ICS Orientation: Colorectal Cancer Screening

Report
Spotlight on
Colorectal Cancer Screening
1
1
Home Screening for Colon
Cancer
• http://www.youtube.com/watch?v=SzJe_D0-J38
2
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
3
Ontario Cancer Statistics 2013
Cancer Type
Colorectal
Incidence
(# New Cases)
Mortality
(# Deaths)
4,800 (M)
4
3,900 (F)
1,850 (M)
1,500(F)
4
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
6
Effectiveness of Screening
Cancer Site
Colorectal
Effectiveness of
Screening
With FOBT:
15% reduction in
mortality with biennial
screening
Type of
Studies
Randomized
controlled
trials
7
Adenoma-Carcinoma Sequence
• Majority of colorectal cancers
arise from adenomatous polyps
• Progression to invasive cancer
takes 10 years on average
8
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
11
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%
12
ColonCancerCheck (CCC)
Program Goals
• Reduce mortality through an
organized screening program
• Improve capacity of primary care to
participate in comprehensive
colorectal cancer screening
13
CCC Program Features
• Colonoscopy and FOBT quality
standards
• Increased colonoscopy capacity across
Ontario
• Primary care provider awareness
• Program-branded FOBT kits
• Financial incentives for family
physicians
14
CCC Program Features
Patient correspondence:
Initiatives to assist with follow-up
of abnormal results
• FOBT result letters
• Recall/reminder letters
• Invitation letters to people age 50 to 74
15
CCC FOBT Process
• At home test
• No bowel prep
• Only one dietary restriction – vitamin C
Clean sample
Sample one area
Smear first window
16
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
17
Sample two area
Smear second
window
Date and time in ink
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
18
Assessing Risk
Assess for colorectal cancer (CRC)
signs and symptoms
Symptoms
(high risk of
CRC)
No symptoms; 1 or
more 1st degree
relatives with CRC
(increased risk of CRC)
Age 50 to74;
no symptoms; no
affected 1st degree
relatives
(average 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
19
FOBT Screening Participation Rate,
by LHIN
100
90
80
70
60
50
CCO program target 2010: 40%
40
30
20
10
0
2004-2005
2006-2007
2008-2009
2010-2011
Overdue for CRC Screening
100
90
80
Overdue (%)
70
60
50
40
30
20
10
0
2008
2009
Year
2010
2011
21
Colonoscopy within 6 months (%)
Follow-up Colonoscopy After
+veFOBT
100
90
80
70
60
50
40
30
20
10
0
2008
2009
2010
Year
2011
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?
24
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?
25
CCC Resources
For more information:
www.cancercare.on.ca/pcresources
https://www.publications.serviceontario.ca/pubont/servlet/ecom/
Questions?
Thank You

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