February 25 2021 Welcome Award Announcement Speakers Jacob Quail MD Joy Christensen local cancer survivor Introduction Early Detection Health Equity Task Force Draft Early Onset Colorectal Cancer Clinical Briefing ID: 911270
Download Presentation The PPT/PDF document "COLORECTAL CANCER Screening 2021 webinar" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
COLORECTAL CANCER Screening 2021 webinarFebruary 25, 2021
WelcomeAward AnnouncementSpeakers - Jacob Quail, MD - Joy Christensen, local cancer survivor
Slide2Introduction Early Detection Health Equity Task Force
Draft Early Onset Colorectal Cancer Clinical Briefing Lung Cancer Screening Assessment Back on Track Cancer Screenings Join us! Contact Chair: Jill.Ireland@cancer.org 2021 SD Colorectal Cancer Screening Achievement Awards Organization of the YearChampion of the Year
Slide32021 South Dakota Colorectal Cancer Achievement Awards
Organization of the Year: Great Plains Colorectal Cancer Screening Initiative Team members:Deanna SwanGina JohnsonEugene GiagoRichard MousseauRachel EnghStella ZimmermanTinka Duran
Slide42021 South Dakota Colorectal Cancer Achievement Awards
Champion of the Year: Dr. Jacob Quail
Slide5COLORECTAL CANCER SCREENINGFor Healthcare professionals
Jacob Quail, MD, FACSGeneral SurgeonSanford Health Vermillion25 February 2021
Slide6ObjectivesReview current colorectal cancer screening (CRC) guidelines
Expectations for future disease and trendsPromoting CRC screening during COVID-19Prioritizing patients for CRC screeningReview USPSTF Guidelines under consideration
Source: ASCRS
Slide7Colorectal cancer screeningWhy is this important for us and our communities?Colorectal cancer is the second-leading cause of death from cancer in the United StatesEstimated 149,500 adults expected to be diagnosed in 2021
Screening for CRC reduces the incidence of and death from the disease Only 68.8% of age-eligible adults report being up-to-dateScreening can detect disease early and also prevent cancer by removing precancerous polypsAmerican Cancer Society Cancer Facts and Figures 2020. 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
Slide8Colon Polyp progression
Source: BJM
Slide9Colorectal cancer in South DakotaEstimates for 2021:Cases450 new cases of colorectal cancer to be diagnosed in South Dakota
149,500 new cases of colorectal cancer to be diagnosed in the USApproximately 13x the population of Vermillion, SDDeaths170 deaths due to colorectal cancer to occur in South Dakota52,980 deaths due to CRC to occur in the USAmerican Cancer Society Cancer Facts and Figures 2020. 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
Slide10CRC Screening guidelinesLast USPSTF Update in 2016Current USPSTF recommendations:
Screen for colorectal cancer starting at age 50 years oldFor adults aged 76 to 85 years old, screening is individualizedVaries depending upon patient’s life expectancy, comorbid conditions and prior screening status Greatest benefit for those that have never been screened before USPSTF screening update is currently pending
Slide11CRC Screening TestsAdvantage for CRC screening -> Many different options
Stool-based tests Guaiac-based fecal occult blood test (gFOBT) every yearFecal immunochemical test (FIT) every yearMulti-targeted stool DNA test every 3 yearsCologuard/FIT-DNADirect visualization testsColonoscopy every 10 yearsFlexible sigmoidoscopy every 5 yearsCT colonography every 5 yearsPositive stool-based test should be followed by a diagnostic colonoscopyBest screening test is the one that gets done!
Slide12CRC Screening TestsStool-based testsAdvantages for Multi-targeted stool DNA tests
Avoids loss of time away from work or family dutiesAllows for patients without access to endoscopy services to undergo CRC screeningUnderserved or rural communities Allows patients that are nervous to engage with a healthcare facility to undergo CRC screeningCOVID pandemicBest screening test is the one that gets done!
Slide13increased risk for crcFactors associated with an increased risk:Older age, male sex and black race
Nearly 94% of new CRC cases occur in adults 45 years and older1Median age of diagnosis is 68 years2A personal history or family history of CRC or certain colon polyps (size > 1 cm)Screening can begin at age 40 years (or 10 years before the age at diagnosis of a family member, whichever is earlier) in persons with a family history of CRCCertain genetic syndromes have increased risk of developing CRCA personal history of inflammatory bowel disease (IBD)
1US Preventive Services Task Force. Colorectal Cancer: Screening Draft Recommendation Statement. October 27
th
, 2020.
2
US Preventive Services Task Force.
Screening for Colorectal Cancer
. JAMA. June 21
st
, 2016. Volume 315, Number 23.
Slide14Early-age onset colorectal cancerRate of CRC in young adults under the age of 55 has been increasingAdults born in the 1990s have double
the lifetime risk of colon cancer and quadruple the risk of rectal cancer, compared to adults born in the 1950sApproximately 20% of all CRCs diagnosed in the US are among those under the age of 55Patients diagnosed with CRC prior to age 55 are 58% more likely to be diagnosed with more advanced diseaseThis is due to a delay in diagnostic evaluation of symptoms and less access to medical care.Siegel, R et al. Colorectal Cancer Incidence Patterns in the United States, 1974-2013 JNCI J Natl Cancer Inst (2017) 109(8); djw322.
Slide15Red Flag signs and symptoms Early recognition of red flag symptoms may save lives…
Rectal bleeding (Let’s talk about hemorrhoids)Change in bowel habits (i.e. constipation/diarrhea, change in stool caliber)Rectal or abdominal mass (Never forget the 24 year-old Marine)Lab abnormalitiesIron-deficiency anemia (Low MCV), Elevated platelets and inflammatory markers, Abnormal liver function testsAbdominal painMust review the Family HistoryThese patients should be evaluated with a diagnostic colonoscopy
Slide16Crc screening during covid19Expectations for Future DiseaseEstimated 90% drop in colonoscopies and biopsies in March through mid-April 2020 compared to same period in 2019
1.7 million missed colonoscopies from March to June 5th, 202018,000 missed or delayed diagnoses of CRC from mid-March through early June, 2020> 4,500 excess deaths from CRC over next decadeCancer Screening During the COVID-19 Pandemic, American Cancer Society, October 2020
Slide17Crc screening during covid19Expectations for Future DiseaseDelays in CRC screening during COVID pandemic will result in a 12% increase in cancer deaths over the next five years
“Need to have an unbroken prevention path for high-impact diseases”No more need to delay putting off a colonoscopyGeneral Surgery News, December 2020
Slide18Crc screening during covid19A United MessageCancer screening must remain a public health priority
Must be able to identify patients who should receive higher priority for CRC screeningScreening disparities are likely to increase as a result of the COVID-19 pandemicBarriers to screening must be identified and strategies developed to overcomeLocal data must be reviewed to identify screening disparitiesEngaging patients to resume cancer screening requires effective and trustworthy messaging Saying “We are open” is not enough, must be proactive in educating publicImplement of process and policy changes to sustain access to primary care and return screening to pre-COVID ratesAddressing missed screenings, prioritizing patients and expanding screening capacity
Cancer Screening During the COVID-19 Pandemic, American Cancer Society, October 2020
Slide19Prioritizing patients for colonoscopy evaluationA Public Health Priority
Who should be prioritized for those who have missed or had their colonoscopy delayed due to COVID?Those with abnormal stool-based cancer screensPatients with a family history of adenomas or cancerPatients with inflammatory bowel diseasePatients with a genetic syndrome associated with an increased risk of CRCIf screening colonoscopy services are limited, stool-based studies provide excellent opportunity to screen the average-risk group for CRC
Slide20Barriers and challenges to screeningLives are busy, some don’t follow through after initial PCP visitWorking to streamline colonoscopy process
Some say that they don’t have any GI symptoms so don’t need a screening colonoscopyScreening not based upon symptomsSome have heard about others’ colonoscopy experienceColonoscopy not only CRC screening optionSmall community – “I know people that work at the hospital!”
Slide21Review USPSTF Guidelines under considerationDraft recommendation statement stage
CRC incidence in 45 year-old adults now approaches that of patients age 50 years1About 1 in every 10 new cases of CRC occur patients under the age of 502USPSTF “concludes with moderate certainty that the net benefit of screening for colorectal cancer in adults ages 45 to 49 years is moderate.”Asymptomatic adultsScreening continues to be individualized in older adults ages 76 to 85 years1
US Preventive Services Task Force. Colorectal Cancer: Screening Draft Recommendation Statement. October 27th, 2020.2CDC National Program of Cancer Registries
Slide22#back on trackConclusionsUSPSTF CRC screening guidelines are changingFocusing on prevention of early-age CRC and
Red Flag symptomsWe need a United Message going forward given the delays and missed screening opportunities due to COVIDPrioritizing patientsScreening disparities likely will be magnifiedConsistent messaging Implementation of screening policies and processes
Slide23A Patient’s Perspective
Joy ChristensenSioux Falls, SD
Slide24Thank you!
Questions?