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Prevention in Primary care with a focus on colorectal cancer screening
Král, Norbert ; Seifert, Bohumil (advisor) ; Lukáš, Milan (referee) ; Matějovská Kubešová, Hana (referee)
Prevention in Primary care with a focus on colorectal cancer screening Introduction: Preventive examinations and screening methods are an integral part of the work of a general practitioner. Primarily are focused on cardiometabolic and oncological diseases that share risk factors. The aim of this study was to evaluate the system of preventive examinations and screening programs for CRCa, and to propose modifications to preventive examinations-with regard to cardiometabolic diseases-that would be in line with current scientific knowledge. Furthermore, to determine the attitude of the Czech population towards preventive examinations and screenings for CRCa, and to analyse the current situation of CRCa screening and identify its major shortcomings. Materials and Methods: The thesis consists of a set of studies. The studies were aimed at the general population, general practitioners, and other primary care professionals. The research took the form of questionnaire surveys distributed among physicians and patients. The Rand/UCLA consensus method, which combines the best available scientific evidence with the collective judgement of a group of experts, was chosen in the search for an appropriate model of preventive examinations. Results: Selective prevention is an effective tool in the prevention of...
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Social Inequalities in Colorectal Cancer Screening (Non-)Attendance in Europe
Vančíková, Sabína ; Kulhánová, Ivana (advisor) ; Ngo, Ondřej (referee)
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide, responsible for nearly a million deaths yearly. Due to its slow progression, there is a unique window of opportunity to detect (and remove) the precancerous lesions or early stages of tumors and reduce CRC incidence and mortality. Regularly repeated fecal occult blood tests for 50-74 years old individuals and a follow-up colonoscopy in case of a positive result is a recommended screening strategy in the European Union. However, each country plans its own CRC screening program, population-based or opportunistic, and the attendance rates vary across Europe. This diploma thesis aimed to characterize the main sociodemographic barriers to CRC screening attendance in Europe, utilizing comparable data from an international cross-sectional health survey EHIS wave 3. To understand the background, lifelong CRC screening non-attendance rates were calculated for each country. Social inequalities were studied on both levels - in the population of the entire Europe and the individual countries. Various socioeconomic and lifestyle factors were used in the analyses as potential predictors of CRC screening attendance behavior. Social inequalities in CRC screening non-attendance persist across Europe. The age- standardized...
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Pathophysiology of colorectal cancer. Colorectal cancer screening effect and the role of microRNA in pathophysiology of colorectal cancer.
Král, Jan ; Špičák, Julius (advisor) ; Keil, Radan (referee) ; Mohelníková Duchoňová, Beatrice (referee)
Colorectal cancer is a serious malignant disease with an incidence of over 1.8 million new cases per year worldwide. There are about 8 000 patients diagnosed with CRC in the Czech Republic each year, and about half of them present with an advanced disease. Screening program identifies patients in the early stages of CRC resulting in overall better prognosis and survival. There is also a lack of biomarkers of early CRC detection and of response to treatment. The first aim of our project was to conduct a national multicentre prospective observational study to evaluate the impact of CRC screening within the framework of a Czech population screening programme. Between March 2013 and September 2015, a total of 265 patients were enrolled in 12 centres across the Czech Republic. Patients were divided into screening and control groups and compared for pathology status and clinical characteristics. Screening was defined as a primary screening colonoscopy or a colonoscopy after a positive FOBT in an average-risk population. The distribution of CRC stages was significantly favourable in the screening group compared with the control group (stages 0, I and II, 63% versus 43.3%; p <0.001). The presence of distant (M1) and local metastases (N1 and N2) was significantly less prevalent in the screening group (0%,...
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The role of preventive colonoscopy in the detection of colorectal neoplasia.
Vojtěchová, Gabriela ; Zavoral, Miroslav (advisor) ; Rejchrt, Stanislav (referee) ; Falt, Přemysl (referee)
Colonoscopy is used in colorectal cancer (CRC) screening either as an independent screening method (screening colonoscopy) or following a positive result of a primary screening test (eg. fecal occult blood test, FOBT). Preventive colonoscopy is the collective name for screening and FOBT+ colonoscopy. Due to the considerable variability in the detection of colorectal neoplasia between individual endoscopists, colonoscopy quality indicators were introduced. Adenoma detection rate (ADR) and polyp detection rate (PDR) are defined as the proportion of colonoscopies in which at least one adenoma (for ADR) or polyp (for PDR) was detected to the total number of colonoscopies performed. ADR is considered a key indicator of the quality of colonoscopy. Adenoma per colonoscopy (APC), defined as the total number of adenomas detected relative to the total number of colonoscopies performed, is the most accurate indicator currently available. However, APC limit values have not yet been set. Both ADR and APC are validated indicators, but their evaluation is time-consuming and personnel-intensive, which limits their use in clinical practice. The main purpose of the presented work is to simplify the monitoring of colonoscopy quality by introducing a more user-friendly indicator, which does not require histological...
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