Colorectal Cancer & Screening 1 st Men s Health Conference

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1 Colorectal Cancer & Screening 1 st Men s Health Conference Dr Muhammad Radzi Abu Hassan Consultant Physician and Gastroenterologist Hospital Sultanah Bahiyah, Alor Star Kedah

2 Outline Colorectal cancer in Malaysia CRC screening the best preventive model Issues in men s health??? solutions Conclusion

3 Global Epidemiology of CRC 1,2 The 3rd most commonly diagnosed malignancy million new cases have been diagnosed annually. The 4th leading cause of deaths. - Accounting for almost 700,000 deaths per year. CRC = colorectal cancer

4 CRC in Malaysia (1) 3 The second most common cancer di Malaysia

5 100,000 population Overall incidence and mortality rate in Malaysia ( ) Incidence Age-adjusted rate (per 100,000) 9.79 Mortality 21 had colorectal carcinoma 10 patients were dead SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer,

6 100,000 population by gender Male Female Overall incidence rate by gender, Incidence Incidence Age-adjusted rate (per 100,000) 24 male had colorectal carcinoma 18 female had colorectal carcinoma SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer,

7 100,000 population by gender Male Female Overall mortality rate by gender, Mortality 8.05 Mortality Age-adjusted rate (per 100,000) 11 male patients were dead 8 female patients were dead SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer,

8 Incidence -Age 50+ Malaysia Persons age 30 years 1 in years 1 in years 1 in years 1 in years 1 in 133 Age-specific incidence rate by sex, Malaysia, Source: 1 National Cancer Patient Registry Colorectal Cancer: Report for Northern Region of Malaysia ( )

9 Blood Vessel Lymph node Serosa Normal Muscle layers Submucosa Mucosa Spread of the cancer To other organs Stage 3 and % Source: National Cancer Patient Registry Colorectal Cancer: Report for Northern Region of Malaysia ( )

10 Economic Burden of CRC treatment in Malaysia 5 Approximately RM 108 million annually. The total treatment costs per patient according to the clinical staging: Total treatment cost (RM) 13,622 19,752 24,972 27,377 36,666 STAGE 1 STAGE 2 STAGE 3 STAGE 4 MONOCLONAL ANTIBODIES Veettil SK, Lim KG, Chaiyakunapruk N, et al. Colorectal cancer in Malaysia: Its burden and implications for a country. Asian J Surg 2017; 40(6):

11 Current Medical Practice Best PRACTICE EVIDENCE based medicine Personalized/PRECISION medicine Value based medicine VALUE based medicine

12 Screening & Prevention: The Way Forward In view of the continuously increasing treatment cost for CRC, regular screening could potentially serve as a more cost-effective strategy, mainly by: 6 Detecting CRC at an early, favorable stage; Preventing CRC through the early detection and removal of precancerous polyps; Reduce/save cost Save life

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14 RECENTLY LAUNCHED JUNE 2018 BY OUR DIRECTOR GENERAL

15 ADENOMA CARCINOMA PATHWAY Normal Adenoma Cancer

16 Screening in Average Risk Population 16

17 Screening/Surveillance in Moderate and High Risk Groups 17

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19 CRC Screening in Malaysia Average Risk (Asymptomatic 50-75) Moderate/High Risk ifobt Assessment by Doctor +ve -ve Colonoscopy Repeat yearly ifobt Colonoscopy

20 Men and Colorectal Cancer: Higher Risk but Poorer Awareness & Attitude As compared with women, men have poorer knowledge about symptoms of colorectal cancer. 9 relatively negative attitude toward colorectal cancer screening. 10 a higher risk of delay in first treatment of colorectal cancer. 11

21 Evidence: Poorer Health Behaviors in Men Smoking rate is higher in men worldwide. 2,3 Men exceed women in highvolume alcohol consumption. 4 Men have a higher risk of gravitating towards substance use. 5

22 Worst of All: Men Have Poorer Health-Seeking Behaviors Delayed help seeking for their physical illnesses. 6 Stigma-driven refusal to seek help for mental and mood disorders. 7 Less use of health facilities. 8

23 CRC Screening by MOH in Total number of screened patients Cancer 26% 2706(9%) IFOBT positive 1174 Colonic Polyp 74% Undergoing scope 43.4%

24 Issue 1: Poor Uptake of Colonoscopy (a qualitative study from Kedah) 7 High refusal for colonoscopy among the patients with a positive ifobt result, which is primarily due to the: Perception that it is an unnecessary procedure; Fear of pain and feeling of embarrassment; Time constraint and transportation problem; Poor support from family members and friends. ifobt = Immunochemical fecal occult blood test.

25 Preliminary Results Motivating factors of undergoing colonoscopy Fear of colorectal cancer. Previous experience from friends who were diagnosed with colorectal cancer.

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29 SCREENING IS MEANINGLESS IF THERE IS NO UPTAKE!!!!

30 Gender Differences in Health: The Elephant in the Room 1 Men and women are different due to biological and societal factors. One size does not fit both genders in health. However, the existing prevention and treatment strategies of many diseases do not take account of the differences.

31 Conclusion Shift our focus on prevention rather than therapeutic Men s health issues Health seeking behavior Discrepancy between male and female achievement Strengthen our crc screening policy COLORECTAL CANCER IS PREVENTABLE

32 Thank YOU