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Survival data for crc and screening recommendations (surgery conference) Survival data for crc and screening recommendations (surgery conference) Presentation Transcript

  • SURVIVAL DATA FOR COLORECTAL CANCER IN KSA AND SCREENING RECOMMENDATIONS By Prof. Mahmoud Shaheen Al-Ahwal Professor of I. Medicine & Medical Oncology Dean Faculty of Medicine, KAU Jeddah, K.S.A. 20th Dec 2011
  • Most Common Cancers (KSA) 2007
  • Regional Distribution in KSA
  • Comparison with Selected Countries
  • Age Specific Incidence Rate
  • Stage Distribution
  • Stage Distribution of CRC between 1994-2004 Total 549 ! In situ 0 0.0% ! Localized 122 22.2% ! Regional 260 47.4% ! Distant 142 25.9% ! Unknown 25 4.6% Saudi Cancer Registry (SCR) MOH, KSA: ancer Incidence and Survival Report Saudi Arabia 2007.
  • Incidence of CRC among Saudis from 1994-2007
  • SURVIVAL DATA FOR COLORECTAL CANCER
  • Number of Cases by Gender Between 1994-2004
  • Results ! Cancer-specific survival rate was analyzed for 5141 eligible Saudi patients who are diagnosed between 1994 – 2004. ! Number of CRC cases between 1994 – 2004: ! Total Number: 549 ! Males 363 (66.1%) ! Females 186 (33.9%)
  • Results 5-Year Overall Survival (OS) for CRC between 1994 - 2004: 44.6%
  • 5-Years OS by Gender and periods Between 1994-2004 ! 5-Year OS 44.6% ! Males 41% p-value= 0.003 ! Females 50.6% ! 5-Year OS stratification by years periods ! 1994-1999 44.7% p-value= 0.07 ! 2000-2004 44.3%
  • 5-Years OS for CRC Stratified by Gender
  • 5-Years OS for CRC
  • 2009 Estimated US Cancer Deaths* ONS=Other nervous system. Source: American Cancer Society, 2009. Men 292,540 Women 269,800 26% Lung & bronchus 15% Breast 9% Colon & rectum 6% Pancreas 5% Ovary 4% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites Lung & bronchus 30% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4% bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 25%
  • Five-Year Relative Survival Rates Among Patients Diagnosed With Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2006.
  • KSA and SEER Data, 5-Years OS Comparison for CRC KSA 5-Years OS 1994-2004 (1) SEER 5- Years OS 1999-2006 (2) 5-Years OS 1994-2004 by Gender SEER 5-Years OS 1999-2006 by Gender All All Male Female Male Female 44.6% 65% 41% 50.6% 65.1% 64.9% (1): Saudi Cancer Registry (SCR) MOH, KSA: ancer Incidence and Survival Report Saudi Arabia 2007. (2): Surveillance Epidemiology and End Results (SEER Cancer Statistics Review 1975-2007) http://seer.cancer.gov/csr/1975-2007/browse-csr.php?section=19&page=sect-19-table.07.html
  • Annual Age- Adjusted Cancer Death Rates* Among Males and Females for Selected Cancers, United States, 1930 to 2007.
  • Comparison of CRC between USA and KSA USA KSA Incidence Decreasing Increasing 5-Year OS: - Males - Females 65% 65.1% 64.9% 44.6% 41% 50.6% Mortality Trend Decreasing Unknown Age at Diagnosis 7% < 50 Years 31.8% < 50 Years Stage at Diagnosis: - Localized - Regional +Advanced More Early (39%) (57%) More Advanced (22.2%) (73.3%) Screening Program Yes No (1): Saudi Cancer Registry (SCR) MOH, KSA: ancer Incidence and Survival Report Saudi Arabia 2007. (2): Surveillance Epidemiology and End Results (SEER Cancer Statistics Review 1975-2007) http://seer.cancer.gov/csr/1975-2007/browse-csr.php?section=19&page=sect-19-table.07.html
  • CRC SCREENING
  • Screening Tests For CRC Sensitivity Specificity ! FOBT: 50% 92% ! Barium Enema: 38% 81% ! Sigmoidoscopy: 70% 100% ! Colonoscopy: 95% 100% ! CT Colography: 62% 91%
  • Screening Techniques for Colorectal Cancer (Starts at age 50Y) §  Fecal occult blood test (FOBT) every year, or §  Flexible sigmoidoscopy (FSIG) every 5 years,or §  A FOBT every year plus FSIG every 5 years (recommended by the American Cancer Society), or §  Double-contrast barium enema every 5 to 10 years, or §  Colonoscopy every 10 years (recommended by the American College of Gastroenterology).
  • Is Colorectal Cancer Preventable? YES! •  Screening •  Chemoprevention
  • Screening For Colon Cancer SAVES LIVES!!! Mortality Test Reduction Fecal occult blood testing 33% Flexible sigmoidoscopy 66% (in portion of colon examined) FOBT + flexible sigmoidoscopy 43% (compared to sigmoidoscopy alone) Colonoscopy ~76-90% (after initial screening and polypectomy)
  • How Can We Improve CRC Survival in Saudi Population KSA Recommended Action Incidence Increasing - Epidemiological studies to Identify risk factors - Establish a National Screening Program 5-Year OS - Males - Females 44.6% 41% 50.6% - Awareness and Education on primary prevention - Establish a National Screening Program - Further Research on CRC and prognostic factors Mortality Trend Unknown - Regular and Accurate database on Cancer Specific Mortality Rate Age at Diagnosis 31.8% < 50 Years - Further Research on CRC in young age group - Establish a National Screening Program starting at a younger age than 50 years Stage at Diagnosis: - Localized - Regional +Advanced More Advanced (22.2%) (73.3%) - Awareness and Education - Establish a National Screening Program Screening Program No - Establish a National Screening Program
  • Conclusions (1) ! Colorectal cancer survival data in Saudi population is much lower than SEER s data for the same period and gender. ! Further epidemiological studies are needed to identify risk and prognostic factors for CRC in Saudi population.
  • Conclusions (2) ! National program on health education and primary prevention such as dietary habits are highly recommended to reduce the incidence of CRC. ! National Screening Program for CRC starting at an age earlier than 50 years, is an essential step to reduce mortality in Saudi Population.
  • DMHMD04 THANK YOU