Publications by authors named "Robert J C Steele"

The requirement of large-scale expensive cancer screening trials spanning decades creates considerable barriers to the development, commercialisation, and implementation of novel screening tests. One way to address these problems is to use surrogate endpoints for the ultimate endpoint of interest, cancer mortality, at an earlier timepoint. This Review aims to highlight the issues underlying the choice and use of surrogate endpoints for cancer screening trials, to propose criteria for when and how we might use such endpoints, and to suggest possible candidates.

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  • The study aimed to improve colorectal cancer (CRC) detection by using risk scoring models (RSMs) alongside faecal immunochemical testing (FIT) in symptomatic patients, potentially reducing the need for endoscopies.
  • By analyzing data from nearly 19,000 patients, key factors such as faecal haemoglobin levels, age, sex, and iron deficiency were identified to create a risk score that improved sensitivity for detecting CRC compared to standard f-Hb thresholds.
  • The findings suggest that while RSMs may enhance detection in some cases, they did not significantly help patients with very low f-Hb levels, indicating a need for alternative strategies that incorporate additional risk factors beyond just FIT.
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  • Scientists are finding new ways to test for colorectal cancer that are easier and less invasive than traditional methods.
  • A group of experts updated the rules for how to evaluate these new tests to make sure they're effective.
  • The new tests should be compared to the existing reliable tests and go through several phases of research to ensure they're safe and useful in real-world situations.
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Introduction: Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions.

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  • Colorectal cancer (CRC) screening through faecal tests has reduced mortality rates, prompting a study to examine sex and age-related differences in mortality trends in Scotland from 1990 to 2020.
  • The analysis showed that while CRC mortality generally declined over this period, the rate of decline varied significantly between men and women, with men experiencing a more substantial decrease following the start of screening.
  • The findings suggest that screening programs had a more pronounced beneficial impact on men's CRC mortality and indicate the need for sex-specific thresholds in screening to promote equality in health outcomes.
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Objective: Colorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap.

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Background: Colorectal cancer (CRC) screening reduces all-cause and CRC-related mortality. New research demonstrates that the faecal haemoglobin concentration (f-Hb) may indicate the presence of other serious diseases not related to CRC. We investigated the association between f-Hb, measured by a faecal immunochemical test (FIT), and both all-cause mortality and cause of death in a population-wide cohort of screening participants.

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Background: The BeWEL randomised controlled trial (RCT) of weight loss in people with colorectal adenomas demonstrated that a significant proportion of people are interested in lifestyle interventions (49%) and clinically relevant changes in body weight were achieved at 12-month follow-up. The current work aimed to assess the feasibility of the BeWEL programme invitation and delivery in a nonresearch setting to assess whether the original results could be replicated.

Methods: The original BeWel programme was modified through the provision of verbal introductions (vs.

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  • * The use of a single f-Hb threshold in screening leads to lower detection rates and worse outcomes for women, including higher rates of interval cancer and CRC mortality.
  • * Implementing different f-Hb thresholds for men and women could improve screening equity, but this approach would require careful consideration of various factors and additional colonoscopy resources, highlighting the need for government support in resource allocation.
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Fecal hemoglobin (f-Hb) detected by the guaiac fecal occult blood test (gFOBT) may be associated with mortality and cause of death in colorectal cancer (CRC) screening participants. We investigated this association in a randomly selected population of 20,694 participants followed for 33 years. We followed participants from the start of the Hemoccult-II CRC trial in 1985-1986 until December 2018.

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Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter.

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Scotland has an organised colorectal cancer screening programme; however, despite proactively offering screening opportunities free to the at-risk population, and also despite using a screening test which may be completed at home, screening participation levels are unequal. Understanding causal pathways linking participation with other population characteristics may be aided by identifying how relationships between the two patterns vary across different localities, and such knowledge may also inform decisions regarding geographical targeting of screening promotion efforts. In this analysis, models calibrated using multiscale geographically weighted regression enabled the assessment of spatial variations of determinants of screening participation levels.

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Background: There is currently no existing evidence on the effects of personalised risk information on uptake of colonoscopy following first line screening for colorectal cancer. This study aimed to measure the impact of providing risk information based on faecal haemoglobin concentration to allow a fully informed choice around whether or not to undergo colonoscopy.

Methods: Two thousand seven hundred sixty-seven participants from the Scottish Bowel Screening Programme (SBoSP) database, who had not recently been invited for screening, were randomised to receive one of three types of hypothetical risk information materials: (1) numerical risk information (risk categories of one in 40, one in 1600 and one in 3500), (2) categorical risk information (highest, moderate and lowest risk), or (3) positive screening result letter (control group).

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  • Lower gastrointestinal symptoms are not very effective in predicting colorectal cancer (CRC), so this study evaluated how well faecal haemoglobin (f-Hb) levels predict CRC during colonoscopy for symptomatic patients.
  • The study involved 4,841 patients in three Scottish NHS Boards, finding that only 0.6% of those with low f-Hb (<10 µg/g) were diagnosed with CRC, compared to 9.4% of those with f-Hb ≥10 µg/g and 22.4% with f-Hb ≥400 µg/g.
  • The results suggest that patients with f-Hb ≥10 µg/g should be further investigated for CRC, while those with f-Hb <10 µ
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Aims: The presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal blood loss. This effect is independent of taking medicines that increase the risk of bleeding. To further investigate the association of f-Hb with chronic disease, the relationship between f-Hb and prescription of medicines for a variety of conditions was studied.

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  • Faecal immunochemical tests for haemoglobin (FIT) are essential for colorectal cancer screening, guiding follow-up investigations based on faecal haemoglobin concentration (f-Hb) thresholds.
  • A study analyzed f-Hb distributions among 887,248 screening participants in Scotland, revealing variations based on sex, age, deprivation levels, and geographical region.
  • Findings indicated that f-Hb is consistently higher in men, increases with age and deprivation, and suggests the need for tailored investigation thresholds, contrasting with previous evaluations from other countries.
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  • The study evaluated the accuracy of faecal immunochemical tests (FIT) in detecting colorectal cancer (CRC) in high-risk patients undergoing surveillance colonoscopy.
  • Out of 1103 patients invited, 639 completed the test, and some were found to have advanced neoplasia, revealing a significant correlation between detectable faecal haemoglobin (f-Hb) and the presence of neoplasia.
  • The findings suggest that measuring f-Hb can effectively indicate risk levels for advanced neoplasia, potentially allowing for more personalized scheduling of colonoscopies in high-risk individuals.
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Background: In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories.

Methods: We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal ('colorectal-specific non-participants'); (3) participated in none.

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  • Many primary care patients have lower bowel symptoms, but serious bowel diseases like colorectal cancer and inflammatory bowel disease are rare; fecal immunochemical tests (FIT) help identify those who should get further colonoscopic evaluation.
  • This study looked at data from a Scottish NHS Board to see if the FAST score, which includes fecal hemoglobin, age, and sex, improves decision-making for colonoscopy referrals based on FIT results from nearly 5,700 specimens collected in the first year.
  • Results showed that while a significant number of patients with serious bowel disease had high fecal hemoglobin levels, using the FAST score could reduce referrals but risked missing some cases, highlighting a balance needed between sensitivity and practicality in screening.
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Background: We investigated demographic and clinical predictors of lower participation in bowel screening relative to breast and cervical screening.

Methods: Data linkage study of routinely collected clinical data from 430,591 women registered with general practices in the Greater Glasgow & Clyde Health Board. Participation in the screening programmes was measured by attendance at breast or cervical screening or the return of a bowel screening kit.

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  • A study aimed to see if a faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) can be safely used in primary care to rule out serious bowel diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD).
  • The research involved 5422 patients who submitted FIT samples, revealing a positivity rate of 21.9%, with 20.5% of those completing a colonoscopy having significant bowel disease.
  • The findings suggest that f-Hb testing, alongside clinical evaluation, is an effective way to assess patients' risk for serious bowel diseases in a primary care setting.
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Background: In Scotland a new, easier to complete bowel screening test, the Faecal Immunochemical Test (FIT), has been introduced. This test gives more accurate information about an individual's risk of having colorectal cancer (CRC), based on their age and gender, and could lead to fewer missed cancers compared to the current screening test. However, there is no evidence of the effect on colonoscopy uptake of providing individuals with personalised risk information following a positive FIT test.

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Background: Previous studies indicate that visual size estimation (in situ) of polyp size tends to differ from postfixation measurements, which effects allocation to surveillance intervals. Little is known about interobserver variation of in-situ measurements of large polyps. The primary objective was to assess interobserver variation of in situ measurements of large colorectal polyps.

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