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Background and study aims: Increasing colonoscopy withdrawal time (CWT) is thought to be associated with increasing adenoma detection rate (ADR). Current English guidelines recommend a minimum CWT of 6 minutes. It is known that in the Bowel Cancer Screening Programme (BCSP) in England there is wide variation in CWT. The aim of this observational study was to examine the relationship between CWT and ADR. Patients and methods: The study examined data from 31 088 colonoscopies by 147 screening program colonoscopists. Colonoscopists were grouped in four levels of mean CWT (<7, 7-8.9, 9-10.9, and⩾11 minutes). Univariable andmultivariable analysis (binary logistic and negative binomial regression) were used to explore the relationship between CWT, ADR, mean number of adenomas and number of right-sided and advanced adenomas. Results: In colonoscopists with a mean CWT<7 minutes, the mean ADR was 42.5% compared with 47.1% in the⩾11-minute group (P<0.001). The mean number of adenomas detected per procedure increased from 0.77 to 0.94, respectively (P<0.001). The increase in adenoma detection was mainly of subcentimeter or proximal adenomas; there was no increase in the detection of advanced adenomas. Regression models showed an increase in ADR from 43% to 46.5% for mean CWT times ranging from 6 to 10 minutes. Conclusions: This study demonstrates that longer mean withdrawal times are associated with increasing adenoma detection, mainly of small or right-sided adenomas. However, beyond 10 minutes the increase in ADR is minimal. Mean withdrawal times longer than 6 minutes are not associated with increased detection of advanced adenomas. Withdrawal time remains an important quality metric of colonoscopy. [ABSTRACT FROM AUTHOR]

The incidence, survival patterns, and presenting symptoms of children with medulloblastoma were studied. Data were ascertained from the Manchester Tumour Registry which is population-based and has collected data on all childhood malignancies in northwest England since 1954. Incidence rates standardized to the European standard population were calculated and Poisson regression models were used to examine temporal changes in the incidence rates during the period 1954 to 1997. Kaplan-Meier survival curves were derived and used to study changes in survival patterns. World-standardized incidence rates were 5.5 per million child years in males and 3.4 per million child years in females. Incidence rates increased from the 1950s to the 1980s but have declined recently. The 5-year survival rate has improved from 29 to 58% with similar rates for males and females. The 1-year survival rate has also improved, but females had worse survival at this point (58%) than males (75%). The type of symptom or sign at presentation is strongly affected by age, with 10 of the 22 recorded symptoms or signs showing significant age differences. The older the child is, the more likely is the presentation to show pressure features of headache, vomiting, and ophthalmic signs. Younger children present with non-specific features such as lethargy, behavioural disturbance, or increasing head size. Ataxia is seen in about 75% of children across the age range. [ABSTRACT FROM AUTHOR]

The age-sex distributions and temporal trends in incidence of leukaemia and lymphoma from the Manchester Children's Tumour Registry (MCTR), 1954-1998, are reported. This 45-year study includes 1795 children, all of whom had a histologically and/or cytologically verified leukaemia or lymphoma. At the time of their diagnoses all the children were under 15 years of age and were resident in a geographically defined area of northwest England covered by the MCTR. Log-linear modelling identified significant linear increases in acute lymphoblastic leukaemia (ALL) (average annual increase 0.7%; P= 0.005) and in Hodgkin's disease (HD) (1.2%, P=0.04), but not in acute myeloid leukaemia (AML), nor in non-Hodgkin's lymphoma (NHL). The increase in ALL was most pronounced amongst males, aged 1-4 years, and is likely to be due to precursor B-cell leukaemias. The increases in ALL and HD are discussed in relation to current hypotheses suggesting a role for infection. Additionally, a non-linear cohort effect was identified for NHL (P= 0.008), which may indicate the involvement of environmental factors other than infection. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Updated investigations of cancer excesses in individuals born or resident in the vicinity of Sellafield and Dounreay" in the 2014 issue is presented.

Introduction Increasing colonoscopy withdrawal time has previously been shown to be associated with increasing adenoma detection rate (ADR). Current guidelines recommend a minimum withdrawal time of 6 min. The optimum mean withdrawal time for adenoma detection is not known. Methods The mean withdrawal time in negative complete colonoscopies (nc-CWT) was estimated for 147 colonoscopists in the NHS Bowel Cancer Screening Programme; colonoscopists were grouped in four levels of nc-CWT (<7, 7–8.9, 9–10.9 and ≤11 min). Logistic regression was used to analyse the relationship between CWT and ADR. Results The study examined data from 31,088 procedures by 147 colonoscopists undertaken between August 2006 and August 2009. The mean ADR in each group was 42.5% in colonoscopists with a mean nc-CWT <7 min, 45.5% in the 7–8.9-min group (p = 0.002 for difference compared to lowest nc-CWT group), 47.3% in the 9–10.9-min group (p < 0.001) and 47.1% in the ≤11-min group (p < 0.001). In multivariable analysis, the ADR of colonoscopists with an nc-CWT of around 10 min was 11% higher than those with an nc-CWT of around 6 min (p < 0.001). Both the proportion of adenomas less than 1 cm in size and the proportion of adenomas detected in the proximal colon increased for longer withdrawal times. Advanced adenoma detection was not affected by increasing withdrawal times. Conclusion Increasing average nc-CWT is shown to be associated with increasing ADR up to 10 min. Beyond 10 min no significant further increase in adenoma yield is seen. This is evidence of the ‘ceiling effect’ of withdrawal time on adenoma detection. Inadequate bowel preparation quality increases mean withdrawal time in complete colonoscopies but this is not associated with any change in ADR. The increase in adenoma detection as a result of longer withdrawal is due to detection of more small and right sided lesions, no increase in detection of large or advanced adenomas is seen. We recommend, on the basis of the findings of this study, that the optimal average nc-CWT per colonoscopist for screening colonoscopy is around 10 min. [ABSTRACT FROM PUBLISHER]

Introduction Colonoscopy is a central investigation in all colorectal cancer (CRC) screening strategies. Success of CRC screening is dependent on the quality of colonoscopy. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood testing to adults aged 60–74 years. Colonoscopy is offered to individuals with a positive faecal occult blood (FOB) test. All colonoscopists practicing within the screening programme are required to meet predefined standards through summative assessment and are subject to ongoing quality assurance. In this study we examine the quality of colonoscopy in the NHS BCSP and describe the measures taken by the BCSP to achieve high quality colonoscopy. Comparison of current quality indicators with existing quality standards and evidence from the UK pilot study of FOB screening will be undertaken. Methods The NHS BCSP national database prospectively collects detailed data on all screening colonoscopies. Data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate, polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated for this period. All screening centres were contacted directly to verify adverse event data. Results In the study period, 2,269,983 individuals returned FOB tests and 36,460 colonoscopies were performed. Mean caecal intubation rate was 95.2% and mean withdrawal time for normal procedures was 9.2 min. The mean adenoma detection rate (ADR) per colonoscopist was 46.5%. ADR did not differ between prevalent and incident rounds (p = 0.90). Patient comfort scores were high and adverse event rates low. Conclusion The NHS Bowel Cancer Screening Programme provides high quality colonoscopy as demonstrated by high caecal intubation rate, adenoma detection rate and comfort scores and low adverse event rate. This quality is achieved by ensuring that BCSP colonoscopists are trained to a high standard and that these standards are maintained through ongoing quality assurance measures. [ABSTRACT FROM PUBLISHER]

Introduction The aim of screening colonoscopy is twofold: Firstly to detect colorectal cancer, secondly to detect and remove adenomas. This study examines the influence of both patient factors (age, gender, body mass index (BMI), smoking, alcohol use, deprivation, geographical location) and colonoscopy factors (withdrawal time, bowel preparation quality, rectal retroversion, colonoscopist, intravenous antispasmodic use, sedation use, time of procedure) on the risk of detecting one or more adenomas, advanced adenomas and right sided adenomas during screening colonoscopy. Methods All patients undergoing colonoscopy in the NHS Bowel Cancer Screening Programme (BCSP) between August 2006 and August 2009 were included in this study. Demographic, lifestyle, procedural and histological data were retrieved from the national database. The relationships between patient and colonoscopy factors with adenoma detection were examined using univariable and multivariable analysis. Results 31 088 patients undergoing screening colonoscopy were included in the analysis. 14 423 had one or more adenomas (46.7%). The following factors increased the relative risk of adenoma detection at screening colonoscopy in both univariable and multivariable analysis (p value <0.001 in multivariable analysis unless otherwise stated): male gender, increasing age, current or previous smoking, current alcohol use, increasing withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time (p=0.018) and increasing colonoscopist experience. Increasing level of deprivation was associated with a reduced risk of adenoma detection (p=0.007). Similar results are demonstrated for the effect of these factors on advanced adenoma and right sided adenoma detection. Rectal retroversion did not increase adenoma detection or rectal adenoma detection. Conclusion This is the largest study to examine the effect of both patient and colonoscopy factors on adenoma detection at colonoscopy following a positive FOB test. The known impact of smoking, alcohol use, and male gender on adenoma risk is also observed in this setting. The relative effect of colonoscopy factors is also demonstrated with caecal intubation, bowel preparation quality, withdrawal time, intravenous antispasmodic use, colonoscopist experience and earlier sessional start time significantly affecting the risk of adenoma detection. This study demonstrates the need for high quality colonoscopy to optimise adenoma detection. [ABSTRACT FROM PUBLISHER]

Background: Medulloblastoma and primitive neuroectodermal tumours (PNET) are the most common central nervous system (CNS) embryonal tumours diagnosed in childhood. Survival outcomes are worse for children diagnosed with CNS PNET compared to medulloblastoma. Less is known about survival outcomes in teenagers and young adults (TYA)., Methods: Data were extracted from two population-based cancer registries of children and young people (0-24 years) in the north of England for all diagnoses of medulloblastoma and CNS PNET between 1990 and 2013. Incidence and survival trends were analysed using Poisson and Cox regression., Results: Between 1990 and 2013, 197 medulloblastomas and 58 CNS PNET were diagnosed, age-standardised incidence rates of 3.8 and 1.5 per million, respectively. Medulloblastoma incidence decreased over time while there was no significant change in trend for CNS PNET. The overall 5-year survival rate was 54%. The risk of death was 2.4 times higher (95% confidence interval [CI] 1.6, 3.7) for patients with CNS PNET compared to medulloblastoma, after adjustment for patient characteristics. There was a 39% reduction (95% CI 0.43, 0.87) in the risk of death for patients diagnosed between 2000 and 2013 compared to 1990-1999. Risk of death did not differ for TYA (15-24 years) compared to children aged 5-9 years., Conclusions: Medulloblastoma incidence decreased over time and differences in survival between medulloblastoma and PNET emerged within the first-year post diagnosis leading to poorer outcomes for children and young adults diagnosed with PNET; however, a significant improvement in survival over time was observed., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Although cancer is relatively rare in teenagers and young adults (TYAs) aged 15-24 years, it is a major cause of death in this age group. This study investigated survival trends in TYA cancer diagnosed in Northern England, 1968-2008., Methods: Five-year survival was analyzed using Kaplan-Meier estimation for four successive time periods. Cox regression analysis was used to investigate associations with demographic factors., Results: The study included 2,987 cases (1,634 males, 1,353 females). Five-year survival for all patients with cancer improved greatly from 46% in 1968-1977 to 84% in 1998-2008 (P < 0.001), for patients with leukemia from 2% to 71% (P < 0.001), lymphoma from 66% to 86% (P < 0.001), central nervous system tumors from 53% to 84% (P < 0.001), bone tumors from 29% to 72% (P < 0.001), germ cell tumors from 39% to 94% (P < 0.001), melanoma and skin cancer from 64% to 100% (P < 0.001), and carcinomas from 48% to 80% (P < 0.001). Cox analysis showed that for all patients with cancer, survival was better for females than males (HR = 0.83; 95% CI 0.74-0.94, P < 0.001), for patients aged 20-24 years compared with those aged 15-19 years (HR = 0.84; 95% CI 0.75-0.94, P = 0.002), but survival was worse for patients who resided in more deprived areas (HR = 1.06; 95% CI 1.01-1.11, P = 0.025)., Conclusion: There have been large improvements in TYA cancer survival in Northern England over the last four decades. Future work should determine factors that could lead to even better survival, including possible links with delayed diagnosis., (© 2014 Wiley Periodicals, Inc.)