Economic Models of Colorectal Cancer Screening in Average-Risk Adults Workshop Summary (2005) / Chapter Skim
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Appendix O Colorectal Cancer Surveillance Testing After Polypectomy--Deborah Schrag, M.D., M.P.H.
Appendix O Colorectal Cancer Surveillance Testing After Polypectomy--Deborah Schrag, M.D., M.P.H.
Pages 241-262
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Appendix O Colorectal Cancer Surveillance Testing After Polypectomy Deborah Schrag, M.D., M.P.H. SLIDE 1 SLIDE 1 NOTES: No notes.
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242 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 2 SLIDE 2 NOTES: No notes.
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APPENDIX O 243 SLIDE 3 SLIDE 3 NOTES: No notes.
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. The NPS was a randomized trial of the timing of surveillance colonoscopy.
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In each of the years between the surveillance procedures, questionnaires were administered.
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In addition, a villous component has been recognized as an important risk indicator, but the data from the NPS did not define advanced adenomas using that criterion.
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. However, the risk of advanced adenoma at three years is identical between the two arms (3.3 percent)
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248 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 8 SLIDE 8 NOTES: This chart shows the point of detection of 5 cancers detected in the study population. The detection of cancers appears not to have been affected by the surveillance strategy.
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This chart shows that for advanced adenomas, the difference in incidence between the two arms is not different.
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250 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 10 SLIDE 10 NOTES: Stratifying patients by age and status of a parent with colorectal cancer shows the increased probability of an advanced adenoma in the years following diagnosis. The rate for patients 60 years of age or older with a parent with colorectal cancer is almost 25 percent.
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APPENDIX O 251 SLIDE 11 SLIDE 11 NOTES: If a person had 3 or more high-risk adenomas at the index event, the risk of an advanced adenoma by the sixth years of surveillance is over 15 percent.
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. The data are currently being reanalyzed with the current definition of high-risk adenoma.
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They have shown that the miss rate is inversely related to the size of the tumor. For advanced adenomas, the miss rate is small, so it is unlikely that the clinicians in the NPS missed a high number of tumors.
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They have shown that the miss rate is inversely related to the size of the tumor. For advanced adenomas, the miss rate is small, so it is unlikely that the clinicians in the NPS missed a high number of tumors.
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APPENDIX O 255 SLIDE 15 SLIDE 15 NOTES: No notes.
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256 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 16 SLIDE 16 NOTES: There are currently three sets of recommendations for surveillance after adenomas. The multi-society task force, which issued guidelines in 2003, represents the consensus of a number of different provider groups.
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Two groups indicate that every-five-years is still warranted, whereas the American Cancer Society recommends that such individuals be considered average risk and returned to a screening pool (with a colonoscopy ever 10 years)
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258 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 18 SLIDE 18 NOTES: No notes.
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APPENDIX O 259 SLIDE 19 SLIDE 19 NOTES: I am not going to address this issue because Todd Anderson's presentation directly addresses it.
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260 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 20 SLIDE 20 NOTES: No notes.
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It appears, from the surveys, that physicians actually take those risk differences into account when they decide on what to recommend to their individual patients.
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REFERENCES Winawer SJ, Zauber AG, May Nah Ho, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, Lightdale CJ, Edelman M, Fleisher M
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