Biomedical subjects

Carlo Senore

Publications and source records attributed to Carlo Senore.

9 recordsLinked to original sources

PubMed2026

Fecal immunochemical tests from population-based colorectal cancer screening programs support prospective microbiome cohorts.

BACKGROUND: Large, prospective cohorts are needed to research the gut microbiome's role in colorectal cancer (CRC) risk. We evaluated the gut microbiome leveraging residual fecal immunochemical tests (FIT) from a CRC screening program in Turin, Italy, and conducted one of the largest population-based case-control studies across the adenoma-carcinoma sequence to date. METHODS: We extracted DNA from residual FIT stool, used whole-genome shotgun sequencing, and included those with CRC (N = 44), advanced adenomas (N = 269), early adenomas (N = 134), and FIT-negative controls (N = 478). Alpha diversity, beta diversity, and species, gene, and pathway relative abundances were estimated. Multivariable logistic regression models were used to estimate associations of these metrics with colorectal neoplasms. RESULTS: Alpha diversity was mostly inversely associated with colorectal neoplasms, particularly early adenomas (OR: 0.45, 95% CI: 0.25-0.80; P = 0.01). Presence of oral pathogens, including Parvimonas micra, was associated with higher odds of CRC. Furthermore, Escherichia coli and Bacteroides fragilis were strongly associated with higher odds of all colorectal neoplasms. Several genes and pathways were associated with colorectal neoplasms. CONCLUSIONS: Our findings align with smaller studies of the gut microbiome and colorectal neoplasms, supporting that CRC screening programs provide opportunities to prospectively study the gut microbiome's association with cancer risk in large populations.

Humans↗

PubMed2005

Early diagnosis, not differential treatment, explains better survival in service screening.

Italian population-based breast cancer screening programmes with 2-year, high-quality mammography started in the cities of Florence and Turin in the early 1990s. Breast cancer cases from the local Tumour Registry were classified by method of detection and tumour characteristics (size, nodal-status and grade). Follow-up was at December 2001. In total, 4444 breast cancer cases were analysed. The Hazard Ratio comparing before and after-invitation breast cancer cases indicated a 27% reduction (HR=0.73; 95%CI: 0.61-0.87) in the risk of dying for the disease. After adjustment for tumour characteristics, survival rate was comparable by invitation status, whereas the proportion of early cancer was 33.7% and 46.6% in the before and after-invitation group. Survival rates by tumour characteristic subgroups was comparable by invitation status. Late stage and grade 3 were indicators of poor prognosis. Adjustment for tumour characteristics confirmed screening and not differential treatment as the most important reason for the observed survival benefit. The survival analysis by specific subgroups did not support the hypothesis that the difference in prognosis was attributable to differential treatment.

Aged↗

PubMed2005

History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy.

BACKGROUND AND AIMS: Screening sigmoidoscopy can reduce incidence of colorectal cancer and mortality. The optimal re-screening interval has not yet been defined. This study is aimed at estimating the risk of distal advanced adenomas (diameter >/=10 mm, villous component >20%, high-grade dysplasia) and cancer at screening flexible sigmoidoscopy in subjects aged 55-64 years who reported pre-screening negative colorectal endoscopy. PATIENTS: Eight thousands two hundred two subjects aged 55-64 years who underwent screening flexible sigmoidoscopy within the SCORE trial in Italy and who were able to report their previous history of colorectal endoscopy. RESULTS: Eight hundred eighty three of 8,202 subjects (10.8%) reported at least one prescreening negative endoscopy: among them, after 3-5 years, 6-10 years and >10 years intervals between last reported examination and screening endoscopy, the Absolute Risk of advanced adenomas was 1.5%, 0.9% and 0.9%; one cancer was detected (0.1%). Among the 7,319 subjects who did not report prescreening endoscopy the risks of advanced adenoma and cancer were 3.2% and 0.4%, respectively. Subjects with a previous colorectal examination had a 65% decreased risk of advanced adenomas (OR=0.35, 95%CI 0.18-0.66) and a 71% decreased risk of cancer (OR=0.29, 95%CI 0.04-1.12) as compared to those who did not. For subjects without family history of colorectal cancer the statistically significant decrease of the risk persisted up to ten years. The observed benefit seems not to apply to subjects with family history of colorectal cancer. CONCLUSIONS: Our results are consistent with the hypothesis that the interval between screening sigmoidoscopies could be safely expanded beyond 5 years for subjects without specific risk factors for colorectal cancer.

Adenoma, Villous↗

PubMed2005

Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates.

BACKGROUND: Although there is general consensus concerning the efficacy of colorectal cancer screening, there is a lack of agreement about which routine screening strategy should be adopted. We compared the participation and detection rates achievable through different strategies of colorectal cancer screening. METHODS: From November 1999 through June 2001 we conducted a multicenter, randomized trial in Italy among a sample of 55-64 year olds in the general population who had an average risk of colorectal cancer. People with previous colorectal cancer, adenomas, inflammatory bowel disease, a recent (< or =2 years) colorectal endoscopy or fecal occult blood test (FOBT), or two first-degree relatives with colorectal cancer were excluded. Eligible subjects were randomly assigned, within the roster of their general practitioner, to 1) biennial FOBT (delivered by mail), 2) biennial FOBT (delivered by general practitioner or a screening facility), 3) patient's choice of FOBT or "once-only" sigmoidoscopy, 4) "once-only" sigmoidoscopy, or 5) sigmoidoscopy followed by biennial FOBT. An immunologic FOBT was used. Participation and detection rates of the strategies tested were compared using multivariable logistic regression models that adjusted for age, sex, and screening center. All statistical tests were two-sided. RESULTS: Of 28 319 people sampled, 1637 were excluded and 26 682 were randomly assigned to a screening arm. After excluding undelivered letters (n = 427), the participation rates for groups 1, 2, 3, 4, and 5 were 30.1% (682/2266), 28.1% (1654/5893), 27.1% (970/3579), 28.1% (1026/3650), and 28.1% (3049/10 867), respectively. Of the 2858 subjects screened by FOBT, 122 (4.3%) had a positive test result, 10 (3.5 per 1000) had colorectal cancer, and 39 (1.4%) had an advanced adenoma. Among the 4466 subjects screened by sigmoidoscopy, 341 (7.6%) were referred for colonoscopy, 18 (4 per 1000) had colorectal cancer, and 229 (5.1%) harbored an advanced adenoma. CONCLUSIONS: The participation rates were similar for sigmoidoscopy and FOBT. The detection rate for advanced neoplasia was three times higher following screening by sigmoidoscopy than by FOBT.

Colonic Polyps↗

PubMed2004

Predicting proximal advanced neoplasms at screening sigmoidoscopy.

PURPOSE: This study was designed to assess the predictive value for advanced proximal neoplasms (cancer, adenoma > or = 10 mm, or villous component > 20 percent, or severe dysplasia) of the characteristics of distal polyps. METHODS: The study was conducted among patients, aged 55 to 64 years, referred for colonoscopy in the Italian trial of sigmoidoscopy screening for colorectal cancer. Patients reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. We compared the prevalence of advanced proximal neoplasia in patients with "low-risk" (1-2 tubular adenomas, < 10 mm, with low-grade dysplasia, or hyperplastic polyp) and in those with "high-risk" (size, > or = 10 mm, or > or = 3 adenomas, or villous component > 20 percent, or severe dysplasia) polyps in the distal colon. RESULTS: Of 426 patients with polyps > 5 mm, 29 (6.9 percent) were detected with an advanced proximal neoplasm (including 4 colorectal cancers). The prevalence of proximal advanced neoplasia was 9.4 percent among patients with high-risk distal polyps and 2.5 percent among those with low-risk lesions (adjusted odds ratio, 3.19; 95 percent confidence interval, 1.06-9.59). Approximately 40 people with low-risk distal polyps 6 to 9 mm should undergo colonoscopy to detect one proximal advanced neoplasm; the corresponding number for patients with high-risk distal polyps is 10. CONCLUSIONS: The 2.5 percent prevalence of proximal advanced neoplasms among people with low-risk 6-mm to 9-mm distal polyps is similar to the prevalence observed among people without distal polyps. Restricting colonoscopy referral to patients with high-risk distal polyps might represent a cost-effective strategy in a screening context.

Adenoma↗

PubMed2002

Baseline findings of the Italian multicenter randomized controlled trial of "once-only sigmoidoscopy"--SCORE.

BACKGROUND: A single sigmoidoscopy examination at around age 60 years has been proposed as a cost-effective strategy to prevent colorectal cancer. A multicenter randomized controlled trial, the SCORE trial, is in progress in Italy to estimate the impact of this strategy on colorectal cancer incidence and mortality and the duration of the protective effect. We present the baseline screening outcomes. METHODS: A questionnaire was mailed to a random sample of 236 568 people aged 55-64 years to assess their eligibility for and interest in screening. Those reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. Eligible, interested respondents were assigned randomly to the control group (no further contact) or the intervention group (invitation to undergo sigmoidoscopy). Screenees with colorectal cancer, polyps larger than 5 mm, three or more adenomas, adenomas 5 mm or smaller with a villous component of more than 20%, or severe dysplasia were referred for colonoscopy. RESULTS: Of the 56 532 respondents (23.9% of those invited), 34 292 were enrolled and 17 148 were assigned to the screening group. Of those, 9999 attended and 9911 were actually examined by sigmoidoscopy. Distal adenomas were detected in 1070 subjects (10.8%). Proximal adenomas were detected in 116 of 747 (15.5%) subjects without cancer at sigmoidoscopy who then underwent colonoscopy. A total of 54 subjects was found to have colorectal cancer, a rate of 5.4 per 1000 (54% of which were Dukes' A). The procedures were relatively safe, with two perforations (one in 9911 sigmoidoscopy exams and one in 775 colonoscopies) and one hemorrhage requiring hospitalization after polypectomy during colonoscopy. The pain associated with sigmoidoscopy was described as mild or less than expected by 83.3% of the screenees. CONCLUSION: Sigmoidoscopy screening is generally acceptable to recipients and safe. The high yield of advanced adenomas is consistent with the projected impact of sigmoidoscopy screening on colorectal cancer incidence.

Adenoma↗

PubMedDate not supplied

[Evaluation of quality of care through hospital discharge reports: an example of rectal cancer surgery].

This study was undertaken to evaluate the usefulness of hospital discharge data for monitoring the impact of a regional practice guideline on treatment of colorectal cancer. The aims of the study were: i) estimating process and outcome indicators; ii) exploring the relationship between patient and hospital characteristics and these indicators. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for all risk factors analysed. All 3,614 patients undergoing potentially curative resection for rectal cancer in 75 hospitals in Piedmont (Italy) between 1997 and 2000 were included. Occurrences of abdominoperineal resections (APR), postoperative complications, reinterventions and hospital mortality were 16.2%, 11.0%, 5.5% and 4.4%, respectively. APR was performed more frequently in patients with distant metastases or urgently admitted and by hospitals with a lower volume of cases (< 25 per year) compared to hospital with more than 50 cases per year (OR = 1.50, CI = 1.16-1.94). The strongest predictors for mortality and complications were: older age, distant metastases and urgency of admission. Incidence of complications and of reinterventions was also increased among males and in patients with lesions of the lower rectum. The rate of complications showed an increasing trend during the period, from 8.5% to 14.5% likely reflecting improvement in coding during time. Low hospital workload was associated to a reduced risk of complications and reinterventions, but there was evidence of underreporting of secondary diagnoses and procedures in smaller hospitals. Outcome indicator based on secondary diagnoses and procedures are of limited value in monitoring improvement of care since they reflect also differences in coding during time and among providers.

Aged↗

PubMedDate not supplied

Time trends of some indicators of mammography screening programmes in Italy, 1996-2003.

Since 1992, the Italian Group for Mammography Screening (GISMa) has been performing a yearly systematic survey of ongoing activities. The screening extension increased from 1996, reaching an overall 68.7% coverage in 2004. This progression has been more evident in Central-Northern Italy while in Southern Italy a real, but still limited (30%), increase has been recorded only recently. Despite this geographical extension, the actual coverage reached only 5 1.1% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well planned political actions. The time trends for the key performance indicators show a good average performance: crude attendance rate exceeds over the years the acceptable 50% standard; BIM ratio is progressively decreasing, reaching a ratio of 0.7:1 (both for first/subsequent screening) in 2003; overall detection rate, detection rate for in situ and small cancers (< or =10 mm) show a good trend, reaching 6.6% per hundred, 1.5% per hundred and 0.7% per hundred respectively for the first screening in 2003. An exception is the referral rate at first screening which exceeds the reference standards (> 7% in the last 2 years). Data have been analysed also according to activity volume and programme duration. In programmes with greater activity (average test number: 24,702) the referral rate for the first screening is higher, but still within acceptable standards: 5.8%; RR: 1.05 (1.02-1.10). This performance is compensated by better specificity and sensitivity: PPV = 13.3: RR: 1.14 (1.03-1.27); overall detection rate = 6.7% per hundred; RR: 1.22 (1.09-1.36). An improvement of quality with the increase of experience is evident: programmes with more than 6 years of activity, compared with newer programmes, show a recall rate in first screening of 6.0%; RR:0.86 (0.86-0.92), a PPV of 13.4; RR: 1.65 (1.40-1.69) and an overall detection rate of 8.1% per hundred; RR: 1.44 (1.25-1.53). These results are consistent with those observed in other European programmes, and encourage new analysis strategies. The web site of the National Centre for Monitoring Screening is http://wwuw.osservatoriotumori.it.

Aged↗

PubMedDate not supplied

Screening for colorectal cancer in Italy: 2004 survey.

We present the main results of the first national survey of organised screening programmes, conducted by the Italian Group for Colorectal Cancer Screening (GISCoR). During 2004, 18 programs, adopting faecal occult blood testing (FOBT), sigmoidoscopy (FS), or a combination of both, were active in Italy. Overall, 331,333 subjects were invited to undergo FOBT and 165,480 were screened; the attendance rate (51.3%) equals the best performances reported in the literature. Positivity rate was 5.4% at first and 3.9% at repeat screening: it increased with age and was higher among men than among women in all age groups. The average attendance rate at colonoscopy (TC) was 83% (range: 70%-100%; median: 85%). Completion rate of TC was 92%, with higher rates among males. At first screening, the detection rate (DR) per 1000 screened subjects was 2.8 and 11.6 for cancer (CRC) and "high-risk" adenomas (HRA) (> or =3 adenomas, 1 adenoma > or =1 cm, or with villous component >20%, or with high grade dysplasia) respectively; the corresponding figures at repeat screening were 1.2 for CRC and 4.9 for HRA. The DR of CRC and adenomas increased with age and it was higher among men than among women; 51% of screen-detected CRCs were at TNM stage 1. The positive predictive value (PPV) was 6.3% for CRC and 25.8% for HRA at first screening, and 3.6% for CRC and 15.1% for HRA at repeat screening. Given this high PPV of positive FOBT, to obtain a high attendance at TC is crucial. In the three FS programmes 15,688 subjects were invited and 4884 were screened (attendance rate: 31.9%). TC referral rates ranged between 7.6% and 14.0%, due to different referral criteria. Among subjects referred to colonoscopy the prevalence of HRA and CRC ranged from 7.9 to 9.9%. The overall DR (subjects with at least one advanced lesion) ranged from 5.5 to 7.0%. Comparing the DR at FS and FOBT in the same age range. FS showed a higher sensitivity both for HRA (DR was four times higher) and for CRC. In conclusion, colorectal cancer screening looks feasible. The reported experiences showed good results in terms of attendance and DR, although some critical aspects need to be carefully addressed when planning and implementing screening activity.

Adult↗