1 st Mens Health Conference Dr Muhammad Radzi Abu Hassan Consultant - - PowerPoint PPT Presentation
Colorectal Cancer & Screening 1 st Mens Health Conference Dr Muhammad Radzi Abu Hassan Consultant Physician and Gastroenterologist Hospital Sultanah Bahiyah, Alor Star Kedah Outline Colorectal cancer in Malaysia CRC screening
Colorectal Cancer & Screening 1st Men’s Health Conference
Dr Muhammad Radzi Abu Hassan Consultant Physician and Gastroenterologist Hospital Sultanah Bahiyah, Alor Star Kedah
Outline
3rd d most commonly diagnosed malignancy.
1.4 mil milli lion
new w ca cases ses ha have e be been en dia diagno gnosed ed ann annuall ually.
Global Epidemiology of CRC
1,2
he 4th 4th lead leading ing ca cause use of
de deaths. ths.
Accounting ting for almo r almost st 700,00 ,000 dea deaths ths per per y year ear.
CRC = colorectal cancer
The second
most common cancer di Malaysia
Overall incidence and mortality rate in Malaysia (2008-2013)
21.32
Incidence
Age-adjusted rate (per 100,000)
SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013
21 had colorectal carcinoma
100,000 population
9.79
Mortality
10 patients were dead
SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013
Overall incidence rate by
gender, 2008-2013
24.16
Incidence
Age-adjusted rate (per 100,000)
24 male had colorectal carcinoma
18.14
Incidence
100,000 population by gender
Male Female
18 female had colorectal carcinoma
SOURCE The Second Annual Report of the National Cancer Patient Registry-Colorectal Cancer, 2008 - 2013
Overall mortality rate by
gender, 2008-2013
11.46
Mortality
Age-adjusted rate (per 100,000)
11 male patients were dead
8.05
Mortality
100,000 population by gender
Male Female
8 female patients were dead
Incidence -Age
Malaysia1 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
Source:
1National Cancer Patient Registry – Colorectal Cancer: Report for Northern Region of Malaysia (2008-2014)Age-specific incidence rate by sex, Malaysia, 2007-2011
N
al B lo
es s el L ym ph no de S ero s a M us cle layers M uco s a S ubm uco s a S pread o f the cancer To
rgans
Stage 3 and 4
Source: National Cancer Patient Registry – Colorectal Cancer: Report for Northern Region of Malaysia (2008-2014)
Economic Burden of CRC treatment in Malaysia 5
13,622 19,752 24,972 27,377 36,666 STAGE 1 STAGE 2 STAGE 3 STAGE 4 MONOCLONAL ANTIBODIES
Total treatment cost (RM) 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 “B es t P
R A C TIC E
” “E
V ID E N C Ebas
ed m edicine”
“P ers
R E C IS IO N
m edicine” “V
A L U E
bas ed m edicine”
Value based medicine
Screening & Prevention: The Way Forward
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
Cancer Adenoma
Normal
Screening in Average Risk Population
16
Screening/Surveillance in Moderate and High Risk Groups
17
18
CRC Screening in Malaysia
Average Risk (Asymptomatic 50-75) iFOBT Colonoscopy Repeat yearly iFOBT Moderate/High Risk Assessment by Doctor Colonoscopy +ve
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
Evidence: Poorer Health Behaviors in Men
Smoking rate is higher in men worldwide.2,3 Men exceed women in high- volume alcohol consumption.4 Men have a higher risk of gravitating towards substance use.5
Worst of All: Men Have Poorer Health-Seeking Behaviors
Delayed help seeking for their physical illnesses.6 Stigma-driven refusal to seek help for mental and mood disorders.7 Less use of health facilities.8
30128
2706(9%)
1174
Cancer 26% Colonic Polyp 74%
Total number of screened patients IFOBT positive Undergoing scope
CRC Screening by MOH in 2016 43.4%
Issue 1: Poor Uptake of Colonoscopy (a qualitative study from Kedah) 7
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
colorectal cancer.
SCREENING IS MEANINGLESS IF THERE IS NO UPTAKE!!!!
Gender Differences in Health: The Elephant in the Room1
to biological and societal factors.
in health.
and treatment strategies of many diseases do not take account of the differences.
Conclusion