The Impact of Colorectal Cancer Nationally and in Tennessee Cathy - - PowerPoint PPT Presentation

The Impact of Colorectal Cancer Nationally and in Tennessee

Cathy Eng, MD, FACP, FASCO David H. Johnson Chair in Surgical and Medical Oncology Professor of Medicine, Hematology and Oncology Co-Director, GI Oncology Co-Leader, Gastrointestinal Cancer Research Program

February 27, 2020 Contact Info: cathy.eng@vumc.org Twitter: @cathyengmd

Incidence of Colorectal Cancer: 2019

https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf

2020 New CRC cases: 147,950 Rectal cancer: 43,340

Sporadic = men and women ≥50 years with average risk; IBD = inflammatory bowel disease; FAP = familial adenomatous polyposis; HNPCC = hereditary nonpolyposis CRC; FH = positive family history.

Adapted from Winawer SJ et al. J Natl Cancer Inst. 1991;83:243-253.

Sporadic average risk ~75%

FH 15%–20% HNPCC 5% IBD 1% FAP 1%

Colorectal Risk Groups

https://seer.cancer.gov/statfacts/html/colorect.html

https://seer.cancer.gov/statfacts/html/colorect.html

Incidence by Age

https://seer.cancer.gov/statfacts/html/colorect.html

Incidence by Age

https://seer.cancer.gov/statfacts/html/colorect.html

Increasing Disparities in Age-Related Incidence of Colon and Rectal Cancer in the United States, 1975-2010

Colon Cancer Rectal; Rectosigmoid Cancer

Bailey et al. JAMA Surg. 2015.

SEER: 1975-2010

International Trends in Colon (Fig A) and Rectal Cancer (Fig B): 1988-2007

Liu et al. Cancer Epidemiol Biomarkers Prev. 2019;28(8):1273-1273.

Age-standardized incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years

Siegal et al: Gut, 2019

Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data

Siegal et al: Gut, 2019

Common Cancers in Tennessee 2011-2015

https://www.tn.gov/content/dam/tn/health/program-areas/reports_and_publications/2019_Cancer_Report.pdf

Facts about Colorectal Cancer in Tennessee

• According to the 2014 Behavioral Risk Factor Survey System

(BRFSS), only 68.7% of age appropriate Tennesseans (> 50 y/o) had a colorectal endoscopy in their lifetime

– 14.1% indicated they had a blood stool test within the past two years

• From 2011- 2015, Tennesseans had a 5.3% chance (1 out of

every 19 individuals probability of developing colorectal cancer) and a 2.1% probability of dying from colorectal cancer in their lifetime.

• Tennesseans who died of colorectal cancer died on average 7.5

years earlier than expected.

Colorectal Cancer Screening in Tenn

https://www.cdc.gov/cancer/ncccp/screening-rates/pdf/colorectal-cancer-screening-tennessee-508.pdf

Stage of Colorectal Cancer Presentation in Tenn (2011-2015)

Age-Adjusted CRC Cancer Incidence and Mortality Rates in Tenn 2011-2015

https://www.tn.gov/content/dam/tn/health/program-areas/reports_and_publications/2019_Cancer_Report.pdf

Conclusions

• Colon cancer is largely a preventable cancer
• Invasive procedures:

– A colonoscopy remains the “gold” standard – A flexible sigmoidoscopy will miss transverse colon/right sided tumors

• Right sided tumors have worse OS for stage IV patients.

– Virtual colonoscopy has limitations

• Non-invasive procedures:

– FOBT

• False positives
• Not specific for site of blood

– FIT/DNA (Cologuard)

• Specific for lower GI tract
• Any screening is better than no screening!
• March is Colorectal Cancer Awareness Month – Remember a

colonoscopy can save a life!