Transcript Original Lay Presentation This project actually came to me second

Colorectal Cancer
#2
Cancer
Killer
SCREENING SAVES LIVES
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The Bad News: Frequency
Average risk - 1 out of 18 chance per lifetime
High risk – 1 out of 5 chance per lifetime
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The Bad News: Deadly
1. Lung Cancer
2. Colorectal Cancer
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The Bad News: Expensive
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Risk for colorectal cancer
Average Risk
1 in 18 chance
High Risk
1 in 5 chance
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Assessing your individual risk
You have more than average risk if you have any of
the following risk factors:
•
•
•
•
Personal history of colorectal cancer or polyps
Personal history of inflammatory bowel disease
Family history of colorectal cancer or polyps
Certain inherited cancer syndromes
Even without symptoms, people with these risk
factors need earlier and more frequent screening
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Assessing your individual risk
Also, you have more than average risk if you
have one or more of the following
symptoms:
–
–
–
–
Rectal bleeding
Iron deficiency anemia
Change in bowel habits; constipation or diarrhea
Persistent abdominal pain
If you have these symptoms, you should
seek evaluation immediately.
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AVERAGE RISK
IF YOU DON’T HAVE THESE RISK
FACTORS OR SYMPTOMS YOU ARE
CONSIDERED TO HAVE AVERAGE
RISK FOR DEVELOPING
COLORECTAL CANCER
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IMPORTANCE OF AGE 50
Colorectal Cancer Occurrence for Average
Risk Individuals
7%
Before Age 50
After Age 50
93%
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LISTEN UP AVERAGE RISK
IOWANS
High-Risk Cases:
25%
75Average-Risk Cases:
75%%
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American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer Society;
2002:20–27.
Good News
A series of changes in the cells lining the colon takes
10 years to progress from normal to colon cancer.
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10
years
Normal
Polyp
There is time to intervene
Cancer
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More Good News
Alive 5 years later
Alive at diagnosis
1 year
2 year
3 year
4 year
5 year
• The most preventable form of digestive
tract cancer if screening is performed
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And More Good News:
FOBT
Colonoscopy
Flex Sig
Double
Contrast
Barium
Enema
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So What’s the Problem?
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Late Detection
Five year survival rates
100
95%
80%
100
75
75
50
50
25
25
0
Stage I
Stage II
(Dukes’ A) (Dukes’ B)
Only 37% of patients
are diagnosed early
55%
10%
0 Stage III Stage IV
(Dukes’ C) (Dukes’ D)
63% of patients
are diagnosed late
American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American15
Cancer Society; 2002.
Why aren’t Iowans screened?
• The most common reasons • A screening test was never recommended
• Misunderstanding, fear and
embarrassment
• Cost
• Assuming that absence of risk factors or
symptoms means that there is no cancer
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How do you screen
for colorectal cancer?
Beginning at age 50:
 Fecal occult blood test (FOBT) every year or
 Flexible sigmoidoscopy (FS) every 5 years,
or
 FOBT annually + FS every 5 years or
 Colonoscopy every 10 yrs or
 Double -contrast barium enema every 5 yrs.
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Fecal Occult Blood Test (FOBT)
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Flexible Sigmoidoscopy
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Location of polyps/cancer
Right side
Left side
10%
30%
15%
25%
20%
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FOBT AND FS
• FOBT detects larger, bleeding polyps, but is
less accurate for smaller, non-bleeding polyps
• Flexible sigmoidoscopy detects left-sided
lesions, but misses 30-40% of all polyps and
cancers that are right-sided
• The combination of both tests largely corrects
the limitations of performing either test alone.
FS + FOBT=75%
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Colonoscopy
examines
entire colon
removes
polyps
biopsies
cancer
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Double Contrast Barium Enema
(DCBE)
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Other New Screening Tests
• Virtual colonoscopy
• Stool DNA test
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Virtual Colonoscopy
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Stool DNA Test
Physician
Sends
Requisition
to Lab
Patient Collects
Stool at Home
Lab Provides
Collection and
Shipping Materials
to Patient
Stool DNA Analysis
Is Performed in Lab
Physician
Patient Returns
Specimen to Lab
Physician
Communicates
Results to Patient
DNA Alteration
Identified:
Perform colonoscopy
No DNA Alteration
Identified
Continue screening
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What Should You Consider in
Choosing a Screening Test
•
•
•
•
What does my doctor recommend?
Which test is most accurate?
Which test is most convenient?
Which causes the least discomfort, fear
embarrassment?
• Cost-insurance, Medicare coverage?
• What do other people say about it?
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Test cost
Screening Test
FOBT
FS
DCBE
Colonoscopy
Estimated Charge
$10-30
$150-300
$250-500
$600-1500
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Medicare Coverage for
Average Risk patients
 Blood stool test (FOBT) annually
 Sigmoidoscopy every 4 years
 Colonoscopy every 10 years
 Double contrast barium enema as an
alternative to either sigmoidoscopy or
colonoscopy every 5 yrs
(since July 1, 2001)
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The Cost of NOT screening
– Individual early disability and death
– Emotional costs for patients and
family
– Treatment cost of colon cancer care
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So What?
• An average risk adult has a 1 in 18
chance of developing this cancer.
• A high risk adult has a 1 in 5 chance of
developing this cancer.
Can you afford to take this chance?
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You Can Reduce Deaths Due
to Colon Cancer
Screening!
Screening!
Any method of screening
is preferable to not
screening!
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Have You and Your Loved Ones
Been Screened?
#2
Cancer
Killer
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This presentation was developed by the
Iowa Colorectal Cancer Task Force
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Acknowledgements
• American Cancer Society
• Centers for Disease Control and
Prevention
• Exact Sciences
• Dr. John Bond, Univ. of Minnesota
• Dr. Douglas Rex, Univ. of Indiana
• Dr. Robert Summers, Univ. of Iowa
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Colorectal Cancer Web Links
www.cancer.org
www.ccalliance.org
www.preventcancer.org/colorectal
www.hopkinskimmelcancercenter.org
www.colorectal-cancer.net
www.cdc.gov/cancer/screenforlife/index.htm
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