hassan c - weo · • hassan c • ‚nuovo regina margherita hospital‘, rome, italy ....
TRANSCRIPT
INTERVAL COLORECTAL CANCERS AFTER NEGATIVE FECAL
IMMUNOCHEMICAL TEST IN A 13-YEAR SCREENING PROGRAM
• Hassan C
• ‚Nuovo Regina Margherita Hospital‘, Rome, Italy
Popolazione ISTAT, popolazione target, invitati e screenati ITALIA 2005 - 2016
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
13873
15856
16194
4421 (32%)
13592
(84%)
811 (12%) 5553
(69%)369 (5%)
2206 (27%)
0
4000
8000
12000
16000
20000
x 1
00
0
screenati invitati popolazione target popolazione ISTAT
The OLDER you are The BETTER it is!
Emilia Romagna. Tassi di incidenza del tumore del colon retto. Età 50-69 anni
Courtesy Alessandra Ravaioli
Tassi standardizzati di mortalità per tumore del colon-retto, per periodo di attivazione
Residenti di 50-74 anni; tassi standardizzati sulla popolazione europea
- 22%
LONG-TERM PERFORMANCE OF COLORECTAL CANCER
SCREENING PROGRAMMES BASED ON THE FAECAL
IMMUNOCHEMICAL TEST
DISTAL
PROXIMAL
DISTAL
PROXIMAL
Interval CRC in FIT program
• After a negative FIT, interval cancer risk:
– Progression of an undetected CRC
– Progression of an undetected advanced adenoma
– De novo CRC
Interval CRC in FIT program
• Uncertainty on log-term risk of IC due to:
– Most available data limited to 1-2 rounds
– Two different systems for measuring IC: • Proportional Interval Cancer Rate (PICR)
– Rate of IC with and without FT screening (historical comparison)
• Interval Cancer Proportion (ICP) – IC/(IC+screen-detected)
Interval CRC in FIT program
Round All I II III IV V VI
Invited (n) 526644 178828 107253 83813 66862 53124 36764
Screened (n) 441647 123347 96129 78770 63069 50441 29891
Participation rate (%) 83.9 69.0 89.6 94.0 94.3 94.9 81.3
Gender (% of males screened) 46.6 47.7 46.7 46.3 45.8 45.6 45.5
Age (mean) 61.1 59.1 60.3 61.4 62.4 63.5 64.5
FIT positivity (%) 4.1 5.7 3.6 3.3 3.3 3.7 3.8
Compliance with colonoscopy (%) 93.3 91.5 94.0 94.7 94.9 94.3 93.8
Colorectal cancers diagnosed (n) 781 412 162 75 61 46 25
Colorectal cancer detection rate (x 1,000
screened) 1.77 3.34 1.69 0.95 0.97 0.91 0.84
Advanced adenomas diagnosed (n) 4713 1958 813 647 540 457 298
Advanced adenoma detection rate (x 1,000
screened) 10.7 15.9 8.5 8.2 8.6 9.1 10.0
Interval cancers after a negative FIT (n) 150 51 33 27 14 17 8
1 EVERY 2,761 FIT SCREENED SUBJECTS
Interval CRC in FIT program
Adjusted rate ratio* 95% confidence interval p value
Round
I**
II
III
IV
V
VI
1.00
0.76
0.71
0.44
0.67
0.89
-
0.49-1.18
0.44-1.14
0.24-0.80
0.38-1.16
0.42-1.91
-
0.22
0.15
0.007
0.15
0.77
Time since last FIT
0-11 months**
12-23 months
1.00
1.78
-
1.28-2.47
-
0.001
Age (years)
50-59**
60-71
1.00
2.37
-
1.61-3.50
-
<0.0001
Anatomical site
Colon, proximal
Colon, distal**
Rectum
3.00
1.00
1.35
1.92-4.68
-
0.81-2.24
<0.0001
-
0.25
Pre-
screening
Post-
screening No
screening Screen
detected (34%)
Non screen
detected
Numero di casi 6.710 2.806 6.759 7.393
Genere
Maschi
59%
62%
60%
58%
Età
65-69
38%
42%
38%
37%
Sede
Distale
38%
51%
36%
30%
Grading
1
2
3
NAS
10%
57%
16%
18%
20%
57%
11%
12%
9%
57%
17%
17%
6%
62%
16%
15%
SCREEN- vs. NON-SCREEN DETECTED
cv cv
FIT sensitivity for CRC
Interval CRC in FIT program
• Long-term risk of interval CRC is reassuringly marginal
• Predictive factors may lead to risk-startification:
– Longer FIT-interval in young subjects
– Proximal IC recommend continuation of FIT programs
• Both methods for FIT programmatic sensitivity for CRC
are biased by underlying CRC incidence prevention
– Absolute risk of IC as best measure