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Survival data for crc and screening recommendations (surgery conference)
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
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.
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%)
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%
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
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
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).
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.