Objectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background
|
|
- Benedict Roberts
- 5 years ago
- Views:
Transcription
1 Colorectal Cancer Screening Payam Afshar, MS, MD Kaiser Permanente, San Diego Objectives Colorectal cancer background Colorectal cancer screening populations Colorectal cancer screening modalities Colonoscopy surveillance program Colorectal cancer screening pearls Definitions Screening = asymptomatic patient with no prior history of colon polyps or cancer Diagnostic testing = symptomatic patient, such as iron deficiency anemia, rectal bleeding, abnormal CT imaging, etc. Surveillance = prior history of polyps or cancer based on prior endoscopic evaluation 1
2 Background 2nd cause of cancer death in U.S. (Lung cancer is 1st) 1 US Cancer Statistics Working Group US Cancer Statistics Working Group Background 2nd cause of cancer death in U.S. (Lung cancer is 1st) 1 in 20 average Americans will have colorectal cancer 1/3 of patients with CRC will mortality associated with it 3-10% of Americans have a 1st degree relative with CRC 1 Incidence: - 90% of CRC > 50 years old - 10% of CRC < 50 years old - 80% of CRC are sporadic - 20% have genetic/hereditary factors 2 1. Henrikson NB, et al. Family history and natural history of colorectal cancer: a systematic review. Genet Med. 2015; 17 (9): Lin JS, et al. Screening for Colorectal Cancer: A Systematic Review for the USPSTF; AHRQ publication 2
3 Background Early colorectal cancer diagnosis = good prognosis Incidence of CRC in U.S. has decreased 3% per year in past decade for those > 50 years of age due to screening 1 1 US Cancer Statistics Working Group Medicare coverage for CRC began January US Cancer Statistics Working Group Background Early colorectal cancer diagnosis = good prognosis Incidence of CRC in U.S. has decreased 3% per year in past decade for those > 50 years of age due to screening 1 Incidence of CRC in U.S. has increased for those < 50 years of age in last decade Environmental factors can help control risk of CRC - Obesity - Diet (processed meats, red meats) - Exercise - Tobacco smoking 1 US Cancer Statistics Working Group
4 Colorectal cancer screening Case #1 75 year old female with maternal grandmother with colorectal cancer had colonoscopy 1 year ago with removal of 3 sigmoid colon polyps. Pathology in the records show all as hyperplastic polyps. Patient is inquiring about next colorectal cancer screening. Your recommendations are: A. Repeat colonoscopy in 2 years due to prior polyps B. Repeat colonoscopy in 2 years due to family history of colon cancer C. Repeat colonoscopy in 9 years D. No future colorectal cancer screening is needed Case #2 48 year old female with paternal grandfather with colorectal cancer is seeing you for non-gi related clinic visit. Patient is inquiring about her first colorectal cancer screening based on her family history of colon cancer. Your recommendations are: A. Start colonoscopy now as she is overdue B. Offer any CRC screening modality now C. Start colonoscopy in 2 years D. Offer any CRC screening modality in 2 years E. Perform rectal exam with guaiac in office today 4
5 Screening populations: Average Risk years old (Grade A recommendation)* years old (Grade C recommendation)** > 85 years old (Grade D recommendation)*** Appropriately screened population: Patient is healthy enough to undergo treatment if CRC detected Patient does not have co-morbid conditions and estimated life expectancy < 10 years * Grade A = recommend service; high certainty that net benefit is substantial ** Grade C = selectively offer or provide service; moderate certainty that net benefit is small (USPSTF recommendations are years old) *** Grade D = discourage the use of the this service USPSTF - Colorectal cancer screening. JAMA 2016; 315 (23); Screening populations: Increased Risk Family history of CRC: Family history Recommendations - CRC or advanced adenomas* in first-degree relative at age < 60, OR - Two or more first-degree relatives with CRC at any age (not genetic syndrome) - CRC or advanced adenomas* in first-degree relative at age > 60 *Advanced adenoma = polyp > 1 cm in size, villous features, high-grade dysplasia Colonoscopy every 5 years starting at age 40, or 10 years before youngest case in the family was diagnosed, whichever comes first Start screening at age 40 with any test; repeat testing as average risk or based on findings Recommendations on family history are being updated in very near future 1. Rex, D, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017 Jul;153(1): CRC screening in African-Americans Medical Societies - US Preventive Service Task Force (USPSTF) - American Cancer Society (ACS) - Multi-Society Task Force on CRC (MSTF) - American College of Radiology (ACR) Age of onset - American College of Gastroenterology (ACG) - American Society for Gastrointestinal Endoscopy (ASGE) 45 - American College of Physicians (ACP) Conclusion: start CRC screening for African-Americans at 50 years of age 5
6 CRC screening in average risk patients < 50 years old : 250,000 cancer deaths identified in government-based study in years olds (median age 49 y/o) All race mortality on the rise since 2005 (1.0% per year) White race mortality on the rise since 2005 (1.4 % per year) Research Letter. JAMA 2017; 318 (6): Screening populations: High Risk History of inflammatory bowel disease - Ulcerative colitis (NOT ulcerative proctitis) - Crohn s colitis Screening populations: Highest risk 1. Lynch syndrome (hereditary non-polyposis colorectal cancer). Completely fulfills following criteria: A. 3 relatives with Lynch syndrome-associated cancers (small bowel, large bowel, upper GU tract, and endometrial) B. 2 successive generations are involved C. 1 first degree relative affected < 50 years old 2. Familial Adenomatous Polyposis (FAP) - > 10 adenomas (attenuated FAP) or > 100 adenomas (classic FAP) Conclusion: refer for genetic counseling for testing OR gastroenterology 6
7 Clinical practice Assessment for risk of CRC Questions to start asking patients around 30 years of age: 1. Do you have a history of Inflammatory Bowel Disease? 2. Do you have any family members with history of colon polyps or colon/rectal cancer? A. First degree relative? B. Age at time of diagnosis? C. Number and type of polyps (if known)? Case #1 75 year old female with maternal grandmother with colorectal cancer had colonoscopy 1 year ago with removal of 3 sigmoid colon polyps. Pathology in the records show all as hyperplastic polyps. Patient is inquiring about next colorectal cancer screening. Your recommendations are: A. Repeat colonoscopy in 2 years due to prior polyps B. Repeat colonoscopy in 2 years due to family history of colon cancer C. Repeat colonoscopy in 9 years D. No future colorectal cancer screening is needed Case #1 75 year old female with maternal grandmother with colorectal cancer had colonoscopy 1 year ago with removal of 3 sigmoid colon polyps. Pathology in the records show all as hyperplastic polyps. Patient is inquiring about next colorectal cancer screening. Your recommendations are: A. Repeat colonoscopy in 2 years due to prior polyps B. Repeat colonoscopy in 2 years due to family history of colon cancer C. Repeat colonoscopy in 9 years D. No future colorectal cancer screening is needed 7
8 Case #2 48 year old female with paternal grandfather with colorectal cancer is seeing you for non-gi related clinic visit. Patient is inquiring about her first colorectal cancer screening based on her family history of colon cancer. Your recommendations are: A. Start colonoscopy now as she is overdue B. Offer any CRC screening modality now C. Start colonoscopy in 2 years D. Offer any CRC screening modality in 2 years E. Perform rectal exam with guaiac in office today Case #2 48 year old female with paternal grandfather with colorectal cancer is seeing you for non-gi related clinic visit. Patient is inquiring about her first colorectal cancer screening based on her family history of colon cancer. Your recommendations are: A. Start colonoscopy now as she is overdue B. Offer any CRC screening modality now C. Start colonoscopy in 2 years D. Offer any CRC screening modality in 2 years E. Perform rectal exam with guaiac in office today Case #3 54 year male with history of type 2 DM (Hgb A1c 10.2%), hypertension intermittently taking medications, and no family history of colorectal cancer is in your clinic based on the demands of his wife. You notice that the last visit to clinic was 2 years ago. The wife is aware that he is due for colorectal cancer screening and wants to know the best test to perform. You offer: A. Rectal exam with guaiac in your office that visit B. Fecal immunochemical test (FIT) at home and repeat annually C. Fecal DNA test at home D. Promote a colonoscopy 8
9 Case #4 64 year old male with normal colonoscopy 2 years ago presents with few days of rectal bleeding prior to day of visit. What is the appropriate management of this patient? A. Guaiac rectal exam, if negative, no work up needed B. Guaiac rectal exam; if positive, send patient to GI C. Rectal exam with anoscopy, if available D. Direct referral to GI Screening Tests: Stool-based Screening Methods Frequency Comments gfobt FIT FIT-DNA Annually Annually Every 1 or 3 yrs Home-based testing No bowel prep needed Requires dietary and medication adjustments Home-based testing No bowel prep needed More accurate than gfobt 75-80% sens, 90-95% spec Uncertain guidelines for follow up in positive tests after negative colonoscope Anxiety associated with (+) test 92% sens, 87% spec Guaiac-based testing is not considered as a valid screening modality based on most recent USPSTF guidelines (updated 2016) Screening Tets: Visualization-based Screening Methods Frequency Comments Colonoscopy CT colonography Flexible Sigmoidoscopy (+/- FIT) Every 10 years Every 5 years Every 5 years (every 10 years with annual FIT) Less frequent screening option Screening and diagnostic with potential of intervention Preferred test for (+)FH of CRC Sens, spec is operator dependent* Potential incidental findings 67-94% sens, 86-98% spec for adenomas > 10 mm No option for intervention Requires colonoscopy if (+) Not covered by Medicare Benefit of unsedated procedure Decreases small risks associated with colonoscopy Combines 2 screening modalities *Adenoma Detection Rate (ADR) 9
10 Life-years gained and CRC deaths averted / 1,000 patients screened similar among all screening modalities USPSTF - Colorectal cancer screening. JAMA 2016; 315 (23); Risks of CRC screening Stool and serologic tests: Risks are related to colonoscopy and sedation Colonoscopy: Preparation risks - dehydration, electrolyte imbalances Sedation - cardiovascular events Procedure - bleeding (< 1 %), perforation (1/2500), infection, missed lesions, death USPSTF Screening CRC 2016 the screening tests are not presented in any preferred or ranked order direct comparison of screening methods to detect colorectal neoplasia in screening programs over time are limited. the best screening test is the one that gets done, and the USPSTF concludes that maximizing the total proportion of the eligible population that receives screening will result in the greatest reduction in colorectal cancer deaths. 10
11 Case #3 54 year male with history of type 2 DM (Hgb A1c 10.2%), hypertension intermittently taking medications, and no family history of colorectal cancer is in your clinic based on the demands of his wife. You notice that the last visit to clinic was 2 years ago. The wife is aware that he is due for colorectal cancer screening and wants to know the best test to perform. You offer: A. Rectal exam with guaiac in your office that visit B. Fecal immunochemical test (FIT) at home and repeat annually C. Fecal DNA test at home D. Promote a colonoscopy Case #3 54 year male with history of type 2 DM (Hgb A1c 10.2%), hypertension intermittently taking medications, and no family history of colorectal cancer is in your clinic based on the demands of his wife. You notice that the last visit to clinic was 2 years ago. The wife is aware that he is due for colorectal cancer screening and wants to know the best test to perform. You offer: A. Rectal exam with guaiac in your office that visit B. Fecal immunochemical test (FIT) at home and repeat annually C. Fecal DNA test at home D. Promote a colonoscopy 11
12 Case #4 64 year old male with normal colonoscopy 2 years ago presents with few days of rectal bleeding prior to day of visit. What is the appropriate management of this patient? A. Guaiac rectal exam, if negative, no work up needed B. Guaiac rectal exam; if positive, send patient to GI C. Rectal exam with anoscopy, if available D. Direct referral to GI Case #4 64 year old male with normal colonoscopy 2 years ago presents with few days of rectal bleeding prior to day of visit. What is the appropriate management of this patient? A. Guaiac rectal exam, if negative, no work up needed B. Guaiac rectal exam; if positive, send patient to GI C. Rectal exam with anoscopy, if available D. Direct referral to GI Prognosis 5-year survival rates Local disease (stages < 2, confined to the wall) - 90% Regional disease with lymph nodes (stage 3) - 70% Widespread disease (stage 4) - 10% 12
13 Prognosis Efforts to raise screening rates should be enhanced. - The National Colorectal Cancer Roundtable proposed the goal of increasing screening rates to at least 80% by More than 150 organizations have signed a pledge to achieve this goal Prognosis Detection and removal of pre-cancerous polyps Decreased incidence of CRC Decreased mortality from CRC Detection and treatment of early-stage CRC Decreased mortality from CRC SoCal Kaiser Data KP SoCal has been screening > 80% of eligible patients for CRC since 2013!!!!!! 13
14 SoCal Kaiser Data Screening for colorectal cancer is a healthcare system s responsibility SoCal Kaiser Data Colorectal Cancer Mortality Down Three-Year Averaged CRC Mortality Rate per 100,000 Person Year Targeted Baseline Year 1 Year 2 Year 3 Year
15 An approach that gets results February 2, 2018 Kaiser Permanente All Rights Reserved. Colonoscopy surveillance program Colonoscopy surveillance Surveillance = follow up testing in patient with increased risk of colorectal cancer based on prior history of polyps or colon cancer Colon polyps: - 2/3 of polyps are adenomas - 30% of men will have polyps at initial screening colonoscopy - 20% of women will have polyps at initial screening colonoscopy - Polyps increase with age and environmental risk factors 15
16 Colonoscopy surveillance Colon polyps increases risk of colon cancer based on: - Increased number of polyps - Increased size of polyp (> 10 mm) - Aggressive histology of polyp (villous features, highgrade dysplasia) Estimated polyp dwell time from small (< 1cm) polyp to an invasive cancer > 10 years in an average risk patient Polyp pathology Hyperplastic polyp (not pre-malignant) Tubular adenoma Tubulovillous adenoma +/- high grade dysplasia Sessile serrated polyp 16
17 Polyp pathology NOT PRE-MALIGNANT Hyperplastic polyp (not pre-malignant) PRE-MALIGNANT Tubular adenoma Tubulovillous adenoma +/- high grade dysplasia Sessile serrated polyp Colon cancer Surveillance recommendations Finding Colon polyp Frequency of colonoscopy - Small tubular adenomas (1-2) 5-10 years - Small tubular adenomas (3-10) 3 years - Small tubular adenomas (>10) < 3 years - Large tubular adenoma (> 10 mm) - any number 3 years - Villous adenoma - any number 3 years - Small sessile serrated polyp w/o dysplasia 5 years - Large sessile serrated polyp (> 10 mm) - Small sessile serrated polyps with dysplasia - Sessile serrated adenoma Colon cancer 3 years Follow up 1 year, 3 years, and every 5 years thereafter 17
18 Pearls for CRC screening 1. Start obtaining a family history for CRC before 40 years of age in your patients 2. Intention to order any stool-based colon study = intention to commit to colonoscopy 3. Family history of CRC is regarding only 1st degree relatives (unless there is a familial pattern of several family members) 4. The best colorectal screening modality for the average risk patient is the one that gets done. Consider colonoscopy for non-compliant medical patients. 5. Do not guaiac a rectal exam on your patients (not recommended as screening modality per USPSTF 2016 guidelines) 18
CLINICAL PRACTICE GUIDELINE FOR COLORECTAL CANCER SCREENING
CLINICAL PRACTICE GUIDELINE FOR COLORECTAL CANCER SCREENING This guideline is designed to assist practitioners by providing the framework for colorectal cancer (CRC) screening, and is not intended to replace
More informationColon Cancer Screening. Layth Al-Jashaami, MD GI Fellow, PGY 4
Colon Cancer Screening Layth Al-Jashaami, MD GI Fellow, PGY 4 -Colorectal cancer (CRC) is a common and lethal cancer. -It has the highest incidence among GI cancers in the US, estimated to be newly diagnosed
More informationScreening & Surveillance Guidelines
Chapter 2 Screening & Surveillance Guidelines I. Eligibility Coloradans ages 50 and older (average risk) or under 50 at elevated risk for colon cancer (personal or family history) that meet the following
More informationQuality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care
Quality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Outcome DESCRIPTION:
More informationColon Cancer Screening & Surveillance. Amit Patel, MD PGY-4 GI Fellow
Colon Cancer Screening & Surveillance Amit Patel, MD PGY-4 GI Fellow Epidemiology CRC incidence and mortality rates vary markedly around the world. Globally, CRC is the third most commonly diagnosed cancer
More informationColorectal Cancer Screening
Recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer Colorectal Cancer Screening Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson
More informationThis is the portion of the intestine which lies between the small intestine and the outlet (Anus).
THE COLON This is the portion of the intestine which lies between the small intestine and the outlet (Anus). 3 4 5 This part is responsible for formation of stool. The large intestine (colon- coloured
More informationGuidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer
Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer David A. Lieberman, 1 Douglas K. Rex, 2 Sidney J. Winawer,
More informationColorectal Cancer Screening: A Clinical Update
11:05 11:45am Colorectal Cancer Screening: A Clinical Update SPEAKER Kevin A. Ghassemi, MD Presenter Disclosure Information The following relationships exist related to this presentation: Kevin A. Ghassemi,
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Outcome High Priority
Quality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Preventive Care 2019 COLLECTION TYPE: MIPS CLINICAL QUALITY
More informationJoint Session with ACOFP and Cancer Treatment Centers of America (CTCA): Cancer Screening: Consensus & Controversies. Ashish Sangal, M.D.
Joint Session with ACOFP and Cancer Treatment Centers of America (CTCA): Cancer Screening: Consensus & Controversies Ashish Sangal, M.D. Cancer Screening: Consensus & Controversies Ashish Sangal, MD Director,
More informationRazvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER
Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental
More informationFinancial Disclosers
Slide 1 Colorectal Cancer Screening Jason Hemming, MD NESGNA November 15, 2014 Slide 2 Bio Slide 3 Financial Disclosers I have no actual or potential conflict of interest relation to this presentation
More informationEARLY DETECTION OF COLORECTAL CANCER. Epidemiology of CRC
Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental
More informationThe New Grade A: USPSTF Updated Colorectal Cancer Screening Guidelines, What does it all mean?
The New Grade A: USPSTF Updated Colorectal Cancer Screening Guidelines, What does it all mean? Robert A. Smith, PhD Cancer Control, Department of Prevention and Early Detection American Cancer Society
More informationColon Cancer Screening Past, Present & Future
Colon Cancer Screening Past, Present & Future Steve Lanspa, MD August 25, 2018 Dr. Lanspa has listed no financial interest/arrangement that would be considered a conflict of interest. Learning Objectives
More informationColon Screening in 2014 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership
Colon Screening in 2014 Offering Patients a Choice Clark A Harrison MD The Nevada Colon Cancer Partnership Objectives 1. Understand the incidence and mortality rates for CRC in the US. 2. Understand risk
More informationColorectal Cancer Screening
Colorectal Cancer Screening An Integrated Care Pathway of the Collaborative Care Network Subject Matter Expert: Kevin Wolov, DO Pathway Custodian: Pat Czapp, MD First, a Friendly Reminder... This Integrated
More information2. Describe pros/cons of screening interventions (including colonoscopy, CT colography, fecal tests)
Learning Objectives 1. Review principles of colon adenoma/cancer biology that permit successful prevention regimes 2. Describe pros/cons of screening interventions (including colonoscopy, CT colography,
More informationColon Cancer Screening and Surveillance. Louis V. Antignano, M.D. Wilson Gastroenterology October 11, 2011
Colon Cancer Screening and Surveillance Louis V. Antignano, M.D. Wilson Gastroenterology October 11, 2011 Colorectal Cancer Preventable cancer Number 2 cancer killer in the USA Often curable if detected
More informationColorectal Cancer Screening. Paul Berg MD
Colorectal Cancer Screening Paul Berg MD What is clinical integration? AMA Definition The means to facilitate the coordination of patient care across conditions, providers, settings, and time in order
More informationColorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer
Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer Douglas K. Rex, MD, MACG 1, C. Richard Boland, MD 2, Jason A. Dominitz,
More informationColorectal Cancer: Preventable, Beatable, Treatable. American Cancer Society
Colorectal Cancer: Preventable, Beatable, Treatable American Cancer Society Reviewed/Revised May 2018 What we ll be talking about How common is colorectal cancer? What is colorectal cancer? What causes
More informationQuality ID #439: Age Appropriate Screening Colonoscopy National Quality Strategy Domain: Efficiency and Cost Reduction
Quality ID #439: Age Appropriate Screening Colonoscopy National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Efficiency DESCRIPTION:
More informationCANCER SCREENING USPSTF AND BEYOND. DeAnn Cummings, MD March 3, 2018
CANCER SCREENING USPSTF AND BEYOND DeAnn Cummings, MD March 3, 2018 OBJECTIVES Review and discuss cancer screening guidelines for: Colorectal CA Prostate CA Breast CA Ovarian CA Secondary prevention, NOT
More informationColorectal Cancer: Screening & Surveillance
Objectives Colorectal Cancer: Screening & Surveillance Chanda K. Ho, MD MPH Advances in Internal Medicine Brief overview epidemiology and pathogenesis of colorectal cancer (CRC) To review screening modalities
More informationFECAL OCCULT BLOOD TEST
MEDICAL POLICY For use with the UnitedHealthcare Laboratory Benefit Management Program, administered by BeaconLBS FECAL OCCULT BLOOD TEST Policy Number: CMP - 023 Effective Date: January 1, 2018 Table
More informationIEHP UM Subcommittee Approved Authorization Guidelines Colorectal Cancer Screening with Cologuard TM for Medicare Beneficiaries
for Medicare Beneficiaries Policy: Based on our review of the available evidence, the IEHP UM Subcommittee adopts the use of Cologuard TM - a multi-target stool DNA test as a colorectal cancer screening
More informationAlberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines
Alberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines June 2013 ACRCSP Post Polypectomy Surveillance Guidelines - 2 TABLE OF CONTENTS Background... 3 Terms, Definitions
More informationCT Colonography. A Radiologist s View of the Colon from Outside-In. Donny Baek, MD
CT Colonography A Radiologist s View of the Colon from Outside-In Donny Baek, MD Computed Tomography (CT) CT Image Reconstruction CT Image Reconstruction CT Image Reconstruction Colorectal Cancer Annual
More informationUpdates in Colorectal Cancer Screening & Prevention
Updates in Colorectal Cancer Screening & Prevention Swati G. Patel, MD MS Assistant Professor of Medicine Division of Gastroenterology & Hepatology Gastrointestinal Cancer Risk and Prevention Clinic University
More informationColorectal Cancer Screening in Ohio CHCs. Ohio Association of Community Health Centers
Colorectal Cancer Screening in Ohio CHCs Ohio Association of Community Health Centers 2 1/29/2015 Your Speakers Dr. Ted Wymyslo Ashley Ballard Randy Runyon 3 1/29/2015 Facts 3 rd most common cancer in
More informationCaring for a Patient with Colorectal Cancer. Objectives. Poll question. UNC Cancer Network Presented on 10/15/18. For Educational Use Only 1
Caring for a Patient with Colorectal Cancer Tammy Triglianos RN, APRN-BC, AOCNP Nurse Practitioner, GI Oncology 10/15/2018 Objectives Describe common signs and symptoms of colorectal cancer Understand
More informationColorectal Cancer Screening and Risk Assessment Workflow. Documentation Guide for Health Center NextGen Users
Colorectal Cancer Screening and Risk Assessment Workflow Documentation Guide for Health Center NextGen Users Colorectal Cancer Screening and Risk Assessment Workflow and Documentation Guide for Health
More informationCancer Screenings and Early Diagnostics
Cancer Screenings and Early Diagnostics Ankur R. Parikh, D.O. Medical Director, Center for Advanced Individual Medicine Hematologist/Medical Oncologist Atlantic Regional Osteopathic Convention April 6
More informationACG Clinical Guideline: Colorectal Cancer Screening
ACG Clinical Guideline: Colorectal Cancer Screening Douglas K. Rex, MD, FACG 1, David A. Johnson, MD, FACG 2, Joseph C. Anderson, MD 3, Phillip S. Schoenfeld, MD, MSEd, MSc (Epi), FACG 4, Carol A. Burke,
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Colorectal cancer: colonoscopic surveillance for prevention of colorectal cancer in patients with ulcerative colitis, Crohn
More information11/9/2015 OUTLINE. Quality Indicators for the Doctor Performing Screening Colonoscopy: What you should expect from your Endoscopist
Quality Indicators for the Doctor Performing Screening Colonoscopy: What you should expect from your Endoscopist Anil K Sharma MD FACP Professor of Clinical Medicine, University of Rochester Chief of Gastroenterology,
More informationIncreasing Colorectal Cancer Screening in Wyoming. Allie Bain, MPH Outreach & Education Supervisor Wyoming Integrated Cancer Services Program
Increasing Colorectal Cancer Screening in Wyoming Allie Bain, MPH Outreach & Education Supervisor Wyoming Integrated Cancer Services Program Overview What is colorectal cancer? What are risk factors for
More informationImproving Outcomes in Colorectal Cancer: The Science of Screening. Colorectal Cancer (CRC)
Improving Outcomes in Colorectal Cancer: The Science of Screening Tennessee Primary Care Association October 23, 2014 Durado Brooks, MD, MPH Director, Prostate and Colorectal Cancers Colorectal Cancer
More informationMeasure #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clincal Care
Measure #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clincal Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION: The percentage
More informationGrand Rounds. Des Moines University. May 5, Durado Brooks, MD, MPH Director, Cancer Control Intervention American Cancer Society
Grand Rounds Des Moines University May 5, 2016 Durado Brooks, MD, MPH Director, Cancer Control Intervention American Cancer Society Case Summary Mrs. J is a 56 y o w female complaining of always tired;
More informationColorectal Cancer Screening. Dr Kishor Muniyappa 2626 Care Drive, Suite 101 Tallahassee, FL Ph:
Colorectal Cancer Screening Dr Kishor Muniyappa 2626 Care Drive, Suite 101 Tallahassee, FL 32308 Ph: 850-297-0351 What we ll be talking about How common is colorectal cancer? What is colorectal cancer?
More informationPatologia sistematica V Gastroenterologia Prof. Stefano Fiorucci. Colon polyps. Colorectal cancer
Patologia sistematica V Gastroenterologia Prof. Stefano Fiorucci Colon polyps Colorectal cancer Harrison s Principles of Internal Medicine 18 Ed. 2012 Colorectal cancer 70% Colorectal cancer CRC and colon
More informationFREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS What is CRC? CRC (CRC) is cancer of the large intestine (colon), the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon. Together,
More informationColorectal Cancer Screening and Surveillance
Medical Coverage Policy Effective Date...10/15/2017 Next Review Date...10/15/2018 Coverage Policy Number... 0148 Colorectal Cancer Screening and Surveillance Table of Contents Related Coverage Resources
More informationCANCER SCREENING USPSTF AND BEYOND. DeAnn Cummings, MD March 9, 2019
CANCER SCREENING USPSTF AND BEYOND DeAnn Cummings, MD March 9, 2019 OBJECTIVES Review and discuss cancer screening guidelines for: Colorectal CA Prostate CA Breast CA Ovarian CA Secondary prevention, NOT
More informationCologuard Screening for Colorectal Cancer
Pending Policies - Medicine Cologuard Screening for Colorectal Cancer Print Number: MED208.056 Effective Date: 08-15-2016 Coverage: I.Cologuard stool DNA testing may be considered medically necessary for
More informationColorectal Cancer Screening. Daniel C. Chung, MD GI Unit and GI Cancer Genetics Service Massachusetts General Hospital
Colorectal Cancer Screening Daniel C. Chung, MD GI Unit and GI Cancer Genetics Service Massachusetts General Hospital March, 2018 CRC Epidemiology 4th most common malignancy in US (136,000 cases/yr) 2nd
More informationremoval of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2
Supplementary Table 1. Study Characteristics Author, yr Design Winawer et al., 6 1993 National Polyp Study Jorgensen et al., 9 1995 Funen Adenoma Follow-up Study USA Multi-center, RCT for timing of surveillance
More informationClinical UM Guideline
Subject: Guideline #: Current Effective Date: 06/28/2016 Status: Revised Last Review Date: 05/05/2016 Description This document addresses colonoscopy, an endoscopic procedure which allows direct visual
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Virtual Colonoscopy / CT Colonography Page 1 of 19 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Virtual Colonoscopy / CT Colonography Professional Institutional
More informationHistorical. Note: The parenthetical numbers in the Clinical Indications section refer to the source documents cited in the References Section below.
Clinical UM Guideline Subject: Colonoscopy Guideline #: CG-SURG-01 Current Effective Date: 01/21/2015 Status: Revised Last Review Date: 05/15/2014 Description Colonoscopy describes the direct visual inspection
More informationCRC Risk Factors. U.S. Adherence Rates Cancer Screening. Genetic Model of Colorectal Cancer. Epidemiology and Clinical Consequences of CRC
10:45 11:45 am Guide to Colorectal Cancer Screening SPEAKER Howard Manten M.D. Presenter Disclosure Information The following relationships exist related to this presentation: Howard Manten MD: No financial
More informationColorectal Cancer Screening
Scan for mobile link. Colorectal Cancer Screening What is colorectal cancer screening? Screening examinations are tests performed to identify disease in individuals who lack any signs or symptoms. The
More informationCOLORECTAL CANCER. Colorectal Cancer (CRC) 3 rd most common cancer in U.S. 3 rd deadliest cancer in U.S. 12/4/2014
The heart and science of medicine. UVMHealth.org/CancerCenter COLORECTAL CANCER Claire Verschraegen, MD Co-Director University of Vermont Cancer Center 1 Colorectal Cancer (CRC) 3 rd most common cancer
More informationColorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer
1016 CLINICAL GUIDELINES CME Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer Douglas K. Rex, MD 1, C. R i chard B ol
More informationDIGESTIVE SYSTEM SURGICAL PROCEDURES May 1, 2015 INTESTINES (EXCEPT RECTUM) Asst Surg Anae
ENDOSCOPY Z50 Duodenoscopy (not to be claimed if Z399 and/or Z00 performed on same patient within 3 months)... 92.10 Z9 Subsequent procedure (within three months following previous endoscopic procedure)...
More informationColorectal Cancer Screening in Later Life: Blum Center Rounds
Colorectal Cancer Screening in Later Life: Blum Center Rounds OCTOBER 10, 2018 Agenda CRC Screening and Surveillance Recommendation Screening for Colon Cancer later in life Discussion and listening Families
More informationColorectal Neoplasia. Dr. Smita Devani MBChB, MRCP. Consultant Physician and Gastroenterologist Aga Khan University Hospital, Nairobi
Colorectal Neoplasia Dr. Smita Devani MBChB, MRCP Consultant Physician and Gastroenterologist Aga Khan University Hospital, Nairobi Case History BT, 69yr male Caucasian History of rectal bleeding No change
More informationQuality Measures In Colonoscopy: Why Should I Care?
Quality Measures In Colonoscopy: Why Should I Care? David Greenwald, MD, FASGE Professor of Clinical Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York ACG/ASGE Best
More informationCOLON CANCER SCREENING: AN UPDATE
Overview COLON CANCER SCREENING: AN UPDATE Siddharth Verma, DO, JD Rutgers New Jersey Medical School Background Screening Updates in Specific Populations African Americans CRC in the younger age USPSTF
More informationA Trip Through the GI Tract: Common GI Diseases and Complaints. Jennifer Curtis, MD
A Trip Through the GI Tract: Common GI Diseases and Complaints Jennifer Curtis, MD Colon Cancer How does it develop? Most cancers arise from polyps Over time these can turn into cancer Combination of genetic
More informationWhen is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool
When is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool Adenomas/Carcinoma Sequence Providing Time for Screening Normal 5-20 yrs 5-15 yrs
More information2017 CANCER ANNUAL REPORT
2017 CANCER ANNUAL REPORT A WORD FROM OUR LEADERSHIP We are pleased to present our 2017 Annual Report highlighting advances in state of the art cancer care at the Roper St. Francis Cancer Program. Our
More informationGENERAL COLORECTAL CANCER INFORMATION. What is colorectal cancer?
GENERAL COLORECTAL CANCER INFORMATION What is colorectal cancer? Colorectal cancer is cancer that develops in the colon or the rectum. The colon and rectum are parts of the digestive system, which is also
More informationColorectal Cancer Screening Guideline Issue Brief Updated May 30 th, 2018
Colorectal Cancer Screening Guideline Issue Brief Updated May 30 th, 2018 Issue Summary The American Cancer Society has updated its colorectal screening guideline, which have been published in CA: A Journal
More informationHow to start a screening Program? WEO Colorectal Cancer Screening Committee Meeting Brasilia Nov R. Sáenz, FACG,FASGE
How to start a screening Program? WEO Colorectal Cancer Screening Committee Meeting Brasilia Nov 11 2017 R. Sáenz, FACG,FASGE Wheel has been discovered already Policy Planning Thanks to GBD Big Data CRC
More informationColorectal Cancer Screening and Surveillance
1 Colorectal Cancer Screening and Surveillance Jeffrey Lee MD, MAS Assistant Clinical Professor of Medicine University of California, San Francisco jeff.lee@ucsf.edu Objectives Review the various colorectal
More informationNeoplastic Colon Polyps. Joyce Au SUNY Downstate Grand Rounds, October 18, 2012
Neoplastic Colon Polyps Joyce Au SUNY Downstate Grand Rounds, October 18, 2012 CASE 55M with Hepatitis C, COPD (FEV1=45%), s/p vasectomy, knee surgery Meds: albuterol, flunisolide, mometasone, tiotropium
More informationACTIVITY DISCLAIMER DISCLOSURE. Alvin B. Lin, MD, FAAFP. Audience Engagement System Step 1 Step 2 Step 3. Learning Objectives.
ACTIVITY DISCLAIMER Colorectal Cancer Alvin B. Lin, MD, FAAFP The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Analysis of Human DNA in Stool Samples as a Page 1 of 11 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Analysis of Human DNA in Stool Samples as a Technique for
More informationGuidelines for Breast, Cervical and Colorectal Cancer Screening
Guidelines for Breast, Cervical and Colorectal Cancer Screening Your recommendation counts. Talk to your patients about screening for cancer. CancerCare Manitoba provides organized, population-based screening
More informationBe it Resolved that FIT is the Best Way to Screen for Colorectal Cancer DEBATE
Be it Resolved that FIT is the Best Way to Screen for Colorectal Cancer DEBATE DEBATE Presenters PRESENTATION MODERATOR Dr. Praveen Bansal -MD, CCFP FCFP Regional Primary Care Lead, Integrated Cancer Screening,
More informationColorectal cancer screening: Is total prevention possible?
Just the facts colorectal cancer Colorectal cancer screening: Is total prevention possible? Jeffrey Fox, MD, MPH Concepts and Controversies 2011 2010 NCI estimates for US: 142, 570 new CRC diagnoses 51,370
More informationEmerging Interventions in Endoscopy. Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital
Emerging Interventions in Endoscopy Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital Colon Cancer Colon cancer is common. 1 in 20 people in the UK will develop the disease 19 000
More informationWellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer
Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Healthy Habits and Cancer Screening Rev 10.20.15 Page
More informationLIST OF ABBREVIATIONS
Gastroenter oenterology 2005 Royal College of Physicians of Edinburgh Screening and surveillance for upper and lower gastrointestinal cancer JN Plevris Consultant Gastroenterologist and Honorary Senior
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Analysis of Human DNA in Stool Samples as a Page 1 of 12 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Analysis of Human DNA in Stool Samples as a Technique for
More informationCENTERS FOR DISEASE CONTROL AND PREVENTION CENTERS FOR DISEASE CONTROL AND PREVENTION. Incidence Male. Incidence Female.
A Call to Action: Prevention and Early Detection of Colorectal Cancer (CRC) 5 Key Messages Screening reduces mortality from CRC All persons aged 50 years and older should begin regular screening High-risk
More informationColonic Polyp. Najmeh Aletaha. MD
Colonic Polyp Najmeh Aletaha. MD 1 Polyps & classification 2 Colorectal cancer risk factors 3 Pathogenesis 4 Surveillance polyp of the colon refers to a protuberance into the lumen above the surrounding
More informationColorectal Cancer Screening Paul Traficanti DO, FACOEP
Health Partners Plans Colorectal Cancer Screening Paul Traficanti DO, FACOEP Colorectal Cancer Centers for Disease Control (CDC) Of cancers that affect both men and women, colorectal cancer is the second
More informationColonoscopy MM /01/2010. PPO; HMO; QUEST Integration 10/01/2017 Section: Surgery Place(s) of Service: Outpatient
Colonoscopy Policy Number: Original Effective Date: MM.12.003 12/01/2010 Line(s) of Business: Current Effective Date: PPO; HMO; QUEST Integration 10/01/2017 Section: Surgery Place(s) of Service: Outpatient
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal surgery prior as factor in laparoscopic colorectal surgery, 554 555 Abscess(es) CRC presenting as, 539 540 Adenocarcinoma of
More informationUPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER. Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists
UPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists WHAT IS COLON CANCER? WHAT CAUSES COLORECTAL CANCER? WHAT ARE THE RISK
More informationDavid P. Ryan, M.D. Clinical Director, MGH Cancer Center Chief, Hematology-Oncology, MGH
Colon Cancer 2015 David P. Ryan, M.D. Clinical Director, MGH Cancer Center Chief, Hematology-Oncology, MGH Colon Cancer Case presentation 72yo woman presented 1/03 abd discomfort and nausea Found to have
More informationEarly detection and screening for colorectal neoplasia
Early detection and screening for colorectal neoplasia Robert S. Bresalier Department of Gastroenterology, Hepatology and Nutrition. The University of Texas. MD Anderson Cancer Center. Houston, Texas U.S.A.
More information1101 First Colonial Road, Suite 300, Virginia Beach, VA Phone (757) Fax (757)
1101 First Colonial Road, Suite 300, Virginia Beach, VA 23454 www.vbgastro.com Phone (757) 481-4817 Fax (757) 481-7138 1150 Glen Mitchell Drive, Suite 208 Virginia Beach, VA 23456 www.vbgastro.com Phone
More informationScreening for Colorectal Cancer: A Systematic Review for the U.S. Preventive Services Task Force
Evidence Synthesis Number 135 Screening for Colorectal Cancer: A Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of
More informationColorectal cancer screening
26 Colorectal cancer screening BETHAN GRAF AND JOHN MARTIN Colorectal cancer is theoretically a preventable disease and is ideally suited to a population screening programme, as there is a long premalignant
More informationPage 1. Selected Controversies. Cancer Screening! Selected Controversies. Breast Cancer Screening. ! Using Best Evidence to Guide Practice!
Cancer Screening!! Using Best Evidence to Guide Practice! Judith M.E. Walsh, MD, MPH! Division of General Internal Medicine! Womenʼs Health Center of Excellence University of California, San Francisco!
More informationGeneral and Colonoscopy Data Collection Form
Identifier: Sociodemographic Information Type: Zip Code: Inpatient Outpatient Birth Date: m m d d y y y y Gender: Height: (inches) Male Female Ethnicity: Weight: (pounds) African American White, Non-Hispanic
More informationGuidelines for the Early Detection of Cancer
Guidelines for the Early Detection of Cancer The American Cancer Society recommends these cancer screening guidelines for most adults. Screening tests are used to find cancer before a person has any symptoms.
More informationGIQIC18 Appropriate follow-up interval of not less than 5 years for colonoscopies with findings of 1-2 tubular adenomas < 10 mm
GI Quality Improvement Consortium, Ltd. (GIQuIC) 1 Following is an overview of the clinical quality measures in GIQuIC that can be reported to CMS for the Quality performance category of the Merit-Based
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #185 (NQF 0659): Colonoscopy Interval for Patients with a History of Adenomatous Polyps Avoidance of Inappropriate Use National Quality Strategy Domain: Communication and Care Coordination 2018
More informationCOMPUTED TOMOGRAPHIC COLONOGRAPHY
COMPUTED TOMOGRAPHIC COLONOGRAPHY Protocol: GAS021 Effective Date: November 1, 2017 Table of Contents Page COMMERCIAL & MEDICAID COVERAGE RATIONALE... 1 MEDICARE COVERAGE RATIONALE... 2 DESCRIPTION OF
More informationLatest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population
Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population David T. Rubin, M.D. Assistant Professor of Medicine Inflammatory Bowel Disease Center MacLean Center for Clinical Medical Ethics
More informationCANCER SCREENING. Er Chaozer Department of General Medicine, Tan Tock Seng Hospital
CANCER SCREENING Er Chaozer Department of General Medicine, Tan Tock Seng Hospital Introduction Screening average risk patients Benefits and harms from screening Early cancer detection early treatment
More information2017 OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS ONLY. MEASURE TYPE: Process
Measure. #185 (NQF 0659): Colonoscopy Interval for Patients with a History of Adenomatous Polyps Avoidance of Inappropriate Use National Quality Strategy Domain: Communication and Care Coordination 2017
More information