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Institute of Medicine (US); National Research Council (US); Pignone M, Russell L, Wagner J, editors. Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary. Washington (DC): National Academies Press (US); 2005.

Cover of Economic Models of Colorectal Cancer Screening in Average-Risk Adults

Economic Models of Colorectal Cancer Screening in Average-Risk Adults: Workshop Summary.

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Appendix PNatural History of Colorectal Adenomas and Cancer

, M.D.

Slide 1. Appendix P Natural History of Colorectal Adenomas and Cancer.

Slide 1

Appendix P Natural History of Colorectal Adenomas and Cancer. SLIDE 1 NOTES: No notes.

Slide 2. Topics.

Slide 2

Topics. SLIDE 2 NOTES: No notes.

Slide 3. De Novo Cancer vs. Pre Existing Adenomas.

Slide 3

De Novo Cancer vs. Pre Existing Adenomas. SLIDE 3 NOTES: The concept of de novo cancer differs according to the perspective of the individual using the term. To an endoscopist it may mean one thing; to a molecular biologist another. For the purpose of (more...)

Slide 4. National Polyp Study.

Slide 4

National Polyp Study. SLIDE NOTES 4: The National Polyp Study found five cancers as part of surveillance colonoscopies (Winawer et al., 1993). The first one listed was quite small and was detected only by an expert colonoscopist in the sigmoid colon. (more...)

Slide 5. PLCO.

Slide 5

PLCO. SLIDE 5 NOTES: Here is a table from the PLCO study (Schoen et al., 2003). This paper suggests an incidence of de-novo distal cancer of 0.02 percent per year, at least in patients undergoing sigmoidoscopy. This result is not much different from the (more...)

Slide 6. Adenoma vs. De Novo.

Slide 6

Adenoma vs. De Novo. SLIDE 6 NOTES: Paul Doria-Rose has been working on a study at Kaiser Permanente that looks at early cohorts from our sigmoidoscopy screening program (Doria-Rose et al., 2004). Focusing on the distal cancers only, about 30 cases occurred (more...)

Slide 7. KP (post SIG) vs. SEER.

Slide 7

KP (post SIG) vs. SEER. SLIDE 7 NOTES: We compared the experience in the Kaiser sigmoidoscopy program with the incidence of cancer reported in the SEER registry for our region. The comparison implies about an 85 percent reduction in incidence of CRC during (more...)

Slide 8. Telemark: FS to Select for Colonoscopy (N = 799).

Slide 8

Telemark: FS to Select for Colonoscopy (N = 799). SLIDE 8 NOTES: The Telemark randomized trial compared sigmoidoscopy vs. no screening, and then polypectomy at colonoscopy and colonoscopy surveillance (Thiis-Evensen et al., 1999). Two interesting results (more...)

Slide 9. Adenoma vs. De Novo.

Slide 9

Adenoma vs. De Novo. SLIDE 9 NOTES: Other sources of data on de novo rates are expected soon, from David Lieberman's cooperative study of follow-up from colonoscopy screening, and the consensus estimates obtained by Reid Ness. Finally, the true proportion (more...)

Slide 10. Adenoma to Cancer Dwell Times.

Slide 10

Adenoma to Cancer Dwell Times. SLIDE 10 NOTES: The next issue is what is the best estimate of the length of time it takes for adenomas to transition into cancer. One problem in attempting to estimate this is the fact that there may be two kinds of adenomas (more...)

Slide 11. Distribution of Dwell Times.

Slide 11

Distribution of Dwell Times. SLIDE 11 NOTES: I found no recent information on the distribution of dwelling times. The Stryker study is the most frequently cited (Stryker et al., 1987). That Mayo Clinic report suggests that about 75 percent of large polyps (more...)

Slide 12. Prevalence of Polyps: Age, Location, Type.

Slide 12

Prevalence of Polyps: Age, Location, Type. SLIDE 12 NOTES: The guidelines promulgated by the GI Consortium led by Dr. Winawer concluded that adenomas of any size were present in 25 percent of people by age 50, large adenomas in 4.6 percent by age 54, (more...)

Slide 13. Advanced Proximal Neoplasia by Distal Findings at Sigmoidoscopy.

Slide 13

Advanced Proximal Neoplasia by Distal Findings at Sigmoidoscopy. SLIDE 13 NOTES: Regarding the question of the frequency with which advanced proximal neoplasia – both adenomas and cancer – are accompanied by a synchronous adenoma in the (more...)

Slide 14. KP-CoCaP Data (CART Analysis).

Slide 14

KP-CoCaP Data (CART Analysis). SLIDE 14 NOTE: As part of the Kaiser study we analyzed (through classification and regression analysis) the risk factors associated with advanced proximal neoplasia (adenomas and cancer) by type in close to 3,000 people (more...)

Slide 15. FS vs. Colonoscopy: Sensitivity for Advanced Proximal Neoplasia.

Slide 15

FS vs. Colonoscopy: Sensitivity for Advanced Proximal Neoplasia. SLIDE 15 NOTES: This chart shows recent findings on the sensitivity of sigmoidoscopy for advanced proximal polyps and cancers (Imperiale et al., 2000; Lieberman et al., 2000). The two studies (more...)

Slide 16. Isolated Advanced Proximal Neoplasia.

Slide 16

Isolated Advanced Proximal Neoplasia. SLIDE 16 NOTES: Lewis did a meta-analysis of studies that examined the relationship between distal and proximal advanced adenomas and cancers. From the three studies, it appears that roughly 3 percent of all screened (more...)

Slide 17. Prognostic Value of Polyps.

Slide 17

Prognostic Value of Polyps. SLIDE 17 NOTES: What is the prognostic value of finding adenomas? In Atkin's study of follow-up after sigmoidoscopy, the presence of a distal advanced adenoma increases the risk of subsequent cancer 3-fold; and multiple advanced (more...)

Slide 18. Stage Specific Dwell Times for Cancer.

Slide 18

Stage Specific Dwell Times for Cancer. SLIDE 18 NOTES: Is there any new information that can inform modelers about the stage-specific dwelling times for colon cancer? Koretz's 1993 analysis showed that the time from the development of malignancy until (more...)

Slide 19. Predicting Progression.

Slide 19

Predicting Progression. SLIDE 19 NOTES: This slide includes a list of tumor and patient characteristics that appear to be correlated with progression of CRC. Note, however, that this list is by no means exhaustive. Other prognostic factors exist. The (more...)

Slide 20. Summary.

Slide 20

Summary. SLIDE 20 NOTES: Similarly, the cancers that can be seen with colonoscopy alone may be different in terms of progression from those that can be seen with both colonoscopy and virtual colonoscopy. Perhaps tumors located “behind a fold” (more...)


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Copyright © 2005, National Academy of Sciences.
Bookshelf ID: NBK83887
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