Background:

In 2018, among all cancers, colorectal cancer (CRC) was the 3rd most common cancer and the second leading cause of death in the world (1). According to the GOLOBOCAN 2018, CRC also is the 3rd common neoplasm with mostly 10000 new cases per year in Iran (2). Early diagnosis of CRC is very important for better survival and effective treatment of the disease and CRC screening tests are known as effective methods in the prevention of CRC (2,3). The efficacy of any screening test is largely dependent on the people behavioral parameters and adherence (4), and it is notable that,  still more than half of adults aged 50-75 years old in the Western countries, are not undergoing screening tests for CRC as recommended in the current guidelines (5,6). In general, screening for CRC is quite low in developing countries, where CRC is increasing and there is no organized screening for colon cancer (7). In Iran, although CRC is the third common cancer, there is no mass screening for colon cancer, as of yet, and screening for CRC is not among the routine health services by family physicians in the primary health care settings, but opportunistic screening is available. The risk of developing CRC is influenced by both environmental and genetic factors; almost all economic indices show that, since the 1979 Iranian revolution, living standards have improved dramatically across the entire country and the country has experienced rapid development in socioeconomic status during the past three decades with significant lifestyle changes like sedentary lifestyle and the diet rich in fat and meat, and poor in cereals and fibre typical of Western population. Recent epidemiologic studies in Iran have shown a rapid increase in the rates of CRC while there are still no preventive measures established. Elucidating the epidemiologic trend of CRC in Iran and adopting the most appropriate evidence-based screening method is necessary in order to prevent morbidity and mortality for this lethal and preventable cancer in the country (9).

References
1.    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
2.    http://gco.iarc.fr/today/data/factsheets/populations/364-iran-islamic-republic-of-fact-sheets.pdf
3.    Bujanda L, Sarasqueta C, Zubiaurre L, et al. Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer. Gut 2007; 56: 1714-18.
4.    Control CfD and Prevention Vital signs: colorectal cancer screening test use--United States, 2012. MMWR. Morbidity and mortality weekly report 2013; 62: 881.
5.    Rabeneck L, Tinmouth JM, Paszat LF, et al. Ontario's ColonCancerCheck: Results from Canada's first province-wide colorectal cancer screening program. Cancer Epidemiology Biomarkers & Prevention 2014; 23: 508-15.
6.    Ladabaum U When even people at high risk do not take up colorectal cancer screening. Gut 2007; 56: 1648-50.
7.    Rawl SM, Champion VL, Scott LL, et al. A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives. Patient education and counseling. 2008;71(2):215-227.
8.    Malekzadeh R, Bishehsari F, Mahdavinia M, Ansari R. Epidemiology and molecular genetics of colorectal cancer in Iran: a review. Arch Iran Med. 2009;12(2):161-169Aza
9.    Salimzadeh H, Delavari A, Montazeri A, et al. Knowledge and practice of iranians toward colorectal cancer, and barriers to screening. International journal of preventive medicine 2012; 3:
29.


Aims & Objectives:
•    To provide an evidence-based infrastructure for developing national guidelines of colorectal cancer screening
•    To identify environmental and genetic risk factors with regard to colorectal cancer
•    To establish a Bio-Specimens database (processing and storing: blood, endoscopic biopsies, and stool) to promote clinical and basic research on colorectal cancer
•    To pilot the best screening modality for colon cancer in Iranian average-risk population
•    To evaluate quality metrics for screening colonoscopy
•    To pilot the best screening modality for colon cancer in Iranian high-risk population
•    To assess the accuracy of cancer registry system in access to CRC patients and their possibly at-risk relatives
•    To measure public awareness, risk perception with respect to colorectal cancer and screening uptake (acceptability)
•    To identify wrong beliefs/misconceptions about colorectal cancer and common barriers to screening from patient/physician/health providers perspectives
•    To develop new targeted/tailored interventions to improve public awareness about colorectal cancer and screening/preventive behaviors among healthy/asymptomatic population of adults age 50 and older

Research Areas:
•    Burden of colorectal cancer
•    Prevention and control and screening of colorectal cancer
•    Risk factors of colorectal cancer & Lifestyle modification for prevention
•    Genome-wide association studies
•    Profiling the fecal microbiome
•    Psychosocial oncology, economic and sociocultural barriers to colorectal cancer screening knowledge, attitudes and practice towards colorectal cancer/screening tests from different perspectives, i.e., patient/ primary care physicians/health providers
•    Developing targeted/tailored interventions/informed decision aids to enhance screening and to reduce common barriers to screening
•    Assessment of acceptability and cost-effectiveness of different screening modalities for colorectal cancer screening in Iranian population

Completed Projects:

•    Feasibility of colon cancer screening by Fecal Immunochemical Test in Iran
•    Annual trends of gastrointestinal cancers mortality in Iran during 1990-2015
•    Systematic assessment of knowledge, attitudes and behavior towards colorectal cancer, and barriers to screening among first degree relatives of patients with colorectal cancer: A population-based study
•    Polyp & adenoma detection rates, and risk of advanced colonic neoplasms in first-degree relatives of  patients with colon cancer: A population-based prospective study
•    Impact of risk assessment counseling vs. routine care on screening colonoscopy uptake among first degree relatives of colon cancer patients, a randomized controlled trial (RCT)
•    Establishment of patient registry and an active and interactive patient education system in DDRI (i.e., phone counseling, face-to-face educations, active follow-up, …) and colonoscopic screening in asymptomatic first-degree relatives of patients with colorectal cancer
•    Developing educational books (colored & pictorial) in plain/understandable language with regard to colon cancer prevention/screening
•    Cost-effectiveness of screening colonoscopy in Iranians high risk population
•    Assessment of predictors of advanced colonic neoplasm among first degree relatives of patients with colorectal cancer using Data Mining method
•    Cancer research priorities and gaps in Iran
•    Evaluation of polyp and adenoma detection rates; A retrospective study of endoscopic database
•    Evaluation of knowledge, attitudes and behavior towards colorectal cancer and screening tests among average-risk adults
•    Systematic review of cancer awareness in Iran
•    Assessment of physician’s knowledge, attitude, and practice with regard to current guidelines of colon cancer screening
•    Cost-effectiveness study for colon cancer screening in Iranians average risk population
•    Effectiveness of a theory-based intervention (Preventive Health Model) to increase colorectal cancer screening among Iranian health club members: A Randomized Controlled Trial
•    Psychosocial determinants of colorectal cancer screening in among average-risk adults in Iran
•    Estimation of 1990 to 2012 trends in the Burden of Digestive Disease in Iran at national and sub-national levels: NASBOD study
•    Evaluation of sensitivity and specificity of faecal tumour M2 pyruvate kinase for detection of colon and rectum adenomas

Future Projects:
•    Evaluation of the protective effect of Aspirin on colorectal adenoma & cancer: A Population-based cohort study
•    Quality of life measurement in patients with colorectal cancer
•    Quality metrics of colonoscopy
•    Palliative care of patients with colorectal cancer
•    GWAS studies
•    Survival studies

 

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