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Risk Factors for CRC

Chief, Division of Gastroenterology. Oregon Health Sciences University ... Morikawa et al; Gastroenterology 2005; 129: 422-8. Levi et al; Ann Intern Med 2007; 146: ...

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Risk Factors for CRC

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    2. Risk Factors for CRC

    3. Colorectal Cancer

    4. Guideline Process Prior guidelines from multiple organizations Consensus guideline included: American Cancer Society Multi-Society Task Force on Colorectal Cancer GI organizations and American College of Physicians American College of Radiology U.S. Preventive Services Task Force

    5. Guideline Process Rules of evidence Where evidence was lacking: Expert opinion Areas for research noted Emphasis on Quality in each program

    6. Lifestyle and Diet

    7. New CRC Guideline: Key Principles Distinguish between Early cancer detection tests Cancer prevention tests Establish minimum standard for early cancer detection tests Emphasis on quality

    8. Raising the bar

    9. Average-Risk CRC Screening

    10. Fecal Occult Blood Test: FOBT

    11. FOBT- One-time testing

    12. Stool Genetic Tests - Issues One-time test can detect more than 50% of cancers Evolving Costly

    13. FOBT: Mortality Reduction

    14. Early Cancer Detection Tests Requires programmaticadherence with (+) and (-) tests Programmatic performance: Unlikely to result in much cancer prevention

    15. Adenoma and Cancer Detection Tests

    16. CT Colonography

    17. CT Colonography: Who should be referred for Colonoscopy ?

    18. CT Colonography: Issues Inter-observer variability Detection of flat polyps Bowel Prep Radiation Extracolonic findings Intervals uncertain: After negative exam After exam with small polyps

    19. Adenoma and Cancer Detection Tests

    20. Colonoscopy Screening Studies (n > 1000) Studies: 2000-2004 VA Cooperative Study ;NEJM: 2000; 343: 162-8 (n = 3121) Indiana Study; NEJM 2000; 343: 169-74 (n = 1994) CT Colonography studies (n = 2447) (Pickhardt, Rockey, Cotton) Fecal DNA Study; NEJM 2004; 351: 2704-14 (n = 4404) Spain, Am J Gastroenterol 2003; 98: 2648-54 (n = 2210) Studies: 2005-2006 Women: (Schoenfeld) NEJM 2005; 352: 2061-8 (n = 1463) Taiwan; Gastrointest Endosc 2005; 61: 547-53 (n = 1708) Japan, Gastroenterology 2005; 129: 422-8 (n = 21,805 with iFOBT) Seattle, JAMA 2006; 295: 2357-65 (N = 1244) Poland, NEJM 2006; 355: 1863-72 (n = 50,148) Germany (n = 1.14M)

    22. Colonoscopy Appropriate utilization High-quality exam to cecum Low rate of missed lesions Low rate of incompletely removed lesions Low rate of adverse events

    23. Colonoscopy Issues Bowel Prep Quality Issues Missed lesions Safety

    24. Obstacles to Screening:Perceptions Patient education:Screening works !!!

    25. Obstacles to Screening:Perceptions It is not fun It is not effective It is not clear what test to use It costs too much

    26. Cost of not screening

    27. Overcoming Obstacles Patient Education Provider Education Understanding obstaclesto compliance

    28. Colon Screening in USA

    29. CRC Age-adjusted incidence rates/100,000210,452 white Americans >21 yrs

    30. Summary of 2008 CRC Screening Guideline Distinguishes: Tests which detect early cancer

    31. Raising the bar

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