Search Results (72)

Background/Objectives: Colorectal cancer is the most frequently diagnosed cancer and second by mortality among all cancers in Croatia. The Organized National Colorectal Cancer Screening Program was introduced by the government in 2007. It targets individuals aged 50–74 years with a biennial screening with a guaiac fecal occult blood test (gFOBT). The aim of this study is to analyze the costs associated with colorectal cancer in Croatia and to compare the cost-effectiveness of three screening strategies: no screening, biennial gFOBT, and biennial fecal immunochemical testing (FIT). Patients and methods: A model was developed to compare the three screening scenarios. The model simulated a cohort of 10,000 patients aged 50 years without colorectal cancer. Health outcomes and associated costs were projected over a five-year time horizon. The model outcomes include the number of newly diagnosed colorectal cancer cases, number of colorectal cancer-related deaths, life-years gained, and costs per life-year gained. Results: The average five-year costs per patient for the treatment of advanced cancer are EUR 39,802, which is substantially higher than the average costs of EUR 16,897 per patient across all stages. The implemented model indicates that both screening options yielded improved health outcomes at lower costs compared with no screening. FIT is considered the preferred screening option due to its higher sensitivity, greater health outcomes, and lower costs relative to gFOBT. Conclusions: The introduction of FIT screening instead of gFOBT could increase screening uptake for colorectal cancer, improve health outcomes, and reduce healthcare expenditures and the economic burden associated with colorectal cancer in Croatia. Full article

Objectives: This study aims to evaluate teachers’ lifestyle habits and to investigate their knowledge and behaviors related to cancer screening. Methods: This cross-sectional survey was performed among teachers randomly selected from schools located in the Campania region, Italy. Results: Only 17% of the teachers were current smokers, while 72.1% consumed alcohol. Female teachers, those who were married/cohabitant, and those who discussed with students about alcohol consumption were more likely to have never smoked or drunk alcohol. Female and older teachers, those with a university or a master/PhD degree, and those who had a moderate/high level of physical activity (PA) were more likely to sufficiently consume fruits and vegetables. Only 20.9% of teachers had a moderate/high level of PA. Those who had at least one child, who taught humanistic and support disciplines, and who needed additional information on healthy lifestyle habits were less likely to have a moderate/high level of PA. Among participants, 42.3% had ever undergone mammography for screening and 37.5% a Pap test and a fecal occult blood test. Conclusions: This survey describes a worrying prevalence of unhealthy behaviors and low adherence to screening programs among Italian teachers, suggesting the need for education and screening campaigns to improve preventive strategies in this population. Full article

Colonoscopy remains the gold standard for colorectal cancer (CRC) screening, but its invasiveness, cost, and limited availability in resource-constrained settings pose major barriers. Stool-based methylated DNA biomarkers, such as vimentin, offer sensitive, non-invasive alternatives. Given the high burden of HIV and helminth co-infections in sub-Saharan Africa and their potential contribution to cancer susceptibility, this study investigated whether stool-derived vimentin methylation could detect early oncogenic changes in these high-risk groups. In this retrospective cross-sectional study, archived stool samples from 62 South African adults were stratified into five groups: uninfected controls, HIV-infected only, helminth-infected only, HIV-helminth co-infected, and CRC-confirmed patients. DNA was extracted, bisulfite-converted, and analyzed for vimentin methylation using a high-resolution melt assay. Fecal occult blood testing (FOBT) was also performed. Vimentin methylation differed significantly across groups (p < 0.0001). CRC cases showed 90% methylation, confirming its role as a CRC biomarker. Interestingly, vimentin methylation frequencies were also observed in HIV-only (92.9%, p < 0.0001 vs. controls), helminth-only (93.3%, p < 0.0001), and HIV-helminth co-infected (77.9%, p < 0.0001) individuals without diagnosed cancer, compared to 10% in controls. Methylation levels in infected groups were not significantly different from CRC patients (all p > 0.05), suggesting infection-induced epigenetic changes of comparable magnitude to malignancy. To support these results, DNMT1–RG108 molecular docking (PDB 4WXX, Maestro 2025-3) demonstrated stable binding (GlideScore −6.285 kcal/mol; ΔG_bind −49.61 kcal/mol) via hydrogen bonding with Glu1266 and Asn1578 and π–π stacking with Phe1145, providing a mechanistic explanation for infection-driven vimentin methylation. No significant differences were found between infected groups. FOBT was positive in 83.3% of CRC cases, with only sporadic positives in infected groups. These findings provide novel evidence that chronic HIV and helminth infections are associated with vimentin promoter methylation at levels indistinguishable from CRC. This supports the hypothesis that persistent infection-driven inflammation promotes early epigenetic reprogramming toward oncogenesis. In high-burden African settings, stool-based methylation assays could serve as early diagnostic tools to identify at-risk individuals long before clinical disease manifests, enabling targeted surveillance and prevention. Full article

Objectives: This study assessed socioeconomic inequalities in cancer screening at the district level in Peru, focusing on bilateral mammography, fecal occult blood test (FOBT), and prostate-specific antigen (PSA) test. Methods: An ecological study was conducted using 2021–2023 data from the Health Information System (HIS) of MINSA. Screening rates were calculated per 1000 eligible individuals. Socioeconomic disparities were assessed using concentration indices (CIs) and gap analysis, with the Human Development Index (HDI) as the stratification variable. Results: Screening rates were higher in districts with greater HDI. The mean district-level rates were 15.41 (SD: 72.66) for mammography, 97.27 (SD: 107.34) for FOBT, and 104.87 (SD: 101.92) for PSA per 1000 eligible individuals. Positive concentration indices indicated a pro-rich inequality: CI for mammography (0.1745, p = 0.045), FOBT (0.0633, p < 0.001), and PSA (0.0290, p = 0.028). The largest gaps were observed in Amazonian and Andean regions, where screening coverage remained markedly low. Spatial distribution revealed that certain districts, particularly in Loreto, Ucayali, and Amazonas, had screening gaps exceeding 97%. Conclusions: Significant disparities in cancer screening exist across Peruvian districts, disproportionately affecting lower-HDI districts areas. Targeted interventions, including education, telemedicine, and improved infrastructure, are necessary to enhance equitable access to early detection services and reduce the burden of disease. Full article

Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide, with patient outcomes highly dependent on early and accurate diagnosis. However, existing diagnostic methods, such as colonoscopy, fecal occult blood testing, and imaging, are often invasive, costly, or lack sufficient sensitivity and specificity, particularly in early-stage disease. In this context, aptamers, which are synthetic single-stranded oligonucleotides capable of binding to specific targets with high affinity, have emerged as a powerful alternative to antibodies for biosensing applications. This review provides a comprehensive overview of aptamer-based strategies for CRC detection, spanning from biomarker discovery to clinical translation. We first examine established and emerging CRC biomarkers, including those approved by regulatory agencies, described in patents, and shared across multiple cancer types. We then discuss recent advances in aptamer selection and design, with a focus on SELEX variants and in silico optimization approaches tailored to CRC-relevant targets. The integration of aptamers into cutting-edge sensing platforms, such as electrochemical, optical, and nanomaterial-enhanced aptasensors, is highlighted, with emphasis on recent innovations that enhance sensitivity, portability, and multiplexing capabilities. Furthermore, we explore the convergence of aptasensing with microfluidics, and wearable technologies to enable intelligent, miniaturized diagnostic systems. Finally, we consider the clinical and regulatory pathways for point-of-care implementation, as well as current challenges and opportunities for advancing the field. By outlining the technological and translational trajectory of aptamer-based CRC diagnostics, this review aims to provide a roadmap for future research and interdisciplinary collaboration in precision oncology. Full article

Background/Objectives: Data on cancer screening programs as well as on the willingness to adhere to these programs in women living in prison (WLP) are lacking. This study investigated the adherence and willingness to undergo cancer screening programs among WLP. Methods: This cross-sectional study was conducted from October 2023 to March 2024. Results: Overall, 159 WLP were eligible for at least one screening test and 56.8%, 57.6%, and 27.6% had undergone a mammography, PAP-test, and fecal occult blood test (FOBT) in screening programs, respectively. Having undergone a PAP-test for screening purposes was significantly more likely for those in the overweight category, who were experiencing their first detention and were involved in working activities in prison. Moreover, 72.5%, 56.7%, and 72.9% expressed their willingness to undergo mammography, PAP-test, and FOBT for screening purposes if offered in prison, respectively. Willingness to undergo a PAP-test for screening in prison was significantly higher in those in their first experience of detention, who were underweight/healthy weight, who reported correct fruit, vegetable, and protein consumption, and who had expressed willingness to receive vaccinations in prison if offered. Furthermore, older WLP and those with a length of detention of 2–5 years were significantly less willing to undergo a PAP-test. Conclusions: The findings of this study have demonstrated that adherence to recommended cancer screening tests is definitely poor in WLP, but have ascertained a strong willingness to participate in cancer screening programs if offered in prison. This is an opportunity that cannot be missed, suggesting that it is imperative to recommend policies aimed at the elimination of barriers for the provision of cancer screening tests as standard preventive care for WLP. Full article

Background: Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), is characterized by chronic intestinal inflammation with fluctuating clinical severity. Although fecal calprotectin (FC) and fecal occult blood (FOBT) are established noninvasive biomarkers of intestinal inflammation, their interplay with nutritional status and disease activity has not been fully elucidated. This study aimed to explore the relationship between FC, FOBT, and disease activity in IBD, and to assess the potential mediating role of nutritional status as measured by the prognostic nutritional index (PNI). Methods: This retrospective study includes 128 adult patients with confirmed IBD (50 UC and 78 CD) examined at a tertiary care center between December 2023 and August 2025. Disease activity was assessed using the Mayo score for UC and the Harvey–Bradshaw Index for CD. FC levels were quantitatively measured using an enzyme-linked immunosorbent assay (ELISA), and fecal occult blood testing was performed with an automated latex agglutination-based system. Multivariable linear regression models were conducted to identify independent predictors of disease activity. Results: UC patients had significantly higher FC levels (278.0 vs. 133.5 µg/g, p < 0.001), FOBT positivity rates (76.7% vs. 43.6%, p = 0.002), and lower PNI (49.2 ± 4.2 vs. 51.5 ± 4.6, p = 0.048) compared to CD patients. In both UC and CD, disease activity scores were positively correlated with FC, FOBT positivity, CRP, and duration of illness, and negatively correlated with PNI (p < 0.05). In multivariable regression, PNI lost predictive value when FC and FOBT were included; FC and FOBT remained strong independent predictors of disease activity. Conclusions: FC and fecal occult blood are independently associated with higher disease activity in IBD, and may mediate the observed relationship between poor nutritional status and inflammation severity. The loss of significance of PNI in adjusted models suggests that intestinal inflammation and bleeding may act as intermediaries linking malnutrition to disease activity. Full article

Background/Objectives: Colorectal cancer (CRC) is the leading cancer-related death in Puerto Rico (PR). Yet CRC screening (CRCS) rates remain low. We developed ¡Salud!, por la Vida, an educational intervention aiming to increase CRCS among age-eligible adults living in PR. Methods: We conducted a cluster randomized controlled trial among adults 50–75 years old at Federally Qualified Health Clinics in PR. Participants could not have a history of CRC nor be currently adherent to CRCS guidelines for a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (within last year) or colonoscopy (within last 5–10 years). Out of 445 randomized participants, 355 completed the study procedures (Control: 277; Intervention: 78) and were included in the main analysis. Participants in the intervention arm completed baseline and follow-up questionnaires alongside the educational intervention (at baseline) and two reminder calls (before follow-up) within a four-month period. Control arm participants only completed baseline and follow-up questionnaires within the same period. All participants were followed up to assess CRCS completion. Results: Post-trial screening rates were significantly higher in the intervention group: FOBT/FIT (55% vs. 39%, p = 0.02), colonoscopy (10% vs. 3%, p = 0.02), and any CRCS (60% vs. 41%, p < 0.01). Compared to controls, those in the intervention group showed a 48% higher probability of undergoing any CRCS (RR = 1.48, 95%CI: 1.17, 1.86), were 1.4 times more likely to complete a FOBT/FIT (RR = 1.40, 95%CI: 1.09, 1.80), and were over 3 times more likely to undergo a colonoscopy (RR = 3.16, 95%CI: 1.26, 7.91). Conclusions: The findings underscore the efficacy of the intervention in increasing CRCS uptake, potentially preventing late-stage detection and reducing CRC mortality in PR. Full article

Background: We investigated immunization status and preventive care among diabetes mellitus (DM) patients by stratifying them into clinically distinct risk clusters based on comorbidities, reflecting a personalized medicine approach. Methods: Using the Austrian health interview survey 2019, we identified four groups: cluster 1 (DM, arterial hypertension (aHTN), dyslipidemia; n = 215), cluster 2 (DM, aHTN, dyslipidemia, obesity class II; n = 33), cluster 3 (DM, aHTN, dyslipidemia, depression; n = 65), and a control cohort (DM without hyperlipidemia, hypertension, depression, or obesity class II; n = 214). The cohorts were compared by chi² tests. By logistic regression the association of the cluster-related variables and the vaccination status/preventive care variables were analyzed. Results: Significant differences in intact diphtheria immunization between the cohorts exist (cluster 1: 45.6%, cluster 2: 27.3%, cluster 3: 52.3%, control: 51.9%, p-value 0.047). Differences in intact tetanus (42.4% vs. 64%, p = 0.027) and diphtheria (27.3% vs. 51.9%, p = 0.013) immunization between cluster 2 and control cohort were investigated. Cluster 2 was negatively associated with tetanus (OR 0.83, p = 0.009) and diphtheria (OR 0.85, p = 0.018) immunization. Cluster 1 reports higher rates of fecal occult blood test (50.7% vs. 39.3%, p = 0.022) and cluster 2 reports a higher rate of colonoscopy (24.2% vs. 8.9%, p = 0.015) in comparison to the control cohort. Conclusions: A personalized medicine approach reveals that DM patients with specific comorbidity patterns, particularly those with hypertension, dyslipidemia, and obesity class II, have lower immunization rates—highlighting the need for targeted preventive strategies. Full article

Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. Despite its preventability through early screening, uptake remains suboptimal in many countries, including Saudi Arabia. This study aimed to assess adherence to CRC screening guidelines and identify barriers among the adult population in Saudi Arabia. Methods: A nationwide cross-sectional study was conducted using a self-administered online questionnaire targeting individuals aged ≥ 40 years across all Saudi regions. Data on demographic characteristics, knowledge, attitudes, screening practices, and perceived barriers were analyzed using SPSS v26, with significance set at p < 0.05. Results: Of the 573 eligible participants, only 12.7% had undergone colonoscopy and 19.5% reported having completed a fecal occult blood test (FOBT). The most frequently cited barriers were the absence of symptoms (49.9%), fear of the procedure (36.6%), and lack of knowledge (35.3%). Notably, 84.5% indicated they would undergo screening if recommended by a physician. Regional disparities were evident, with participants from the Southern region significantly more likely to undergo FOBT (OR = 8.97, p < 0.001). Awareness was generally low, with over half of the participants rating their CRC screening knowledge as 1 out of 10. Conclusions: This study revealed a concerningly low rate of colorectal cancer screening among adults in Saudi Arabia. Efforts to increase screening rates should prioritize raising awareness, correcting misconceptions, and encouraging non-invasive screening methods. Establishing a nationwide screening initiative could help close existing gaps and support earlier detection of colorectal cancer. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

Colorectal cancer (CRC) remains a major global health burden, necessitating continuous advancements in diagnostic methodologies. Traditional screening techniques, including barium enema and fecal occult blood tests, have been progressively replaced by more precise modalities, such as colonoscopy, liquid biopsy, and artificial intelligence (AI)-assisted imaging. Objective: This review explores the evolution of CRC diagnostic tools, from conventional imaging methods to cutting-edge AI-driven approaches, emphasizing their clinical utility, cost-effectiveness, and integration into multidisciplinary healthcare settings. Methods: A comprehensive literature search was conducted using the PubMed, Medline, and Scopus databases, selecting studies that evaluate various CRC diagnostic tools, including endoscopic advancements, liquid biopsy applications, and AI-assisted imaging techniques. Key inclusion criteria include studies on diagnostic accuracy, sensitivity, specificity, clinical outcomes, and economic feasibility. Results: AI-assisted colonoscopy has demonstrated superior adenoma detection rates (ADR), reduced interobserver variability, and enhanced real-time lesion classification, offering a cost-effective alternative to liquid biopsy, particularly in high-volume healthcare institutions. While liquid biopsy provides a non-invasive means of molecular profiling, it remains cost-intensive and requires frequent testing, making it more suitable for post-treatment surveillance and high-risk patient monitoring. Conclusions: The future of CRC diagnostics lies in a hybrid model, leveraging AI-assisted endoscopic precision with molecular insights from liquid biopsy. This integration is expected to revolutionize early detection, risk stratification, and personalized treatment approaches, ultimately improving patient outcomes and healthcare efficiency. Full article

Colorectal cancer (CRC) continues to be a primary contributor to the global health burden, and early detection is vital for optimal outcomes. Standard detection techniques, including colonoscopy and fecal occult blood tests, have been confirmed effective yet their invasiveness and poor sensitivity are a limitation. MicroRNA (miRNA) are now recognized as stable non-invasive biomarkers with differential expression in cancerous tissues, but reports have been heterogeneous and studied under different settings. This study, completed based on PRISMA guidelines, was a systematic review of miRNA signature diagnostic accuracy to detect early CRC. Case-case control studies, cross-sectional, and cohort research published between 2014–2024 were identified through the Scopus, PubMed, and Cochrane databases. We extracted diagnostic metrics such as sensitivity and specificity while assessing bias with the ROBINS-e tool and the Newcastle-Ottawa Scale. Meta-analyses showed that miRNA panels have high diagnostic accuracy with a pooled sensitivity of 1.84 (95% CI: 1.48–2.19) and a pooled specificity of 1.43 (95% CI: 1.01–1.85). The accuracy of miRNA-139-3p was the highest among all panels. Meta-regression did not reveal any significant confounders, while publication bias was not detected. These results highlight the miRNA panels’ potential as non-invasive biomarkers in early CRC detection, providing a promising alternative to conventional screening methods, with miRNA-139-3p as the most diagnostically accurate biomarker. Full article

Background/Objectives: Gut microbiota interacts with nutrients, which may be relevant to assigning a microbial signature to colorectal cancer (CRC). We aim to evaluate the potential of gut microbiota combined with dietary habits in the early detection of pathological findings related to CRC in the course of a screening program. Methodology: The colonoscopy performed on 152 subjects positive for fecal occult blood test showed that 6 subjects had adenocarcinoma, 123 had polyps, and 23 subjects had no pathological findings. Gut microbiota was analyzed by 16S metagenomic. Caret package was used to build the classification models in R. Results: Random forest (RF) classifier models were used to test the potential of gut microbiota alone or combined with dietary habits as a biomarker to discern between individuals with CRC-related lesions (polyps or adenocarcinoma) versus individuals without pathological findings. RF classifier models yielded an area under the curve of 0.790 using gut microbiota data, 0.710 using dietary habits data, and 0.804 in the combined model including gut microbiota and dietary habits data. The abundance of Suterella, Oscillospirales, Proteobacteria, and Burkholderiales was highly discriminant between groups, together with the consumption of fruit and vegetables and the consumption of carbonated and/or sweetened beverages. Conclusions: Our results suggest that the interaction between gut microbiota and dietary habits is relevant when a microbial signature is used as a marker in CRC. Moreover, gut microbiota signature and information about the dietary habits of the individuals seem to be important for improving screening programs for the early detection of CRC. Full article

Background: The aim of this study is to assess the impact of disability on participation in CRC screening and to determine the overall effect size. Methods: We conducted a systematic review and meta-analysis to compare CRC screening participation in individuals with and without disabilities. The search encompassed five databases (PubMed, EMBASE, Scopus, Google Scholar, medRxiv). Pooled estimates were calculated for each type of CRC screening and disability categories to synthesize the findings. The participation in CRC screening was derived using a random effects model. Results: A total of 20 articles were included, most of them from the USA. Based on pooled estimates, individuals with disabilities have lower odds of undergoing CRC screening versus those without disabilities (OR = 0.80, 95%CI 0.73–0.87). Analysis by screening type indicated that individuals with a disability have lower odds of a fecal occult blood test or a fecal immunochemical test (OR: 0.72, 95%CI 0.65–0.81), with no significant difference for a colonoscopy. Individuals with intellectual disabilities had significantly lower rates of CRC screening participation (OR = 0.65, 95%CI 0.53–0.79), especially for FOBT/FIT (OR = 0.58, 95%CI 0.49–0.69). Conclusions: Disparities exist for CRC screening participation in people with disabilities. Further research and coordinated efforts are essential to develop interventions for improving early cancer diagnosis for this non-negligible patient group. Full article