colorectal cancer screening the basics
Download
Skip this Video
Download Presentation
Colorectal Cancer Screening: The Basics

Loading in 2 Seconds...

play fullscreen
1 / 40

Colorectal Cancer Screening: The Basics - PowerPoint PPT Presentation


  • 251 Views
  • Uploaded on

Colorectal Cancer Screening: The Basics. July 21, 2010. Take Home Points. Colorectal Cancer Overview Screening Guidelines Screening Participation Screening Barriers CRC Screening Tests CRC Screening Algorithm. Colorectal Cancer . 3 rd most common 475 incidence cases (avg/yr 2002-06)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Colorectal Cancer Screening: The Basics' - craig


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
take home points
Take Home Points
  • Colorectal Cancer
    • Overview
    • Screening Guidelines
    • Screening Participation
    • Screening Barriers
  • CRC Screening Tests
  • CRC Screening Algorithm
colorectal cancer
Colorectal Cancer
    • 3rd most common
      • 475 incidence cases (avg/yr 2002-06)
  • 3rd deadliest cancer
      • 170 deaths in MT (avg/yr 2003-07)
  • Screening for CRC is effective
  • CRC screening rates could be better
crc risk factors
CRC Risk Factors
  • Age
  • Gender
  • Race/Ethnicity
  • No racial/ethnic differences in MT
colorectal cancer5

CENTERS FOR DISEASE CONTROL

AND PREVENTION

Colorectal Cancer

Sporadic (average risk) (65%–85%)

Family

history(10%–30%)

Rare syndromes (<0.1%)

Hereditary nonpolyposis colorectal cancer (HNPCC) (5%)

Familial adenomatouspolyposis (FAP) (1%)

crc screening guidelines 2008
CRC Screening Guidelines2008

The American College of Obstetricians and Gynecologists

The American Collegeof Physicians, American Academy of Family Physicians, AmericanCollege of Preventive Medicine, and Centers for Disease Controland Prevention

USPSTF

Joint Guideline: ACS, U. S. Multi-Society Task Force on Colorectal Cancer, American College of Radiology

6

cancer screening
Cancer Screening

U.S. Preventive Services Task Force:

  • Sufficient Evidence
    • Breast
    • Cervical
    • Colorectal
  • Not Sufficient Evidence
    • Lung
    • Prostate
    • All Others
crc screening guidelines 20088
CRC Screening Guidelines2008

USPSTF CRC screening recommendation:

  • Age 50-75: screening using
    • Annual high-sensitivity FOBT
    • Sigmoidoscopy every 5 yrs combined with high-sensitivity FOBT every 3 yrs
    • Colonoscopy at intervals of 10 yrs
  • Age 76-85: against routine screening, considerations may support screening in individuals
  • Age >85: against screening

8

crc screening tests
CRC Screening Tests

Tests recommended USPSTF:

  • Colonoscopy
  • Sigmoidoscopy
  • Fecal Occult Blood Testing (FOBT)
    • Guaiac
    • Immunochemical

9

mt cancer screening by race

MT Cancer Screening by Race

* p < .05, ** p< .01

mt cancer screening 2008 brfss
MT Cancer Screening2008 BRFSS
  • Approximately 20% had both
  • < 60% had FOBT or endoscopy or both

13

why not montana
Why Not: Montana

BRFSS Cancer Screening Questions:

  • Have you ever had a
    • Mammogram
    • Pap smear
    • PSA test
    • DRE
    • Colonoscopy or sigmoidoscopy
    • FOBT
  • If yes, when was your last one
why not montana15
Why Not: Montana

Added for Mammogram & Endoscopy:

  • Has provider ever recommended that you have…
  • Have you had…(endoscopy ever / mammogram within 2 years)
  • If never screened or not up to date,

Why not?

  • What is main reason you have not…

Use responses to infer barriers

colonoscopy capacity survey 2008
Colonoscopy Capacity Survey 2008

41 hospitals perform colonoscopy

40 returned surveys

Info from M.D. for nonresponding hospital

3 ambulatory centers

Affiliated with large hospitals

All returned surveys

colonoscopy capacity survey 200819
Colonoscopy Capacity Survey 2008

13 Urban

15,000 screens per year

Total capacity ~21,000

7 week wait

25% of screen capacity unused

31 Rural

4,000 screens per year

Total capacity ~22,000

2 week wait

80% of screen capacity unused

slide20

Why emphasize CRC screening:

      • Incidence
      • Mortality
      • Risk factors
      • Benefits
      • Current screening status
  • Questions?
colonoscopy
Colonoscopy

Sensitivity for CRC =95%

Estimate: $800 - $1600

risk factor polyps
Risk Factor - Polyps

Different types:

  • Hyperplastic
    • minimal cancer

potential

  • Adenomatous
    • approximately 90% of colon and rectal cancers arise from adenomas

24

flat lesions
Flat Lesions

Soetikno, JAMA 2008

Caveats

  • Most lesions not

truly flat

25

slide26

Human colon carcinogenesis

Normal Polyp Cancer

Normal to Adenoma to Carcinoma

26

benefits of crc screening
Benefits of CRC Screening

Benefits:

  • Cancer Prevention: Removal of pre-cancerous polyps
  • Long-term survival: Improved by early detection

27

colonoscopy28
Colonoscopy

Colonoscopy – Pros

  • Can usually view entire colon
  • Can biopsy and remove polyps
  • Done every 10 years
  • Can diagnose other diseases
colonoscopy29
Colonoscopy

 Colonoscopy – Cons

  • Can miss small polyps
  • Full bowel preparation needed
  • More expensive on a one-time basis
  • Sedation of some kind is usually needed
  • Will need someone else to drive home
  • May require a missed day of work
colonoscopy30
Colonoscopy

 Colonoscopy – Cons

  • Risk of serious Complications 25/10,000
    • Bleeding 12.3/10,000
    • Tear or perforations 3.8/10,000
    • Infection or diverticulities
    • Cardiovascular events
    • Severe abdominal pain
  • Serious complication consequence:
    • Hospital admission
    • Surgery
    • Death 0.6/10,000 procedures reported
guaiac fecal occult blood test
Guaiac Fecal Occult Blood Test

Sensitivity for CRC =varies (64% for Hemoccult SENSA)

Estimate:$10 - $25

slide32
FOBT

Fecal Occult Blood Test – Pros

  • No direct risk to the colon
  • No bowel preparation
  • Sampling done at home
  • Inexpensive
slide33
FOBT

Fecal Occult Blood Test – Cons

  • May miss many polyps and some cancers
  • May produce false-positive test results
  • May have pre-test dietary limitations
  • Should be done annually
  • Organized system needed for follow-up
  • Colonoscopy needed if abnormal
in office fobt
In-Office FOBT
  • Single sample, in-office CRC sensitivity = 9.5 %
  • Hemoccult II 3 card, take-home sensitivity = 43.9 %
  • In-office FOBT not a CRC screening tool
  • Nearly 30% of physicians reported using for screening colorectal cancer

Nadel et al, Annals of Int Med Jan 2005

fecal immunochemical test
Fecal Immunochemical Test

Sensitivity for CRC =varies (66% for Magstream FIT)

Estimate: $28

slide36
FIT

Fecal Immunochemical Test – Pros

  • No direct risk to the colon
  • No bowel preparation
  • No pre-test dietary restrictions
  • Sampling done at home
  • Fairly inexpensive
slide37
FIT

Fecal Immunochemical Test – Cons

  • May miss many polyps and some cancers
  • May produce false-positive test results
  • Should be done annually
  • Colonoscopy needed if abnormal
colorectal cancer symptoms
Colorectal cancer symptoms

Blood in or on the stool

Stomach pains, aches, or cramps that are persistent

Unexplained weight loss

Change in bowel habits

resources
Resources

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline:

http://caonline.amcancersoc.org/cgi/content/full/CA.2007.0018v1

USPSTF CRC screening 2008 update: http://www.ahrq.gov/CLINIC/uspstf/uspscolo.htm

MDPHHS Cancer Control webpage: www.cancer.mt.gov

Email questions on cancer control: [email protected]

The Community Guide: www.thecommunityguide.org

How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician\'s Evidence-Based Toolbox and Guide: http://www.cancer.org/docroot/PRO/content/PRO_4_1x_ColonMD_Clinicians_Manual.pdf.asp

Ballew, Lloyd, and Miller. 2009. Capacity for Colorectal Cancer Screening by Colonoscopy, Montana, 2008. American Journal of Preventive Medicine 36:329-332.

ad