Spotlight on Colorectal Cancer Screening 1 1

Home Screening for Colon Cancer 2

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 3

Ontario Cancer Statistics Cancer TypeIncidence (# New Cases) Mortality (# Deaths) Colorectal4,800 (M) 3,900 (F) 1,850 (M) 1,500(F) 4

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

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 6

Effectiveness of Screening Cancer SiteEffectiveness of Screening Type of Studies ColorectalWith FOBT: 15% reduction in mortality with biennial screening Randomized controlled trials 7

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

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

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 10

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

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% 12

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

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

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

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

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 17

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 piecesMail Canada Post 18

Assessing Risk Assess for colorectal cancer (CRC) signs and symptoms Symptoms (high risk of CRC) Age 50 to74; no symptoms; no affected 1 st degree relatives (average risk of CRC) No symptoms; 1 or more 1 st degree relatives with CRC (increased 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 every 2 years 19

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

Overdue for CRC Screening 21

Follow-up Colonoscopy After +ve FOBT

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? 1.Fecal Immunochemical Test (FIT) 2.Fecal Occult Blood Test (FOBT) 3.Flexible Sigmoidoscopy 4.Colonoscopy 23

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? 24

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? 25

CCC Resources For more information: /

ColonCancerCheck Update  Program letters now expanded to entire target population age  Invitation & Recalls – Oct 2013  Screening Activity Report (SAR) report  first release - October 2013  Cervical and Breast screening information added to the second release May 2014  SAR can be accessed by physicians through oneID secure website 27

Questions? Thank You