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