Spotlight on
Colorectal Cancer Screening
1
1
Home Screening for Colon
Cancer
• http://www.youtube.com/watch?v=SzJe_D0-J38
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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
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Ontario Cancer Statistics 2013
Cancer Type
Colorectal
Incidence
(# New Cases)
Mortality
(# Deaths)
4,800 (M)
4
3,900 (F)
1,850 (M)
1,500(F)
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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
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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
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Effectiveness of Screening
Cancer Site
Colorectal
Effectiveness of
Screening
With FOBT:
15% reduction in
mortality with biennial
screening
Type of
Studies
Randomized
controlled
trials
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Adenoma-Carcinoma Sequence
• Majority of colorectal cancers
arise from adenomatous polyps
• Progression to invasive cancer
takes 10 years on average
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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
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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
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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
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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%
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ColonCancerCheck (CCC)
Program Goals
• Reduce mortality through an
organized screening program
• Improve capacity of primary care to
participate in comprehensive
colorectal cancer screening
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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
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CCC Program Features
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
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CCC FOBT Process
• At home test
• No bowel prep
• Only one dietary restriction – vitamin C
Clean sample
Sample one area
Smear first window
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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
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Sample two area
Smear second
window
Date and time in ink
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
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Assessing Risk
Assess for colorectal cancer (CRC)
signs and symptoms
Symptoms
(high risk of
CRC)
No symptoms; 1 or
more 1st degree
relatives with CRC
(increased risk of CRC)
Age 50 to74;
no symptoms; no
affected 1st degree
relatives
(average 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
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FOBT Screening Participation Rate,
by LHIN
100
90
80
70
60
50
CCO program target 2010: 40%
40
30
20
10
0
2004-2005
2006-2007
2008-2009
2010-2011
Overdue for CRC Screening
100
90
80
Overdue (%)
70
60
50
40
30
20
10
0
2008
2009
Year
2010
2011
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Colonoscopy within 6 months (%)
Follow-up Colonoscopy After
+veFOBT
100
90
80
70
60
50
40
30
20
10
0
2008
2009
2010
Year
2011
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
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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?
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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?
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CCC Resources
For more information:
www.cancercare.on.ca/pcresources
https://www.publications.serviceontario.ca/pubont/servlet/ecom/
Questions?
Thank You