C R C s c r e e n i n g i n t h e N e t h e r - PowerPoint PPT Presentation

C R C s c r e e n i n g i n t h e N e t h e r l a n d s ; f r om p i l o t s t o n a t i o n a l p r o g r amm e M a r i e - L o u i s e H e i j n e n , P h D I r i s L a n s d o r p - V o g e l a a r , P h D 1 7 O c t o b e r 2 0 1 4 M e e t i n g W E O C R C S c r e e n i n g C omm i t t e e

L e a d - u p t o t h e b o w e l c a n c e r s c r e e n i n g p r o g r amm e 2 0 0 6 : S t a r t o f p i l o t s c r e e n i n g p r o g r amm e s 2 0 0 9 : A d v i s o r y r e p o r t i s s u e d b y t h e H e a l t h C o u n c i l o f t h e N e t h e r l a n d s 2 0 1 1 : F e a s i b i l i t y s t u d y c o n d u c t e d b y R I V M J u n e 2 0 1 1 : M i n i s t e r i a l d e c i s i o n E a r l y 2 0 1 3 : A p p l i c a t i o n a n d r e c omm e n d a t i o n f o r p e rm i t u n d e r P o p u l a t i o n S c r e e n i n g A c t S e p t em b e r 2 0 1 3 : S t a r t o f p i l o t J a n u a r y 2 0 1 4 : N a t i o n a l l a u n c h

C R C s c r e e n i n g s t a r t e d e n d o f J a n u a r y 2 0 1 4 –F I T ( F O B G o l d , c u t - o f f 1 5 µ g / g ) + c o l o n o s c o p y –M e n a n d w om e n 5 5 – 7 5 y e a r s o l d –B i - a n n u a l l y –P h a s e d i n t r o d u c t i o n ; w h e n f u l l y im p l em e n t e d : 2 , 2 m i l l i o n i n v i t e e s p e r y e a r –T i l l 1 3 O c t o b e r : 4 7 3 , 4 3 5 i n v i t e e s ; 1 4 , 8 9 4 c o l o n o s c o p i e s

I n J u l y c u t - o f f w a s i n c r e a s e d –F I T ( F O B G o l d ) f r om 8 8 t o 2 7 5 n g /m l –C u t - o f f d i d n o t g i v e t h e r i g h t h a rm - b e n e f i t r a t i o , 1 2% r e f e r r a l r a t e , t o o m a n y f a l s e p o s i t i v e s , t o o l i t t l e c o l o n o s c o p y c a p a c i t y –R a t i o n a l e f o r d e c i s i o n e x p l a i n e d t h i s m o r n i n g i n F I T f o r s c r e e n i n g s e s s i o n ; S e e a l s o h t t p : / / w w w . r i vm . n l / e n / T o p i c s / B / B o w e l _ c a n c e r _ s c r e e n i n g _ p r o g r amm e –N e x t y e a r c om p a r a t i v e s t u d y F O B G o l d a n d O C s e n s o r N ow : r e s u l t s o f f i r s t h a l f y e a r w i t h c u t - o f f 8 8 n g /m l b y E r a sm u s M e d i c a l C e n t r e + A n t o n i ev a n L e e uw e n h o e k h o s p i t a l , n a t i o n a l e v a l u a t o r

Invitation and participation Target population: 891,294 Not yet invited: 701,684 Invited: 189,610 Non-participants: Reminder: 22,255 (11.7%) 57,023 (95.9% of Non-responders: non-responders) 37,960 (20.0%) Participants: 129,395 (68.2%) National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Invitations per birth cohort 100% 80% 60% 40% 20% 0% 1938 1939 1947 1949 1951 Totaal Invited Not yet invited terug National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Participation: 68.2% 80% 70% 60% 50% 40% 30% 20% 10% 0% Men Women 1938 1939 1947 1949 1951 Total National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Screening Participants: 129,395 (68.2%) Unreliable: Not analyzable: 946 (0.7%) 1,150 (0.9%) Participants with analyzable FIT: 127,680 (98.7%) Negative test: Positive test: 112,297 (88.0%) 15,383 (12.0%) National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Postivity rate: 12.0% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Men Women 1938 1939 1947 1949 1951 Total National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Intake colonoscopy Positive test: 15,383 (12.0%) Non-participants: Reminder: 1,625 (10.6%) 224 (99.6% of no- No-show: shows) 225 (1.5%) Intake: 13,220 (85.9%) Colonoscopy: 12,167 (92.0%) National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

C o n c l u s i o n s i n t a k e 2 % 1 % 5 % 0 % 9 2 % C o l o n o s c o p y C T c o l o n o g r a p h y D i f f e r e n t i n t a k e l o c a t i o n C o l o n o s c o p y d e l a y e d E x c l u s i o n N a t i o n a l M o n i t o r i n g & E v a l u a t i o n C o l o r e c t a l C a n c e r S c r e e n i n g P r o g r a m m e E r a s m u s M C – N K I / A v L

Colonoscopy Colonoscopy: 11,430 (95.4%) Non-adenomatous Non-advanced Advanced Colorectal cancer: findings: adenomas: adenomas: 763 (6.7%) 4,195 (36.7%) 2,640 (23.1%) 3,832 (33.5%) National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Colonoscopies per postive test result • Of the 15.383 particpants with a positive test result currently 11,430 (74.3%) received a colonoscopy terug National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

Y i e l d o f c o l o n o s c o p y 7 % 3 2 % 3 3 % 5 % 2 3 % C o l o r e c t a l c a n c e r A d v a d e n o m a s N o n - a d v a d e n o m a s S e r r a t e d p o l y p s N o f i n d i n g s N a t i o n a l M o n i t o r i n g & E v a l u a t i o n C o l o r e c t a l C a n c e r S c r e e n i n g P r o g r a m m e * O p b r e n g s t v a n c o l o s c o p i e k o m t o v e r e e n m e t d e P P V v a n i F O B T E r a s m u s M C – N K I / A v L

Positivity and detection rates Pilot studies National program National program 88 ng/ml 275 ng/ml Test positivity 6.4% 12.0% 7.2% Colonoscopy 85.7% 74.3% Detection rate * CRC 4.5 per 1,000 5.9 per 1,000 5.0 per 1,000 Detection rate * CRC+AA 28.3 per 1,000 36.2 per 1,000 25.4 per 1,000 PPV CRC 8.2% 6.7% 9.5% PPV CRC+AA 51.6% 40.2% 48.1% False-positive FIT † 48.4% 59.8% 51.9% NNScope CRC 12.2 14.9 10.5 NNScope CRC+AA 1.8 2.5 2.1 PPV = Positive predictive value of a positive FIT * Detection rate per 1,000 screened individuals † False-positive FIT = percentage of positive FIT for which no advanced neoplasia are found during follow-up colonoscopy National Monitoring & Evaluation Colorectal Cancer Screening Programme Erasmus MC – NKI / AvL

F u r t h e r i n f o rm a t i o n h t t p : / / w w w . r i vm . n l / e n / T o p i c s / B / B o w e l _ c a n c e r _ s c r e e n i n g _ p r o g r amm e m a r i e- l o u i s e . h e i j n e n@ r i vm . n l i . v o g e l a a r@ e r a sm u sm c . n l