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 45 yr 50 yr screening High‐sensitivity stool‐based test OR a Different methods can be Choice of test structural exam used • • FIT annually FIT annually • • HSgFOBT annually HSgFOBT annually • • mt‐sDNA every 3y mt‐sDNA every 1y or 3y • • Colonoscopy every 10y Colonoscopy every 10y Acceptable • • CTC every 5y CTC every 5y test options • • FS every 5y FS every 5y • FS every 10y + FIT every yr • • Continue to 75 yr as long as good 76‐85 yr: Individual Age to stop health and life expectancy 10+ yr decision making • • screening 76‐85 yr: Individual decision making >85 yr: discouraged • >85 yr: discouraged from screening 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 45 yr 50 yr screening High‐sensitivity stool‐based test OR a Different methods can be Choice of test structural exam used • • FIT annually FIT annually • • HSgFOBT annually HSgFOBT annually • • mt‐sDNA every 3y mt‐sDNA every 1y or 3y • • Colonoscopy every 10y Colonoscopy every 10y Acceptable • • CTC every 5y CTC every 5y test options • • FS every 5y FS every 5y • FS every 10y + FIT every yr • • Continue to 75 yr as long as good 76‐85 yr: Individual Age to stop health and life expectancy 10+ yr decision making • • screening 76‐85 yr: Individual decision making >85 yr: discouraged • >85 yr: discouraged from screening 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% African‐Americans 838 9.3% 2629 7.9% <0.001 Asian & Pacific 415 4.6% 1245 3.7% Islanders 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% Stage II 1756 26.6% 7296 29.7% <0.001 i Stage III 2663 40.3% 7656 31.2% Tumor Differentiation Well 657 8.3% 2583 8.7% differentiated Moderately 6178 77.7% 23391 79.0% differentiated <0.001 j Poorly 1034 13.0% 3362 11.3% differentiated Undifferentiated, 83 1.0% 290 1.0% anaplastic Histology Adenocarcinoma 8521 93.4% 32130 94.6% Mucinous < 0.001 k 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

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