Screening for Colorectal CRC Epidemiology and Cancer ... · CRC Epidemiology and Screening Programs...
Transcript of Screening for Colorectal CRC Epidemiology and Cancer ... · CRC Epidemiology and Screening Programs...
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CRC Epidemiology and
Screening Programs
Screening for Colorectal
Cancer:
Global Vision Linda Rabeneck MD MPH
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Global Public Health Issue
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Colorectal Cancer Incidence: South
America (both sexes, per 100,000)
GLOBOCAN 2012 (IARC)
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CRC Incidence and Mortality
(males and females, per 100,000)
Arnold M, et al. Gut 2017;66:683–691.
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Opportunistic vs
Organized Screening?
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European Guidelines
IARC, 2010
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Organized Screening Program
•Defined target population
•Invitations to screen
•Timely access
•Quality assurance
•Tracking of outcomes
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Organized Screening Program
•Greater protection against harms
Over-screening
Poor quality
Poor follow-up
Complications
Miles A et al. Cancer 2004;101(Suppl 5):1201-13.
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Screening is a Process
Identify Invite/
remind
Assess
risk Screen
Notify of
results
Recall/
remind
Follow up
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How Long Does it Take?
•>10 yrs to plan, pilot and implement
CRC screening program
•Additional yrs before full impact of
the program can be measured
V Karsa L et al. Best Practice & Research Clin Gastro 2010;24:381-96.
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Toronto
Pearson
Airport
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When to Start Screening?
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•CRC incidence
>30/100,000
•Resource level
Rabeneck L et al. DCP-3. 2015;Vol 6:101-19.
Proposed Strategies
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Health Policy
•A major determinant
•How is health care is funded,
organized and delivered?
•Publicly funded, universal access,
single payer?
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Moving Forward
•Establish/adopt guidelines
•Consider a pilot
•Selected urban region(s)
•Test the steps in the process
•Colonoscopy quality
•Expand
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WEO CRC Screening Cte
•Regional Meetings (2017)
NA (DDW, Chicago)
Asia-Pacific (APDW, Hong Kong)
Europe (UEGW, Barcelona)
Latin America (SBAD, Brasilia)
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Summary
• Global public health issue
• When to start screening
• Moving forward
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Obrigada
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