Colon Cancer Screening Past, Present & Future

Transcription

1 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 Explain why the USPTF lowered the age for general screening Explain screening past age 75 y Explain the significance of family history of adenomas, advanced adenomas, CRC 1

2 PAST: US Preventive Service Task Force. JAMA June 21, 2016 Several tests used FOBT yearly (hydrogen peroxide test for heme) FIT yearly (antibodies to detect globin) Stool DNA every 1 3 years Colonoscopy every 10 years Flex sig every 5 years CTC (virtual colonoscopy) every 5 years Flex sig (q 10 years) plus FIT yearly USPSTF does not recommend one over the other Stop screening age 75 years PAST: ACG Guidelines. Preferred Screening Colonoscopy every 10 years, beginning age 50y (45y African Americans) Annual fecal immunochemical test (FIT) for blood for those who decline colonoscopy Flex sig, CT, fecal DNA not preferred 2

3 The IARC Perspective on Colorectal Cancer Screening NEJM May 2018 (Present) * * * Annual Report to the Nation on the Status of Cancer Cancer 2018;124: (May) Men Incidence decreased 1.9% Mortality decreased 2.5% Women Incidence decreased 1.7% Mortality dropped 2.7% CRC mortality rates have decreased from due to CMS' decision to cover colonoscopy cost. 3

4 CRC screening for average risk adults: 2018 guideline update from the American Cancer Society. Under Age 50y Colorectal cancer screening for average risk adults: 2018 guideline update from the American Cancer Society Aged 20-49y Aged 50+y 4

5 American Cancer Society CRC Screening, 2018 Aged 45 y and older, average risk: regular screening high sensitivity stool based test or a structural (visual) examination This is a qualified recommendation Aged 50 y and older regular screening is a strong recommendation. Aged y patient preferences life expectancy, health status prior screening history This is a qualified recommendation Aged over 85 y discouraged (qualified recommendation). A Message to Members of ACG, AGA and ASGE Regarding a Statement from the Multisociety Task Force on CRC The MSTF has reviewed the ACS recommendation to lower the age to 45y This change was a qualified recommendation based largely on a modeling study Evidence from screening studies is very limited at this time Lowering the age to 45y may improve prevention of CRC Calls for research of the benefits and risks The MSTF further states The rate of CRC is increasing in Americans down to age 20y Screening at 45y addresses only part of the problem For all persons under 50y, promptly assess rectal bleeding and unexplained iron deficiency anemia 5

6 Multisociety Task Force on Colorectal Cancer. Positive Family Hx = colonoscopy 1 first-degree relative with CRC or advanced adenoma at age <60 years or 2 first-degree relatives with CRC and/or advanced adenomas >60 years Colonoscopy every 5 years Begin 10 years younger than the youngest relative or age 40, whichever is earlier 1 first-degree relative with CRC or advanced adenoma at age 60 years Begin screening at age 40y, then routine 1 or more first-degree relatives with advanced serrated lesion Colonoscopy every 5 years Begin 10 years younger than the youngest relative or age 40, whichever is earlier Offered annual FIT if they decline colonoscopy Future Technology Artificial Intelligence Self propelled Magnetic advancing Scope Cap Stool DNA Stool tumor proteins 6

7 Utility of Endoring for GIs with a High Baseline Adenoma Detection Rate (ADR). DDW June 2018 Drs. Machain, Bhavsar, Buaisha Jenkins, Reddymasu No improvemeny GI docs who already have a high (41%) baseline ADR May be beneficial in detection of SSAs and right-sided polyps Question 1 Why did the US Preventive Task Force recommend screening for CRC begin at age 45 years for average risk Americans? A. The success of age 50y screening suggests that expanding the program would be cost-effective. B. It was based on modeling from a database showing increasing incidence of CRC in Americans 20-49y. C. They are not allowed to correlate CRC risk with race. 7

8 Question 1 Why did the US Preventive Task Force recommend screening for CRC begin at age 45 years for average risk Americans? A. The success of age 50y screening suggests that expanding the program would be cost-effective. B. It was based on modeling from a database showing increasing incidence of CRC in Americans 20-49y. C. They are not allowed to correlate CRC risk with race. Question 2 Which of the following is not mentioned by the USPTF for screening CRC after age 75y? A. Patient preferences B. Life expectancy and health status C. Prior screening history D. Country of origin E. Discourage individuals over 85y 8

9 Question 2 Which of the following is not mentioned by the USPTF for screening CRC after age 75y? A. Patient preferences B. Life expectancy and health status C. Prior screening history D.Country of origin E. Discourage individuals over 85y Question 3 Which of the following is used in the family history to recommend CRC screening? A. Who in the family had CRC? B. Who had advanced lesions (i.e., villous, high grade dysplasia)? C. Were they over 60y? D. What was the age of the youngest in the family with a colon lesion? E. All the above 9

10 Question 3 Which of the following is used in the family history to recommend CRC screening? A. Who in the family had CRC? B. Who had advanced lesions (i.e., villous, high grade dysplasia)? C. Were they over 60y? D. What was the age of the youngest in the family with a colon lesion? E. All the above 10