Spotlight on Colorectal Cancer Screening
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1
Home Screening for Colon Cancer
• http://www.youtube.com/watch?v=SzJe_D0-J38
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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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Ontario Cancer Statistics 2013
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Cancer Type Incidence (# New Cases)
Mortality(# Deaths)
Colorectal 4,800 (M)3,900 (F)
1,850 (M)1,500(F)
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Burden 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 2013
• Incidence of colorectal cancer in Canada is similar to other developed countries, and is among the highest in the world 5
Burden of Disease
• Approximately 93% of cases are diagnosed in people aged 50 years and older
• 5-year relative survival rate for colorectal cancer has improved over the past decade in Canada
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Effectiveness of Screening
Cancer Site Effectiveness of Screening
Type of Studies
Colorectal With FOBT:15% reduction in mortality with biennial screening
Randomized controlled trials
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Adenoma-Carcinoma Sequence
• Majority of colorectal cancers arise from adenomatous polyps
• Progression to invasive cancer takes 10 years on average
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Recommended Screening
Average Risk: fecal occult blood test (FOBT)•Men and Women age 50 to 74• Biennial (every 2 years) • Follow up abnormal FOBT with colonoscopy 9
Recommended Screening
Increased Risk: Colonoscopy • One or more first-degree relatives with a history of colorectal cancer• Begin at age 50, or 10 years earlier than age relative was diagnosed, whichever is first 10
FOBT and Colonoscopy
Average risk patients:• with a negative (normal)
colonoscopy should not be screened for 10 years
• following which screening should resume using either FOBT or colonoscopy
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Evidence for Screening Using FOBT
A meta-analysis of 3 randomized clinical trials shows that regular screening with FOBT reduces colorectal cancer mortality by 15%
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ColonCancerCheck (CCC) Program Goals
• Reduce mortality through an organized screening program
• Improve capacity of primary care to participate in comprehensive colorectal cancer screening
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• Colonoscopy and FOBT quality standards
• Increased colonoscopy capacity across Ontario
• Primary care provider awareness• Program-branded FOBT kits• Financial incentives for family
physicians
CCC Program Features
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Patient correspondence: Initiatives to assist with follow-upof abnormal results• FOBT result letters • Recall/reminder letters • Invitation letters to people age 50
to 74
CCC Program Features
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CCC FOBT Process• At home test• No bowel prep• Only one dietary restriction – vitamin C
Clean sample Sample one area
Smear first window
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CCC FOBT Process• Three different bowel movements• Record date and time on each flap in ink• Complete and mail within 10 days of first
sample
Sample two area
Smear second window
Date and time in ink
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CCC FOBT Process
• Personal info matches requisition• Place Kit in foil envelope and seal• Include foil envelope and requisition
Use foil lined envelope
Include all pieces
Mail Canada Post
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Assessing Risk
Assess for colorectal cancer (CRC) signs and symptoms
Symptoms(high risk of
CRC)
Age 50 to74;no symptoms; no
affected 1st degree relatives(average risk of
CRC)
No symptoms; 1 or more 1st degree
relatives with CRC(increased risk of
CRC)
Refer to colonoscopy;
FOBT not appropriate
Refer to colonoscopy;
start at 50 years of age or 10 years
before age of relative’s diagnosis
FOBT every 2 years
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FOBT Screening Participation Rate, by LHIN
Ontario
Erie St. C
lair
South West
Waterlo
o Welli
ngton
Hamilto
n Niagara
Haldimand Bran
t
Central W
est
Mississa
uga Halto
n
Toronto CentralCentral
Central East
South East
Champlain
North Simcoe Muskoka
North East
North West
0
10
20
30
40
50
60
70
80
90
100
2004-2005 2006-2007 2008-2009 2010-2011
CCO program target 2010: 40%
Overdue for CRC Screening
2008 2009 2010 20110
10
20
30
40
50
60
70
80
90
100
Year
Ove
rdue
(%)
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Follow-up Colonoscopy After +veFOBT
2008 2009 2010 20110
102030405060708090
100
Year
Col
onos
copy
with
in 6
mon
ths
(%)
ColonCancerCheck• In Ontario, what is the recommended
screening test for colorectal cancer if the individual is 50+ and has no family history of CRC and no signs or symptoms?
1. Fecal Immunochemical Test (FIT)
2. Fecal Occult Blood Test (FOBT)
3. Flexible Sigmoidoscopy
4. Colonoscopy
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Clinical Case Study 1
A 54-year-old asymptomatic male comes in for his periodic health visit
What screening test would you suggest for him?
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Clinical Case Study 2
• A 47-year-old woman inquires about colorectal cancer screening• Her mother was diagnosed at age 65
with colorectal cancer
What would you suggest?
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CCC Resources
For more information: www.cancercare.on.ca/pcresources
https://www.publications.serviceontario.ca/pubont/servlet/ecom/
Questions?
Thank You