ARCHIVED - Technical Report for the National Committee on Colorectal Cancer Screening

Table of Contents

Technical Report for the
National Committee on
Colorectal Cancer Screening
May 2002

Recommendations for Population-based Colorectal Cancer Screening

by the National Committee on Colorectal Cancer Screening, an expert panel

Introduction

Criteria for Development of Recommendations

• Criterion 1: The condition should be an important health problem.
• Criterion 2: The natural history of the condition, including development from latent to declared disease, must be understood. There should be a recognizable latent (asymptomatic) period or early symptomatic stage.
• Criterion 3: There should be a suitable screening test or examination.
• Criterion 4: The overall benefit of the screening program should outweigh the potential harms from its application.
• Criterion 5: The test (inclusive of screening and diagnosis) should be acceptable to the population.
• Criterion 6: Evidence-based recommendations should be available to identify who should be offered further diagnostic investigation and/or treatment, and the choices available to them.
• Criterion 7: Treatment or intervention that improves survival or quality of life (compared with not screening) should be available for patients with recognized disease.
• Criterion 8: Adequate staffing and facilities for recruitment, testing, diagnosis and follow-up, treatment, and program management should be available.
• Criterion 9: The resources allocated to the screening program (including testing, diagnosis, and treatment of patients diagnosed) should be economically balanced in relation to other health care priorities.

Appendices

• Appendix A: Terms of Reference
• Appendix B: Primary Prevention of Colorectal Cancer
• Appendix C: Screening for Colorectal Cancer Using the Fecal Occult Blood Test: Assessing the Impact of a Canadian Population-based Program Using an Actuarial Model
• Appendix D: Modelling colorectal cancer screening in POHEM
• Appendix E: Summary of key informant interviews regarding national capacity for colonoscopy as diagnostic follow-up to FOBT, for population-based colorectal cancer screening
• Appendix F: Comparison of Three Randomized Controlled Trials of FOBT Screening for Colorectal Cancer

List of Tables

• Table 1: Canadian Adaptation of the WHO Principles of Early Disease Detection
• Table 2: Lifetime Probability of Developing or Dying from Colorectal, Lung, Breast and Prostate Cancer
• Table 3: Potential Years of Life Lost Due to Colorectal, Lung, Breast, and Prostate Cancer, in Canada, 1997
• Table 4: Relative Mortality Reduction (%) from CRC in the Minnesota, Funen and Nottingham trials
• Table 5: Measures of FOBT Performance from RCTs: Sensitivity, Specificity, and Positive Predictive Value (as reported in the National Advisory Committee on Health and Disability)
• Table 6: General Types of FOBT
• Table 7: Underlying Assumptions for Population Health Model (POHEM)
• Table 8: Impact of a 10 Year Annual and Biennial FOBT Screening Program, in Canada, Projected from the POHEM
• Table 9: Reported Major Complication Rates with Colonoscopy and Polypectomy (post-procedure)
• Table 10: Projected Number of Complications Resulting from Colonoscopy During a 10-year Screening Program, in Canada (from the POHEM)
• Table 11: Individual Potential Gains/Risks from Full Participation in a Biennial CRC Screening Program, Starting at Age 50 and Stopping at Age 74
• Table 12: Participation and Compliance Rates in Randomized Controlled Trials of FOBT
• Table 13: Comparison of CRC Stage Distributions: Ottawa Regional Cancer Centre vs. US Surveillance Epidemiology and End Results (SEER) Program
• Table 14: Five Year CRC Survival, by Stage (US SEER 1989-95)
• Table 15: Estimated Number of Annual FOBTs Incurred in the First Year (2000) of a Biennial Screening Program, with 67% Participation (from POHEM)
• Table 16: Estimated Number of Annual FOBTs Incurred in the First Year (2000) of a Biennial Screening Program, with 67% Participation rate achieved (ramped up) over 5 years (from POHEM)
• Table 17: Projected Rates of Colonoscopy Procedures for the Year 2000 of a Biennial Screening Program, Based on Current Rates of Procedures (CIHI) and Modelling Projections (POHEM)
• Table 18: Colonoscopy Cost Analysis (4 diagnostic colonoscopies) - Endoscopy Suite in P.E.I.
• Table 19: Cost per Service for Colonoscopy, by Province, 1995/96 (CIHI, 2000)
• Table 20: Estimated Costs of Screening Program Components for Core Scenario
• Table 21: Estimated Costs of Screening Program Components for the Sensitivity Analyses
• Table 22: Incremental Cost Per Life Year Gained with Biennial Screening Starting at Different Ages (ending at age 74)
• Table 23: Incremental Cost Per Life Year Gained with Extending Screening to Different Ages (starting at age 50)

Technical Report for the
National Committee on
Colorectal Cancer Screening
May 2002