Screening di Popolazione. del Cancro Colorettale. C. Hassan

Transcription

1 Screening di Popolazione del Cancro Colorettale C. Hassan

2 The Present 1. Organized screening program - Active invitation (less inequality) - Rapid coverage of the target population (2 yrs) - Quality Assurance

3 Rapid coverage of target population Popolazione italiana anni: Popolazione italiana interessata: 79,6% Numero programmi attivi: 120

4 The Present 1. Organized screening program 2. Primary test: Immunochemical Faecal test (FIT) Advantages Disadvantages - High uptake - High DR Advanced Neoplasia - Effective in reducing mortality - Suboptimal programmatic compliance

5 High Uptake Popolazione ISTAT, popolazione target, invitati e screenati NORD (90%) 6973 x (49%) (78%) 498 (15%) 229 (7%) (41%) screenati invitati popolazione target popolazione ISTAT

6 CRC mortality -22%

7 The Present 1. Organized screening program 2. Primary test: FIT 3. Secondary test: Colonoscopy Advantages - High Positive Predictive value Disadvantages - Suboptimal compliance - Variability in quality - Rigid capacity long waiting list

8 High PPV for Advanced Neoplasia 30 Des ad. avanzato 25 Acc carcinoma x 100 colonscopie PPV 25% 21,0 Des Acc 18, ,8 primo esame 2,8 es. successivi

9 Compliance to post-fit colonoscopy ,7 x 100 SOF Puglia Campania Sardegna Lazio Basilicata Sicilia Piemonte Liguria Toscana Marche Emilia Romagna Umbria Lombardia Friuli V. Giulia Veneto Abruzzo Valle d'aosta Trentino Standard accettabile > 85%, desiderabile > 90% Italia 2013

10 Variability in colonoscopy performance Ratio advanced-/non advanced- adenoma

11 FIT+ colonoscopies 5

12 5

13 Early Future 1. Organized screening program NO CHANGE 2. Primary test: FIT Sigmoidoscopy Advantages - CRC incidence prevention - One-time screening yrs. Disadvantages - Lower uptake vs. FIT - Slow coverage (1 birth cohort/year) - Uncertainty when added to FIT

14 CRC incidence prevention by sigmoidoscopy May 2010 September 2011

15 CRC incidence prevention by sigmoidoscopy UK FS PP CRC incidence SCORE -33% -31% CRC mortality -43% -38%

16 Low uptake with sigmoidoscopy Sigmoidoscopy programs in Italy N programmi Popolazione target N invitati Estensione inviti (%) 64,8 97,9 88,2 84,0 84,1 N screenati Adesione all invito (%) 24,3 24,0 24,0 25,1 23,3

17 Uncertainty of sigmoidoscopy in FIT programs Disruption FIT programs impractical Uncertainty of adding sigmoidoscopy over FIT: - FS trials vs no screening (not vs FIT) - Additional efficacy FS over FIT unknown - FIT- subjects at low-risk of Adv. Neoplasia

18 Invite first at sigmo......after at FIT 30% uptake at sigmo. 20% additional uptake at FIT

19 Early Future 1. Organized screening program 2. Primary test: FIT 3. Secondary test: Colonoscopy Better colon. - Split preparation - Retraining - NBI

20 Results (I) Split vs. Non-split BP RCT in organized program Paggi S, et al. DDW OP # Total n= 690 (FIT+) Split n= 345 Full n= 345 ADR p < % 42.6% Adv. ADR 30% 21% p 0.02 Mean age years years Males 48% 51% First round 152 (44%) 137 (40%)

21 60 Retraining in organized programs Retrospective analysis (Zorzi M, personal data) Adenoma DR Standardizzato 50 x 100 colonscopie Before After Totale 10 RETRAINING Emilia-Romagna Veneto 0 pre-retraining 1 trimestre 2 trimestre 2 semestre 2 anno

22 NBI in organized programs Total n= 237 (FIT+) HD n= 120 NBI n= 117 ADR 44% 32% p n.s. Adv. ADR 55% 52% p n.s.

23 Late Future 1. Organized screening program NO CHANGE 2. Primary test: Sigmoid. CT colonography Advantages - Full colonic imaging - Potentially higher uptake. Disadvantages - Radiation exposure - Rigid capacity

24 Sigmoidoscopy vs. CT colonography Results (I) RCTs in organized program (Regge D,...Segnan N, to be submitted) Uptake CTC 26.7% FS 27% p n.s. AN CTC 10.2% FS 10% p n.s.

25 Late Future 1. Organized screening program 2. Primary test: FIT 3. Secondary test: Colonoscopy Colon capsule FUSE

26 Results (I) CCE in FIT+ Head-to-head colonoscopy studies

27 The CCANDY trial new perspectives on screening Colon Capsule for Adenoma and Neoplasia Diagnostic Yield Italian Multicenter Trial (n=400) Organised population screening program Comparative study (CCE2 vs OC) Aim: to assess Sens, Spec, PPV and NPV of CCE2 in detecting CRC and Advanced Adenomas in patients with a positive FIT

28 The Lancet Oncology March 2014

29 FUSE vs. Standard endoscopy in organized programs - RCT Total n= 700 (FIT+) FUSE n= 350 Standard n= 350 Enrolled 80% - Next UEGW

30 Conclusions FIT: we are more than happy! Implementation of sigmoidoscopy uncertain Please, split & QA! CT colonography complementary role Impact of endoscopic technological advances to be proven

31 Incorporate your research in organized programs! Better Research = Better screening