Colorectal Cancer Screening: How Early to Start ? Atif Iqbal, M.D. - - PowerPoint PPT Presentation

Colorectal Cancer Screening: How Early to Start ?

Atif Iqbal, M.D.

Associate Professor Chief, Colorectal Surgery Baylor College of Medicine

Disclosures

None

Colorectal cancer estimates (2018)

• 140,250 new cases expected in US
• 50,630 deaths estimated
• 1.2 million Americans with CRC

Declining CRC Mortality

Siegel et al CEBP 2015

Reason for Declining Mortality

• SCREENING

 Polyp removal  Early cancer detection WHEN TO START SCREENING?

Early 2018  Guidelines said 50 years

ACS (2018) USPSTF (2016) Age to start screening 45 yr 50 yr Choice of test High‐sensitivity stool‐based test OR a structural exam Different methods can be used Acceptable test options

• FIT annually
• HSgFOBT annually
• mt‐sDNA every 3y
• Colonoscopy every 10y
• CTC every 5y
• FS every 5y
• FIT annually
• HSgFOBT annually
• mt‐sDNA every 1y or 3y
• Colonoscopy every 10y
• CTC every 5y
• FS every 5y
• FS every 10y + FIT every

yr Age to stop screening

• Continue to 75 yr as long as good

health and life expectancy 10+ yr

• 76‐85 yr: Individual decision making
• >85 yr: discouraged from screening
• 76‐85 yr: Individual

decision making

• >85 yr: discouraged

from screening

Reasoning for starting screening at 45 y

Rising incidence in younger population

CRC Colon Rectum 1990 6.4% 5.8% 8.0% 2000 7.9% 6.5% 11.6% 2010 10.7% 9.2% 14.3% 2015 12.4% 11.1% 15.4%

ACS (2018) USPSTF (2016) Age to start screening 45 yr 50 yr Choice of test High‐sensitivity stool‐based test OR a structural exam Different methods can be used Acceptable test options

• FIT annually
• HSgFOBT annually
• mt‐sDNA every 3y
• Colonoscopy every 10y
• CTC every 5y
• FS every 5y
• FIT annually
• HSgFOBT annually
• mt‐sDNA every 1y or 3y
• Colonoscopy every 10y
• CTC every 5y
• FS every 5y
• FS every 10y + FIT every

yr Age to stop screening

• Continue to 75 yr as long as good

health and life expectancy 10+ yr

• 76‐85 yr: Individual decision making
• >85 yr: discouraged from screening
• 76‐85 yr: Individual

decision making

• >85 yr: discouraged

from screening

Rectal cancer patients under 50 years of age lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease

Andrew Kolarich; Thomas J. George, Jr; Steven J. Hughes; Daniel Delitto, MD; Carmen J. Allegra; William A. Hall; George J. Chang; Sanda A. Tan; Christiana M. Shaw; Atif Iqbal

Patients < 50 years old Patients 50 ‐ 75 years old

p value

n % of total n % of total Gender Female

3791 41.5% 12269 36.1% <0.001

Race Caucasians

7626 85.5% 29429 87.9% <0.001

African‐Americans

838 9.3% 2629 7.9%

Asian & Pacific Islanders

415 4.6% 1245 3.7%

Spanish Origin Hispanic

677 7.8% 1831 5.7% <0.001

Insurance Status Uninsured

590 6.6% 1469 4.4% <0.001

Patients < 50 years old Patients 50 ‐ 75 years old

p value

n % of total n % of total Stage at Diagnosis Stage I

2194 33.2% 9586 39.1% <0.001i

Stage II

1756 26.6% 7296 29.7%

Stage III

2663 40.3% 7656 31.2%

Tumor Differentiation Well differentiated

657 8.3% 2583 8.7% <0.001j

Moderately differentiated

6178 77.7% 23391 79.0%

Poorly differentiated

1034 13.0% 3362 11.3%

Undifferentiated, anaplastic

83 1.0% 290 1.0%

Histology Adenocarcinoma

8521 93.4% 32130 94.6% < 0.001k

Mucinous

500 5.5% 1677 4.9%

Signet ring cell

105 1.2% 173 0.5%

Rectal cancer patients under 50 years of age lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease

Andrew Kolarich; Thomas J. George, Jr; Steven J. Hughes; Daniel Delitto, MD; Carmen J. Allegra; William

• A. Hall; George J. Chang; Sanda A. Tan; Christiana M. Shaw; Atif Iqbal

Rectal cancer patients under 50 years of age lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease

Thank you