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Spotlight on Colorectal Cancer Screening. 1. Home Screening for Colon Cancer. http:// ColonCancerCheck (CCC). First population-based, organized colorectal screening program of its kind in Canada Goals:

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Spotlight on Colorectal Cancer Screening

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    1. Spotlight on Colorectal Cancer Screening 1

    2. Home Screening for Colon Cancer •

    3. ColonCancerCheck (CCC) First population-based, organized colorectal screening program of its kind in Canada Goals: • To reduce deaths from colorectal cancer through an organized screening program; • To support health care providers in providing the best possible colorectal cancer screening for their patients

    4. Ontario Cancer Statistics 2013 4 4

    5. Burden of Disease • In Ontario, an estimated 8,700 new cases of colorectal cancer will be diagnosed and 3,350 people will die from it in 2013 • Incidence of colorectal cancer in Canada is similar to other developed countries, and is among the highest in the world 5

    6. Burden of Disease • Approximately 93% of cases are diagnosed in people aged 50 years and older • 5-year relative survival rate for colorectal cancer has improved over the past decade in Canada

    7. Effectiveness of Screening 7

    8. Adenoma-Carcinoma Sequence • Majority of colorectal cancers arise from adenomatous polyps • Progression to invasive cancer takes 10 years on average 8

    9. Recommended Screening Average Risk: fecal occult blood test (FOBT) • Men and Women age 50 to 74 • Biennial (every 2 years) • Follow up abnormal FOBT with colonoscopy 9

    10. Recommended Screening Increased Risk: Colonoscopy • One or more first-degree relatives with a history of colorectal cancer • Begin at age 50, or 10 years earlier than age relative was diagnosed, whichever is first

    11. FOBT and Colonoscopy Average risk patients: • with a negative (normal) colonoscopy should not be screened for 10 years • following which screening should resume using either FOBT or colonoscopy 11

    12. Evidence for Screening Using FOBT A meta-analysis of 3 randomized clinical trials shows that regular screening with FOBT reduces colorectal cancer mortality by 15%

    13. ColonCancerCheck (CCC) Program Goals • Reduce mortality through an organized screening program • Improve capacity of primary care to participate in comprehensive colorectal cancer screening

    14. CCC Program Features • Colonoscopy and FOBT quality standards • Increased colonoscopy capacity across Ontario • Primary care provider awareness • Program-branded FOBT kits • Financial incentives for family physicians

    15. CCC Program Features Patient correspondence: Initiatives to assist with follow-upof abnormal results • FOBT result letters • Recall/reminder letters • Invitation letters to people age 50 to 74 15

    16. CCC FOBT Process • At home test • No bowel prep • Only one dietary restriction – vitamin C Clean sample Sample one area Smear first window

    17. CCC FOBT Process • Three different bowel movements • Record date and time on each flap in ink • Complete and mail within 10 days of first sample Sample two area Smear second window Date and time in ink

    18. CCC FOBT Process • Personal info matches requisition • Place Kit in foil envelope and seal • Include foil envelope and requisition Use foil lined envelope Include all pieces Mail Canada Post

    19. Assessing Risk Assess for colorectal cancer (CRC) signs and symptoms No symptoms; 1 or more 1st degree relatives with CRC (increased risk of CRC) Age 50 to74; no symptoms; no affected 1stdegree relatives (average risk of CRC) Symptoms (high risk of CRC) Refer to colonoscopy; FOBT not appropriate Refer to colonoscopy; start at 50 years of age or 10 years before age of relative’s diagnosis FOBT every2 years

    20. FOBT Screening Participation Rate, by LHIN CCO program target 2010: 40%

    21. Overdue for CRC Screening 21

    22. Follow-up Colonoscopy After +veFOBT

    23. ColonCancerCheck • In Ontario, what is the recommended screening test for colorectal cancer if the individual is 50+ and has no family history of CRC and no signs or symptoms? • Fecal Immunochemical Test (FIT) • Fecal Occult Blood Test (FOBT) • Flexible Sigmoidoscopy • Colonoscopy

    24. Clinical Case Study 1 A 54-year-old asymptomatic male comes in for his periodic health visit What screening test would you suggest for him?

    25. Clinical Case Study 2 • A 47-year-old woman inquires about colorectal cancer screening • Her mother was diagnosed at age 65 with colorectal cancer What would you suggest?

    26. CCC Resources For more information:

    27. Questions? Thank You