Colorectal cancer screening program in Poland pathologists - - PowerPoint PPT Presentation

Colorectal cancer screening program in Poland – pathologist’s perspective

Andrzej Mróz Department of Gastroenterology, Hepatology and Clinical Oncology Medical Center of Postgraduate Education Warsaw Poland Visegrad 27.05.2017, Hungary

WHO: Screening programs

• 1. Common disease with high mortality
• 2. Possible detection of precursor lesions or

asymptomatic illness

• 3. Early detection improves prognosis
• 4. Socially acceptable
• 5. Cost effective

Wilson JMG, WHO, 1968

Malignant tumors in Poland

Lung cancer Colorectal cancer Breast cancer

Wojciechowska i wsp. Nowotwory złośliwe w Polsce w 2010 roku, KRN

Dynamics of colorectal cancer incidence

Colorectal cancer Lung cancer Males Females

Incidence Incidence

y 90’ 95’ 00’ 05’ y 90’ 95’ 00’ 05’

Cancer develops from polyps (adenomas)

> > >

adenoma

> > > > >

CA >>

Duration: 7 - 12 YEARS

5 year survivals ratios in CRC

diagnosis 2000

Europe: 53,5% Poland: 43,7%

Berrino F, et al. Lancet Oncol 2007 Krajowy Rejestr Nowotowrów, COI

CRC screening program in Poland

Method:

screening colonoscopy

• pportunistic program till 2011

+ invitations based since 2012

Start:

2000

Priorities:

quality control trainings of doctors/centers

• ptimalization

Why colonoscopy in Poland?

• The only one step strategy
• Simple organization: once every 10 years
• Not expensive: ca.120 euro

per/procedure (5 rounds of FOBT)

• FOBT acceptance (80-ties) - 16%

Efficacy of population screening programs in RCT

FOBT

• CRC mortality reduction: 0,86 (95%CI 0,80-0,92)

Sigmoidoscopy

• CRC mortality reduction: 0,72 (95%CI 0,65-0,79)
• CRC mortality reduction: 0,77 (95%CI 0,70-0,84)

Colonoscopy

• Probably ≥ Sigmoidoscopy

Holme O, et al. Cochrane Database Syst Rev, 2013

Expected results in 2026 !

Kaminski MF, et al. Endoscopy, 2012

Opportunistic program, 2000-11

320 000 screening colonoscopies

92 centers in 2011

Invitations based screening program

High Quality Histopathology

Unification of reports Pathologic report in categorization Linked to central database (as a

incoherent part)

Trainings Adenoma detection rate – checked by

pathologists as endoscopist and screening quality indicator

Histopathological report

Histological type Architecture Grade of dysplasia Completeness of resection

Adenoma

Reporting challenges

Grade of dysplasia – some of pathologists

are used to three tier classification

No proforma required Completeness of excision reporting –

restrictive way, limited contact with the clinician

Completeness of excision

HGD in adenomas EGuide

7.21- Pathologists reporting in a

colonoscopy screening programme should not report high-grade neoplasia in more than 5% of lesions and those in an FOBT programme in not more than 10% of lesions

HGD – up to 5%

Reporting of polyps –

by center

Reporting of polyps –

by pathologist

Reporting of polyps –

by pathologist

Reporting of polyps –

by pathologist

Serrated polyps 2000-2004

Morphological analysis

and predilection factors of colonic serrated polyps in participants of colon cancer screening programme in years 2000-2004.

Serrated polyps 2000-2004 2970 SP

1819 MVHP 816 GCHP 249MPHP 58 SSP 28 TSA

MVHP GCHP MPHP SSP TSA All

Rectum

58,25% 31,38% 9,62% 0,30% 0,44% 1351

Sigmoid colon

62,74% 28,15% 7,27% 1,13% 0,72% 977

Descending colon

62,32% 26,81% 5,80% 2,17% 2,90% 138

Transverse colon

66,83% 17,07% 7,32% 6,83% 1,95% 205

Ascending colon

66,99% 15,53% 7,28% 8,25% 1,94% 206

Cecum

62,37% 13,98% 10,75% 9,68% 3,23% 93

All

1819 (61,25%) 816 (27,24%) 249 (8,38%) 58 (1,95%) 28 (0,94%) 2970 (100%)

MVHP GCHP MPHP SSP TSA All Rectum

43,27% 51,96% 52,21% 6,90% 21,43% 45,49%

Sigmoid colon

33,70% 33,70% 28,51% 18,97% 25,00% 32,90%

Descending colon

4,73% 4,53% 3,21% 5,17% 14,29% 4,65%

Transverse colon

7,53% 4,29% 6,02% 24,14% 14,29% 6,90%

Ascending colon

7,59% 3,92% 6,02% 29,31% 14,29% 6,94%

Cecum

3,19% 1,59% 4,02% 15,52% 10,71% 3,13%

All

1819 (100%) 816 (100%) 249 (100%) 58 (100%) 28 (100%) 2970 (100%)

Serrated polyps 2009-2012

Serrated polyps 2009-2012

Serrated polyps

Incidence is

variable (2,2-4,8%)

Criteria applied Not restricted to

right bowel

Trainings for pathologists

Initial training – at the entrance point Ad hoc trainings – upon results of analysis

(HGD, villous component, completeness of excision )

Serrated polyps – unconventional!!! -

international cooperation?

Why is it crucial?

Cumulated risk of interval cancer according to ADR

Most advanced lesion and categorization; incorportation of

histopathological diagnosis in central database

Most advanced lesion and categorization; incorportation of

histopathological diagnosis in central database

Summary

High quality pathology is a must Shortage of pathologists Regular trainings Cooperation Most advanced lesion and centralized

histology