NICaN workshop: Colorectal Cancer Follow-up

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1 NICaN workshop: Colorectal Cancer Follow-up The Changing Picture of Colorectal Cancer in Northern Ireland Dr Helen Coleman Lecturer in Cancer Epidemiology & CRUK Population Research Postdoctoral Fellow Centre for Public Health /NICR Queen s University Belfast h.coleman@qub.ac.uk

2 Colorectal cancer in Northern Ireland: overview - Trends in colorectal cancer incidence - Risk factors for colorectal cancer - Colorectal cancer survival - Impact of bowel cancer screening - On colorectal polyp diagnoses - On colorectal cancer staging

3 Colorectal cancer in Northern Ireland: overview - Trends in colorectal cancer incidence - Risk factors for colorectal cancer - Colorectal cancer survival - Impact of bowel cancer screening - On colorectal polyp diagnoses - On colorectal cancer staging

4 Colorectal cancer incidence, males

5 Colorectal cancer incidence, females

6 Northern Ireland Colorectal cancer incidence summary Age-standardised rates are relatively stable However, the actual number of colorectal cancer cases is rising due to ageing population 2011: 1,224 cases 2006:1,064 cases 2001: 967 cases 2 nd most common cancer in NI, 3 rd most common cancer in UK

7 Breast Colorectal Prostate Melanoma Lymphoma Lung Head and Neck Uterus Bladder Ovary Kidney Leukaemia Stomach Cervix Testis Multiple Oesophagus Brain Pancreas Liver Cancer Prevalence Prevalence of cancer in Northern Ireland: Diagnosed in , alive at the end of 2004 Female Male Cancer site

8 Colorectal cancer in Northern Ireland: overview - Trends in colorectal cancer incidence - Risk factors for colorectal cancer - Colorectal cancer survival - Impact of bowel cancer screening - On colorectal polyp diagnoses - On colorectal cancer staging

9 Colorectal cancer risk factors What we can t change: - Increasing age (median age of diagnosis 71 yrs in men; 73 years in women) - Being male - Genetic syndromes (<5%) What we can be change: - Lifestyle factors (up to 70%!!)

10 Colorectal cancer risk factors Less of this: More of this:

11 Colorectal cancer in Northern Ireland: overview - Trends in colorectal cancer incidence - Risk factors for colorectal cancer - Colorectal cancer survival - Impact of bowel cancer screening - On colorectal polyp diagnoses - On colorectal cancer staging

12 Limited improvements in survival rates over time in Northern Ireland Sex Time period Number of patients One-year survival Five-year survival % 95%CI % 95%CI Male , , , * Female , , , * Persons , , , *

13 International Cancer Benchmarking Partnership

14 ICBP data and methods Colorectum, lung, breast (F), ovary 2.4 million cancer patients (aged 15-99) Diagnosed Followed up to 31 December 2007 All primary, invasive cancers Relative survival Age-specific, age-standardised rates

15 ICBP Module 1 - summary Survival rose for all 4 cancers, all countries High in Australia, Canada, Sweden Intermediate in Norway Low in Denmark, UK Data quality and artefact unlikely Direct relevance to health policy after Richards, 2009

16 What could explain survival differences? Longer delays, more advanced disease Differences in co-morbidity Availability and uptake of screening Access to treatment Quality of treatment Organisation of treatment services Human and financial resources after Richards, 2009

17 Relative survival (%) Relative survival from colorectal cancer by stage: N. Ireland 100% 90% Dukes A 80% Dukes B 70% 60% 50% Dukes C 40% Unstaged 30% 20% 10% Dukes D 0% Time since diagnosis (years)

18 Colorectal cancer in Northern Ireland: overview - Trends in colorectal cancer incidence - Risk factors for colorectal cancer - Colorectal cancer survival - Impact of bowel cancer screening - On colorectal polyp diagnoses - On colorectal cancer staging

19 - Introduced in June Rolled out to all 5 health & social care trusts by FOBT - AIM: to detect bowel cancers at an early stage, when there are better chances of effective treatment.

20 % colorectal cancer Earlier stage of diagnosis shift seen in first three screening trusts (60-71yrs) Stage

21 % colorectal cancer Stage of diagnosis shift not yet evident in other trusts (60-71 yrs) Stage

22 % colorectal cancer Marginal knock-on effect in non-screen ages throughout NI? Stage

23 Colorectal polyps and future cancer risk (outside of screening programmes) - Most colorectal cancers arise from precancerous lesion (polyps) Adenoma (+) Hyperplastic (-?) - NICR also has a colorectal polyp register - >11,000 individuals had colorectal polyps removed Adenoma: 0.43% per year progress to colorectal cancer - Hyperplastic polyps: 0.17% per year progress to colorectal cancer

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25 Colorectal cancer incidence after polypectomy Population group Standardised Incidence Ratio (95%CI) General 100 Adenoma all 285 ( ) Adenoma men 276 ( ) Adenoma women 269 ( ) Hyperplastic all 179 ( ) Hyperplastic men 167 ( ) Hyperplastic women 189 ( )

26 Impact of screening on colorectal polyp diagnoses Compared with polyp register, BCS-detected polyp patients are more likely to: - Be male (64% vs. 57%) - Have polyp detected in colon (82% vs. 76%) - Have multiple polyps removed (55% vs %)

27 Changing picture of colorectal cancer in Northern Ireland 1. More cases are being diagnosed 2. Bowel cancer screening IS WORKING, has led to: - Earlier stage of diagnosis - More males being diagnosed earlier Future picture: - Challenge for follow-up of more cases - Hope that screening will translate to better survival - Promotion of screening uptake - Promotion of healthier lifestyle factors to reduce recurrence

28 Thank you for your attention