1 / 73

Colorectal Cancer A Preventable Burden

Colorectal Cancer A Preventable Burden. Citywide Colorectal Cancer Control Coalition Ambassador Program. NYC Coalition Mission. “To increase awareness & screening for colorectal cancer & adenomatous polyps in NYC men and women in order to reduce the incidence & mortality of this disease”.

Download Presentation

Colorectal Cancer A Preventable Burden

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Colorectal Cancer A Preventable Burden Citywide Colorectal Cancer Control Coalition Ambassador Program

  2. NYC Coalition Mission “To increase awareness & screening for colorectal cancer & adenomatous polyps in NYC men and women in order to reduce the incidence & mortality of this disease”

  3. C5 Ambassadors Program:Goals To educate health care providers: • CRC as a public health problem • Effectiveness of CRC screening • What are the current guidelines • Recommendations of the NYC DOHMH

  4. There Are Major Health Disparities of Colorectal Cancer in the U.S * Rates per 100,000 U

  5. Colorectal Cancer Risk Groups FAP 5% HNPCC-Hereditary Non-Polyposis Colorectal Cancer Winawer, Schottenfeld, Flehinger, JNCI 1991: 83:243-253. U

  6. Normalcecum3/95 Cecalcecum5/96 Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

  7. Amsterdam Criteria • Three or more relatives with Hereditary Non-Polyposis Colorectal Cancers • One a first degree relative of the other two • Two or more generations • One with cancer < age 50 Vasen et al. GE 1999; 116 (6): 1453

  8. Population risk of CRC 1 in 20 1 first-degree relative 1 in 17 1 FDR & 1 second-degree relative 1 in 12 1 relative aged under 45 1 in 10 2 first-degree relatives 1 in 6 Autosomal dominant pedigree 1 in 2 Lifetime Risks Of Colorectal Cancer

  9. Colorectal Cancer “The most preventable, but least prevented, cancer” U

  10. The Best Screening Test Is THE ONE THAT GETS DONE.

  11. Low Screening Rates • CRC has far lower screening rates than breast or cervical cancer U

  12. Why Screen for Colon Cancer? • Proven effectiveness of screening • Highly preventable cancer • Well defined pre-malignant phase (adenoma) • Adenomas take 5-10 years to become cancer • Molecular basis of carcinogenesis is the best understood of all solid tumors (molecular diagnostics) U

  13. Barriers to CRC Screening

  14. % Mortality Reduction Using Different Screening Methods 1000 Colonoscopy Every 10 years 90%† Annual FOBT 33%* Sigmoidoscopy Every 5-10 years 30%* *Observed †Estimated U

  15. Prospective, randomized, controlled trials Mandel Hardcastle Kronborg (USA) (UK) (Denmark) Duration 1975-92 1981-95 1985-95 Subjects (n) 46,551 152,850 140,000 Frequency annual/ biennial biennial biennial F/U duration (yrs) 13 7.8 10 CRC mortality 33%/21% 15% 18% Reduction Effectiveness of FOBT

  16. Colorectal Cancer Mortality Study Design Reduction Published Kaiser Retrospective, 30% Selby, NEJMPermanente, Case Control 1992USA Univ. Retrospective, 40% Newcomb,Wisconsin, Case Control JNCI 1992USA Colorectal Cancer Mortality Reduction By Sigmoidoscopy Reviewed in Colorectal Cancer Screening: Clinical Guidelines and Rationale. Winawer, Fletcher, et al., Gastroenterology, Feb. 1997.

  17. Lieberman1 Imperiale2 Setting VA; Multi-center Eli Lilly co No. Of subjects 3,121 1,994 Male 96.8% 58.9% Age (mean) 62.9 yrs 59.8 yrs Cancer 1.0% 0.6% Adenoma (any) 37.0% -- Adenoma >1 cm 7.9% -- Adenoma w/ HGD 1.6% -- What Do You Find If You Perform Screening Colonoscopy on Average-risk Subjects? 1N Engl J med 343:162, 2000 2N Engl J med 343:169, 2000 U

  18. 15-22 cancers are prevented or detected early per 1,000 screening colonoscopies 1,000 average-risk asymptomatic men and women aged 50 and older COLONOSCOPY 5% - 6% will have advanced adenomas ►50-60 advanced adenomas detected by screening 0.5% - 1% will have cancer ► 5-10 cancers detected early by screening 20% (10-12) would have developed cancer over 20 years

  19. Cost Effectiveness of Colon Cancer Screening vs. Other Measures Cost ($) per added year of life (x 1000) Colon Hypertension Mammography Cholesterol Screening* *Any colon screening The cost varies with the model used; this is a ballpark number Lieberman 2003.

  20. Randomized trial Surveillance intervals Surveillance methods Colorectal Cancer incidence Adenoma-carcinoma model 7 clinical centers Memorial Sloan Kettering Coord. Center National Polyp Study

  21. Colorectal Cancer Incidence in NPS Following Colonoscopic Polypectomy (1418 pts ; 8401 person yrs)

  22. Resources Less Intensive Surveillance Increased Resources for Screening

  23. Alternative and Future Colorectal Cancer Screening Methods

More Related