1 / 25

Organizing Colorectal Cancer Screening

Colorectal cancer (CRC) remains a significant health challenge, often diagnosed in advanced stages. Dr. Robert E. Schoen's research emphasizes the importance of organized screening strategies to improve outcomes. Lifetime risks for CRC vary by gender and race, highlighting the need for tailored screening approaches. Various methodologies, including annual FOBT and colonoscopy, have shown efficacy in early detection and mortality reduction. Understanding the nuances of screening can lead to better compliance and outcomes, ultimately addressing the rising incidence rates of CRC.

josh
Télécharger la présentation

Organizing Colorectal Cancer Screening

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Organizing Colorectal Cancer Screening Robert E. Schoen, MD MPH Associate Professor of Medicine and Epidemiology Division of Gastroenterology University of Pittsburgh

  2. Lifetime Risk of CRC (%) Male, Female LR Dx LR Death All Races 5.95, 5.63 2.43, 2.40 Whites 6.00, 5.64 2.45, 2.38 Blacks 4.73, 5.31 2.34, 2.65 SEER, 1996 - 98

  3. Click for larger picture

  4. Prevalence of Adenomatous Polyps Diminutive or Small - 15 - 30% Large - 3 - 5% Cancer - 0.3 - 1%

  5. Screening for Colorectal Cancer

  6. CRC Often Diagnosed Late U.S. CRC, By Stage, 1992 - 1997 Localized 37% Regional 38% Distant 20% SEER: 1973 - 1998

  7. Consensus Guidelines  50  Options:  Annual FOBT  FS q 5 yrs  FOBT + FS  DCBE q 5-10 yr  Colon q 10 yr  + TCE: Colonoscopy or DCBE + FS Gastro. 1997:112;594

  8. Minnesota FOBT Trial: 18 Yr Follow Up Annual Biennial Control 15,570 15,587 15,394 240,325 240,163 237,420 .67 (.51-.83) .79 (.62-.97) 1.0 # enrolled PYO CRC Mortality Ratio* *Overall mortality not changed Mandel, JNCI 1999;91:434

  9. Decreased Incidence of CRC in the Minnesota FOBT Study 17% in biennial 20% in annual Click for larger picture Mandel JS et al. N Engl J Med 2000:343:1603-7

  10. Highlights of Trials of Non-Rehydrated FOBT % Compliance % with positive test (initial screen) % with positive test found to have cancer % reduction in CRC mortality (biennial testing) 60 - 69 0.6 - 4.4 5 - 17.2 15 - 18

  11. Screening Sigmoidoscopy - Efficacy Case Control Study: Compared Rigid Sig Use in 261 pts who died of distal CRC to 868 matched age/sex) controls 8.8% of Cases Screened VS. 24.2% of Controls OR for CRC Mortality w/ Sigmo = .41 or  59%* • * adjusted for polyp hx, fam hx, check ups • Benefits persisted 10 years • No difference in screening in 268 • cases/controls with CA above rectosigmoid Selby et al. NEJM 1992;326:653

  12. Is Sigmoidoscopy Half a Mammogram?

  13. Screening Colonoscopy Studies Imperiale et al - “Lilly Cohort” NEJM 2000; 343:162 Lieberman et al - “VA Cooperative 380” NEJM 2000; 343:169

  14. Success - Complications NEJM 2000: Screening Colonoscopy Studies Cecum - 97+% Perforation - 1/5115 or 0.02% VAStudy: Major morbidity - 0.32% (GI bleed, MI, CVA)

  15. VA Colonoscopy Study 380 N=3121, 97% male, mean age 63 Adenoma 37.5% Advanced Adenoma* 10.7% Tubular 5.0% Villous 3.0% HGD 1.7% CA 1.0% * 1 cm, Villous, HGD, CA Lieberman et al, NEJM 2000

  16. Lilly Cohort N=1994, 58.9% male, mean age 60 Adenoma 20% Advanced Adenoma* 5.6% CA 0.6% *Villous, HGD (not  1 cm) Imperiale et al, NEJM 2000

  17. What Does Screening Colonoscopy Detect That Sigmoidoscopy Doesn’t? VA StudyLilly Cohort Neoplasia 37.5%  20% Advanced Proximal Neoplasia 4.1% 2.5% “Missed” Advanced Proximal Neoplasia 2.1% 1.2% Older age, males higher risk

  18. Missed Advanced Proximal Neoplasia VA - 52% “missed” (67/128) or 2.1% Limit Advanced Definition to HGD or CA: VA - 14.8% missed (12/81) or 0.4%

  19. Incident CRC After Colonoscopy Incidence/ 1000 PYO PYO CRC Cases Observed (yrs) N 1418 1905 1303 5.9 3.05 2.91 8401 5810 3789 5 14 9 Winawer (NPS) Schatzkin (PPT) Alberts (Wheat Bran) 0.6 2.4 2.4

  20. Sigmoidoscopy vs. Colonoscopy Colonoscopy Sigmoidoscopy Vs. Sensitive enough? Safer Less expensive Frequency (1/5 yr)? Accessible? Satisfied? More sensitive More invasive, safe? Expensive Less frequent (1/10 yr)? Less accessible Better satisfaction

More Related