Nereo Segnan MD MSc Epi

Center for Epidemiology and Prevention in Oncology, CPO Piedmont WHO Collaborative Center for Cancer Early Diagnosis and Screening

University Hospital “Città della Salute e della Scienza”, Turin, Italy

Cancer Screening in the European Union

Second Report:

Colorectal cancer Screening

Wien 14 October 2011

• No conflict of interest to declare

Second Report on Cancer Screening in the EU Co-financed by the EU Health Programme

-

Main collaborating institutions

• International Agency for Research on Cancer, Lyon, France (coordination)

• CPO Piemonte, University Hospital “Città della Salute e della Scienza”CPO, Turin, Italy

• Finnish Cancer Registry, Mass Screening Registry,

Helsinki, Finland

Authors

• A Ponti, A Anttila, G Ronco, C Senore, N Segnan, M Tomatis, P Basu,

M Primic-Žakelj, P Dean, J Dillner, M Fernan, M Elfström, S Lönnberg,

R Sankaranaryanan, I Soerjomataram, D Vale, L von Karsa

Scientific Committee*

• L Altenhofen, R Ancelle-Park, N Ascunce, H de Koning, E Lynge, O

Májek,

F Nicula, J Patnick, J Regula, S Törnberg, M Zappa

Over 80 Data providers from all 28 EU Member States*

*invited reviewers of full report,

and co-authors of publication in

peer-reviewed journal

Data Provider’s Workshop (22 Member States

Participating) – 16-17 Feb, 2016; IARC

Second Report on the Implementation of Council

Recommendations on Cancer Screening - objectives

• To document changes in approach to program

implementation compared to first report

• To collect more detailed information on program

organization

• To include selected performance parameters

– Key determinants of quality and impact recommended in the

European QA guidelines

– Suitable for comparison between Member States

Second Report – Standardized Data Output

Site Specific Questionnaires to collect information on

• Program organization, invitation, QA, financing, cost

• Screening tests, eligibility, screening interval, further assessment

Site Specific Tables on annual aggregated data stratified by age groups & initial vs subsequent screening

• Screening tests

• Further assessment recommendations

• Further assessment compliance

• Outcome of further assessment

o Detection rates

o Positive predictive values

Necessity of Regular Reporting on Cancer

Screening in the EU

• Current performance determines impact of screening

on burden of disease

• Impact is measurable only after many years

• Regular monitoring permits timely response to

potential problems and recognition of

opportunities for improvement

– Avoids unnecessary harm and cost

– Maximises benefit of screening

Web Based Data Collection

EU CRC screening

• Annual target population 50 -74 yrs:

69,636,000

• Invited: 23,343,000 (33.5%)

• Screened: 9,985,000 (14.2%)

0%

25%

50%

75%

100%

Table 4.15

N = Individuals screened of invited in the year

D = Individuals personally invited in the year

COLON - Participation rate (All ages)

FIT, 10 countries

N = 3,621,692

D = 7,313,175

Result = 49.5% (22.8% - 71.3%)

gFOBT, 6 countries

N = 5,352,356

D = 16,158,260

Result = 33.1% (4.5% - 66.6%)

0%

25%

50%

75%

100%

COLON - Participation rate (60-69 years) Table 4.15

N = Individuals screened of invited in the year

D = Individuals personally invited in the year

FIT, 8 countries

N = 1,736,995

D = 3,277,339

Result = 53.0% (28.7% - 74.0%)

gFOBT, 5 countries

N = 3,035,378

D = 7,316,925

Result = 41.5% (5.0% - 66.6%)

0%

5%

10%

15%

20

20

NA

15

-20

15

15

20

15

-47

20

16

-20

18

0

COLON – Screen positivity (60-69 years)

FIT, 11 countries

N = 144,089

D = 2,195,044

Result = 6.6% (3.1% - 10.6%)

gFOBT, 6 countries

N = 64701

D = 3140223

Result = 2.1% (1.7% - 4.5%)

Table 4.18.1

N = Positive screening tests in the year

D = Individuals screened in the year with adequate test - test results available

« Positivity cut off µg/gr faeces

COLON – Detection rate of colorectal cancers (60-69 years)

FIT, 9 countries

N = 4501

D = 1923252

Result = 2.3‰ (1.3‰ - 4.1‰)

gFOBT, 5 countries

N = 3704

D = 3112437

Result = 1.2‰ (0.9‰ - 2.6‰)

Table 4.18.6

0

1

2

3

4

5

N = Colorectal cancers detected

D = Individuals screened in the year with adequate test - test results available

COLON – Detection rate of advanced adenomas (60-69 years)

FIT, 6 countries

N = 25958

D = 1889223

Result = 13.7‰ (5.8‰ - 27.5‰)

gFOBT, 5 countries

N = 6963

D = 3013386

Result = 2.3‰ (1.0‰ - 5.4‰)

Table 4.18.5

0

5

10

15

20

25

30

N = Advanced ademonas detected

D = Individuals screened in the year with adequate test - test results available

COLON – Detection rate of colorectal cancers (All ages)

FIT, 9 countries

N = 7519

D = 3751139

Result = 2.0‰ (1.2‰ - 4.9‰)

gFOBT, 6 countries

N = 6545

D = 5529765

Result = 1.2‰ (0.9‰ - 1.9‰)

Table 4.18.6

0

1

2

3

4

5

N = Colorectal cancers detected

D = Individuals screened in the year with adequate test - test results available

0

5

10

15

20

25

30

COLON – Detection rate of advanced adenomas (All ages)

FIT, 6 countries

N = 55059

D = 3713008

Result = 14.8‰ (7.4‰ - 27.0‰)

gFOBT, 5 countries

N = 12706

D = 5143744

Result = 2.5‰ (0.9‰ - 4.6‰)

Table 4.18.5

N = Advanced ademonas detected

D = Individuals screened in the year with adequate test - test results available

0%

25%

50%

75%

100%

COLON – Follow-up colonoscopy participation rate (All ages)

FIT, 11 countries

N = 187918

D = 266420

Result = 70.5% (36.3% - 92.2%)

gFOBT, 6 countries

N = 99037

D = 117844

Result = 84.0% (72.6% - 93.2%)

Table 4.18.2

N = Further colonoscopies performed

D = Data on further col. performance available

50%

60%

70%

80%

90%

100%

COLON – Completion rate follow-up colonoscopy (All ages)

FIT, 7 countries

N = 138412

D = 147090

Result = 94.1% (92.4% - 98.8%)

gFOBT, 4 countries

N = 54813

D = 56496

Result = 97.0% (91.0% - 97.6%)

Table 4.18.3

N = Further colonoscopies completed

D = Data on col. completion available

50-59 60-69

FIT gFOBT TC FIT gFOBT TC

Tests 1753K 1294K 12K 2195K 3140K -

Screen positivity 5,1% 2,0% 11,5% 6,6% 2,1% -

F.U. colonoscopy

participation rate 76,8% 83,1% 82,2% 75,0% 84,5% -

Completion rate

F.U. colonoscopy 93,9% 97,8% 97,2% 93,7% 96,8% 97,1%

Detection Rate

advanced adenoma 8,7‰ 2,5‰ 49,5‰ 13,7‰ 2,3‰ 72,4‰

Detection Rate

colorectal cancers 1,1‰ 0,6‰ 3,5‰ 2,3‰ 1,2‰ 8,1‰

gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total

N D % N D % N D % N D % N D %

Women 197 21.570 0,9%

Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%

Women 145 33.382 0,4% 145 33.382 0,4%

Men 270 26.003 1,0% 270 26.003 1,0%

Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%

Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%

Women 173 36.491 0,5% 173 36.491 0,5%

Men 317 28.571 1,1% 317 28.571 1,1%

Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%

Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%

Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%

Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%

Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%

Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%

Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%

Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%

Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)

Thank to

Partha Basu (IARC),

Mariano Tomatis, Antonio Ponti, Carlo

Senore (CPO Piemonte)

for providing slides and data

Thank you for your

attention

gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total

N D % N D % N D % N D % N D %

Women 70 9.014 0,8% 99 9.794 1,0% 28 2.762 1,0% 197 21.570 0,9%

Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%

Women 145 33.382 0,4% 145 33.382 0,4%

Men 270 26.003 1,0% 270 26.003 1,0%

Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%

Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%

Women 173 36.491 0,5% 173 36.491 0,5%

Men 317 28.571 1,1% 317 28.571 1,1%

Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%

Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%

Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%

Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%

Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%

Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%

Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%

Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%

Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)

FIT 50-59 years 60-69 years 70-74 years 75-79 years Total

N D % N D % N D % N D % N D %

Women 898 119.189 0,8% 1.443 129.721 1,1% 555 41.651 1,3% 286 24.976 1,1% 3.182 315.537 1,0%

Men 1.652 85.428 1,9% 2.308 90.206 2,6% 728 29.124 2,5% 334 15.414 2,2% 5.022 220.172 2,3%

Women 44 5.673 0,8% 46 5.801 0,8% 22 1.981 1,1% 112 13.455 0,8%

Men 45 4.392 1,0% 61 4.297 1,4% 37 1.464 2,5% 143 10.153 1,4%

Women 44 2.307 1,9% 45 2.149 2,1% 89 4.456 2,0%

Men 64 1.775 3,6% 99 1.629 6,1% 163 3.404 4,8%

Women 3.868 189.432 2,0% 2.925 80.347 3,6% 6.793 269.779 2,5%

Men 7.230 181.983 4,0% 4.623 72.373 6,4% 11.853 254.356 4,7%

Women 4.161 530.280 0,8% 6.198 532.458 1,2% 10.359 1.062.738 1,0%

Men 7.025 447.464 1,6% 10.579 459.329 2,3% 17.604 906.793 1,9%

Women 1.121 79.937 1,4% 1.244 58.766 2,1% 2.365 138.703 1,7%

Men 2.336 65.695 3,6% 2.390 47.550 5,0% 4.726 113.245 4,2%

Women 2.100 126.358 1,7% 2.928 115.171 2,5% 5.028 241.529 2,1%

Men 4.401 109.270 4,0% 5.585 98.160 5,7% 9.986 207.430 4,8%

Total Women 8.368 863.744 1,0% 11.904 844.066 1,4% 577 43.632 1,3% 286 24.976 1,1% 21.135 1.776.418 1,2%

Total Men 15.523 714.024 2,2% 21.022 701.171 3,0% 765 30.588 2,5% 334 15.414 2,2% 37.644 1.461.197 2,6%

Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)

Endoscopy 50-59 years 60-69 years 70-74 years 75-79 years Total

N D % N D % N D % N D % N D %

Women 468 5.567 8,4% 468 5.567 8,4%

Men 954 5.996 15,9% 954 5.996 15,9%

Women 477 2.402 19,9% 522 2.365 22,1% 999 4.767 21,0%

Men 786 2.375 33,1% 833 2.170 38,4% 1.619 4.545 35,6%

Women 124 727 17,1% 255 1.142 22,3% 66 241 27,4% 19 108 17,6% 464 2.218 20,9%

Men 252 810 31,1% 420 1.134 37,0% 78 243 32,1% 35 99 35,4% 785 2.286 34,3%

Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)