Spotlight on Colorectal Cancer Screening

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Spotlight on Colorectal Cancer Screening. 1. Home Screening for Colon Cancer. http:// www.youtube.com/watch?v=SzJe_D0-J38. ColonCancerCheck (CCC). First population-based, organized colorectal screening program of its kind in Canada Goals: - PowerPoint PPT Presentation

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PowerPoint Presentation

Spotlight on Colorectal Cancer Screening

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1Slide Objective: Introduce section on colorectal cancer screening1Home Screening for Colon Cancerhttp://www.youtube.com/watch?v=SzJe_D0-J382

ColonCancerCheck (CCC)First population-based, organized colorectal screening program of its kind in Canada

Goals:To reduce deaths from colorectal cancer through an organized screening program; To support health care providers in providing the best possible colorectal cancer screening for their patients

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To support that goal, the Government of Ontario, in collaboration with Cancer Care Ontario launched the first population based organized colorectal screening program of its kind in Canada - in 2008. 3Ontario Cancer Statistics 20134Cancer TypeIncidence (# New Cases)Mortality(# Deaths)Colorectal 4,800 (M)3,900 (F)1,850 (M)1,500(F)4Slide Objective: Present burden of disease for breast, cervical and colorectal cancerContext for Cervical Cancer:The end point for cervical cancer screening is cervical intraepithelial neoplasia (CIN) 2 and/or CIN 3, NOT cervical cancer.The aim of screening is to prevent cervical cancer. The benefit of widespread cervical cancer screening in Ontario is a reduced incidence of cervical cancer cases.Less-developed countries that do not have widespread cervical cancer screening with the Pap test have much higher cervical cancer incidence and mortality rates compared to Ontario and Canada.

Background:Breast cancer (GLOBOCAN 2008)Global incidence rate of 38.9 per 100,000 compared to 83.2 per 100,000 in CanadaGlobal mortality rate of 12.4 per 100,000 compared to 15.6 per 100,000 in Canada

Cervical cancer (GLOBOCAN 2008)Incidence rate globally is more than two times higher than in Canada (global cervical cancer incidence rate is 15.2 per 100,000 compared to 6.6 per 100,000 in Canada)Mortality rate globally is four times higher than in Canada (global cervical cancer mortality rate of 7.8 per 100,000 compared to 1.9 per 100,000 in Canada)

Colorectal cancer (GLOBOCAN 2008) Global incidence of 17.2 per 100,000 compared to 38.1 per 100,000 in CanadaGlobal mortality rate of 8.2 per 100,000 compared to 11.7 per 100,000 in Canada

References:Canadian Cancer Societys Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Toronto: Canadian Cancer Society; 2013. Available online: http://www.cancer.ca.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet].Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr, accessed September 19, 2013

4Burden of Disease In Ontario, an estimated 8,700 new cases of colorectal cancer will be diagnosed and 3,350 people will die from it in 2013Incidence of colorectal cancer in Canada is similar to other developed countries, and is among the highest in the world55Slide Objective: Highlight burden of disease for colorectal cancer

Background Information:Colorectal cancer is the third most common cancer diagnosed in Ontario, and the second leading cause of cancer deaths.Despite a higher incidence of colorectal cancer in Canada compared to global rates, mortality rates tend to be lower in Canada than regions of Europe for men and women.Approximately 93% of cases are diagnosed in people aged 50 years and older.

References: Canadian Cancer Societys Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Toronto, ON: Canadian Cancer Society; 2013.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 International Agency for Research on Cancer [Internet].; 2010 [cited 2012 Apr 18]. Available from: http://globocan.iarc.fr

Canadian Partnership Against Cancer. Cancer control snapshot #3: colorectal cancer staging and survival [Internet]. Toronto: Canadian Partnership Against Cancer; 2010 [cited 2011 Mar 24]. Available from: http://www.cancerview.ca/idc/groups/public/documents/webcontent/rl_crc_snapshot_three_en.pdf

Curado M P, Edwards B, Shin HR, Storm H, Ferlay J, Heanue, et al., editors. Cancer incidence in five continents, Vol. IX IARC Scientific Publications No. 160. International Agency for Research on Cancer [Internet]. 2007 [cited 2012 Apr 18]. Available from: http://ci5.iarc.fr/CI5i-ix/ci5i-ix.htm

Burden of Disease Approximately 93% of cases are diagnosed in people aged 50 years and older5-year relative survival rate for colorectal cancer has improved over the past decade in Canada 66Slide Objective: Highlight burden of disease for colorectal cancer

Background Information:Colorectal cancer is the third most common cancer diagnosed in Ontario, and the second leading cause of cancer deaths.Despite a higher incidence of colorectal cancer in Canada compared to global rates, mortality rates tend to be lower in Canada than regions of Europe for men and women.Approximately 93% of cases are diagnosed in people aged 50 years and older.

References: Canadian Cancer Societys Steering Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Toronto, ON: Canadian Cancer Society; 2013.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 International Agency for Research on Cancer [Internet].; 2010 [cited 2012 Apr 18]. Available from: http://globocan.iarc.fr

Canadian Partnership Against Cancer. Cancer control snapshot #3: colorectal cancer staging and survival [Internet]. Toronto: Canadian Partnership Against Cancer; 2010 [cited 2011 Mar 24]. Available from: http://www.cancerview.ca/idc/groups/public/documents/webcontent/rl_crc_snapshot_three_en.pdf

Curado M P, Edwards B, Shin HR, Storm H, Ferlay J, Heanue, et al., editors. Cancer incidence in five continents, Vol. IX IARC Scientific Publications No. 160. International Agency for Research on Cancer [Internet]. 2007 [cited 2012 Apr 18]. Available from: http://ci5.iarc.fr/CI5i-ix/ci5i-ix.htm

Effectiveness of ScreeningCancer SiteEffectiveness of ScreeningType of StudiesColorectalWith FOBT:15% reduction in mortality with biennial screeningRandomized controlled trials7Slide Objective: Highlight effectiveness and corresponding evidence of screening

References:Breast: A recent summary of evidence associated with using mammography to screen for breast cancer found a 21% reduction in breast cancer mortality in women aged 50 to 69 years.

The Canadian Task Force on Preventive Health Care. "Recommendations on Screening for Breast Cancer in Average-risk Women Aged 4074 Years." Canadian Medical Association Journal 183.17 (2011): 19912001.

Cervical:World Health Organization. International Agency for Research on Cancer. IARC handbooks of cancer prevention: cervix cancer screening. Vol 10. Lyon: IARC Press;2005.

Colorectal:Note: biennial screening refers to FOBT followed by colonoscopy for those who test positive. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update. Am J Gastroenterol. 2008;103(6):15419.7Adenoma-Carcinoma Sequence

Majority of colorectal cancers arise from adenomatous polypsProgression to invasive cancer takes 10 years on average8Slide Objective: Provide explanation of progression of adenomatous polyps to colorectal cancer

Background Information: Majority of carcinomas arise from adenomas, and on average, progression of adenoma to cancer takes 10 years; colonoscopic removal of adenomatous polyps can reduce incidence of colorectal cancer by 76% to 90%. Hyperplastic polyps have a very low risk for progression, but risk of colorectal cancer (CRC) may increase in cases of hyperplastic polyposis syndrome, hyperplastic polyps located on the right side of the colon, and larger hyperplastic polyps (10 mm). Recent studies indicate some polyps, called sessile serrated polyps, previously identified as hyperplastic and benign, may develop into carcinoma; natural history of this pathway is not clear and optimal management requires further study.

References: Boparai KS, Mathus-Vliegen EMH, Koornstra JJ, Nagengast FM, van Leerdam M, van Noesel CJM, et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut. 2010 Aug;59(8):10941100.

Hiraoka S, Kato J, Fujiki S, Kaji E, Morikawa T, Murakami T, et al. The presence of large serrated polyps increases risk for colorectal cancer. Gastroenterology. 2010 Nov;139(5):150310, 1510.e13.

Huang CS, Farraye FA, Yang S, OBrien MJ. The clinical significance of serrated polyps. Am J Gastroenterol. 2011 Feb;106(2):22940.

Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010 Jun;138(6):20882100.

Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008 May;134(5):157095.

Noffsinger AE. Serrated polyps and colorectal cancer: new pathway to malignancy. Annu Rev Pathol. 2009;4:34364.

Zauber AG, Winawer SJ, OBrien MJ, Lansdorp-Vogelaar I, van Ballegoojien M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb 23: 366:687696.

Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, et al. Colorectal cancer screening and