Colorectal Cancer Screening - key statements of the Health Council of the Netherlands
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A few slides about the key figures on benefits and harms of colorectal cancer screening based on data summarized in "Bevolkingsonderzoek naar Darmkanker" van de Nederlandse Gezondheidsraad (2009). This publication is in Dutch. This recommendation to the Dutch minister of health was the basis for the introduction of colorectal cancer screening in teh Netherlands. I prepared these slides mainly to examine for myself the benefits and harms of colorectal cancer screening (see slide 5 and 6) but everybody is welcome to share and comment on obvous and less obvious mistakes.
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Colorectal Cancer Screening - key statements of the Health Council of the Netherlands
- 1. Key statements of the Health Council of the Netherlands on Colorectal Cancer Screening (2009) Kernpunten uit het Advies van de Gezondheidraad over Bevolkingsonderzoek naar Darmkanker (2009) http://www.gezondheidsraad.nl/sites/default/files/200913.pdf With a summary of Benefits and Harms by Carsten R Lincke , MD, PhD September 2014
- 2. Bevolkingsonderzoek naar darmkanker Advies Gezondheidsraad 2009 Samenvatting, p 16 http://www.gezondheidsraad.nl/nl/adviezen/preventie/bevolkingsonderzoek-naar-darmkanker
- 3. (pagina 63) http://www.gezondheidsraad.nl/sites/default/f iles/200913.pdf
- 5. Colorectal Cancer Screening - Risks, Benefits and Harms abs NL* % per 100.000 Prevalence colorectal cancer adenocarcinoma 0,8 800,00 advanced adenoma 6,7 6700,00 progression rate to carcinoma 50%/10 yrs Mortality colorectal cancer without screening 5335 38,00 with screening 4534,75 32,30 at least 15% reduction of mortality due to colorectal cancer Prognosis 5Yr survival stage I 94 stage III 70 stageIV 8 NB: 45% diagnosed in stage III/IV complications colonoscopy fatal 0,0004 0,40 perforation 0,1 100,00 bleeding 0,14 140,00 positive iFOBT in screening programs 6 6000,00 NN to screen iFOBT 785 to prevent one death due to CRC NN to scope after + IFOBT 40 to prevent one death due to CRC
- 6. no screening screening per 100.000 per jaar per 100.000 per jaar Benefits How many people died from CR cancer? 38,00 32,8 15%-25% relative risk reduction How many people survived due to screening? 0,00 5,2 this results in at least 800 - 1500 more survivors of CRC How many adenocarcinoma's were discovered? 408 deduced from a PVV of 6,8% and 6% positive iFOBT's How many advanced adenomas were discoverd? 1920 deduced from a PPV of 32 % and 6% positive iFOBTs Harms How many people had false positive iFOBT? (and received "unnecessary" colonoscopy) 0,00 3672,00 6% positive IFOBT's in screened population: 6000 - 408 - 1920 How many people suffer complications from colonoscopy? 0,00 240,4 fatal 0,00 0,4 Balance (assuming 100% participation) how many colonoscopies to prevent one death 1154 assuming that all positive iFOBTs have colonoscopy how many colonoscopies to detect one carcinoma? 15 how many colonoscopies to detect one advanced adenoma? 3 how many death due to colonoscopy to prevent one death due to CRC? 0,08 Data based on http://www.gezondheidsraad.nl/sites/default/files/200913.pdf ©C.R. Lincke, MD PhD, september 2014
- 7. Pagina 78
- 8. For comparison: • Breast cancer screening • Prostate cancer screening Credits to: https://www.harding-center.mpg.de/en/health-information