cancer screening second report: colorectal cancer screening · second report: colorectal cancer...
TRANSCRIPT
Nereo Segnan MD MSc Epi
Center for Epidemiology and Prevention in Oncology, CPO Piedmont WHO Collaborative Center for Cancer Early Diagnosis and Screening
University Hospital “Città della Salute e della Scienza”, Turin, Italy
Cancer Screening in the European Union
Second Report:
Colorectal cancer Screening
Wien 14 October 2011
• No conflict of interest to declare
Second Report on Cancer Screening in the EU Co-financed by the EU Health Programme
-
Main collaborating institutions
• International Agency for Research on Cancer, Lyon, France (coordination)
• CPO Piemonte, University Hospital “Città della Salute e della Scienza”CPO, Turin, Italy
• Finnish Cancer Registry, Mass Screening Registry,
Helsinki, Finland
Authors
• A Ponti, A Anttila, G Ronco, C Senore, N Segnan, M Tomatis, P Basu,
M Primic-Žakelj, P Dean, J Dillner, M Fernan, M Elfström, S Lönnberg,
R Sankaranaryanan, I Soerjomataram, D Vale, L von Karsa
Scientific Committee*
• L Altenhofen, R Ancelle-Park, N Ascunce, H de Koning, E Lynge, O
Májek,
F Nicula, J Patnick, J Regula, S Törnberg, M Zappa
Over 80 Data providers from all 28 EU Member States*
*invited reviewers of full report,
and co-authors of publication in
peer-reviewed journal
Data Provider’s Workshop (22 Member States
Participating) – 16-17 Feb, 2016; IARC
Second Report on the Implementation of Council
Recommendations on Cancer Screening - objectives
• To document changes in approach to program
implementation compared to first report
• To collect more detailed information on program
organization
• To include selected performance parameters
– Key determinants of quality and impact recommended in the
European QA guidelines
– Suitable for comparison between Member States
Second Report – Standardized Data Output
Site Specific Questionnaires to collect information on
• Program organization, invitation, QA, financing, cost
• Screening tests, eligibility, screening interval, further assessment
Site Specific Tables on annual aggregated data stratified by age groups & initial vs subsequent screening
• Screening tests
• Further assessment recommendations
• Further assessment compliance
• Outcome of further assessment
o Detection rates
o Positive predictive values
Necessity of Regular Reporting on Cancer
Screening in the EU
• Current performance determines impact of screening
on burden of disease
• Impact is measurable only after many years
• Regular monitoring permits timely response to
potential problems and recognition of
opportunities for improvement
– Avoids unnecessary harm and cost
– Maximises benefit of screening
Web Based Data Collection
EU CRC screening
• Annual target population 50 -74 yrs:
69,636,000
• Invited: 23,343,000 (33.5%)
• Screened: 9,985,000 (14.2%)
0%
25%
50%
75%
100%
Table 4.15
N = Individuals screened of invited in the year
D = Individuals personally invited in the year
COLON - Participation rate (All ages)
FIT, 10 countries
N = 3,621,692
D = 7,313,175
Result = 49.5% (22.8% - 71.3%)
gFOBT, 6 countries
N = 5,352,356
D = 16,158,260
Result = 33.1% (4.5% - 66.6%)
0%
25%
50%
75%
100%
COLON - Participation rate (60-69 years) Table 4.15
N = Individuals screened of invited in the year
D = Individuals personally invited in the year
FIT, 8 countries
N = 1,736,995
D = 3,277,339
Result = 53.0% (28.7% - 74.0%)
gFOBT, 5 countries
N = 3,035,378
D = 7,316,925
Result = 41.5% (5.0% - 66.6%)
0%
5%
10%
15%
20
20
NA
15
-20
15
15
20
15
-47
20
16
-20
18
0
COLON – Screen positivity (60-69 years)
FIT, 11 countries
N = 144,089
D = 2,195,044
Result = 6.6% (3.1% - 10.6%)
gFOBT, 6 countries
N = 64701
D = 3140223
Result = 2.1% (1.7% - 4.5%)
Table 4.18.1
N = Positive screening tests in the year
D = Individuals screened in the year with adequate test - test results available
« Positivity cut off µg/gr faeces
COLON – Detection rate of colorectal cancers (60-69 years)
FIT, 9 countries
N = 4501
D = 1923252
Result = 2.3‰ (1.3‰ - 4.1‰)
gFOBT, 5 countries
N = 3704
D = 3112437
Result = 1.2‰ (0.9‰ - 2.6‰)
Table 4.18.6
0
1
2
3
4
5
N = Colorectal cancers detected
D = Individuals screened in the year with adequate test - test results available
COLON – Detection rate of advanced adenomas (60-69 years)
FIT, 6 countries
N = 25958
D = 1889223
Result = 13.7‰ (5.8‰ - 27.5‰)
gFOBT, 5 countries
N = 6963
D = 3013386
Result = 2.3‰ (1.0‰ - 5.4‰)
Table 4.18.5
0
5
10
15
20
25
30
N = Advanced ademonas detected
D = Individuals screened in the year with adequate test - test results available
COLON – Detection rate of colorectal cancers (All ages)
FIT, 9 countries
N = 7519
D = 3751139
Result = 2.0‰ (1.2‰ - 4.9‰)
gFOBT, 6 countries
N = 6545
D = 5529765
Result = 1.2‰ (0.9‰ - 1.9‰)
Table 4.18.6
0
1
2
3
4
5
N = Colorectal cancers detected
D = Individuals screened in the year with adequate test - test results available
0
5
10
15
20
25
30
COLON – Detection rate of advanced adenomas (All ages)
FIT, 6 countries
N = 55059
D = 3713008
Result = 14.8‰ (7.4‰ - 27.0‰)
gFOBT, 5 countries
N = 12706
D = 5143744
Result = 2.5‰ (0.9‰ - 4.6‰)
Table 4.18.5
N = Advanced ademonas detected
D = Individuals screened in the year with adequate test - test results available
0%
25%
50%
75%
100%
COLON – Follow-up colonoscopy participation rate (All ages)
FIT, 11 countries
N = 187918
D = 266420
Result = 70.5% (36.3% - 92.2%)
gFOBT, 6 countries
N = 99037
D = 117844
Result = 84.0% (72.6% - 93.2%)
Table 4.18.2
N = Further colonoscopies performed
D = Data on further col. performance available
50%
60%
70%
80%
90%
100%
COLON – Completion rate follow-up colonoscopy (All ages)
FIT, 7 countries
N = 138412
D = 147090
Result = 94.1% (92.4% - 98.8%)
gFOBT, 4 countries
N = 54813
D = 56496
Result = 97.0% (91.0% - 97.6%)
Table 4.18.3
N = Further colonoscopies completed
D = Data on col. completion available
50-59 60-69
FIT gFOBT TC FIT gFOBT TC
Tests 1753K 1294K 12K 2195K 3140K -
Screen positivity 5,1% 2,0% 11,5% 6,6% 2,1% -
F.U. colonoscopy
participation rate 76,8% 83,1% 82,2% 75,0% 84,5% -
Completion rate
F.U. colonoscopy 93,9% 97,8% 97,2% 93,7% 96,8% 97,1%
Detection Rate
advanced adenoma 8,7‰ 2,5‰ 49,5‰ 13,7‰ 2,3‰ 72,4‰
Detection Rate
colorectal cancers 1,1‰ 0,6‰ 3,5‰ 2,3‰ 1,2‰ 8,1‰
gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 197 21.570 0,9%
Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%
Women 145 33.382 0,4% 145 33.382 0,4%
Men 270 26.003 1,0% 270 26.003 1,0%
Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%
Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%
Women 173 36.491 0,5% 173 36.491 0,5%
Men 317 28.571 1,1% 317 28.571 1,1%
Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%
Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%
Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%
Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%
Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%
Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%
Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%
Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
Thank to
Partha Basu (IARC),
Mariano Tomatis, Antonio Ponti, Carlo
Senore (CPO Piemonte)
for providing slides and data
Thank you for your
attention
gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 70 9.014 0,8% 99 9.794 1,0% 28 2.762 1,0% 197 21.570 0,9%
Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%
Women 145 33.382 0,4% 145 33.382 0,4%
Men 270 26.003 1,0% 270 26.003 1,0%
Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%
Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%
Women 173 36.491 0,5% 173 36.491 0,5%
Men 317 28.571 1,1% 317 28.571 1,1%
Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%
Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%
Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%
Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%
Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%
Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%
Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%
Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
FIT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 898 119.189 0,8% 1.443 129.721 1,1% 555 41.651 1,3% 286 24.976 1,1% 3.182 315.537 1,0%
Men 1.652 85.428 1,9% 2.308 90.206 2,6% 728 29.124 2,5% 334 15.414 2,2% 5.022 220.172 2,3%
Women 44 5.673 0,8% 46 5.801 0,8% 22 1.981 1,1% 112 13.455 0,8%
Men 45 4.392 1,0% 61 4.297 1,4% 37 1.464 2,5% 143 10.153 1,4%
Women 44 2.307 1,9% 45 2.149 2,1% 89 4.456 2,0%
Men 64 1.775 3,6% 99 1.629 6,1% 163 3.404 4,8%
Women 3.868 189.432 2,0% 2.925 80.347 3,6% 6.793 269.779 2,5%
Men 7.230 181.983 4,0% 4.623 72.373 6,4% 11.853 254.356 4,7%
Women 4.161 530.280 0,8% 6.198 532.458 1,2% 10.359 1.062.738 1,0%
Men 7.025 447.464 1,6% 10.579 459.329 2,3% 17.604 906.793 1,9%
Women 1.121 79.937 1,4% 1.244 58.766 2,1% 2.365 138.703 1,7%
Men 2.336 65.695 3,6% 2.390 47.550 5,0% 4.726 113.245 4,2%
Women 2.100 126.358 1,7% 2.928 115.171 2,5% 5.028 241.529 2,1%
Men 4.401 109.270 4,0% 5.585 98.160 5,7% 9.986 207.430 4,8%
Total Women 8.368 863.744 1,0% 11.904 844.066 1,4% 577 43.632 1,3% 286 24.976 1,1% 21.135 1.776.418 1,2%
Total Men 15.523 714.024 2,2% 21.022 701.171 3,0% 765 30.588 2,5% 334 15.414 2,2% 37.644 1.461.197 2,6%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
Endoscopy 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 468 5.567 8,4% 468 5.567 8,4%
Men 954 5.996 15,9% 954 5.996 15,9%
Women 477 2.402 19,9% 522 2.365 22,1% 999 4.767 21,0%
Men 786 2.375 33,1% 833 2.170 38,4% 1.619 4.545 35,6%
Women 124 727 17,1% 255 1.142 22,3% 66 241 27,4% 19 108 17,6% 464 2.218 20,9%
Men 252 810 31,1% 420 1.134 37,0% 78 243 32,1% 35 99 35,4% 785 2.286 34,3%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)