Screening for Colorectal Cancer in the Elderly. The Broad Perspective
|
|
- Edmund Lawrence
- 6 years ago
- Views:
Transcription
1 Screening for Colorectal Cancer in the Elderly Charles J. Kahi, MD, MSCR Indiana University School of Medicine Richard L. Roudebush VA Medical Center Indianapolis, Indiana ACG Regional Midwest Course Symposium Indianapolis, Indiana August 24, 2014 The Broad Perspective Age is an important risk factor for CRC: - Incidence per 100,000: 74.5 at ages after age 75 - Elderly are greatest proportion of new CRC diagnoses Lukejohn et al. Am J Gastroenterol. 2011; 106 (7): Between 2000 and 2010, the population 65 years and over increased at a faster rate (15.1%) than the total U.S. population (9.7%) High rate of colonoscopy utilization in older age groups: - Analysis of 1.4 M reports from CORI - 13% 75 yo, 23% 70 yo - Most common indication in older patients is surveillance of polyps Lieberman et al. Gastrointest. Endosc 2014; In press. 1
2 Population 65 Years and Older by Size and Percent of Total Population: 1900 to 2010 (For more information on confidentiality protection, nonsampling error, and definitions, see /prod/cen2010/doc/sf1.pdf) Number (in millions) Percentage (of total population) Millions Percent Sources: U.S. Census Bureau, decennial census of population, 1900 to 2000; 2010 Census Summary File 1. Expectation of Life at Birth Year Total Male Female (proj) (proj) U.S. Census Bureau, Statistical Abstract of the United States:
3 (In)appropriate Colonoscopy in the Elderly 75,000 Medicare beneficiaries in Texas - Inappropriate colonoscopy based on age or occurrence too soon after colonoscopy with negative findings - Rate about 40% for 76-85, 25% for 86 year-olds Scheffield et al. JAMA Intern Med 2013; 173: ,000 Medicare patients with negative screening colonoscopy % underwent colonoscopy within 7 years without clear indication - Higher risk if male, more comorbidity, high-volume endoscopist Goodwin et al. Arch Intern Med 2011; 171: ,000 Medicare patients after colonoscopy with polypectomy % underwent surveillance colonoscopy at 5 years Cooper et al. Cancer 2013; 119 (10): USPSTF GUIDELINES Continued screening in 75-year-old persons after consecutive negative screenings singe age 50 is of little benefit For individuals older than age 85, competing causes of mortality preclude a mortality benefit that outweighs the harms For adults (75-85) who have not been previously screened, decisions about first-time screening in this age group should be made in the context of the individual s health status and competing risks Zauber et al. Annals Int Med 2008; 149(4):
4 When 900 years you will reach, look as good, you will not. - Jedi Master Yoda. THE ELDERLY ARE A HETEROGENEOUS GROUP, AND THERE IS NO SINGLE AGE THRESHOLD BEYOND WHICH SCREENING WILL SUDDENLY LOSE ITS BENEFITS, OR BECOME MORE HARMFUL, EQUALLY FOR ALL PATIENTS Walter et al. Am J Med. 2005; 118 (10):
5 FACTORS INVOLVED Patient chronological age and life expectancy Comorbidity, functional status Magnitude of protective effect of screening Natural history of colon neoplasms Individual risk for colonic neoplasia Prior screening/surveillance history Procedure-related related harm Patient preference and beliefs Physician preference and practice pattern. YIELD STUDIES High prevalence of CRC and advanced polyps Yield highest for patients with symptoms Low complication rates Many conclude (incorrectly) that high prevalence of advanced colon neoplasms is reason enough to screen Sardinha et al. Int J Colorectal Dis. 1999; 14(3): Arora et al. Gastrointest. Endosc. 2004; 60(3): Feingold et al. Am J Surg. 2003; 185 (4): Stevens et al. Am J Gastroenterol. 2003; 98 (8): Ure et al. Surg Endosc. 1995; 9 (5): Duncan et al. Dis Colon Rectum. 2006; 49(5):
6 COLONOSCOPY RISK IN THE ELDERLY Not as straightforward as in younger patients - Higher rate of poor bowel preparation - Procedure takes longer to complete - Risk of incomplete/aborted procedures is higher Froehlich et al. Gastrointest Endosc. 2005; 61 (3): Increased major complication risk - 53,220 Medicare beneficiaries age 66-95, outpatient colonoscopy (matched beneficiaries without colonoscopy) - Higher complication rate, increased with age, comorbidity - Risk per 1,000 procedures: 0.6 for perforation, 8.7 for postpolypectomy hemorrhage, 19.4 for cardiovascular events Warren et al. Ann Intern Med 2009; 150(12): LIFE EXPECTANCY AND SCREENING OUTCOMES Screening for cancer aims to prolong life through prevention or early detection Framework based on quantitative estimates of life expectancy, risk of CRC death, screening outcomes, harm: Significant variation in survival benefit for patients with similar ages but varying life expectancy. Walter and Covinsky. JAMA 2001; 285(21): Meta-analysis of 4 FOBT screening RCTs: - Average 10.3 years (95% CI ) before one CRC death was prevented for 1000 patients screened Lee et al. BMJ 2012; 345:e
7 Cumulative Colorectal-Cancer Mortality. Long-Term Mortality after Screening for Colorectal Cancer Shaukat A et al. N Engl J Med 2013;369: AGE OF SCREENING CESSATION BASED ON MODELS OF HARM AND BENEFIT Microsimulation models to estimate harms and benefits of having one cancer screen in regularly screened cohorts aged 66 to 90 years by comorbid condition level CRC screening using FIT Harms and benefits compared with those of average-health cohort screened at age 74 Harms and benefits in comparison 74 yo cohort similar to: - 76 yo with no comorbidity - 72 yo with moderate comorbidity - 66 yo with severe comorbidity Lansdorp-Vogelaar et al. Ann Int Med 2014; 161:
8 COST-EFFECTIVENESS Model with previously unscreened average-risk persons yo CRC screening using FIT, sigmoidoscopy, colonoscopy At threshold of $100,000 per QALY, CRC screening was cost-effective in unscreened elders until age: Colonoscopy Sigmoidoscopy FIT No comorbidity Severe comorbidity van Hees et al. Ann Int Med 2014;160: BEYOND MODELS: REAL WORLD CLINICAL IMPLICATIONS Relationship between the prevalence of colorectal neoplasms and impact of screening on life expectancy, and long-term outcome after screening Cross-sectional study conducted among 1244 asymptomatic individuals who underwent screening colonoscopy Age Group N Prevalence of Neoplasia Extension of life expectancy (Mean, SD) % 0.85 (3.40) % 0.17 (0.49) % 0.13 (0.30) Lin et al. JAMA 2006; 295 (20):
9 Survival of Elderly Persons after Colonoscopy Retrospective cohort of 404 Veterans aged 75 - Total deaths: 167 (41%). - Mean survival: 4.1 ± 0.1 years. - Most common cause of death: CV (35%) Mortality predicted by: - Age (HR 1.16 for each year increase beyond age 75) - Charlson score (HR 8.3 for each point increase) - Colonoscopy indication and advanced adenoma NOT predictive Median survival of patients was > 5 years if Charlson 4 Among patients 80, median survival was < 5 years regardless of Charlson score. Kahi et al. Gastrointest. Endosc 2007; 66 (3): QUANTIFYING THE IMPACT OF COLONOSCOPY ON CRC IN THE ELDERLY Effectiveness of lower GI endoscopic procedures to prevent CRC in geriatric populations: Understudied Complicating issue: Colonoscopy associated with decreased protection against right-sided CRC Case-control study, VA-Medicare, patients aged cases with CRC, 1869 controls without CRC - Exposure to lower GI endoscopy associated with 42% CRC reduction (aor , 95%CI ) - Colonoscopy associated with significant reductions in distal CRC (aor 0.45, ) and proximal CRC (aor 0.65, ) Kahi et al. Gastroenterology 2014; 146(3):
10 Screening/Surveillance Decisions Assessment of life expectancy by clinicians should be main driver of CRC screening/surveillance decisions Healthy older patients are not receiving screening while older patients with significant comorbidity are receiving it regardless: - VA-Medicare study of 27,068 Veterans 70 years - Rate of screening: No comorbidity 5-year mortality = 19% 47% Severe comorbidity 5-year mortality = 55% 41% Walter et al. Ann Internal Med 2009; 150(7): Screening/Surveillance Decisions Surveys of providers regarding CRC screening practices: - Providers incorporate patient age, comorbidity, life expectancy, and prior screening history when making decisions - Significant prevalence of inappropriate screening Kahi et al. J Gen Int Med 2009; 24(12): Cooper et al. Arch Int Med 1997; 157(17): % would screen a 75-year-old with active non-colon malignancy, severe CHF, or severe COPD Kahi et al. J Gen Int Med 2009; 24(12):
11 Screening/Surveillance Decisions Reasons for inappropriate screening unclear, but probably multifactorial: - Organizational pressures (performance measures) - Fear of litigation - Oversimplification of benefits of CRC screening - Erroneous impression that CRC screening benefits are universal - Reliance on heuristics, intuitive decision-making Kahi et al. J Gen Int Med 2009; 24(12): Hoffman and Walter. J Gen Int Med 2009; 24(12): Screening/Surveillance Decisions: Practical Guide Use USPSTF guidelines as basic framework Communicate with patient t and PCP Base decisions on health-adjusted estimate of life expectancy, NOT just chronological age If LE < 5-7 years, stop! Compare LE to recommended colonoscopy surveillance interval: Stop if LE < surveillance interval. 11
12 Screening/Surveillance Decisions Based on LE Women Men Top 25th percentile 50th percentile Lowest 25th percentile Top 25th Percentile 50th Percentile Lowest 25th Percentile Walter and Covinsky. JAMA 2001; 285(21):
Colorectal Cancer Screening: Colonoscopy, Potential and Pitfalls. Disclosures: None. CRC: still a major public health problem
Colorectal Cancer Screening: Colonoscopy, Potential and Pitfalls Disclosures: None Jonathan P. Terdiman, M.D. Professor of Clinical Medicine University of California, San Francisco CRC: still a major public
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 Cancer Screening: Cost-Effectiveness and Adverse events October, 2005
Colorectal Cancer Screening: Cost-Effectiveness and Adverse events October, 2005 David Lieberman MD Chief, Division of Gastroenterology Oregon Health and Science University Portland VAMC Portland, Oregon
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 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 informationUpdate in Outpatient Medicine JNC 8, Hypertension and More
Update in Outpatient Medicine JNC 8, Hypertension and More March 6 th 2015 Robert Gluckman, MD, FACP CMO Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers Squibb GE Proctor
More informationScreening Start Age in Light of New ACS Guidelines. Charles Kahi, MD, MS Indiana University Richard L. Roudebush VAMC Indianapolis, Indiana, USA
Screening Start Age in Light of New ACS Guidelines, MD, MS Indiana University Richard L. Roudebush VAMC Indianapolis, Indiana, USA CRC Screening for Average-Risk Adults: 2018 Guideline Update from the
More informationProvider Contribution to Overuse and Underuse of Colorectal Cancer Screening (mostly colonoscopy)
Provider Contribution to Overuse and Underuse of Colorectal Cancer Screening (mostly colonoscopy) James S. Goodwin, MD George and Cynthia Mitchell Distinguished Chair in Geriatric Medicine Director, Sealy
More informationStaging and survival of colorectal cancer (CRC) in octogenarians: Nationwide Study of US Veterans
Original Article Staging and survival of colorectal cancer (CRC) in octogenarians: Nationwide Study of US Veterans Gurjiwan Sing Virk 1, Mikram Jafri 2, Syed Mehdi 3, Christopher Ashley 4 1 Department
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 informationEstimates of complications and clinically significant findings in screening and surveillance colonoscopy
Oregon Health & Science University OHSU Digital Commons Scholar Archive February 2011 Estimates of complications and clinically significant findings in screening and surveillance colonoscopy J. Lucas Williams
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 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 informationTitle Description Type / Priority
Merit-based Incentive Payment system (MIPS) 2019 Qualified Clinical Data Registry (QCDR) Measure Specifications Summary Listing of QCDR measures supported by the NHCR Measure # NHCR4 NHCR5 GIQIC12 GIQIC15
More informationWEO CRC SC Meeting. Barcelona, Spain October 23, 2015
WEO CRC SC Meeting Barcelona, Spain October 23, 2015 Identification of serrated polyposis syndrome in the context of population-based CRC screening programs Evelien Dekker Academic Medical Center Amsterdam,
More informationImproving Access to Endoscopy at Safety-Net Hospitals. Lukejohn W. Day MD Assistant Professor of Medicine
Improving Access to Endoscopy at Safety-Net Hospitals Lukejohn W. Day MD Assistant Professor of Medicine Goals Background Improving Access to Endoscopic Care Electronic referral: ereferral Direct Access
More informationAugust 21, National Quality Forum th St, NW Suite 800 Washington, D.C Re: Colonoscopy Quality Index (NQF# C 2056)
August 21, 2012 National Quality Forum 1030 15th St, NW Suite 800 Washington, D.C. 20005 Re: Colonoscopy Quality Index (NQF# C 2056) The American College of Gastroenterology (ACG), American Gastroenterological
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 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 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 informationGI Quality Improvement Consortium, Ltd. (GIQuIC) QCDR Non-PQRS Measure Specifications
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 Physician Quality Report System (PQRS) via GIQuIC
More informationSteven Jubelirer, MD Clinical Professor Medicine WVU Charleston Division Senior Research Scientist CAMC Research Institute
Steven Jubelirer, MD Clinical Professor Medicine WVU Charleston Division Senior Research Scientist CAMC Research Institute Objectives Develop a systematic way to think about benefits and harms of cancer
More informationEstimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies Modeling Study for the US Preventive Services Task Force
Clinical Review & Education US Preventive Services Task Force MODELING STUDY Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies Modeling Study for the US Preventive Services
More informationSCREENING FOR BOWEL CANCER USING FLEXIBLE SIGMOIDOSCOPY REVIEW APPRAISAL CRITERIA FOR THE UK NATIONAL SCREENING COMMITTEE
SCREENING FOR BOWEL CANCER USING FLEXIBLE SIGMOIDOSCOPY REVIEW APPRAISAL CRITERIA FOR THE UK NATIONAL SCREENING COMMITTEE The Condition 1. The condition should be an important health problem Colorectal
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 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 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 informationPresenter Disclosure Information
2 3:15pm Screening Seniors: the Good, the Bad and the Questionable Presenter Disclosure Information The following relationships exist related to this presentation: Katherine Galluzzi, DO, CMD, has no financial
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 informationEpidemiology and Treatment of Colonic Angiodysplasia; a Population-Based Study. Naomi G. Diggs, MD Lisa L. Strate, MD MPH March 2, 2010
Epidemiology and Treatment of Colonic Angiodysplasia; a Population-Based Study. Naomi G. Diggs, MD Lisa L. Strate, MD MPH March 2, 2010 Background Angiodysplasia is an important cause of occult and acute
More informationFinding and Removing Difficult Polyps (safely)
Finding and Removing Difficult Polyps (safely) David Lieberman MD Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Colonoscopy Clouds Interval Cancers Interval Cancer:
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 informationColon Polyps: Detection, Inspection and Characteristics
Colon Polyps: Detection, Inspection and Characteristics Stephen Kim, M.D. Assistant Professor of Medicine Interventional Endoscopy Services UCLA Division of Digestive Diseases September 29, 2018 1 Disclosures
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 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 informationNational Colonoscopy Study (NCS) Screening Colonoscopy versus Annual Fecal Occult Blood Test NCT
National Colonoscopy Study (NCS) Screening Colonoscopy versus Annual Fecal Occult Blood Test NCT 00102011 Ann Zauber Sidney Winawer, Michael O Brien, John Allen, Andrew Feld, Glenn Mills, Robin Mendelsohn,
More informationObjectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background
Colorectal Cancer Screening Payam Afshar, MS, MD Kaiser Permanente, San Diego Objectives Colorectal cancer background Colorectal cancer screening populations Colorectal cancer screening modalities Colonoscopy
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 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 informationC olorectal adenomas are reputed to be precancerous
568 COLORECTAL CANCER Incidence and recurrence rates of colorectal adenomas estimated by annually repeated colonoscopies on asymptomatic Japanese Y Yamaji, T Mitsushima, H Ikuma, H Watabe, M Okamoto, T
More informationMeasuring the quality of colonoscopy: Where are we now and where are we going?
Measuring the quality of colonoscopy: Where are we now and where are we going? Timothy D. Imler, MD Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
More informationPage 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis
Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center
More informationTips to Improve ADRs during Colonoscopy
Tips to Improve ADRs during Colonoscopy Aasma Shaukat, MD, MPH, FACG GI Section Chief, Minneapolis VAMC Associate Professor, University of Minnesota Outline Why is quality important? Fundamentals of high-quality
More informationUpdate in Outpatient Medicine ACP Scientific Session November 12, 2016
Update in Outpatient Medicine ACP Scientific Session November 12, 2016 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers
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 informationSummary. Cezary ŁozińskiABDF, Witold KyclerABCDEF. Rep Pract Oncol Radiother, 2007; 12(4):
Rep Pract Oncol Radiother, 2007; 12(4): 201-206 Original Paper Received: 2006.12.19 Accepted: 2007.04.02 Published: 2007.08.31 Authors Contribution: A Study Design B Data Collection C Statistical Analysis
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 informationThe Prevalence Rate and Anatomic Location of Colorectal Adenoma and Cancer Detected by Colonoscopy in Average-Risk Individuals Aged Years
American Journal of Gastroenterology ISSN 0002-9270 C 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00430.x Published by Blackwell Publishing The Prevalence Rate and Anatomic Location
More informationDigestive Health Southwest Endoscopy 2016 Quality Report
Digestive Health 2016 Quality Report Our 2016 our quality and value management program focused on one primary area of interest: Performing high quality colonoscopy High quality Colonoscopy We selected
More informationIncreasing the number of older persons in the United
Current Capacity for Endoscopic Colorectal Cancer Screening in the United States: Data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices Martin L. Brown, PhD, Carrie N.
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 informationEXPERT WORKING GROUP Surveillance after neoplasia removal. Meeting Chicago, May 5th 2017 Chair: Rodrigo Jover Uri Ladabaum
EXPERT WORKING GROUP Surveillance after neoplasia removal Meeting Chicago, May 5th 2017 Chair: Rodrigo Jover Uri Ladabaum AIM To improve the quality of the evidences we have regarding post- polypectomy
More informationFive-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy
The new england journal of medicine original article Five-Year Risk of Colorectal Neoplasia after Negative Screening Colonoscopy Thomas F. Imperiale, M.D., Elizabeth A. Glowinski, R.N., Ching Lin-Cooper,
More informationRE: United States Preventive Services Task Force Draft Research Plan for Colorectal Cancer Screening
February 5, 2014 Virginia A. Moyer, MD, MPH Chair United States Preventive Services Task Force 540 Gaither Road Rockville, MD 20850 RE: United States Preventive Services Task Force Draft Research Plan
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 informationSelected Controversies. Cancer Screening. Breast Cancer Screening. Selected Controversies. Page 1. Using Best Evidence to Guide Practice
Cancer Screening Using Best Evidence to Guide Practice Judith M.E. Walsh, MD, MH Division of General Internal Medicine Women s Health Center of Excellence University of California, San Francisco Selected
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators
More informationShort and longterm outcomes after endoscopic resection of malignant polyps.
Short and longterm outcomes after endoscopic resection of malignant polyps. Short and longterm outcomes High risk features Lymph node metastasis Lymph node metastases sm1 sm2 sm3 Son 2008 3.1 % 14.9% 25.0
More informationResearch Article Development of Polyps and Cancer in Patients with a Negative Colonoscopy: A Follow-Up Study of More Than 20 Years
ISRN Gastroenterology, Article ID 261302, 4 pages http://dx.doi.org/10.1155/2014/261302 Research Article Development of Polyps and Cancer in Patients with a Negative Colonoscopy: A Follow-Up Study of More
More informationHamideh Salimzadeh, PhD Assistant Professor, Digestive Diseases Research Center,Tehran University of Medical Sciences, Shariati Hospital, North
Hamideh Salimzadeh, PhD Assistant Professor, Digestive Diseases Research Center,Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue 14666 Tehran, Iran. Tel: +98-21-82415415 Fax:
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 informationPage 1. Cancer Screening for Women I have no conflicts of interest. Overview. Breast, Colon, and Lung Cancer. Jeffrey A.
Cancer Screening for Women 2017 Breast, Colon, and Lung Cancer Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco I have no conflicts
More informationCost-effectiveness of adenoma surveillance - the Dutch guidelines -
Cost-effectiveness of adenoma surveillance - the Dutch guidelines - WEO working group adenoma surveillance 20 May, 2016 Iris Lansdorp-Vogelaar, PhD On behalf of the SAP study-group Introduction Adenoma
More informationDouglas K. Rex, MD Indiana University Hospital Indianapolis, IN
Serrated Adenomas: What do they mean and what to do about them? Douglas K. Rex, MD Indiana University Hospital Indianapolis, IN Colorectal Cancer Molecular Basis Pathway Frequency Genes MSI Precursor Speed
More informationCRC screening at age 45 What does the modeling suggest?
CRC screening at age 45 What does the modeling suggest? Elisabeth Peterse Erasmus University Medical Center, Rotterdam, The Netherlands Possible conflicts of interest No disclosures. Elisabeth Peterse
More informationMeasure #425: Photodocumentation of Cecal Intubation National Quality Strategy Domain: Effective Clinical Care
Measure #425: Photodocumentation of Cecal Intubation National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process DESCRIPTION: The
More informationPost-polypectomy follow-up after. removal of colorectal neoplasia
Post-polypectomy follow-up after removal of colorectal neoplasia Post-polypectomy endoscopic surveillance For each type of polyp BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance?
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 informationCASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD
CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD Disclosure Statement NKC: No relevant conflicts to disclose. DTR: No relevant
More informationColonoscopy with polypectomy significantly reduces colorectal
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:562 567 Utilization and Yield of Surveillance Colonoscopy in the Continued Follow-Up Study of the Polyp Prevention Trial ADEYINKA O. LAIYEMO,*, PAUL F. PINSKY,
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 informationRetroflexion and prevention of right-sided colon cancer following colonoscopy: How I approach it
Retroflexion and prevention of right-sided colon cancer following colonoscopy: How I approach it Douglas K Rex 1 MD, MACG 1. Indiana University School of Medicine Division of Gastroenterology/Hepatology
More informationSupplementary Online Content
Supplementary Online Content Tran AH, Ngor EWM, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med. Published online August 11, 2014. doi:10.1001/jamainternmed.2014.3746
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 informationColorectal cancer is the second leading cause of cancer-related. Colonoscopic Miss Rates for Right-Sided Colon Cancer: A Population-Based Analysis
GASTROENTEROLOGY 2004;127:452 456 Colonoscopic Miss Rates for Right-Sided Colon Cancer: A Population-Based Analysis BRIAN BRESSLER,* LAWRENCE F. PASZAT,, CHRISTOPHER VINDEN,, CINDY LI, JINGSONG HE, and
More informationBackground and Rationale for Gipson bill AB The imperative for colonoscopy after a positive FOBT (Fecal Occult Blood Test)
Background and Rationale for Gipson bill AB 1763 The imperative for colonoscopy after a positive FOBT (Fecal Occult Blood Test) The Affordable Care Act (ACA) requires all private insurers (except grandfathered
More informationTechnology and Interventions to Improve ADR
Technology and Interventions to Improve ADR Aasma Shaukat, MD MPH, FACG GI Section Chief, Minneapolis VAMC Associate Professor, University of Minnesota Outline Why is quality important? Fundamentals of
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 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 informationImproving you ADR. Robert Enns Colonoscopy Education Day October 2018
Improving you ADR Robert Enns Colonoscopy Education Day October 2018 ADR Applying to CSP Assume 50% ADR in FIT positive patients Out of 40 patients only 20 will have polyps Out of 20 likely 15 will be
More informationRomanian Journal of Morphology and Embryology 2006, 47(3):
Romanian Journal of Morphology and Embryology 26, 7(3):239 23 ORIGINAL PAPER Predictive parameters for advanced neoplastic adenomas and colorectal cancer in patients with colonic polyps a study in a tertiary
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 informationThe Natural History of Right-Sided Lesions
The Natural History of Right-Sided Lesions Jasper L.A. Vleugels Dept of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands. None Disclosures Agenda Is there evidence that
More informationThe Canadian Cancer Society estimates that in
How Do I Screen For Colorectal Cancer? By Ted M. Ross, MD, FRCS(C); and Naomi Ross, RD, BSc To be presented at the University of Toronto s Primary Care Today sessions (October 3, 2003) The Canadian Cancer
More informationCA Cancer J Clin 2006;56:
Guidelines for Colonoscopy Surveillance after Polypectomy: A Consensus Update by the US Multi- Society Task Force on Colorectal Cancer and the American Cancer Society *, Sidney J. Winawer, MD; Ann G. Zauber,
More informationStructured Follow-Up after Colorectal Cancer Resection: Overrated. R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007
Structured Follow-Up after Colorectal Cancer Resection: Overrated R. Taylor Ripley University of Colorado Grand Rounds April 23, 2007 Guidelines for Colonoscopy Production: Surveillance US Multi-Society
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 informationCOLON CANCER SCREENING IN CYSTIC FIBROSIS
COLON CANCER SCREENING IN CYSTIC FIBROSIS Laveena Chhatwani, MD, MSc Associate Director, Adult Cystic Fibrosis Program Clinical Assistant Professor of Medicine Outline Background Risk of colorectal cancer
More informationCarol A. Burke, MD, FACG
Updated Guidelines for CRC C Screening and Surveillance Carol A. Burke MD, FACG, FASGE, FACP Cleveland Clinic, Cleveland, OH Gastroenterology t 2012;143:844 143 Gut 2010;59:666 1 Caveat for all Recommendations
More informationHow to Screen a patient with a Family History of Adenoma(s)
How to Screen a patient with a Family History of Adenoma(s) CDDW Banff 3-5-17 David Lieberman MD Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Disclosures 2016
More informationResult of screening and surveillance colonoscopy in young Korean adults < 50 years
SEP 25, 2017 Result of screening and surveillance colonoscopy in young Korean adults < 50 years Jae Myung Cha, MD. PhD. Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung
More informationAccepted Manuscript. En bloc resection for mm polyps to reduce post-colonoscopy cancer and surveillance. C. Hassan, M. Rutter, A.
Accepted Manuscript En bloc resection for 10-20 mm polyps to reduce post-colonoscopy cancer and surveillance C. Hassan, M. Rutter, A. Repici PII: S1542-3565(19)30412-4 DOI: https://doi.org/10.1016/j.cgh.2019.04.022
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 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 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 informationThe Dutch bowel cancer screening program Relevant lessions for Ontario
The Dutch bowel cancer screening program Relevant lessions for Ontario Ernst J Kuipers Erasmus MC University Medical Center Rotterdam - The Netherlands 1 Ismar Boas (1858 1938) Colorectal cancer screening
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 informationMeasure #425: Photodocumentation of Cecal Intubation National Quality Strategy Domain: Effective Clinical Care
Measure #425: Photodocumentation of Cecal Intubation National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: The rate of screening
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 informationBenchmarking For Colonoscopy. Technology and Technique to Improve Adenoma Detection
Benchmarking For Colonoscopy Technology and Technique to Improve Adenoma Detection Objectives 1. Review the latest data on performance characteristics and efficacy for colon cancer prevention 2. Highlight
More information