Prevenzione attraverso lo Screening del Colon retto

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1 Prevenzione attraverso lo Screening del Colon retto Pierluigi Fracasso UOC Gastroenterologia ed Endoscopia Digestiva Ospedale Coniugi Bernardini Palestrina ASL RM 5

2 Estimated number of incidence cases, both sexes, European Union (EU-28) (top 10 cancer sites) in 2012 Data source: GLOBOCAN 2012 Graph production: Cancer Today ( International Agency for Research on Cancer 2016

3 Estimated age-standardized rates (World) of incidence cases, both sexes, colorectal cancer, Europe in 2012 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization / International Agency for Research on Cancer concerning the legal Data source: GLOBOCAN 2012 Graph production: Cancer Today ( World Health Organization International Agency for Research on Cancer 2016

4 The burden of colorectal cancer in EU countries Over 3 milions people with colorectal cancer are living in Europe

5 Patients aged >50 had 6-10% risk of CRC Patients aged <50 had risk 2% of CRC Jellema P, BMJ 2010

The UEG and the Written Declaration 68/2010 68/2010 Written declaration on the fight against colorectal cancer in the European Union The European Parliament, having regard to Rule 123 of its Rules of

6 The UEG and the Written Declaration 68/ /2010 Written declaration on the fight against colorectal cancer in the European Union The European Parliament, having regard to Rule 123 of its Rules of Procedure, A. whereas in the EU yearly there are over new cases and deaths of colorectal cancer (CRC), CRC being the 2nd most frequent cancer killer, B. whereas CRC is associated with lifestyle factors (obesity, lack of exercise, alcohol and smoking) tackling these factors will decrease CRC development, C. whereas screening in some EU countries has already lowered CRC mortality, in others screening activities have not been initiated, D. whereas early detection of CRC will not only lead to a reduction of 40% mortality rate, but will also significantly reduce treatment costs, E. whereas, following the European Commission, the fight against CRC should be a priority in public health as death by CRC is preventable with the medical tools available in the EU, 1. Calls on the Commission and the Member states to support in the EU awareness campaigns on lifestyle factors causing CRC, aiming particularly at teenagers and young adults, to stimulate implementation of CRC screening best practice in all EU countries and to publish progress reports every 2 years; to make dissemination of CRC screening related research and knowledge a priority in upcoming work programmes of Research Framework Programme 7 and the EU Health Programme; to introduce nationwide CRC screening, in accordance with EU guidelines; 2. Instructs its President to forward this declaration, together with the names of the signatories, to the Council, the Commission and the parliaments of the Member States.

7 Screening: opzioni Opportunistico: Offrire uno strumento di screening caso per caso Di Popolazione: Invitare tutte le persone eligibili a sottoporsi a screening

8 Screening CRC: opzioni One step screening: colonoscopia Two steps screening: SOF/sigmoidoscopia + colonscopia Combinato (FOBT + sigmo/colonoscopy)

9 Screening del CCR in Europa Country Type National CRC screening program Method/screening interval, age CZECH REP. nonpb established in 2000, adapted in 2009 FOBT/1-2/colonoscopy, >50 HUNGARY PB pilot program FOBT/2/colonoscopy, GERMANY nonpb established in 1976, adapted in 2002 FOBT/1-2/colonoscopy, >50 ITALY PB since 2000 FOBT/2/FS/in life time, FRANCE PB established 2003 FOBT/2, FINLAND PB established 2004 FOBT/2, AUSTRIA nonpb established FOBT/1-2, >50 SWEDEN PB Regional plans FOBT/2, PORTUGAL PB plan FOBT/2, DENMARK national screening studies Not decided yet SLOVAKIA nonpb national program established in 2002 FOBT/2/colonoscopy, >50 UK PB program started in 2006 FOBT/2/colonoscopy, BELGIUM national screening studies Not decided yet SPAIN BP pilot program FOBT/2/, NETHERLANDS National program to be launched.. FOBT/colonoscopy POLAND opport national program established in 2000 Colonoscopy/10, ESTONIA discussed Screening established in 19 of 27 EU countries.136 million individuals suitable for screening. Zavoral M. et al, Colorectal Cancer Screening in Europe, World Journal of Gastroenterology 2009; 15/47:

10 Storia dello Screening in Italia Dal 1999 colonscopia di prevenzione gratuita in persone > 45. La Colonscopia è gratuita anche prima dei 45 anni se è sospettata una predisposizione ereditaria (FAP, Sindrome di Lynch) Nel 2001 sono iniziati i programmi di screening basati sul sangue occulto fecale, su base regionale

11 Punti deboli nella prevenzione basata sulla Colonscopia Non esiste una raccolta dati sulla qualità della colonscopia (e miglioramenti), sulle diagnosi e sulle complicanze Allargata l indicazione alla colonscopia

12 Radaelli DLD 2013 Survey AIGO sulla qualità della colonscopia Indicazioni Screening 14.6% 15.1% Sorveglianza 23.1% 20.7% Sintomi 63.3% 64.2%

13 Completamento della colonscopia Radaelli DLD 2013

14 Detection rate dei polipi Radaelli DLD 2013

15 Estensione dello Screening con SOF in Italia

16 Tendenza nel tempo nell estensione del SOF Passi

17 Numeri assoluti dello Screening in Italia Standard rif. Inviti 4,693,213 5,653,262 44% 46% Positivi 5.4% 5.1% <6% Colonscopia 79.8% 79.4% >85% Cancri

18 Sangue occulto nelle persone di età anni PASSI

19 Accettazione della colonscopia dopo SOF+

20 Adesione a lungo termine al SOF Round Esaminati Colonscopie Cancri Adenoma Av Crotta Clinical Gastroenterology 2012

21 Fattori relativi all accettazione del SOF PASSI Survey

22 Ragioni per non eseguire lo Screening PASSI

23 Screening con sigmoidoscopia (Piemonte, Verona) Inviti 32,159 29,028 39,512 Accettati 28% 26% 26% Colosc 11.3% % Acc. CS 90% 85% 84% Cancri

24 Quale screening in Italia? Differenze Nord Sud Qualità Educazione Screening opportunistico Screening di massa

25 Quale programma di screening in Italia? 1. Colonscopia di prevenzione 2. Screening di massa con Sangue occulto (Estensione al Nord 80%, al Sud 10%) 3. Screening con sigmoidoscopia in Piemonte 4 DIFFERENTI SCREENINGS

26 Screening nel Lazio Invitati Rispondenti Positivi SOF 6,3% 6,4% 6.0% Colonscopia 85.3% 78% n.d. Cancri 3.2/1000 3/1000 n.d.

27 Conclusioni Lo screening può essere di massa o opportunistico La stategia deve essere ritagliata sulla cultuta della popolazione Bisogna allocare risorse sullo screening, dato che l efficacia è dimostrata Il controllo della qualità delle prestazioni e la misurazione dei risultati sono punti chiave di un programma di screening

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