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
No conflict of interest to declare
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
Data Provider s Workshop (22 Member States Participating) 16-17 Feb, 2016; IARC
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
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
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
Web Based Data Collection
EU CRC screening Annual target population 50-74 yrs: 69,636,000 Invited: 23,343,000 (33.5%) Screened: 9,985,000 (14.2%)
COLON - Participation rate (All ages) FIT, 10 countries N = 3,621,692 D = 7,313,175 Result = 49.5% (22.8% - 71.3%) gfobt, 6 countries N = 5,352,356 D = 16,158,260 Result = 33.1% (4.5% - 66.6%) Table 4.15 100% N = Individuals screened of invited in the year D = Individuals personally invited in the year 75% 50% 25% 0%
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% - 74.0%) gfobt, 5 countries N = 3,035,378 D = 7,316,925 Result = 41.5% (5.0% - 66.6%) 100% N = Individuals screened of invited in the year D = Individuals personally invited in the year 75% 50% 25% 0%
20 20 NA 15-20 15 15 20 15-47 20 16-20 180 COLON Screen positivity (60-69 years) Table 4.18.1 FIT, 11 countries N = 144,089 D = 2,195,044 Result = 6.6% (3.1% - 10.6%) gfobt, 6 countries N = 64701 D = 3140223 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
COLON Detection rate of colorectal cancers (60-69 years) Table 4.18.6 FIT, 9 countries N = 4501 D = 1923252 Result = 2.3 (1.3-4.1 ) gfobt, 5 countries N = 3704 D = 3112437 Result = 1.2 (0.9-2.6 ) 5 N = Colorectal cancers detected D = Individuals screened in the year with adequate test - test results available 4 3 2 1 0
COLON Detection rate of advanced adenomas (60-69 years) Table 4.18.5 FIT, 6 countries N = 25958 D = 1889223 Result = 13.7 (5.8-27.5 ) gfobt, 5 countries N = 6963 D = 3013386 Result = 2.3 (1.0-5.4 ) 30 N = Advanced ademonas detected D = Individuals screened in the year with adequate test - test results available 25 20 15 10 5 0
COLON Detection rate of colorectal cancers (All ages) Table 4.18.6 FIT, 9 countries N = 7519 D = 3751139 Result = 2.0 (1.2-4.9 ) gfobt, 6 countries N = 6545 D = 5529765 Result = 1.2 (0.9-1.9 ) 5 N = Colorectal cancers detected D = Individuals screened in the year with adequate test - test results available 4 3 2 1 0
COLON Detection rate of advanced adenomas (All ages) Table 4.18.5 FIT, 6 countries N = 55059 D = 3713008 Result = 14.8 (7.4-27.0 ) gfobt, 5 countries N = 12706 D = 5143744 Result = 2.5 (0.9-4.6 ) 30 N = Advanced ademonas detected D = Individuals screened in the year with adequate test - test results available 25 20 15 10 5 0
COLON Follow-up colonoscopy participation rate (All ages) Table 4.18.2 FIT, 11 countries N = 187918 D = 266420 Result = 70.5% (36.3% - 92.2%) 100% N = Further colonoscopies performed D = Data on further col. performance available gfobt, 6 countries N = 99037 D = 117844 Result = 84.0% (72.6% - 93.2%) 75% 50% 25% 0%
COLON Completion rate follow-up colonoscopy (All ages) Table 4.18.3 FIT, 7 countries N = 138412 D = 147090 Result = 94.1% (92.4% - 98.8%) 100% N = Further colonoscopies completed D = Data on col. completion available gfobt, 4 countries N = 54813 D = 56496 Result = 97.0% (91.0% - 97.6%) 90% 80% 70% 60% 50%
50-59 60-69 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
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) gfobt 50-59 years 60-69 years 70-74 years 75-79 years Total N D % N D % N D % N D % N D % Women 197 21.570 0,9% Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4% Women 145 33.382 0,4% 145 33.382 0,4% Men 270 26.003 1,0% 270 26.003 1,0% Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4% Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9% Women 173 36.491 0,5% 173 36.491 0,5% Men 317 28.571 1,1% 317 28.571 1,1% Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4% Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7% Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4% Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9% Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2% Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6% Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4% Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Thank to Partha Basu (IARC), Mariano Tomatis, Antonio Ponti, Carlo Senore (CPO Piemonte) for providing slides and data Thank you for your attention
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) gfobt 50-59 years 60-69 years 70-74 years 75-79 years Total N D % N D % N D % N D % N D % Women 70 9.014 0,8% 99 9.794 1,0% 28 2.762 1,0% 197 21.570 0,9% Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4% Women 145 33.382 0,4% 145 33.382 0,4% Men 270 26.003 1,0% 270 26.003 1,0% Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4% Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9% Women 173 36.491 0,5% 173 36.491 0,5% Men 317 28.571 1,1% 317 28.571 1,1% Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4% Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7% Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4% Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9% Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2% Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6% Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4% Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) FIT 50-59 years 60-69 years 70-74 years 75-79 years Total N D % N D % N D % N D % N D % Women 898 119.189 0,8% 1.443 129.721 1,1% 555 41.651 1,3% 286 24.976 1,1% 3.182 315.537 1,0% Men 1.652 85.428 1,9% 2.308 90.206 2,6% 728 29.124 2,5% 334 15.414 2,2% 5.022 220.172 2,3% Women 44 5.673 0,8% 46 5.801 0,8% 22 1.981 1,1% 112 13.455 0,8% Men 45 4.392 1,0% 61 4.297 1,4% 37 1.464 2,5% 143 10.153 1,4% Women 44 2.307 1,9% 45 2.149 2,1% 89 4.456 2,0% Men 64 1.775 3,6% 99 1.629 6,1% 163 3.404 4,8% Women 3.868 189.432 2,0% 2.925 80.347 3,6% 6.793 269.779 2,5% Men 7.230 181.983 4,0% 4.623 72.373 6,4% 11.853 254.356 4,7% Women 4.161 530.280 0,8% 6.198 532.458 1,2% 10.359 1.062.738 1,0% Men 7.025 447.464 1,6% 10.579 459.329 2,3% 17.604 906.793 1,9% Women 1.121 79.937 1,4% 1.244 58.766 2,1% 2.365 138.703 1,7% Men 2.336 65.695 3,6% 2.390 47.550 5,0% 4.726 113.245 4,2% Women 2.100 126.358 1,7% 2.928 115.171 2,5% 5.028 241.529 2,1% Men 4.401 109.270 4,0% 5.585 98.160 5,7% 9.986 207.430 4,8% Total Women 8.368 863.744 1,0% 11.904 844.066 1,4% 577 43.632 1,3% 286 24.976 1,1% 21.135 1.776.418 1,2% Total Men 15.523 714.024 2,2% 21.022 701.171 3,0% 765 30.588 2,5% 334 15.414 2,2% 37.644 1.461.197 2,6%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%) Endoscopy 50-59 years 60-69 years 70-74 years 75-79 years Total N D % N D % N D % N D % N D % Women 468 5.567 8,4% 468 5.567 8,4% Men 954 5.996 15,9% 954 5.996 15,9% Women 477 2.402 19,9% 522 2.365 22,1% 999 4.767 21,0% Men 786 2.375 33,1% 833 2.170 38,4% 1.619 4.545 35,6% Women 124 727 17,1% 255 1.142 22,3% 66 241 27,4% 19 108 17,6% 464 2.218 20,9% Men 252 810 31,1% 420 1.134 37,0% 78 243 32,1% 35 99 35,4% 785 2.286 34,3%