Spotlight on Colorectal Cancer Screening

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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)

4,800 (M) 4 3,900 (F)

Mortality (# Deaths)

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

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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

Colorectal

Effectiveness of Screening

With FOBT: 15% reduction in mortality with biennial screening

Type of Studies

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

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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

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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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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

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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

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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 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

Sample two area Smear second window Date and time in ink 17

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) Refer to colonoscopy; FOBT not appropriate No symptoms; 1 or more 1 st degree relatives with CRC (increased risk of CRC) Refer to colonoscopy; start at 50 years of age or 10 years before age of relative’s diagnosis Age 50 to74; no symptoms; no affected 1 st degree relatives (average risk of CRC) FOBT every 2 years 19

20 10 0 80 70 60 50 40 30

FOBT Screening Participation Rate, by LHIN

100 90 CCO program target 2010: 40% 2004-2005 2006-2007 2008-2009 2010-2011

Overdue for CRC Screening

100 90 80 70 60 50 40 30 20 10 0 2008 2009 2010 Year 2011

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Follow-up Colonoscopy After

+ve

FOBT

100 90 80 70 60 50 40 30 20 10 0 2008 2009 2010 2011 Year

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 23

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