Advanced disease at presentation for Canadian patients with colorectal cancer despite provincial screening programs: A call to action
Bibliographic record
Abstract
ObjectiveWe sought to evaluate the presentation and outcomes of patients with a diagnosis of colorectal cancer (CRC) at an academic Canadian center to identify strategies to improve the existing screening system for CRC.SettingRoyal Alexandra Hospital, Edmonton, Alberta, Canada.MethodsWe performed a prospective cohort study. Data collected included: patient demographics, presentation, treatment, and outcomes 1 year after study completion.ResultsOne hundred consecutive patients were included with a median age of 68 years (SD = 13.3). Most (58%) participants were male and 25% had a first-degree family history of CRC. Only 26% of CRC presentations were identified through screening. Of the screened patients, 81% had stage 0-2 disease, all underwent surgery and there were no deaths in this group 1 year after recruitment.In contrast, 74% of patients presented with symptoms, including bleeding (26%), anemia (22%), and obstruction (19%). Thirty-six (49%) received elective surgery, 33 (45%) underwent emergency surgery, and 5 (7%) did not receive surgery. One year after recruitment, 21 patients (28%) in this group were deceased. Within the symptomatic cohort, 55% of patients were outside the age range recommended for screening, 22% did not have a family physician, and 50% had not been offered regular screening.ConclusionsDespite an established screening program, a significant proportion of patients diagnosed with CRC at our center were not diagnosed via screening. Patients presenting with symptoms were more likely to have advanced disease, require more urgent surgeries, and experience worse outcomes compared to their screened counterparts. The current provincial approach to screening for CRC needs to be improved.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".