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The important of “ Cancer Screening”

The important of “ Cancer Screening”. Aumkhae Sookprasert, MD Medicine department, KKU. Cancer Screening. Decreased overall and specific mortality. Detect early stage case. Reduction in the incidence of advanced case. Population based, RCT !. Improve overall survival.

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The important of “ Cancer Screening”

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  1. The important of“ Cancer Screening” Aumkhae Sookprasert, MD Medicine department, KKU

  2. Cancer Screening

  3. Decreased overall and specific mortality Detect early stage case Reduction in the incidence of advanced case Population based, RCT ! Improve overall survival The most important end points for cancer screening

  4. Levels of Evidence in Cancer Screening

  5. 1. Selection bias Potential “Bisases” of Screening

  6. 2. Lead time bias Death Control Screen Potential “Bisases” of Screening

  7. 3. Length bias Death Symptoms Indolent cancer, Pts with old age Control “Overdiagnosis” Fast growing Death rapidly Screen Slow growing, favorable prog Asymptomatic + Screening Potential “Bisases” of Screening

  8. Harmful of Cancer Screening !!

  9. Levels of Evidence in Cancer Screening

  10. Especially if it trigger invasive diagnostic procedures !! Characteristic of “Good Cancer Screening test” High sensitivity High specificity

  11. Standard Common Cancer Screening & Level of Evidence

  12.  Breast Cancer

  13. Breast Cancer :How to screen effectively ? 40 50 60  Mortality

  14. 40 50 60  Mortality Breast Cancer :How to screen effectively ?

  15. Cervical Cancer

  16.   40 50 21 60 3 yr Cervical Cancer :How to screen effectively ?

  17. X X Ovarian Cancer

  18. Prostate Cancer X X X

  19. Testicular Cancer Screening! X

  20. Colorectal Cancer

  21. q 3 yrs FOBT 40 50 60 Colorectal Cancer :How to screen effectively ?

  22. X X ? Lung Cancer Screening

  23. Female Male  19.5 37.6   25.9 17.2  10.8 16.0  6.8 10.0   4.8 7.3  4.6 5.2 4.9 4.8 4.2 3.6 4.1 3.6 3.5 3.9 ASR (World) ASR (World) Leading cancers in Thailand (estimated), 1996 Tumor registry report 2000 Courtsey from Dr Pisaln Mairiang.

  24. Male Female 95.7 35.4 37.6 16.0 18.4 7.5 28.7 12.4 85.0 32.7 14.4 3.9 5.7 1.4 ASR (World) ASR (World) Liver cancers in different regions, 1995-1997 Tumor registry report 2000 Courtsey from Dr Pisaln Mairiang.

  25. Tumor Registry Cancer Unit, Khon-kaen University Statistical Report 2003

  26. Number of cancer cases by type of patients

  27. 5 Leading sites of cancer in both sexes 1. Liver and bile ducts : 1,186 29.3% 2. Bronchus and Lung : 368 9.1 % 3. Cervix uteri : 337 8.3 % 4. Breast : 192 4.7 % 5. Lymph nodes : 184 4.5 %

  28. Nasopharyngeal : 3.4% Lymph nodes : 5.2% Bronchus & lung : 12.6% Hepato-biliary : 39.5% Leukemia : 4.6%

  29. Bronchus & lung : 12.6% Thyroid gland : 6,8% Breast : 9.6% Hepato-biliary : 39.5% Cervical : 17%

  30. X X HCC & Gastric CA screening

  31. + HBV markers 19,200 : 35-59 yr Chronic hepatitis Control (9443) R RCT of screening for HCC Screen gr (9757) Participate (9373) Not told, No screen Zhang B, Yang B, Tang Z et al. J Cancer Res Clin Oncol 2004

  32. + HBV markers 19,200 : 35-59 yr Chronic hepatitis AFP, U/S q 6 mo Participate (9373) Control (9443) R Not told, No screen Recruited 1993 - 1995 Screen gr (9757) End of study at 1997 - At least 5-7 times screening Zhang B, Yang B, Tang Z et al. J Cancer Res Clin Oncol 2004

  33. + HBV markers 19,200 : 35-59 yr Not told, No screen Chronic hepatitis AFP, U/S q 6 mo 67 pts with HCC 54 dies from HCC Control (9443) 1st screen + HCC - 17 pts (0.18%) By the end (1997) - 69 pts (0.73) R December 1997 - 32 dies from HCC Recruited 1993 - 1995 Screen gr (9757) Participate (9373)

  34. Incidence of HCC between screening & control 279.3 : 100,000 267 : 100,000 (268 : 100,000)

  35. Stage distribution

  36. Treatment modality

  37. Disease specific end points : Death from HCC

  38. 35 50 59 + HBV CAH q 6 Months ! How can we make a conclusion ?

  39. Cholangiocarcinoma (CHCA) Courtsey from Dr Pisaln Mairiang.

  40. CT SCAN Courtsey from Dr Pisaln Mairiang.

  41. ERCP Courtsey from Dr Pisaln Mairiang.

  42. Ultrasonography Courtsey from Dr Pisaln Mairiang.

  43. Any methods should we used to detect early cancer ? Surgery is the only chance for cure !

  44. Etiology Infection:Opisthorchis viverrini, Clonorchis sinensis Inflammatory bowel disease and Primary sclerosing cholangitis Chemical exposures: Thorium dioxide, rubber and wood industry Congenital diseases: Choledochal cyst and Caroli disease Other: Ductal adenoma, biliary papillomatosis and alpha1-antitrysin deficiency Courtsey from Dr Pisaln Mairiang.

  45. Stool exam CT ERCP MRCP U/S

  46. Stool exam Prevalence : 24.5% Incidence of CHCA in age > 35 = 93 – 317 / 100,000 = 0.0009 – 0.003 With highest prevalence 1 CHCA : 3,333 ¼ U/S : 833 With Lowest prevalence 1 CHCA : 111,111 ¼ U/S : 27,777 Sriumporn S, Pisani P et al. Trop Med Int Health 2004

  47. No effective screening for CHCA !!

  48. AFP,U/S q 6 mo >/= 35 yrs Breast Mammo,CBE q 1 yr, >/= 40 HCC (high risk gr) Cervical Colon PAP q 1 x 3 >/= 21 yrs FOBT q 1 yr >/= 50 yrs Conclusion

  49. AFP,U/S q 6 mo >/= 35 yrs HCC (high risk gr) Colon FOBT q 1 yr >/= 50 yrs Conclusion

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