1. 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

3. Most Common Cancers (KSA) 2007

5. Regional Distribution in KSA

6. Comparison with Selected Countries

7. Age Specific Incidence Rate

8. Stage Distribution

9. 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.

10. Incidence of CRC among Saudis from
1994-2007

11. SURVIVAL DATA
FOR
COLORECTAL CANCER

12. Number of Cases by Gender
Between 1994-2004

13. 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%)

14. Results
5-Year Overall Survival (OS) for CRC between
1994 - 2004: 44.6%

15. 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%

16. 5-Years OS for CRC Stratified by
Gender

17. 5-Years OS for CRC

18. 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%

19. Five-Year Relative Survival Rates Among Patients Diagnosed
With Selected Cancers by Race and Stage at
Diagnosis, United States, 1999 to 2006.

20. 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

21. Annual Age-
Adjusted Cancer
Death Rates*
Among Males and
Females for
Selected Cancers,
United States, 1930
to 2007.

22. 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

23. CRC
SCREENING

24. Screening Tests For CRC
Sensitivity Specificity
! FOBT: 50% 92%
! Barium Enema: 38% 81%
! Sigmoidoscopy: 70% 100%
! Colonoscopy: 95% 100%
! CT Colography: 62% 91%

25. 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).

27. Is Colorectal Cancer
Preventable?
YES!
• Screening
• Chemoprevention

28. 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)

29. 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

30. 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.

31. 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.

32. DMHMD04
THANK YOU