How Effective Is Colorectal Cancer Screening in detecting and treating colon cancer on women aged between 55 and 65 years old?

This essay report explores the effectiveness of colorectal cancer screening in detecting and treating colon cancer in women aged between 55 and 65 years old. It covers background information, methodology, critical appraisal of selected sources, and recommendations.

Research Methods and
Critical Appraisal
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Contents
TITLE: How Effective Is Colorectal Cancer Screening in detecting and treating colon cancer on
women aged between 55 and 65 years old?.....................................................................................3
INTRODUCTION...........................................................................................................................3
1. BACKGROUND.........................................................................................................................3
2. METHODOLOGY......................................................................................................................4
3. CRITICAL APPRAISAL............................................................................................................6
4. DISCUSSION AND RECOMMENDATIONS..........................................................................9
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11
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TITLE: How Effective Is Colorectal Cancer Screening in detecting and treating
colon cancer on women aged between 55 and 65 years old?
INTRODUCTION
Critical appraisal is referred as the course of action for systematically examining investigation to
assess its relevance, value and reliability to direct professionals in significant clinical decision
making. Colorectal cancer is a type of cancer that is developed from rectum or colon. It includes
abnormal cells growth that have ability to spread in other parts of body (LoBiondo-Wood and
Haber, 2017). This is an essay report which is based on the topic “How Effective Is Colorectal
Cancer Screening in detecting and treating colon cancer in women aged between 55 and 65 years
old?” This report covers background of the topic which includes summary about significance of
the topic area and some key areas associated with it. It also covers a methodology part in which
peacock framework is discussed and used and information about the selected sources or articles
are included. Apart from this, critical appraisal of the three selected sources is done which covers
in findings of study and its strengths and limitations. At last, discussion of the overall review and
recommendations are provided along with the brief conclusion.
1. BACKGROUND
The chosen public health topic for this essay is effectiveness of colorectal cancer screening in
treating colon cancer in women who is aged between 55 to 65 years. Colorectal cancer is defined
as a malignant tumour which is arising from inner wall of the rectum or large intestine. The main
reason behind selecting this study area is that it is one of the main cause of cancer in both men as
well as women which leads them towards mortality (Shea and et. al., 2017). The screening of
colorectal cancer can help in preventing the development of cancer or diagnose disease at early
stage when it can be cured effectively. However, the available methods of screening of colorectal
cancer are underutilized. The common risk factors associated with rectal cancer includes family
history, increasing age, long standing ulcerative colitis and colon polyps. Most of the cancers
generate from polyps and removal of these polyps can help in prevention of colon cancer. Early
cancer and calling polyps may have no early symptoms or signs specific to cancer. Thus,
screening of colorectal cancer at regular basis is crucial. This type of cancer can be diagnosed by
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colonoscopy or by sigmoidoscopy with biopsy confirmation of the tissue which is cancerous
(Quick and Hall 2015).
The treatment of disease is relying on size, location and the degree to which cancer is spread
along with health of the patient. In order to treat the colorectal cancer, surgery is the common
treatment. For doing literature review, the chosen public health area is important as it will help in
determining the effectiveness of colorectal cancer screening for treating the cancer in women.
Surgery alone is enough to treat the early stage cancer. Apart from this chemotherapy can extend
and improve the life quality who have metastatic colorectal cancer. It can also decline the risk of
recurrence. The genetic background of a person is significant factor in risk of colon cancer. For
carcinoma and advanced changes, adenoma size is most important predictor. The study
conducted on fecal occult blood testing and sigmoidoscopic polypectomy have depicted the
effectiveness of colorectal cancer screening by detecting lesions at early stage and declining
colorectal cancer mortality (Taylor and Hignett, 2014).
Optical colonoscopy is also a screening test that helps in reducing colon cancer. It is considered
as a gold standard entire structural colonic examination, which permitting direct inspection of
diagnostic biopsy, colonic mucosa and therapeutic polypectomy. However, from the study it has
been found that Computed Tomographic Colonography could reduce the colorectal cancer
mortality. It is a minimally invasive, cross sectional imaging examination or testing which
permits entire structure assessment of column in virtually. Computed tomographic colonography
overall structural colonic assessment or examination to patients unable to undergo optical
colonoscopy, average risk asymptomatic screening population, patients with incomplete optical
colonoscopy and patients with obstructing neoplasm. The provided article named as 'Computed
Tomography Colonography (CTC): the future of colon cancer screening' discuss about the
advantage of CTC over double contrast barium enema and optical colonoscopy. By reviewing
the article, it has been found that computed tomographic colonography would see as the next best
choice (Pluye, 2015).
2. METHODOLOGY
Literature review is defined as a review of scholarly articles, books and journals associated with
the specific topic or the question of research. It is a scholarly paper that shows current
Knowledge involving substantive findings, methodological and theoretical contributions to a
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specific topic. The main purpose of conducting literature review on the topic “How Effective Is
Colorectal Cancer Screening in detecting and treating colon cancer in women aged between 55
and 65 years old?” is to render foundation of knowledge on it. It also helps in finding
inconsistencies and gaps in research and the need of additional research on the topic (Cook and
Reed, 2015).
For addressing the research question, PICO framework is utilizing which is a tool that is use
in evidence based clinical practice. In relation to this research, the PICO framework is mentioned
below:
Population Women aged between 55 and 65 years old
Intervention Colorectal cancer screening
Comparison Comparison with other test like optical colonoscopy
Outcome Reduction in mortality rate
For gathering information on the research question, the article 'Computed Tomography
Colonography (CTC): the future of colon cancer screening' is utilize. At the time of searching the
content, a particular search strategy is used to find out the content on the topic. Keywords are
used to search articles, books and journals on the topic. Boolean search strategy is also used in
this research that allow researcher to combine the keywords with operators like NOT, OR, AND
in order to the development of relevant results (Nuckols and, 2014).
The Boolean operations like AND and OR are used by searching the content on the topic. This
help in limiting the search outcomes to only those documents containing keywords. Use of
Boolean operators helps in getting more productive and focused results and also helps in saving
time as well as efforts through eliminating hits which are not appropriate and should be scanned
before discarding. Instead of writing the complete topic at the time of searching content,
keywords used in research which makes it easy to search the topic in less time. Many books and
articles are searched among which 6 articles are selected to review and collect the information on
the topic (Johansen and Thomsen, 2016).
There are six articles selected in this research which are relevant to the question of research.
These articles include: Article 1: Prognostic Impact of Tumor Location in Colon Cancer: The
Monitoring of Cancer Incidence in Japan (MCIJ) Project. Article 2: Computed Tomography
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Colonography: The Future of Colon Cancer Screening. Article 3: Opportunities for Reducing
Emergency Diagnosis of Colon Cancer in Women and Men: A Data Linkage Study On Pre
Diagnostic Symptomatic Presentations and Benign Diagnosis. Article 4: Testing to Prevent
Colon Cancer: Results from A Rural Community Intervention. Article 5: Use of Colonoscopy to
Screen Asymptomatic Adults for Colorectal Cancer. Article 6: Colorectal Cancer Screening
Pilot Program for Underserved Women in Cumberland County, Maine.
Among these six articles, thee three main articles for further reviewing the topic includes article
2, 4 and 5 are utilize. For getting effective results, keywords search strategy is appropriate
(Sheehan and Perry, 2015). However, sometimes it is not much effective as resist researcher to
gain detailed information regarding other areas associated with the topic. In order to maintain
authenticity of data, authentic sources, articles and journals are used in the literature review. The
data which is older than 10 years is not included in the essay. Apart from this, the designed study
is qualitative in nature.
There are some ethical issues that requires to be considered by literature reviewer. These issues
include ambiguity in decision making, conflicting values, privacy and confidentiality of data,
informed consent of participants, anonymity etc. At the time of conducting research, informed
consent is one of the big ethical issue. Taking informed consent of patient help in protecting their
right to autonomy. It is necessary for the researcher to ensure that a person voluntarily and
knowingly gives his consent to participate. Confidentiality and anonymity is the another issue
that is proximally connected with the rights of fidelity, beneficence and respect for dignity
(Wakeam and Hyder, 2015). When the Identity of subject cannot be related with personal
responses, anonymity is protected. this issue also needs to take into consideration while
performing research. Apart from this, ensuring that the information cannot be accessed by
anyone, but the researcher is also necessary.
3. CRITICAL APPRAISAL
Critical appraisal is referred as the process of systematically and carefully assessing the results of
a scientific study in order to judge its relevance, value as well as trustworthiness in a specific
context. It is a systematic procedure which is utilised to determine the strength and weaknesses
of article to assess the validity and usefulness of findings of research (Gray, Grove and
Sutherland 2016). It allows researcher to emphasize on articles which are relevant to the question
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of research and that can support reliability its claims with evidence of high quality. For critically
appraise the research paper, its validity is assessing along with its usefulness and clinical
applicability. The most relevant papers are identified and evidence are distinguishing from
assumptions, misreporting, opinion and belief (Barton and Peat, 2014).
Article 3: Opportunities for Reducing Emergency Diagnosis of Colon Cancer in Women and
Men: A Data Linkage Study On Pre Diagnostic Symptomatic Presentations and Benign
Diagnosis
The aim of this research is to determine opportunities for reducing emergency colon
cancer diagnosis, evaluated symptoms and benign diagnoses recorded before emergency
presentations. It was a kind of cohort study and the study was conducted on patients with an
incident colon cancer who diagnosed in England in year 2005 to 2010. around 6.9 % of the
population of United Kingdom is covered by clinical practice research data link and involved
patients are considered as the representative of general population of United Kingdom. The
patients with 18 years of age or more at cancer diagnosis and having one year of primary care
records prior to the diagnosis of cancer. For getting the data on topic, previous work done on
topic is considered. This study intent to take past work further and develop an understanding on
the causes for high risk of emergency presentations in women so as to determine possible
opportunities for early diagnosis in women (Trainor and Leavey, 2016). For this, consultation
patterns, benign diagnosis recorded before the diagnosis of colon cancer, symptoms, comparing
non-emergency and emergency presented by gender, and taking cancer sub sites in account. The
main explanatory variables that were used in research are signs and symptoms recorded before
the diagnosis of cancer. The analysis emphasizes on primary care records that are referring to pre
diagnostic year, but up to 5 years’ records of the diagnosis were utilised to examine the
frequency of consultations of GP overtime. Apart from this Poisson regression was utilised in
study to examine changes in consultation rates and for the examining the risk of emergency
presentations, mixed effects multivariable logistic regression was utilised. There are some
limitations of the study including that it does not reflect symptom and benign diagnosis
prevalence in the general population. The study will have required to be extended to more recent
years. It has been found from the study that women have high risk of EP, because of less specific
symptoms as well as more frequent attribution to diagnosis of benign. Around one fifth of the
women had alarm symptoms that offering opportunities for early diagnosis.
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Article 4: Testing to Prevent Colon Cancer: Results from A Rural Community Intervention
The purpose of this investigation was to develop and test a community-based
participatory approach to maximize colon cancer screening. For conducting this research
community based participatory research approach, Community Advisory Council and High
Plains Research Network established a multicomponent intervention, i.e., Testing to Prevent
Colon Cancer in order to maximize colon cancer screening. 9 intervention nations in northeast
Colorado along with 7 control nations in southeast Colorado are compared by a controlled trial.
Baseline as well as post intervention random digit dial telephone survey was performed. The
analysis in paper were based on around 1050 surveys which was completed at baseline and 1048
were completed at follow up. The follow up and baseline samples were same except few minor
differences (Pluye and Hong, 2014). The community based participatory approach in research to
develop and disseminate prevention message of colon cancer engaged many rural community
members in multicomponent motivational and educational campaign. In the intervention reason,
around 5% maximization in screening was seen as compared with control reason. Although, the
increase in screening in intervention region was more in comparison to control region, the
differentiation was not significant statistically. It has been found from research that the
community-based multicomponent intervention involved many members of community invite
dissemination which emphasized at maximizing colorectal cancer screening. Though, any
significant differences were not found, the outcomes are consistent with an intervention related
maximization in the screening and administer preliminary evidence on efficiency and
effectiveness of such interventions to enhance the screening of colon cancer.
Article 5: Use of Colonoscopy to Screen Asymptomatic Adults for Colorectal Cancer
The aim of this study is to analyze the use of colonoscopy to screen asymptomatic adults
for colorectal cancer. A colonoscopy is performed at 13 veterans affairs medical centres in order
to identify the prevalence as well as location of advanced colonic neoplasm along with the
advanced proximal neoplasm risk in asymptomatic patients with or without distal neoplasia. This
study was performed to determine the risk components for neoplastic lesions with diameter of 10
millimetre or more in asymptomatic patients who are aged between 50 and 75 years. the main
purpose of the study was to identify the location and prevalence of colonic neoplasia in
asymptomatic patients (Peyvandi Oldenburg and Friedman, 2016) The protocol of study was
approved true Central Human Rights committee and through corresponding committee. Informed
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consent was taken from the respondents to completed questionnaires that includes physical
activity, family history of cancer, diet and drug use. In order to evaluate the coagulation,
laboratory studies were ordered and physical examination was conducted. all the statistical
analysis and database Management were conducted with SAS software. For the enrolment in
study, total 17732 patients or persons were screened and 3196 eligible persons were enrolled.
The patients were recruited through random selection from the list of clinic. As a primary
screening, use of colonoscopy was evaluated in large population of asymptomatic adults. It has
been found from the study that colonoscopy screening can help in detecting advanced colonic
neoplasms. Many of these will not be detected with sigmoidoscopy.
4. DISCUSSION AND RECOMMENDATIONS
From the above discuss review of three articles, it has been found that women's have high
risk of colon cancer due to less specific symptoms. One fifth of the females have alarm
symptoms that provides opportunities for the diagnosis in early stage. It has also been found that
the study should be expanded to more recent years so that more accurate data can be gathered in
the study and effective results can be presented (Gray, Grove and Sutherland 2016). No
significant differentiation in maximization of screening was found from the study intervention
region and control region. The community based multicomponent intervention utilised in the
research held in involving many community members by dissemination of message. The
utilisation of colonoscopy in order to screen asymptomatic adults for colorectal cancer was
effective. It can help in detecting the advanced colonic neoplasm which was not detected with
sigmoidoscopy. It has been found from the review of article that colorectal cancers are slow
growing cancers which take around a year to develop. Around 39% of patients who suffer from
colon and rectum cancer are diagnosed at local phase before it has flood outside. Early detection
is the effective prevention for colorectal cancer. The elimination of precancerous colorectal
polyps is also the effective prevention way of cancer. Screening is appropriately executed only to
the utilisation of testing to see for cancer evidence or precancerous polyps in asymptomatic
patients. Distinct types of screening tests are identified from the review including occult blood
testing, colonoscopy, sigmoidoscopy etc. It is recommended that the screening should be initiate
at the age of 50 years for average risk adults (Peyvandi Oldenburg and Friedman, 2016).
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CONCLUSION
As per the above mentioned report, it has been concluded that the colorectal cancer initiates
when the procedure of normal substitution of cells colon lining goes awry. Colorectal cancer is
one of the most common cause of cancer among both women and men. By screening
asymptomatic patients at average risk, it is evidence that the mortality rate from colorectal cancer
can be decline. Colonoscopy is reserved for the persons with positive outcomes of screening for
those people with higher than average colorectal cancer risk. The combination of prevention and
enhance survival of Cancer by early detection administers strong national for promoting the
screening nationwide.
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REFERENCES
Books and Journals
Barton, B. and Peat, J., 2014. Medical statistics: A guide to SPSS, data analysis and critical
appraisal. John Wiley & Sons.
Cook, D.A. and Reed, D.A., 2015. Appraising the quality of medical education research
methods: the medical education research study quality instrument and the Newcastle–
Ottawa scale-education. Academic Medicine, 90(8), pp.1067-1076.
Gray, J.R., Grove, S.K. and Sutherland, S., 2016. Burns and Grove's The Practice of Nursing
Research-E-Book: Appraisal, Synthesis, and Generation of Evidence. Elsevier Health
Sciences.
Johansen, M. and Thomsen, S.F., 2016. Guidelines for reporting medical research: a critical
appraisal. International scholarly research notices, 2016.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing research-E-book: methods and critical
appraisal for evidence-based practice. Elsevier Health Sciences.
Nuckols, T.K., and et. al, 2014. Opioid prescribing: a systematic review and critical appraisal of
guidelines for chronic pain. Annals of internal medicine, 160(1), pp.38-47.
Peyvandi, F., Oldenburg, J. and Friedman, K.D., 2016. A critical appraisal of one‐stage and
chromogenic assays of factor VIII activity. Journal of Thrombosis and
Haemostasis, 14(2), pp.248-261.
Pluye, P. and Hong, Q.N., 2014. Combining the power of stories and the power of numbers:
mixed methods research and mixed studies reviews. Annual review of public health, 35,
pp.29-45.
Pluye, P., 2015. Mixed kinds of evidence: synthesis designs and critical appraisal for systematic
mixed studies reviews including qualitative, quantitative and mixed methods studies.
Quick, J. and Hall, S., 2015. Part two: Qualitative research. Journal of perioperative
practice, 25(7-8), pp.129-133.
Shea, B.J., and et. al., 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that
include randomised or non-randomised studies of healthcare interventions, or
both. bmj, 358, p.j4008.
Sheehan, P.W. and Perry, C.W., 2015. Methodologies of hypnosis (psychology revivals): A
critical appraisal of contemporary paradigms of hypnosis. Routledge.
Taylor, E. and Hignett, S., 2014. Evaluating evidence: defining levels and quality using critical
appraisal mixed methods tools. HERD: Health Environments Research & Design
Journal, 7(3), pp.144-151.
Trainor, K. and Leavey, G., 2016. Barriers and facilitators to smoking cessation among people
with severe mental illness: A critical appraisal of qualitative studies. Nicotine & Tobacco
Research, 19(1), pp.14-23.
Wakeam, E. and Hyder, J.A., 2015. Raising the bar for failure to rescue: critical appraisal of
current measurement and strategies to catalyze improvement. JAMA surgery, 150(11),
pp.1023-1024.
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