diabetic and Dislipidaemic Constitution and Diabetes Primary Prevention. The Lancet. March 06 2007. http://www.thelancet.com/journals/lancet/article/PIIS0140673607603316/comments?totalcomments=1
3. Stagnaro S. Rimodellamento Microvascolare, Costituzioni Semeiotico - Biofisiche e Reale Rischio Semeiotico-Biofisico. Ruolo dei Dispositivi Endoarteriolari di Blocco neoformati-patologici www.clicmedicina.it, 10/4/2007, http://www.clicmedicina.it/pagine%20n%2028/rimodellamento.htm
4. Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico- Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Ed. Travel Factory, Roma, 2004. http://www.travelfactory.it/
5. 1Stagnaro S., Stagnaro-Neri M., Oncological Terrain, conditio sine qua non of Oncogenesis, 2004: http://www.gutjnl.com/cgi/eletters?lookup=by_date&days=60
6. Stagnaro Sergio. Bed-Side Prostate Cancer Detecting, even in early stages ("Real Risk" of Cancer): BMC Family Practice, 2005, 6:24 doi:10.1186/1471-2296-6-24 http://www.biomedcentral.com/1471- 2296/6/24/comments#202466
7. Stagnaro Sergio. Clinical tool reliable in bedside early recognizing pancreas tumour, both benign and malignant. World Journal of Surgical Oncology 2005, 3:62 doi:10.1186/1477-7819-3-62; http://www.wjso.com/content/3/1/62/comments
Conflict of Interest:
None declared
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Hemoglobin values and age are significant predictors of positive faecal occult blood test.
Submit responseTO THE EDITOR:
Population based mass screening for colorectal cancer (CRC) has been a matter of debate for decades (1). We read with interest the article of Walter et al, who concluded that advancing age was inversely associated with colorectal cancer screening, whereas comorbidity was a weaker predictor, so that more attention to comorbidity is needed to better target screening (2). In order to establish the main determinants of positive tests for CRC screening at our laboratory, we retrieved results of faecal occult blood tests (FOBT) performed at the Laboratory Medicine department of the University Hospital of Verona, which serves an area with a population of 270,000 inhabitants and a hospital with 750 beds and specialized care units. Results of FOBT tests performed between March 2007 and March 2009 were retrieved from the databases of our Laboratory Information System for 886 outpatients, excluding subjects who underwent this testing for non-screening reasons, as indicated by cancer-specific medications, diagnoses, and procedures. Overall, we identified 306 positive FOBT tests (35%). In multivariate linear regression analysis, age (standardized beta coefficient=0.178; p=0.004) and hemoglobin values (standardized beta coefficient=-0.313; p<0.001), but not sex (standardized beta coefficient = -0.099; p=0.781), were significant predictors of FOBT positive test. After stratifying the study population according to the hemoglobin thresholds for anemia (<132 g/L in men and <122 g/L in women) (3), the prevalence of positive tests was significantly higher among anemic subjects (86% versus 55%; p<0.001 by ÷2 test). Taken together our results further support the suggestion of Walter et al, that CRC screening should be better targeted among older patients by considering comorbidity. Moreover, we have also shown that unexplained anemia is an important determinant of positive FOBT tests, especially among older subjects, so that more attention to this condition is needed to guide CRC screening.
References.
1. Lippi G, Brocco G, Guidi GC. The appropriateness of colorectal cancer screening by fecal occult blood tests. Am J Gastroenterol. 2008;103:800-1.
2. Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150:465-73.
3. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107:1747-50.
Conflict of Interest:
None declared