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Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
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Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
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Colon cancer screening
Colon cancer screening
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Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
Colon cancer screening
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Colon cancer screening

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20-min. presentation at "GDA" (Geneeskundige Dagen van Antwerpen) 11 september 2011 for GP's

20-min. presentation at "GDA" (Geneeskundige Dagen van Antwerpen) 11 september 2011 for GP's

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  • 1. Maar het mag ook niet te lang duren…. Luc Colemont
  • 2. 30  June  2002   (3365  dagen  geleden)  
  • 3. Aantal  doden  door  darmkanker     in  Vlaanderen   0  0  0  0  0  0  
  • 4. European Code against Cancer and EU council recommendation (December 2003)“Men and women from 50 years of age should participate in colorectal screening. This should be within programmes with built-in quality assurance procedures”“Faecal occult blood testing is actually the only recommended screening strategy”
  • 5. 12 augustus 2004
  • 6. Gazet van Antwerpen 16 november 2005
  • 7. “Werkgroep darmkanker” 2006- Installatie op 2 februari 2006 •  Minister Inge Vervotte later Minister Steven Vanackere, Minister Veerle Heeren en nu Minister Jo Vandeurzen- Samenstelling •  Eric Van Cutsem (voorzitter) (digestieve oncologie) •  Johan Pauwels, Dirk Dewolf, Pieter Vandenbulcke, Jessy Hoste & Karen Colaert (Vlaamse Gemeenschap) •  Frans Goovaerts & Jos Desmedt (huisartsen) •  Joost Weyler (epidemioloog) •  Michiel Callens, Patrick Galloo, Raf Mertens (IMA) •  Liesbeth Van Eycken (Kankerregister) •  Erwin Declerck (VLK) •  Luc Colemont, Marc Peeters & Sabine Tejpar (maag- en darmziekten) •  Gerrie Kiebooms (psychologe, ethicus) •  ad hoc Dr. Bielen (radioloog)
  • 8. 262  pag.  Federaal  Kenniscentrum   20  december  2006  
  • 9. Het behoort tot de taken van de huisarts om zijnpatiënten vanaf 50 jaar – en vanaf 40 jaar indien errisicofactoren zijn – screening op colorectale kankeraan te bieden.Wij bevelen huisartsen aan om de Hemoccult II alsscreeningstest aan te bieden (gFOB) September 2008 “Huisarts Nu”
  • 10. European  guidelines  for  quality  assurance  in  colorectal  cancer  screening  and  diagnosis    -­‐    first  edi*on   3  Februari  2011  
  • 11. Richtlijnen Praktijk
  • 12. Just  do  it  !  
  • 13. 370.000  N° 2 qua aantal overlijdens    
  • 14.    USA  
  • 15. LONG                    6487  DARM          2930  BORST            2329   Belgian  Cancer  Registry  2011  
  • 16. LONG                    6487  DARM          2930  BORST            2329  VERKEER                        847 Belgian  Cancer  Registry  2011  
  • 17. Risico    =  5  %  
  • 18. Risico    =  5  %  
  • 19. Marx 1991
  • 20. Trasformazione Adenoma- CarcinomaQuale è il tempo di passaggio (“dwelling time”) ?-  Knight (1989) minimo 5 anni – in media 10-15 anni-  Eddy (1990) 7 anni da 1 cm a CRC-  Atkin (1993) 10 – 35 anni-  Wagner (1995) 5 – 10 anni-  Winawer (1997) 10 anni da < 1 cm a CRC
  • 21. “Adenoma – Carcinoma” evolutie poliep kanker2011 2021 verwijderen poliep
  • 22. DARMKANKER Coloncarcinoom“Erfelijke of familiale belasting” 20 % 80 % “Sporadisch”
  • 23. 25  kanker  100  >  1cm   1000   poliepen  
  • 24. Screening StrategiesOne-Stage Screening Two-Stage Screening Colonoscopy FOBT Flex Sig. Virtual Colonoscopy Stool DNA Mutations Colonoscopy 41
  • 25. Screening StrategiesOne-Stage Screening Two-Stage Screening Colonoscopy FOBT Flex Sig. Virtual Colonoscopy Stool DNA Mutations Colonoscopy 42
  • 26. Conclusions.    Annual  fecal  occult-­‐blood  tesOng    decreased  the  13  year  cumulaOve  mortality  from  colorectal  cancer  by  33  percent.    (N  Engl  J  Med  1993;328:1365-­‐71)   The  “Minnesota”  study  (Mandell)  
  • 27. Annual FOBT Saves Lives! } 33% reductionMandel JS et al. N Engl J Med 1993 328:1365-71.
  • 28. The  “FUNEN”  study  (Kronberg)   the  “NOTTINGHAM”  study  (Hardcastle)   The  Lancet  30  november  1996  
  • 29. Slechts 25 % van de patiëntenmet een distale rectumtumorhad voordien een rectaal touchégehad…
  • 30. Slechts 25 % van de patiëntenmet een distale rectumtumorhad voordien een rectaal touchégehad…
  • 31. “Pilootproject” Universiteit Antwerpen – ZNA19 november 2008 (begin 2009 – eind 2010)Borgerhout – Schilde – Vosselaar20.000 personen50-74 jaar i-FOB via huisarts / post
  • 32. ** *Flemish French - Germancommunity community Pilot study 2009 Population study 2009
  • 33. ** *Flemish French - Germancommunity community Pilot study 2009 Population study 2009 20.000 535.740
  • 34. ** *Flemish French - Germancommunity community Pilot study 2009 Population study 2009 20.000 535.740 i-FOB-test g-FOB-test
  • 35. ** *Flemish French - Germancommunity community Pilot study 2009 Population study 2009 20.000 535.740 i-FOB-test g-FOB-test 44 % participation rate 8 % participation rate
  • 36. Deelname JA per gemeente/districtGemeente/ Deelname noemer %district JABorgerhout 3207 9732 33,0Vosselaar 1804 3150 57,3Schilde 3228 6660 48,5TOTAAL 8239 19.542 42,2 Prof. Dr. Guido Van Hal (UA)
  • 37. Positieve iFOB-test : 5,3 %Colonoscopie : 318APD adenomen/carc : 159 (0,9 %)APD carcinomen : 18 (0,1 %)
  • 38. Vosselaar Schilde Borgerhout Buggenhout HagelandOktober 08
  • 39. 21 Huisartsen (Nathalie Claes)4092 patiëntenGuaiac-FOB-test25 % participatiegraadQuality-award RIZIV (3° prijs)
  • 40. Besluit van de Vlaamse Regering van 12 december 2008betreffende bevolkingsonderzoek in het kader vanziektepreventie decreet van 21 november 2003
  • 41. Besluit van de Vlaamse Regering van 12 december 2008betreffende bevolkingsonderzoek in het kader vanziektepreventie •  Art. 31 Bevolkingsonderzoek “§2. Bevolkingsonderzoeken, in het kader van ziektepreventie, die niet in opdracht van de Vlaamse regering worden uitgevoerd, vereisen een toestemming van de Vlaamse regering.” decreet van 21 november 2003
  • 42. Nature  Clinical  PracOce  Gastroenterology  &  Hepatology                                March  2009    Vol  6    No  3  
  • 43. Guaiac  FOBT     Immunochemical  FOBT  
  • 44. Guaiac  FOBT     Immunochemical  FOBT  
  • 45. Guaiac  FOBT     Immunochemical  FOBT  •  Detects  peroxidase  acOvity   •  AnObody  reacts  to  human   of  heme  (stable)     globin  (degraded)    
  • 46. Guaiac  FOBT     Immunochemical  FOBT  •  Detects  peroxidase  acOvity   •  AnObody  reacts  to  human   of  heme  (stable)     globin  (degraded)    •  Diet/drug  restricOons   •  No  restricOon  
  • 47. Guaiac  FOBT     Immunochemical  FOBT  •  Detects  peroxidase  acOvity   •  AnObody  reacts  to  human   of  heme  (stable)     globin  (degraded)    •  Diet/drug  restricOons   •  No  restricOons  •  3  samples       •  1  sample  
  • 48. Guaiac  FOBT     Immunochemical  FOBT  •  Detects  peroxidase  acOvity   •  AnObody  reacts  to  human   of  heme  (stable)     globin  (degraded)    •  Diet/drug  restricOons   •  No  restricOons  •  3  samples       •  1  sample  •  Low  cost   •  Moderate  cost  
  • 49. 20.623 patients Gastroenterology July 2008
  • 50. g-FOBT i-FOBT 10.301 10.322 Participation 46.9 % 59.6 % Positive Test 2.4 % 5.5 %Adv.adenom/CRC 57 (0.6 %) 145 (1.4 %) CRC 11 (0.1 %) 24 (0.2%) Gastroenterology July 2008
  • 51. The latest generation of iFOBTs should replacetraditional gFOBTs in two step screening for CRCNature  Clinical  PracOce  Gastroenterology  &  Hepatology                                March  2009    Vol  6    No  3  
  • 52. 276 patientsGut, February 2009
  • 53. 276 patientsHigh-resolution and low-dose CTC is feasiblefor CRC screening for polyps > 5mmIn cases where stool tests are performediFOBT should be recommended rather thangFOBT Gut, February 2009
  • 54. in  Canada  Conclusions:  CRC  screening  with  iFOB    lowers  health  care  costs  in  comparison  to  no  screening  and  to  other  exisOng  screening  strategies.  CRC  screening  using  iFOB  is  economically  acracOve.   23  November  2010  
  • 55. iFOB-test bij 50-plusser 5 % positief Darmonderzoek Coloscopie 95 % negatief Herhalen na 2 jaar
  • 56. Colonoscopie •  Moeilijk •  Pijnlijk •  Ingrijpend •  Niet moeilijk •  Niet pijnlijk •  Niet ingrijpend
  • 57. i-FOB test immunochemisch Kwantitatief Kwalitatief(Speciaal) toestel Geen toestel (thuis) “self-test” (Apotheek)
  • 58. guaiac  KwanUtaUef   iFOB  KwalitaUef     iFOB   zelf-­‐test  
  • 59. Labo   Guaiac  FOB   iFOB  kwanU   iFOB  self-­‐test  Weet-­‐Vlaanderen  West-­‐Vlaanderen  West-­‐Vlaanderen  West-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Antwerpen  Antwerpen  Antwerpen  Antwerpen  Antwerpen  Limburg  Limburg  Vlaams-­‐Brabant  
  • 60. Labo   Guaiac  FOB   iFOB  kwanU   iFOB  self-­‐test  Weet-­‐Vlaanderen  West-­‐Vlaanderen   Clear  View  West-­‐Vlaanderen  West-­‐Vlaanderen   AkOm  Oost-­‐Vlaanderen   AkOm  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen   Clear  View  Oost-­‐Vlaanderen   Clear  View  Antwerpen   Clear  View  Antwerpen   Clear  View  Antwerpen   Clear  View  Antwerpen   AkOm  Antwerpen   Clear  View  Limburg   Forlab  China  Limburg   AkOm  Vlaams-­‐Brabant   Clear  View  
  • 61. Labo   Guaiac  FOB   iFOB  kwanU   iFOB  self-­‐test  Weet-­‐Vlaanderen  West-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen   op  aanvraag  Antwerpen   op  aanvraag  Oost-­‐Vlaanderen   Clear  View  Antwerpen   Clear  View  Antwerpen   AkOm  Limburg   Forlab  China  West-­‐Vlaanderen   Clear  View  West-­‐Vlaanderen   AkOm  Oost-­‐Vlaanderen   Clear  View  Antwerpen   Clear  View  Antwerpen   AkOm  Limburg   AkOm  Vlaams-­‐Brabant   Clear  View  
  • 62. Labo   Guaiac  FOB   iFOB  kwanU   iFOB  self-­‐test  Weet-­‐Vlaanderen  West-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen  Oost-­‐Vlaanderen   op  aanvraag  Antwerpen   op  aanvraag  Oost-­‐Vlaanderen   Clear  View  Antwerpen   Clear  View  Antwerpen   AkOm  Limburg   Forlab  China  West-­‐Vlaanderen   Clear  View  West-­‐Vlaanderen   AkOm  Oost-­‐Vlaanderen   Clear  View  Antwerpen   Clear  View  Antwerpen   AkOm  Limburg   AkOm  Vlaams-­‐Brabant   Clear  View  
  • 63. Aantal  doden  door  darmkanker     In  Vlaanderen   0  1  6  5  9  3  
  • 64. Am  J  Gastroenterol    July  2010  
  • 65. Lack  of  knowledge  of  early  detecOon  of  CRC      
  • 66. General  PopulaUon  Lack  of  knowledge  of  early  detecOon  of  CRC      
  • 67. General  Physicians   General  PopulaOon  Lack  of  knowledge  of  early  detecOon  of  CRC      
  • 68. Specialists   General  Physicians   General  PopulaOon  Lack  of  knowledge  of  early  detecOon  of  CRC      
  • 69. Gezonde  levenssOjl    :    25  %  reducOe  van  de  mortaliteit  
  • 70. All  screening  programs  do  harm…  some  can  do  good  as  well  !     Sir  Muir  Gray   NHS    UK  
  • 71. www.darmkankergetest.be

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