Whats New in Colon Cancer Screening

1
Whats New in Colon Cancer Screening?

• Raj Putcha, M.D.
• Gastroenterologist,
• Texas Digestive Disease Consultants
• North Texas SGNA
• November 15, 2009

2
Why is Colorectal Cancer a Big Deal?

• 3rd most common cause of death (overall)
• Men (AMI, lung CA)
• Women (AMI, breast CA)
• 2nd most common cause of death (cancer related)
• Men
• Women

3
Colon Cancer Statistics

• 150,000 new cases each year
• 110,000 colon
• 40,000 rectum
• 50,000 die each year

4
Colon Cancer Who is At Risk?

• Age
• Environmental
• Alcohol
• Smoking
• Diabetes
• Genetic (family history)
• IBD

5
Increasing Incidence CRC with Age
Age (years)
6
Who should get screened?

• Age gt 50 (male/female)
• African american gt 45
• Family history CRC/adenomatous polyp lt60 1st
  degree relative
• 2 1st degree relatives any age
• Age 40 or 10y rule
• Every 5y if negative
• Family history CRC/adenomatous polyp gt60 1st
  degree relative
• 2 or more 2nd degree relatives
• Age 40
• Every 10y if negative

7
Colon Cancer Screening Lowering the Risk

• Colonoscopy (gt90 risk reduction)
• Other screening methods
• Guaiac FOBT
• iFOBT (aka FIT)
• Stool DNA
• Virtual/CT Colonoscopy
• (Flex Sig)
• (ACBE)

8
Virtual CT (CT colonography)
9
Virtual CT (CT colonography)

• Non invasive
• Perforation risk
• Prep?
• Radiation exposure
• Cancer risk 0.14
• Incidentalomas
• Cost

10
Virtual CT (CT colonography)
11
Virtual CT (CT colonography)

• Sensitivity
• gt10mm polyp (92)
• lt10mm polyp (55-85)
• Surveillance interval? (5y)
• Interpretation ability
• Reimbursement
• () --gt colonoscopy another day!

12
iFOBT (FIT)

• More specific than gFOBT
• Selectively detects human globin (part of Hgb)
• Colonic globin blood loss
• Degradation of globin upper GI bleedingMore
  specific than gFOBT
• Less stool samples (1)

13
Stool DNA

• Colorectal neoplasm shed DNA
• PregGen-Plus
• commercially available DNA stool kit
• Panel of DNA markers
• Not all genetic abnormalities included
• False negatives false positives
• Sn 62-100 Sp 82-100
• Expensive
• 5 y interval for (-)

14
Guaiac FOBT

• Detect Hgb
• peroxidase reaction
• Hemoccult-SENSA most Sn
• Special diet before
• Avoid red meat/hi fiber
• Avoid NSAIDs
• iron ok
• High false ()
• DRE specimen NOT useful

15
Colonoscopy

• Risks
• Sedation (cardiac, pulmonary)
• Conscious
• Anesthesiologist (propofol)
• Bleeding
• Perforation
• Diagnostic 1/6000
• Therapeutic 1/1000
• Infection (HCV, HIV, HBV, bacterial pathogens)
• Cleaning scopes

16
Colonoscopy

• The Prep
• NO more Go-Lytely (4L)
• NO more Fleets Soda
• New PEG 2L
• More palatable
• Less side effects
• ?split dose prep

17
Colonoscopy new horizons

• HD/NBI
• ?results
• Colon PILLCAM
• Recent study NEJM
• Aer-O-Scope
• Self propelling/self navigating

18
Colon Cancer Lowering the Risk (what else)

• High fiber diet
• Low red meat diet
• Regular physical activity
• HRT post menopausal
• Aspirin daily
• Calcium

19
Is Colon Cancer Screening Effective?

• Decreasing incidence rates
• Increasing incidence rate
• right sided (ascending/cecum)
• Bias?
• Improved 5 year survival
• Mortality
• Except right sided

20
Who should be doing screening CRC?

• GI
• CRS
• Family practioners/IM
• General surgeons

21
Are People Getting Screened?

• Couric effect (year 2000)
• 20 increase
• 40 adults gt50
• Insured
• Higher education
• Non hispanic
• Regular medical care

22
Are People Getting Screened?
23
Why Dont People Get Screened for CRC?

• Fear
• you cant handle the truth
• Prep
• Cost
• Time off from work
• Embarrassing
• Complication(s)
• perforation

24
Colon Cancer Staging Prognosis
25
What Can You Do?

• Frontline of medicine
• Get yourself screened
• Get your family screened
• Get your friends screened
• Understand CRC stats screening methods

26
Summary

• CRC is common
• CRC is preventable
• Get screened
• Age gt 50
• Family history gt 40
• Getting screened NOT big deal
• Risks
• Prep