Cancer Screening in the European Union Second Report: Colorectal cancer Screening

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1 Cancer Screening in the European Union Second Report: Colorectal cancer Screening Wien 14 October 2011 Nereo Segnan MD MSc Epi Center for Epidemiology and Prevention in Oncology, CPO Piedmont WHO Collaborative Center for Cancer Early Diagnosis and Screening University Hospital Città della Salute e della Scienza, Turin, Italy

2 No conflict of interest to declare

3 Second Report on Cancer Screening in the EU Co-financed by the EU Health Programme Main collaborating institutions - International Agency for Research on Cancer, Lyon, France (coordination) CPO Piemonte, University Hospital Città della Salute e della Scienza CPO, Turin, Italy Finnish Cancer Registry, Mass Screening Registry, Helsinki, Finland Authors A Ponti, A Anttila, G Ronco, C Senore, N Segnan, M Tomatis, P Basu, M Primic-Žakelj, P Dean, J Dillner, M Fernan, M Elfström, S Lönnberg, R Sankaranaryanan, I Soerjomataram, D Vale, L von Karsa Scientific Committee* L Altenhofen, R Ancelle-Park, N Ascunce, H de Koning, E Lynge, O Májek, F Nicula, J Patnick, J Regula, S Törnberg, M Zappa Over 80 Data providers from all 28 EU Member States* *invited reviewers of full report, and co-authors of publication in peer-reviewed journal

4 Data Provider s Workshop (22 Member States Participating) Feb, 2016; IARC

5 Second Report on the Implementation of Council Recommendations on Cancer Screening - objectives To document changes in approach to program implementation compared to first report To collect more detailed information on program organization To include selected performance parameters Key determinants of quality and impact recommended in the European QA guidelines Suitable for comparison between Member States

6 Second Report Standardized Data Output Site Specific Questionnaires to collect information on Program organization, invitation, QA, financing, cost Screening tests, eligibility, screening interval, further assessment Site Specific Tables on annual aggregated data stratified by age groups & initial vs subsequent screening Screening tests Further assessment recommendations Further assessment compliance Outcome of further assessment o Detection rates o Positive predictive values

7 Necessity of Regular Reporting on Cancer Screening in the EU Current performance determines impact of screening on burden of disease Impact is measurable only after many years Regular monitoring permits timely response to potential problems and recognition of opportunities for improvement Avoids unnecessary harm and cost Maximises benefit of screening

8 Web Based Data Collection

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11 EU CRC screening Annual target population yrs: 69,636,000 Invited: 23,343,000 (33.5%) Screened: 9,985,000 (14.2%)

12 COLON - Participation rate (All ages) FIT, 10 countries N = 3,621,692 D = 7,313,175 Result = 49.5% (22.8% %) gfobt, 6 countries N = 5,352,356 D = 16,158,260 Result = 33.1% (4.5% %) Table % N = Individuals screened of invited in the year D = Individuals personally invited in the year 75% 50% 25% 0%

13 COLON - Participation rate (60-69 years) Table 4.15 FIT, 8 countries N = 1,736,995 D = 3,277,339 Result = 53.0% (28.7% %) gfobt, 5 countries N = 3,035,378 D = 7,316,925 Result = 41.5% (5.0% %) 100% N = Individuals screened of invited in the year D = Individuals personally invited in the year 75% 50% 25% 0%

14 20 20 NA COLON Screen positivity (60-69 years) Table FIT, 11 countries N = 144,089 D = 2,195,044 Result = 6.6% (3.1% %) gfobt, 6 countries N = D = Result = 2.1% (1.7% - 4.5%) 15% N = Positive screening tests in the year D = Individuals screened in the year with adequate test - test results available 10% 5% 0% «Positivity cut off µg/gr faeces

15 COLON Detection rate of colorectal cancers (60-69 years) Table FIT, 9 countries N = 4501 D = Result = 2.3 ( ) gfobt, 5 countries N = 3704 D = Result = 1.2 ( ) 5 N = Colorectal cancers detected D = Individuals screened in the year with adequate test - test results available

16 COLON Detection rate of advanced adenomas (60-69 years) Table FIT, 6 countries N = D = Result = 13.7 ( ) gfobt, 5 countries N = 6963 D = Result = 2.3 ( ) 30 N = Advanced ademonas detected D = Individuals screened in the year with adequate test - test results available

17 COLON Detection rate of colorectal cancers (All ages) Table FIT, 9 countries N = 7519 D = Result = 2.0 ( ) gfobt, 6 countries N = 6545 D = Result = 1.2 ( ) 5 N = Colorectal cancers detected D = Individuals screened in the year with adequate test - test results available

18 COLON Detection rate of advanced adenomas (All ages) Table FIT, 6 countries N = D = Result = 14.8 ( ) gfobt, 5 countries N = D = Result = 2.5 ( ) 30 N = Advanced ademonas detected D = Individuals screened in the year with adequate test - test results available

19 COLON Follow-up colonoscopy participation rate (All ages) Table FIT, 11 countries N = D = Result = 70.5% (36.3% %) 100% N = Further colonoscopies performed D = Data on further col. performance available gfobt, 6 countries N = D = Result = 84.0% (72.6% %) 75% 50% 25% 0%

20 COLON Completion rate follow-up colonoscopy (All ages) Table FIT, 7 countries N = D = Result = 94.1% (92.4% %) 100% N = Further colonoscopies completed D = Data on col. completion available gfobt, 4 countries N = D = Result = 97.0% (91.0% %) 90% 80% 70% 60% 50%

21 FIT gfobt TC FIT gfobt TC Tests 1753K 1294K 12K 2195K 3140K - Screen positivity 5,1% 2,0% 11,5% 6,6% 2,1% - F.U. colonoscopy participation rate 76,8% 83,1% 82,2% 75,0% 84,5% - Completion rate F.U. colonoscopy 93,9% 97,8% 97,2% 93,7% 96,8% 97,1% Detection Rate advanced adenoma 8,7 2,5 49,5 13,7 2,3 72,4 Detection Rate colorectal cancers 1,1 0,6 3,5 2,3 1,2 8,1

22 Table Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) gfobt years years years years Total N D % N D % N D % N D % N D % Women ,9% Men ,2% ,5% ,6% ,4% Women ,4% ,4% Men ,0% ,0% Women ,3% ,5% ,6% ,4% Men ,7% ,0% ,1% ,9% Women ,5% ,5% Men ,1% ,1% Women ,4% ,5% ,4% Men ,7% ,8% ,7% Women ,3% ,4% ,5% ,4% ,4% Men ,6% ,0% ,1% ,7% ,9% Women ,2% ,2% ,2% Men ,6% ,6% ,6% Total Women ,3% ,4% ,5% ,4% ,4% Total Men ,7% ,8% ,9% ,7% ,8%

23 Thank to Partha Basu (IARC), Mariano Tomatis, Antonio Ponti, Carlo Senore (CPO Piemonte) for providing slides and data Thank you for your attention

24 Table Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) gfobt years years years years Total N D % N D % N D % N D % N D % Women ,8% ,0% ,0% ,9% Men ,2% ,5% ,6% ,4% Women ,4% ,4% Men ,0% ,0% Women ,3% ,5% ,6% ,4% Men ,7% ,0% ,1% ,9% Women ,5% ,5% Men ,1% ,1% Women ,4% ,5% ,4% Men ,7% ,8% ,7% Women ,3% ,4% ,5% ,4% ,4% Men ,6% ,0% ,1% ,7% ,9% Women ,2% ,2% ,2% Men ,6% ,6% ,6% Total Women ,3% ,4% ,5% ,4% ,4% Total Men ,7% ,8% ,9% ,7% ,8%

25 Table Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) FIT years years years years Total N D % N D % N D % N D % N D % Women ,8% ,1% ,3% ,1% ,0% Men ,9% ,6% ,5% ,2% ,3% Women ,8% ,8% ,1% ,8% Men ,0% ,4% ,5% ,4% Women ,9% ,1% ,0% Men ,6% ,1% ,8% Women ,0% ,6% ,5% Men ,0% ,4% ,7% Women ,8% ,2% ,0% Men ,6% ,3% ,9% Women ,4% ,1% ,7% Men ,6% ,0% ,2% Women ,7% ,5% ,1% Men ,0% ,7% ,8% Total Women ,0% ,4% ,3% ,1% ,2% Total Men ,2% ,0% ,5% ,2% ,6%

26 Table Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) Endoscopy years years years years Total N D % N D % N D % N D % N D % Women ,4% ,4% Men ,9% ,9% Women ,9% ,1% ,0% Men ,1% ,4% ,6% Women ,1% ,3% ,4% ,6% ,9% Men ,1% ,0% ,1% ,4% ,3%

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