Colorectal Cancer: Putting Prevention into Practice

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  • 1. Colorectal Cancer:Putting Prevention into Practice Durado Brooks, MD, MPHDirector, Prostate and Colorectal Cancers

2. Colorectal Cancer The third most common cancer in U.S. and thesecond deadliest 141,000 new cases expected this year More than 49,000 deaths nationwide 1.1 million Americans living with colorectalcancer Death rates have fallen steadily over the past 20years 3. Trends in CRCCRC incidence and mortality have fallen steadilyover the past 2 decades.Research suggests that observed declines inincidence and mortality are due in large part to: Screening and polyp removal, preventing progressionof polyps to invasive cancers NEJM study Feb 2012 showed polyp removal associated with 53% lower risk of CRC death Screening detecting cancers at earlier, moretreatable stages CRC treatment advances 4. Risk Factors 5. Colorectal Cancer Risk Factors Age 90% of cases occur in people 50 and older Gender slight male predominance, but common in both men and women Race/Ethnicity Increased rates documented in African Americans, Alaska Natives, some American Indian tribes, Ashkenazi Jews 6. Colorectal Cancer Risk FactorsModifiable Risk Factors Diet Obesity Physical Activity Tobacco Alcohol 7. Non-Modifiable Risk Factors Increased risk with: Personal history of inflammatory bowel disease, adenomatous polyps or colon cancer Family history of adenomatous polyps, colon cancer, other conditions Individuals with these risk factors may requireearlier and more intensive screeningThe remainder of this presentation will focuson the average risk population. 8. Colorectal Cancer Sporadic (average risk) (65%85%) Family history(10%30%) Raresyndrome s ( 50 yearsAdenoma CRC IBD High Risk: Adenoma orGermlinecancerDo notScreenSyndromescreenSurveillance HNPCC or FAPColonoscopy If positive,diagnosis bycolonoscopy Screening Screen withOptionsTests That Find Polyps and Cancercolonoscopy, geneticcolonoscopy 10 yearsFlexible sigmoidoscopy every 5 years, or testing, and otherbefore youngestcancer screening as relative or age 40Colonoscopy every 10 yearsappropriateDouble-contrast barium enema every 5 years,or *The multiple stool take-home test should be used. One test done by the doctorCT colonography (virtual colonoscopy) everyin the office is not adequate for testing.5 yearsThe tests that are designed to find both early cancer and polyps are preferred if *This version of stage theory was adaptedTests That Primarily Find Cancer these tests are available and the patientfrom the work have one of these more is willing to of RE Myers.Yearly fecal occult blood test (gFOBT) *, or invasive tests. 36. High Quality Stool TestingClinicians Reference: FOBTOne page document designedto educate clinicians aboutimportant elements of colorectalcancer screening using fecaloccult blood tests (FOBT).Provides state-of-the-scienceinformation about guaiac andimmunochemical FOBT, testperformance and characteristicsof high quality screeningprograms.Available 37. #3 Be Persistent with RemindersDetermine how yourEssential practice will notify #3:patient and physician whenscreening and follow up isdue.Ensure that your systemEssential tracks test results and #3:uses reminder promptsfor patients and providers. 38. Reminder Fold-Over Postcard 39. Patient EducationGet Tested For ColonCancer: Heres How."An 7-minute video reviewingoptions for colorectal cancerscreening tests, including testpreparation.Available as DVD, or you canrefer patients to the URL toview from their personalcomputer. 40. Office Wall Chart Screening guidelinesfor Breast, Cervical,Colon, Prostate andother cancers Generallifestyle/prevention Tobaccocessation Healthy diet Weight, etc English and Spanish 41. Clinician Reminder Types Chart Prompts Problem lists Screening schedules Integrated summaries Alerts Flags placed in chart Follow-Up Reminders Tickler System Logs and Tracking Electronic Reminder Systems 42. #4 Measure Practice ProgressDiscuss how your screeningEssential system is working during #4:regular staff meetings andmake adjustments asneeded.Have staff conduct aEssential screening audit or contact #4:a local company that canperform such a service. 43. Saving Lives Through PreventiveCancer ScreeningADJUSTPLAN STUDYACT 44. Communication 45. Health Card Kit 46. ACS ResourcesInformation and materials on colorectal cancerfor clinicians and patients are available materials for other cancers areavailable on a new