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Presentasjon lastes. Vennligst vent

Forskning i forprosjektet Hva er forskbare tema? Hva skjer på forskningsfronten? Geir Hoff CRC screeningseminar Oslo, 22. – 23. november 2012.

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Presentasjon om: "Forskning i forprosjektet Hva er forskbare tema? Hva skjer på forskningsfronten? Geir Hoff CRC screeningseminar Oslo, 22. – 23. november 2012."— Utskrift av presentasjonen:

1 Forskning i forprosjektet Hva er forskbare tema? Hva skjer på forskningsfronten? Geir Hoff CRC screeningseminar Oslo, 22. – 23. november 2012

2 Publiseringspotensiale i forprosjektet Design av studie/program og funn i screeningfasen, FS og iFOBT screening (oppslutning, neoplasi deteksjon, komplikasjoner) Kvalitetssikring av skopier (FS og koloskopi). Intubasjon, adenom deteksjon etc Helseøkonomi (kostnad/effektivitet FS vs/iFOBT) Screeningens påvirkning av livsstil. (Søkt HSØ med tanke på ny PhD kandidat til dette) Screeningens påvirkning av angstnivå (HADS) og livskvalitet (SF-12). (Søkt HSØ med tanke på ny PhD kandidat til dette) Forekomst av divertikkelsykdom i Norge (Johannes Kurt Schultz) - skrinlagt Forekomst og varighet av symptomer i gruppene med hhv n.f., low-risk, high-risk og CRC Sigmo tilbakemeldinger via Gastronet. Bedre u.s. med SkopGuide? (Tone-Lise) «Hvor-lett-å-finne-fram-til-screeningsenter»-prosjektet Tilbakemeldinger fra deltakere til FS og etter koloskopi (Gastronet) Degradering av Hgb konsentrasjoner over tid/temperaturvariasjon (Catherine) Kvaliteten av vevsmateriale ved bruk av biopsitang uten vs/med pigg (rct) Tømningsregime

3 Endpoint time frames CRC mortality: 10 yrs of follow-up (primary endpoint) Other disease-specific mortality: 10 yrs of follow-up CRC incidence: 10 yrs of follow-up Total mortality: 10 yrs of follow-up Cost-effectiveness: 10 yrs of follow-up Sensitivity and specificity: 5 yrs of follow-up (to be estimated by comparing with Cancer Registry incidence data which has close to 2 yrs reporting delay) CRC stage at diagnosis: 3 yrs of follow-up (Cancer Registry data has nearly 2 yrs reporting delay) Attendance rate: To be evaluated continuously from start of pilot Detection rate of advanced lesions (CRC and high-risk adenomas): To be evaluated continuously from start of pilot Complications: To be evaluated continuously from start of pilot Psychological and physical effects: To be evaluated continuously from start of pilot Spontaneous un-programmatic screening: To be evaluated continuously from start of pilot

4 Oppdat. annen CRC screening

5 C Littlejohn et al. Review and meta-analysis for Flexible Sigmoidoscopy (FS) as a screening method. Br J Surg 2012;99: Detection rate of....FS detection rateFS detection compared FOBT gFOBTiFOBT CRC 3-6/1000x3similar Advanced adenoma50/1000 (UK)x7x3

6 Outcomes of the CRC screening programme in England after first million tests. Gut 2012;61: Invited at age 60 yrs, around time of birthday, for biennial gFOBT until age 70 yrs Second letter (this time with kit) 1-2 weeks after the first letter Two samples from 3 stools (6 windows), no dietary restriction Asked to return test kits within 14 days 1-4 windows positive: Repeat test. Any positive then accepted as pos. If repeat test negative – repeat test. Any positive then accepted as pos. Postive test: Appointment within 14 days to discuss colonoscopy All colonoscopies at accredited centers by accredited endoscopists (JAG) Patient accompanied by an SSP from a nurse-run Specialist Screening Practitioner (SSP) clinic at each centre Ongoing QA: Caecal intubation, asdenoma detection, polyp retrieval, withdrawal time, comfort score, complications SSP appointment following week for results New gFOBT in 2 yrs also for colonoscopy negatives

7 Outcome after first million screened with gFOBT in England 49.6% (men) and 54.4% (women) compliance after 2.1 mill invited 2.5% (men) and 1.5% (women) had positive tests 94% attended SSP clinic for work-up of screen positivity – 6% not attending despite reminders. 83% finally underwent investigation CRC in 11.6% (men) and 7.8% (women) of those investigated after positive screening High risk adenomas in 43% (men) and 29% (women) of those investigated after positive screening 17 perforations in 17,518 examinations (1:1030) 77% of CRCs were leftsided (expected 66% in non-screened)

8 The US Prostate, Lung, Colorectal, Ovarian cancer (PLCO) study 154,900 men and women at age yrs randomised 1:1 to flexible sigmoidoscopy or care as usual – enrolled Carcinoids included as CRC Physician and nurse endoscopists Positive screening defined as finding of any polyp or mass – biopsy not routinely performed Referred to primary physician for decisions regarding diagnostic follow-up FS at baseline and repeat after 3 yrs (randomised before 1995) or 5 yrs (randomised after 1995) 83.5% attended at baseline, 54.0% subsequently 80.5% of screen-positives underwent work-up exam. 21.9% of screening attendees underwent colonoscopy

9 PLCO 10-yr follow-up. RE Schoen et al. CRC incidence and mortality with screening FS. NEJM 2012 IncidenceRR (95% CI) CRC0.79( ) Distal CRC0.71( ) Prox. CRC0.86( ) Mortality CRC0.74( ) Distal CRC0.50( ) Prox. CRC0.97( )

10 PLCO 10-yr follow-up. RE Schoen et al. CRC incidence and mortality with screening FS. NEJM 2012 IncidenceRR (95% CI) Men0.73( ) Women0.86( ) yr0.78( ) yr0.79( ) Mortality Men0.66( ) Women0.87( ) yr0.84( ) yr0.65( )

11 Spanish rct iFOBT vs/colonoscopy E Quintero et al. NEJM 2012;366: IncludedAttendanceCRC baseline Advanced ad. Non-adv.ad. iFOBT26, %33 (0.1%)231 (0.9%)119(0.4%) Colo26, %30 (0.1%)514 (1.9%)1109(4.2%)

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14 CancerCareOntario Started 2008 gFOBT – average risk, yrs Colonoscopy – 1st degree relative w/CRC, from age 50yrs (or 10 yrs younger than index case) A pilot on iFOBT – results expected in 2013

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17 1 CRC diagnosed per 1000 screened

18 I krystallkulen

19 iFOBTFlexSig Colonoscopy Mol. markers Endpoints CER – additional arms during roll-out of program

20 iFOBTFlexSig Colonoscopy Mol. markers Endpoints CER – additional arms during roll-out of program HADS SF-12 SWD Gnet QA Lifestyle

21 iFOBTFlexSig Colonoscopy Mol. markers Endpoints CER – additional arms during roll-out of program ??????

22 MIT breaktrough: Substituting colonoscopy and CT colonography? FEMTO technology


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