1 st Mens Health Conference Dr Muhammad Radzi Abu Hassan Consultant - PowerPoint PPT Presentation

Colorectal Cancer & Screening 1 st Men’s Health Conference Dr Muhammad Radzi Abu Hassan Consultant Physician and Gastroenterologist Hospital Sultanah Bahiyah, Alor Star Kedah

Outline • Colorectal cancer in Malaysia • CRC screening – the best preventive model • Issues in men’s health • ??? solutions • Conclusion

Global Epidemiology of CRC 1,2 ✓ The 3r 3rd d most commonly diagnosed malignancy . - 1.4 1.4 mil milli lion on ne new w ca cases ses ha have e be been en dia diagno gnosed ed ann annuall ually. ✓ The he 4th 4th lead leading ing ca cause use of of de deaths. ths. - Ac Accounting ting for almo r almost st 700,00 ,000 dea deaths ths per per y year ear. CRC = colorectal cancer

CRC in Malaysia (1) 3 The second most common cancer di Malaysia

100,000 population Overall incidence and mortality rate in Malaysia (2008-2013) 21.32 9.79 Incidence Mortality Age-adjusted rate (per 100,000) 21 had colorectal carcinoma 10 patients were dead SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013

100,000 population by gender Overall incidence rate by gender , 2008-2013 Male Female 24.16 18.14 Incidence Incidence Age-adjusted rate (per 100,000) 24 male had colorectal carcinoma 18 female had colorectal carcinoma SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013

100,000 population by gender Overall mortality rate by gender , 2008-2013 Male Female 11.46 8.05 Mortality Mortality Age-adjusted rate (per 100,000) 11 male patients were dead 8 female patients were dead SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013

Incidence -Age 50+ Malaysia 1 2008-2014 Persons age 30 years 1 in 3446 40 years 1 in 1135 50 years 1 in 442 60 years 1 in 188 70+ years 1 in 133 Age-specific incidence rate by sex, Malaysia, 2007-2011 Source: 1 National Cancer Patient Registry – Colorectal Cancer: Report for Northern Region of Malaysia (2008-2014)

N o rm al B lo o d V es s el L ym ph no de S ero s a M us cle layers S ubm uco s a M uco s a Stage 3 and 4 61.3% S pread o f the cancer To o ther o rgans Source: National Cancer Patient Registry – Colorectal Cancer: Report for Northern Region of Malaysia (2008-2014)

Economic Burden of CRC treatment in Malaysia 5 • Approximately RM 108 million annually. • The total treatment costs per patient according to the clinical staging: Total treatment cost (RM) 36,666 27,377 24,972 19,752 13,622 STAGE 1 STAGE 2 STAGE 3 STAGE 4 MONOCLONAL ANTIBODIES Veettil SK, Lim KG, Chaiyakunapruk N, et al. Colorectal cancer in Malaysia: Its burden and implications for a country. Asian J Surg 2017; 40(6): 481-489.

Current Medical Practice t P R A C TIC E “B es ” “ E V ID E N C E bas edicine ” ed m Value based medicine nalized/ P R E C IS IO N “P ers o m edicine” “ V A L U E bas ed m edicine”

Screening & Prevention: The Way Forward • In view of the continuously increasing treatment cost for CRC, regular screening could potentially serve as a more cost-effective strategy, mainly by: 6 ✓ Detecting CRC at an early, favorable stage; ✓ Preventing CRC through the early detection and removal of pre- cancerous polyps; ✓ Reduce/save cost ✓ Save life

RECENTLY LAUNCHED JUNE 2018 BY OUR DIRECTOR GENERAL

ADENOMA CARCINOMA PATHWAY Adenoma Normal Cancer

Screening in Average Risk Population 16

Screening/Surveillance in Moderate and High Risk Groups 17

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CRC Screening in Malaysia Average Risk Moderate/High Risk (Asymptomatic 50-75) Assessment by iFOBT Doctor +ve -ve Colonoscopy Repeat yearly iFOBT Colonoscopy

Men and Colorectal Cancer: Higher Risk but Poorer Awareness & Attitude ❑ As compared with women, men have ➢ poorer knowledge about symptoms of colorectal cancer. 9 ➢ relatively negative attitude toward colorectal cancer screening. 10 ➢ a higher risk of delay in first treatment of colorectal cancer. 11

Evidence: Poorer Health Behaviors in Men Smoking rate is higher in Men exceed women in high- Men have a higher risk of men worldwide. 2,3 volume alcohol consumption. 4 gravitating towards substance use. 5

Worst of All: Men Have Poorer Health-Seeking Behaviors Less use of health facilities. 8 Delayed help seeking for Stigma-driven refusal to seek their physical illnesses. 6 help for mental and mood disorders. 7

CRC Screening by MOH in 2016 Cancer 26% Total number of screened patients 30128 IFOBT positive 2706(9%) Colonic Polyp 74% 1174 Undergoing scope 43.4%

Issue 1: Poor Uptake of Colonoscopy (a qualitative study from Kedah) 7 • High refusal for colonoscopy among the patients with a positive iFOBT result, which is primarily due to the: ✓ Perception that it is an unnecessary procedure; ✓ Fear of pain and feeling of embarrassment; ✓ Time constraint and transportation problem; ✓ Poor support from family members and friends. iFOBT = Immunochemical fecal occult blood test.

Preliminary Results Motivating factors of undergoing colonoscopy • Fear of colorectal cancer. • Previous experience from friends who were diagnosed with colorectal cancer.

SCREENING IS MEANINGLESS IF THERE IS NO UPTAKE!!!!

Gender Differences in Health: The Elephant in the Room 1 • Men and women are different due to biological and societal factors. • One size does not fit both genders in health. • However, the existing prevention and treatment strategies of many diseases do not take account of the differences.

Conclusion • Shift our focus on prevention rather than therapeutic • Men’s health issues • Health seeking behavior • Discrepancy between male and female achievement • Strengthen our crc screening policy • COLORECTAL CANCER IS PREVENTABLE

Thank YOU