1 / 39

Whitney F. Jones, M.D. Founder, Coloncancerpreventionproject

Early Age Onset Colorectal Cancer: 2018 Implementing ACTION while solving the puzzle Iowa Cancer Consortium September 24, 25, 2018. Whitney F. Jones, M.D. Founder, Coloncancerpreventionproject.org. Financial Disclosures. Myriad genetics -Consultant and Speaker

reginaldf
Télécharger la présentation

Whitney F. Jones, M.D. Founder, Coloncancerpreventionproject

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. Early Age Onset Colorectal Cancer: 2018 Implementing ACTION while solving the puzzleIowa Cancer ConsortiumSeptember 24, 25, 2018 Whitney F. Jones, M.D. Founder, Coloncancerpreventionproject.org

  2. Financial Disclosures • Myriad genetics -Consultant and Speaker • Premier Surgery Center of Louisville, Partner • Upstream Health Strategies, Principal Slide acknowledgements: Rebecca Siegel, MPH ACS Dennis Ahnen, MD, University of Colorado Katie Bathje, MPH, Kentucky Cancer Consortium

  3. Learning objectives: EAO-CRC • 1. Understand the evolving features of EAO-CRC including demographics, racial, anatomic, pathologic and clinical outcomes. • 2. Review known and proposed causes of EAO-CRC. • Genetic, familial, environmental ( exosome) • 3. Discuss the major clinical challenges leading to delay in diagnosis. • 4. Explore options to expand the continuum of CRC prevention to the under 50 age group.

  4. BSE first appeared in humans in 1996. 74 people in Britain, 2 in France and 1 in Ireland are dead or dying from mad cow disease

  5. Anatomy of the colorectum (right-sided colon) (left-sided colon)

  6. Incidence trends by age: 50+ versus 20-49 Ages 20-49 Ages 50+ Men Men 51% since 1994 Women Women Source: SEER 9 delay-adjusted rates, 1975-2012; 2-yr moving average.

  7. Age-specific incidence rates by sex 90% of cases Men Women Source: SEER 18 delay-adjusted rates, 2008-2012.

  8. Top 5 cancers, ages 20-49 years Incidence Mortality Men Women Men Women Breast (36%) Thyroid (12%) Melanoma (7%) Colorectum (5%) Cervix uteri (5%) Colorectum (10%) Testis (9%) Prostate (9%) Melanoma (8%) NHL (7%) Breast (26%) Lung (15%) Colorectum (8%) Cervix uteri (7%) Ovary (5%) Lung (18%) Colorectum (12%) Brain (8%) Leukemia (7%) Pancreas (5%)

  9. Subsite distribution by sex and age

  10. Trends in young adults by anatomic subsite 4.8 in 2012 Rectum 2.7% annually since 1991 Proximal colon 2.6 in 1991 Distal colon 2.1% annually since 1994 Source: SEER 9 delay-adjusted rates, 1975-2012; 3-yr moving average.

  11. Trends in young adults by stage at diagnosis Incidence rate per 100,000 3.0% annually, 2003-2012 3.6% annually, 2003-2012 Source: SEER 9 delay-adjusted rates, 1975-2012; 3-year moving average.

  12. Trends in young adults by race/ethnicity Annual % change from 1992-2012 Source: SEER 13 delay-adjusted rates, 1992-2012; 3-year moving average.

  13. Opposing trends within ages 50-59 years -0.8% annually, 2003-2012 -2.7% annually, 2003-2012 55-59 55-59 50-54 50-54 +2.4% annually, 2003-2012 +0.7% annually, 2003-2012 Source: SEER 9 delay-adjusted rates, 1975-2012; 3-yr moving average.

  14. Stage distribution: early vs. later onset Source: SEER 18 registries, 2005-2011.

  15. Five-year relative survival Trend By stage 68% 56% Data Sources: Trends, SEER 9 registries, 1975-2011; Stage-specific, SEER 18 registries, 2005-2011.

  16. Early-onset CRC incidence trends elsewhere 35-39 30-34 25-29 20-24

  17. State variation in incidence rates by age 50+ years 20-49 years

  18. WHY DOES IT OCCUR? Birth Cohort? • Genetic • Familial • Environmental/exosome: • Microbiome • Glyphosate • High fructose corn syrup • Obesity • Oxidative stress • Tobacco [Sleisenger and Fordtran Fig. 123-6]

  19. Hereditary and Familial Colorectal Cancer Sporadic (≈ 70%) Familial (≈ 25%) Rare CRC Syndromes Lynch Syndrome (2-3%) (HNPCC) Familial Adenomatous Polyposis (<1%) Adapted from Burt RW et al. Prevention and Early Detection of CRC, 1996

  20. Young Onset (< 35) Colorectal Cancer Sporadic (≈ 50%) IBD Familial (≈ 20%) Rare Synds Lynch Like Syndrome Lynch Syndrome (12%) Familial Adenomatous Polyposis (8%) Adapted Mork et al J ClinOnc 33; 3544: 2015

  21. Familial Adenomatous Polyposis+ Attenuated FAP • Rare • Autosomal Dominant • High CRC risk ≈100% • Early Onset • Easily recognized • Genetic testing or screening at around age 12 • Surveillance annually

  22. Lynch Syndrome • Autosomal Dominant – 3% of CRCs • High CRC risk- up to 50% • Early onset- 44 yrs • Proximal location- 65% • Other cancers • Under-recognized ≈ 10% • Screening works • Annual colonoscopy • Start at age 25 or 10 years younger than earliest Lynch cancer in the family

  23. EAO-CRC: Deadly delays and misdiagnosisRectal bleeding, abdominal pain, change in bowel habits, and anemia • Patient delays average 6 months • Low CRC awareness under age 50 • Internal Hemorrhoids and IBS common • Symptoms wax and wane • Physician delays in 15-30% • Reluctance to proceed directly to colonoscopy • Poor collection of family history The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action Ahnen, Dennis J. et al.Mayo Clinic Proceedings , Volume 89 , Issue 2 , 216 - 224 O’Connell, J.B., Maggard, M.A., Livingson, E.H. et al. Colorectal cancer in the young. Am J Surg. 2004; 187: 343–348

  24. Who else should begin screening before 50?

  25. Overall results: Early-onset cohort • 1 out of 6 (16%)had at least one hereditary cancer syndrome (75 mutations/72 patients) • 1 out of 12 (8.4%)had Lynch syndrome (38*) • 36 (8%) had Lynch syndrome only • 2 (0.4%) had Lynch syndrome plus another syndrome • 1 out of 13 (7.8%)had another syndrome (35*) • 1 patient had two syndromes • Conclusion: Genetic counseling and broad MGPT should be considered for all patients diagnosed <50 years of age, regardless of fhx or MMR tumor status *One patient is counted twice Pearlman et al. JAMA Oncol. 2017;3(4):464-471

  26. 5/17

  27. You don’t have to be a meteorologist to understand your need to get out of a hail storm.

  28. Colonoscopy Rates Are Improving In FDRs But….. Colonoscopy within 10 years FDRs ≥50 Non-FDRs ≥50 Percent FDRs 40-49 Tsai et al. PrevChronic Dis 2015;12:140533

  29. Young Onset (< 35) Colorectal Cancer IBD - 70% have FH of other cancer Sporadic - 10% FDR with CRC - 90% SDR Familial Rare Synds Lynch Like Syndrome Lynch Syndrome (12%) Familial Adenomatous Polyposis (8%) Adapted Mork et al J ClinOnc 33; 3544: 2015

  30. Genetic Counseling Referrals: Drop-out Rate

  31. Lead Time Messaging Normal risk screen High risk screen Age 18 Age 40 Age 50 Message, timing, frequency 1, 3, 7, ?

  32. Timeline of EAO-CRC and Sporadic CRC Messaging Current Message Package 50yr  35-40yr 18yr >75yr

  33. Timeline of EAO-CRC and Sporadic CRC Messaging DONE!! Message Package On Time Message Package On time date + On time options + Early Message Package ID + evaluate symptoms  Family history + test  Lifestyle modification  35-40yr 50yr  >75yr 18yr

More Related