Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

Cystic Fibrosis Colorectal Cancer Screening Task Force

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background & Aims: Improved therapy has substantially increased survival of persons with cystic fibrosis (CF). But the risk of colorectal cancer (CRC) in adults with CF is 5−10 times greater compared to the general population, and 25−30 times greater in CF patients after an organ transplantation. To address this risk, the CF Foundation convened a multi-stakeholder task force to develop CRC screening recommendations. Methods: The 18-member task force consisted of experts including pulmonologists, gastroenterologists, a social worker, nurse coordinator, surgeon, epidemiologist, statistician, CF adult, and a parent. The committee comprised 3 workgroups: Cancer Risk, Transplant, and Procedure and Preparation. A guidelines specialist at the CF Foundation conducted an evidence synthesis February−March 2016 based on PubMed literature searches. Task force members conducted additional independent searches. A total of 1159 articles were retrieved. After initial screening, the committee read 198 articles in full and analyzed 123 articles to develop recommendation statements. An independent decision analysis evaluating the benefits of screening relative to harms and resources required was conducted by the Department of Public Health at Erasmus Medical Center, Netherlands using the Microsimulation Screening Analysis model from the Cancer Innervation and Surveillance Modeling Network. The task force included recommendation statements in the final guideline only if they reached an 80% acceptance threshold. Results: The task force makes 10 CRC screening recommendations that emphasize shared, individualized decision-making and familiarity with CF-specific gastrointestinal challenges. We recommend colonoscopy as the preferred screening method, initiation of screening at age 40 years, 5-year re-screening and 3-year surveillance intervals (unless shorter interval is indicated by individual findings), and a CF-specific intensive bowel preparation. Organ transplant recipients with CF should initiate CRC screening at age 30 years within 2 years of the transplantation because of the additional risk for colon cancer associated with immunosuppression. Conclusions: These recommendations aim to help CF adults, families, primary care physicians, gastroenterologists, and CF and transplantation centers address the issue of CRC screening. They differ from guidelines developed for the general population with respect to the recommended age of screening initiation, screening method, preparation, and the interval for repeat screening and surveillance.

Original languageEnglish (US)
Pages (from-to)736-745.e14
JournalGastroenterology
Volume154
Issue number3
DOIs
StatePublished - Feb 1 2018

Fingerprint

Early Detection of Cancer
Cystic Fibrosis
Colorectal Neoplasms
Consensus
Advisory Committees
Guidelines
Transplantation
Transplants
Decision Support Techniques
Primary Care Physicians
Organ Transplantation
Colonoscopy
PubMed
Netherlands
Colonic Neoplasms
Immunosuppression
Population
Neoplasms
Decision Making
Public Health

Keywords

  • Cancer
  • CFTR
  • Colon
  • Colonoscopy
  • Cost-Effectiveness Analysis
  • Cystic Fibrosis
  • Intestine
  • Large Bowel
  • Recommendations
  • Rectum
  • Screening

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cystic Fibrosis Colorectal Cancer Screening Task Force (2018). Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations. Gastroenterology, 154(3), 736-745.e14. https://doi.org/10.1053/j.gastro.2017.12.012

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations. / Cystic Fibrosis Colorectal Cancer Screening Task Force.

In: Gastroenterology, Vol. 154, No. 3, 01.02.2018, p. 736-745.e14.

Research output: Contribution to journalArticle

Cystic Fibrosis Colorectal Cancer Screening Task Force 2018, 'Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations', Gastroenterology, vol. 154, no. 3, pp. 736-745.e14. https://doi.org/10.1053/j.gastro.2017.12.012
Cystic Fibrosis Colorectal Cancer Screening Task Force. Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations. Gastroenterology. 2018 Feb 1;154(3):736-745.e14. https://doi.org/10.1053/j.gastro.2017.12.012
Cystic Fibrosis Colorectal Cancer Screening Task Force. / Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations. In: Gastroenterology. 2018 ; Vol. 154, No. 3. pp. 736-745.e14.
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AU - Cystic Fibrosis Colorectal Cancer Screening Task Force

AU - Hadjiliadis, Denis

AU - Khoruts, Alexander

AU - Zauber, Ann G.

AU - Hempstead, Sarah E.

AU - Maisonneuve, Patrick

AU - Lowenfels, Albert B.

AU - Braid, Amy Leigh

AU - Cullina, Joanne

AU - Daggett, Anne

AU - Fink, Aliza

AU - Gini, Andrea

AU - Hadjiliadis, Denis

AU - Harron, Paul F.

AU - Lieberman, David

AU - Khoruts, Alexander

AU - Lansdorp-Vogelaar, Iris

AU - Lieberman, David

AU - Liou, Theodore

AU - Lomas, Paula

AU - Lowenfels, Albert

AU - Maisonneuve, Patrick

AU - Marshall, Bruce

AU - Meyer, Keith

AU - Rustgi, Anil

AU - Shaukat, Aasma

AU - Zauber, Ann

AU - Sabadosa, Kathy

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background & Aims: Improved therapy has substantially increased survival of persons with cystic fibrosis (CF). But the risk of colorectal cancer (CRC) in adults with CF is 5−10 times greater compared to the general population, and 25−30 times greater in CF patients after an organ transplantation. To address this risk, the CF Foundation convened a multi-stakeholder task force to develop CRC screening recommendations. Methods: The 18-member task force consisted of experts including pulmonologists, gastroenterologists, a social worker, nurse coordinator, surgeon, epidemiologist, statistician, CF adult, and a parent. The committee comprised 3 workgroups: Cancer Risk, Transplant, and Procedure and Preparation. A guidelines specialist at the CF Foundation conducted an evidence synthesis February−March 2016 based on PubMed literature searches. Task force members conducted additional independent searches. A total of 1159 articles were retrieved. After initial screening, the committee read 198 articles in full and analyzed 123 articles to develop recommendation statements. An independent decision analysis evaluating the benefits of screening relative to harms and resources required was conducted by the Department of Public Health at Erasmus Medical Center, Netherlands using the Microsimulation Screening Analysis model from the Cancer Innervation and Surveillance Modeling Network. The task force included recommendation statements in the final guideline only if they reached an 80% acceptance threshold. Results: The task force makes 10 CRC screening recommendations that emphasize shared, individualized decision-making and familiarity with CF-specific gastrointestinal challenges. We recommend colonoscopy as the preferred screening method, initiation of screening at age 40 years, 5-year re-screening and 3-year surveillance intervals (unless shorter interval is indicated by individual findings), and a CF-specific intensive bowel preparation. Organ transplant recipients with CF should initiate CRC screening at age 30 years within 2 years of the transplantation because of the additional risk for colon cancer associated with immunosuppression. Conclusions: These recommendations aim to help CF adults, families, primary care physicians, gastroenterologists, and CF and transplantation centers address the issue of CRC screening. They differ from guidelines developed for the general population with respect to the recommended age of screening initiation, screening method, preparation, and the interval for repeat screening and surveillance.

AB - Background & Aims: Improved therapy has substantially increased survival of persons with cystic fibrosis (CF). But the risk of colorectal cancer (CRC) in adults with CF is 5−10 times greater compared to the general population, and 25−30 times greater in CF patients after an organ transplantation. To address this risk, the CF Foundation convened a multi-stakeholder task force to develop CRC screening recommendations. Methods: The 18-member task force consisted of experts including pulmonologists, gastroenterologists, a social worker, nurse coordinator, surgeon, epidemiologist, statistician, CF adult, and a parent. The committee comprised 3 workgroups: Cancer Risk, Transplant, and Procedure and Preparation. A guidelines specialist at the CF Foundation conducted an evidence synthesis February−March 2016 based on PubMed literature searches. Task force members conducted additional independent searches. A total of 1159 articles were retrieved. After initial screening, the committee read 198 articles in full and analyzed 123 articles to develop recommendation statements. An independent decision analysis evaluating the benefits of screening relative to harms and resources required was conducted by the Department of Public Health at Erasmus Medical Center, Netherlands using the Microsimulation Screening Analysis model from the Cancer Innervation and Surveillance Modeling Network. The task force included recommendation statements in the final guideline only if they reached an 80% acceptance threshold. Results: The task force makes 10 CRC screening recommendations that emphasize shared, individualized decision-making and familiarity with CF-specific gastrointestinal challenges. We recommend colonoscopy as the preferred screening method, initiation of screening at age 40 years, 5-year re-screening and 3-year surveillance intervals (unless shorter interval is indicated by individual findings), and a CF-specific intensive bowel preparation. Organ transplant recipients with CF should initiate CRC screening at age 30 years within 2 years of the transplantation because of the additional risk for colon cancer associated with immunosuppression. Conclusions: These recommendations aim to help CF adults, families, primary care physicians, gastroenterologists, and CF and transplantation centers address the issue of CRC screening. They differ from guidelines developed for the general population with respect to the recommended age of screening initiation, screening method, preparation, and the interval for repeat screening and surveillance.

KW - Cancer

KW - CFTR

KW - Colon

KW - Colonoscopy

KW - Cost-Effectiveness Analysis

KW - Cystic Fibrosis

KW - Intestine

KW - Large Bowel

KW - Recommendations

KW - Rectum

KW - Screening

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