1、Colorectal ScreeningNZ Bowel Screening PilotWHO Screening criteriaImpt Health conditionIdentifiable Latent or early stageUnderstand natural hx of diseaseSuitable effective test for screening existsTest should be safe and acceptable to screened populationAccepted Rx (early Rx leads to better outcomes

2、)Agreed policy as to whom to treatFacilities for Dx and Rx should be availableCost of case finding should be viableCase finding should be a continual process not once and for all.Wilson JMG, Jungner G Principles and Practice of Screening for Disease. Geneva: WHO public papers No. 34 1968Colorectal C

3、ancerGood understanding of disease process and of early stagesPolyp to carcinoma sequenceLong Lag time from early to late stagesStage 1 approx 94% 5 year survivalStage 4 approx 8% 5 year survivalWell established treatment protocolsThe problem in New Zealand2966 new registrations for c/r cancer 20101

4、501 male, 1465 female44.8/100000 age standardised 49.3/100000 male, 40.9/100000 femaleNZ Colorectal Cancer Registrations per age and sex 2010 Late presentationColorectal screeninggFOBTiFOBTFlexible sigmoidoscopyCT colonographyColonoscopy(Faecal biomarkers)gFOBTGuaiac FOBTGum of Guaiacum Officinale (

5、tree)Oxidation rxn with hydrogen peroxide leads to colour changescatalysed by HaemNot human specificHemocult IIgFOBTReduction in C/R cancer mortality by about 15% (11 to 18%)Low sensitivity for cancer if used once (around 13 to 38%)lImproved by multiple samples and biennial screening (50%)Low uptake

6、 around 40 to 50%lMultiple sampleslDietary restrictionsImmuno-FOBT (iFOBT)Antibody to GlobinHuman specificNo dietary restrictionsGlobin is broken down in small bowel Can measure absolute levels therefore can preset the threshold for +ve testCan automate the testingFlexible SigmoidoscopyAt least as s

7、ensitive as iFOBT for ca and more so for advanced adenomaApprox 70% cancers are stage 1 or 2 Doesnt look at the right colon (approx 30-40% all malignancies)Low participation in true pop based trials (around 30%)Needs very large endoscopic capacityOther technologyColonoscopyCT colonographyCapsule end

8、oscopyMolecular tests (stool)DNA methylationGenetic markersRNABloodNZ Bowel Screening PilotPilot using iFOB (OC-sensor, Eiken)Competitive RFP won by WDHB with support of ADHB and CMDHBWDHB residents50 74 years of age135,000 eligible populationCommence October 17th 2011Two 2-year screening cyclesNZ B

9、owel Screening PilotPoints of differenceRegisterInvitation basedPriority populationsMenCoordination CentreInvitationPrimary care endorsementBatchingOpting offNZ bowel Screening PilotColonoscopyWaitakere HospitalDedicated and ring-fenced roomHistology LabPlus AReferral (surgery/oncology) 5 year recal

10、l/surveillanceProject StructureSteering GroupProject Management GroupWorking Groups (Primary Care, Colonoscopy, IT, Quality, Awareness Raising)Workshops Equity, MenMinistry of HealthNZ bowel Screening PilotInvitation sent out on birthdayTest kit 4 weeks laterResults to GP/BSP (positive) within 3 day

11、sReferrals for colonoscopy within 10 daysColonoscopy within 50 daysResults (histology) to BSP within 10 daysFSA if cancer within 10 daysMDM within 20 daysThe assumption gamePrediction of colonoscopy requirement is an imprecise science66,000 per year to be screened in wdhbAssume 60% uptakeAssume that

12、 at 75ng/ml we have 6% positivity rateAssume 100% uptake colo2376 colos per year950 will have pathology (40% of all scopes)Colorectal Cancer at WDHB270 new cases in public in 2009/2010Inceasing by approx 2 to 3% per annum2006 undertook large colorectal service projectPatient journey was looked at in detail and time lines measuredLeading laparoscopic ce