Colorectal Cancer Screening

Transcription

1 Colorectal Cancer Screening December 5, 2017 Connecticut Cancer Partnership 14th Annual Meeting Xavier Llor, M.D., PhD. Associate Professor of Medicine Co-Director, Cancer Genetics and Prevention Program Smilow Cancer Center S L I D E 1

2 Estimated New US Cancer Cases 2013 Prostate 29% Lung & bronchus 14% Men 854,790 Women 805,500 Colon & rectum 9% (73,680) (69,140) Urinary bladder 6% Non-Hodgkin lymph. 4% Melanoma of skin 5% Kidney 5% Leukemia 3% Oral cavity 3% Pancreas 3% All Other Sites 19% 30% Breast 14% Lung & bronchus 9% Colon & rectum 6%Uterine corpus 4%Non-Hodgkin lymphoma 4% Melanoma of skin 5% Thyroid 3%Ovary 3% Kidney 3% Leukemia 3% Pancreas 21% All Other Sites Surveillance Epidemiology and End Results (SEER) : seer.cancer.gov (accessed ) S L I D E 2

3 Trends in Colorectal Cancer Incidence and Death Rates by Sex, US, Incidence: SEER Program. NCI, 2013 S L I D E 3

4 Trends in Colorectal Cancer Incidence ( ) and Mortality ( ) rates by age and sex US Incidence: SEER Program. NCI, 2016 S L I D E 4

5 Trends in CRC Incidence and Mortality Rates by Race/Ethnicity and Sex, S L I D E 5

6 S L I D E 6

7 CRC screening options Direct visualization tests (invasive; detect polyps and cancer): Colonoscopy every 10 years Sigmoidoscopy every 5 years Sigmoidoscopy every 10 years with FIT every year CT colonography every 5 years Stool based tests (non-invasive; detect basically cancer): Fecal occult blood test (FOBT) every year Fecal immunohystochemical test (FIT) every year Fecal FIT-DNA test (frequency not yet established) S L I D E 7

8 Colorectal Cancer Screening Prevalence (%) among Adults Age 50 Years and Older by State, 2014 Colorectal Cancer Facts and Figures ACS 2017 S L I D E 8

9 CRC screening challenges 1/3 of eligible individuals have not undergone CRC screening. Screening levels have plateaued Goal: maximize the total number of persons who are screened Can screening rates be increased when all screening options are considered? S L I D E 9

10 New USPSTF approach to CRC screening Limited data to permit direct comparison of screening methods in screening programs over time USPSTF commissioned the Cancer Intervention and Surveillance Modeling Network (CISNET) to inform recommendations through analytic modeling Sensitivity of the tests over time is more important than single test performance Analysis should include benefits, harms and burden of CRC screening S L I D E 10

11 Characteristics of Colorectal Cancer Screening Strategies S L I D E 11

12 Characteristics of Colorectal Cancer Screening Strategies S L I D E 12

13 Characteristics of Colorectal Cancer Screening Strategies S L I D E 13

14 Characteristics of Colorectal Cancer Screening Strategies S L I D E 14

15 Characteristics of Colorectal Cancer Screening Strategies S L I D E 15

16 Characteristics of Colorectal Cancer Screening Strategies S L I D E 16

17 Characteristics of Colorectal Cancer Screening Strategies S L I D E 17

18 CRC screening by age Benefits of early detection and intervention for CRC screening decline after age 75 Among older adults previously screened, at best moderate benefit to continuing screening during ages If not previously screened, more likely to benefit Benefit for adults 85 and older at most small as rate of serious adverse events is much higher S L I D E 18

19 CISNET Modeling: life years gained/1000 screened Life-years gained with non-colonoscopy strategies within 90% of the colonoscopy strategy S L I D E 19

20 CISNET Modeling: CRC deaths averted/1000 screened 3-4 deaths difference among different screening options/1000 screened S L I D E 20

21 CISNET Modeling: complications/1000 screened 3-4 complications difference among different screening options/1000 screened S L I D E 21

22 CISNET Modeling: lifetime colonoscopies/1000 screened Non-colonoscopy strategies result in about half of total colonoscopies performed S L I D E 22

23 New USPSTF approach to CRC screening USPSTF no longer prioritizing a single strategy but supporting offering different choices with the hope of increasing CRC screening uptake: Clinical decision involve more considerations than evidence alone Individualize decision making to the specific patient or situation S L I D E 23

24 Trends in CRC incidence (men) Globocan IARC S L I D E 24

25 Thank you! S L I D E 25