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Prompt follow-up colonoscopy vital regardless of FIT source
A prompt colonoscopy should be provided to all patients with positive faecal immunochemical test (FIT) results, regardless of whether the test was offered through the National Bowel Cancer Screening Program (NBCSP) or via a community-based source, according to research published by the MJA. Dr Simon Whitcher, a surgical registrar at John Hunter Hospital, working with academics from the University of Newcastle, analysed data from the Newcastle Direct Access Colonoscopy Service for the period 2014–18 to investigate whether colonoscopy services should provide endoscopies to patients with positive FIT results with the same priority, regardless of whether the test was instigated by the NBCSP. There were 2365 complete screening colonoscopy outcomes analysed: 1233 following community-initiated and 1132 following NBCSP testing. “Colonoscopy quality was high: the completion rate … was 97.1% (community-initiated, 1193 of 1233, 96.8%; NBCSP, 1104 of 1132, 97.5%), and the adenoma detection rate was 49%, exceeding international benchmarks for either symptomatic or screening patients,” the researchers found. “The rate of colorectal neoplasia (malignant or pre-malignant) was similar in the two groups. Importantly, the difference in the rates of adenocarcinoma was not statistically significant (community-initiated, 4.0%; NBCSP, 2.7%).” Whitcher and colleagues concluded that “evaluation should be performed equally promptly for patients with positive results from NBSCP and community-initiated FITs”. “The incidence and detection rates of colorectal neoplasia in people aged 50–74 years were similar for people with positive results for NBCSP or community-initiated FITs.”
New rheumatic heart disease guidelines put culture at centre of care
New medical guidelines released by RHDAustralia place people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and their families and communities at the centre of care. RHD represents the greatest cardiovascular inequality between Indigenous and non-Indigenous Australians. From 2013 to 2017, 94% of all new RHD cases were among Aboriginal and Torres Strait Islander people. The new 2020 Australian guideline for prevention, diagnosis and management of ARF and RHD (3rd edition) recognises this disparity and highlights the need for health professionals to place people at the centre of care. Vicki Wade, a respected Noongar woman with more than 30 years of experience working in cardiovascular health and RHDAustralia’s senior cultural advisor, was central in ensuring the new guideline addresses RHD as the leading cause of cardiovascular inequality and provides health professionals with a more holistic model of care. “By refocusing on people with this disease, this guideline acknowledges Aboriginal and Torres Strait Islander peoples’ unique culture, and the social, economic and environmental circumstances in which they live,” said Ms Wade. “The updated guideline identifies the systemic factors that drive disparities in best practice care delivery and offers culturally safe solutions. We have come a long way from the first edition, and this journey has culminated in an important balance between cultural and clinical competence.” Ms Wade says the new guideline features case studies and the lived experiences of patients with ARF and RHD to encourage clinicians to look beyond the biomedical context when delivering evidence-based care.
Bacterial infection linked to colorectal cancer
A distinct mutational signature in colorectal cancer linked to bacterial infection is identified in a research published in Nature. This signature may be directly traced to past exposure to a specific strain of Escherichia coli. Various species of intestinal bacteria have been associated with the development of colorectal cancer, yet a direct role of bacteria in the occurrence of cancerous mutations has not been established. Some strains of E. coli carry a cluster of genes that produce colibactin, a toxic substance that damages DNA. To define whether these strains (termed pks+ E. coli) induce specific mutations, Hans Clevers and colleagues at the Netherlands’ Hubrecht Institute exposed human intestinal organoids to the bacteria. They repeatedly injected pks+ E. coli into the organoids over a period of 5 months. The authors conducted whole-genome sequencing of the organoids before and after the injections and identified a distinct mutational signature that was absent from organoids injected with a control E. coli strain that cannot produce active colibactin. They then found the same mutational signature in a subset of 5876 human cancer genomes — mostly genomes of colorectal cancer — from two independent cohorts. The authors concluded that their data suggest a discrete mutational signature in colorectal cancer and imply that the underlying mutational process directly results from past exposure to pks+ E. coli. They note that pks+ E. coli is present in around 20% of healthy individuals and that removing the strains could decrease the risk of developing colorectal cancer in some people, although further research is needed to confirm these findings.
What’s new online at the MJA
Podcast: Penelope Strauss, youth mental health researcher at Telethon Kids Institute, and Emery Wishart, Services Manager at Transfolk of WA, talk about misgendering structural stigma and the harms they do to the health of trans and gender diverse Australians … OPEN ACCESS permanently
Research: The dispensing of psychotropic medicines to older people before and after they enter residential aged care
Harrison et al; doi: 10.5694/mja2.50501
Psychotropic dispensing rates for older Australians are generally high, but increase markedly when they enter residential care … OPEN ACCESS permanently
Podcast: Associate Professor Craig Whitehead, geriatrician and Regional Director of Rehabilitation and Aged Care, Southern Adelaide Local Health Network, talking about psychotropic use in aged care … OPEN ACCESS permanently
Research: Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation
Nedkoff et al; doi: 10.5694/mja2.50496
Strategies for providing evidence-based therapies and cardiovascular prevention must be improved … OPEN ACCESS permanently
Research letter: Comparison of colonic neoplasia detection rates in patients screened inside and outside the National Bowel Cancer Screening Program
Whitcher et al; doi: 10.5694/mja2.50508
Endoscopy should be provided to all patients with positive FIT results, regardless of test origin … OPEN ACCESS permanently
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The fires close to us had been extinguished months previously. Then while swimming in our family pool I picked up one of the kid’s blow up floating rings. Underneath was a thick black ring. The pool was clear though, or maybe we just couldn’t see what is floating on the surface of the pool that has fallen from the sky. Perhaps the air quality is not as good as we think. Even though the smoke has long cleared and we can no long see the pollution, clearly it is possible that there is a residue in the air and that we need to know how to manage our health in these conditions. It seems that there is a need for better public health advice about our air quality and the need for government action to better manage the situation.