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Study Country Comparator/ screening test O’Leary et al 36 McMahon et al 37 United States Wong et al 38 Leshno et al 39 McGrath et al 40 Australia FSIG 10yrly vs FOBT yrly/ biennially vs COL 10yrly vs no screening FSIG vs FOBT vs COL vs DCBE Singapore FOBT, vs Immuno FOBT vs FSIG vs DCBE vs COL for ages 50–54yrs, 55–59yrs, 60– 64yrs, 65–60yrs Israel Single COL vs FOBT + SIG vs Annual FOBT vs COL 10yrly vs DNA vs no screening Canada FSIG vs FSIG + ACBE vs CTC vs COL Conclusion FSIG and COL are cost-effective strategies. Compared to no screening, ICERs/LYG for FSIG 10yrly, COL 10yrly, FOBT biennially and FOBT yrly were $A16,801, $A19,285, $A41,183 and $A46,910. Results are sensitive to several parameters, but order of effectiveness mostly remains unchanged. Strategies including DCBE emerged as optimal. In average-risk persons, DCBE 3yrly, or 5yrly with FOBT yrly, had ICERs
Study Country Comparator/ screening test Glick et al 41 Sorrentino et al 42 Shimbo et al 43 Lieberman 44 256 United States DCBE 5yrly vs DCBE 5yrly + FOBT yrly vs FOBT yrly vs COL 5yrly vs SIG 5yrly vs SIG 5yrly + FOBT Italy FOBT vs SIG vs FOBT+ SIG vs COL vs FC50 vs no screening Japan Combinations of BFOBT or IFOBT with COL, BE, or BE/SIG with variations in screening intervals United States FOBT yrly vs FSIG (5yrly repeat if -ve) vs FSIG 5yrly/FOBT yrly vs COL 10yrly vs BE (5yrly repeat if -ve) over 10 year period The prevention, early detection and management of colorectal cancer Conclusion All programs are cost-effective in the order of SIG, DCBE, SIG + FOBT, FOBT, COL, DCBE + FOBT (for 5yr polyp dwell time) and DCBE, FOBT, SIG + FOBT, FOBT, COL, DCBE + FOBT (for 10yr dwell time). CERs/LYG for 5yr and 10yr dwell times, range from $US11,947–14,750 ($A18,657–23,035) and $US9435–12,815 ($A14,734–20,013). DCBE 5yrly was sensitive to changes in test sensitivity and specificity, but CERs remain acceptable. Screening programs based on SIG or COL are more cost-effective than FOBT. FC50 at age 50yrs appears to be most costeffective. The 10yr cost/death prevented for FOBT, SIG, FOBT+ SIG, COL vs FC50 are $US77,200, $US15,500, $US35,000, $US15,100 and $US14,000 ($A135,685, $A27,279, $A61,597, $A26,575, $A24,639). Programs using IFOBT are the most costeffective, with IFOBT 2yrly followed by COL if test +ve the most cost-effective (ICER = $US13,100 [$A26,265]/LYG). Beginning screening at 45yrs has best CER ($US12,400 [$A24,862]/LYG). However, commencement at age 40yrs is still costeffective with ICER vs 45yrs of $US16,800 ($A33,643)/LYG. However, if compliance drops 10, 15 and 20% after each screening, commencement at 40yrs is dominated by later screening. COL has the greatest impact on mortality. FOBT alone is the most cost-effective at 100% compliance. Cost/death prevented for FOBT, FSIG, FOBT/FSIG, COL, BE ranged from $US225,000–280,000 ($A420,118–522,813). At 50% compliance, ranges were $US331,000– 367,000 ($A618,040–685,258). (FOBT becomes comparable with FS/FOBT and COL). FOBT cost-effectiveness is sensitive to detection rate, cost of care, cost of COL, and compliance with evaluation of +ve results.
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Clinical Practice Guidelines FOR TH
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© The Cancer Council Australia/Aus
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2.11 Conclusions...................
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11.2 High ligation ................
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17.4 Cost effectiveness of follow u
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Table 14.3 Pathological TNM staging
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Executive Summary • Colorectal Ca
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STRENGTH OF RECOMMENDATIONS 2,3 The
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Should red meat intake be altered t
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Chapter Recommendations 4 COMMUNICA
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Chapter 8 Recommendations How shoul
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Chapter Recommendations Should bowe
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Chapter Recommendations When should
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Chapter 17 Recommendations What pos
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Section I Early Colorectal Cancer
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Adenomatous polyps (adenomas) are b
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17. South Australian Cancer Registr
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CHAPTER 2 PRIMARY PREVENTION Studie
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Colorectal adenomas, especially adv
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vegetable (3.5 serves/1000 kcals) d
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mustard greens, swedes and turnips)
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for protection against Colorectal C
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Does selenium supplementation reduc
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the optimal duration of use, and ad
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References 1. Jass JR. Pathogenesis
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34. Kushi L, Giovannucci E. Dietary
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67. Fearon ER, Vogelstein B. A gene
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100. Il'yasova D, Hodgson ME, Marti
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133. Meyskens FL, Jr., Gerner EW. D
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CHAPTER 3 POPULATION SCREENING FOR
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studies also demonstrate that age i
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• symptoms • family medical his
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Should screening be recommended? Gu
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Box 3.3 Screening Pathway used in t
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References 1. Young GP, Levin B, Ro
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33. Alexander F, Weller D. Evaluati
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CHAPTER 4 COMMUNICATION WITH THE PA
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4.6 Coordination of care Treatment
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• assistance with and care of chi
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17. National Breast Cancer Centre,
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CHAPTER 5 THE PATIENT WITH SYMPTOMS
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considered (see 8.1.5). Double cont
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58 The prevention, early detection
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diagnoses prove difficult to confir
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What recommendations are there for
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References 1. Woolf CM. A genetic s
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34. Australian Health Technology Ad
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CHAPTER 7 HIGH-RISK FAMILIAL COLORE
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offered predictive genetic testing.
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endoscopically uncontrollable numbe
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mutation carriers. 52 There is also
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standard for consideration of MSI a
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added to transvaginal ultrasound. 8
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category 2, see Chapter 6) but may
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What screening is recommended for e
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References 1. Vasen HF, Griffioen G
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33. Giardiello FM, Hamilton SR, Kru
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international criteria for the dete
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96. Burt RW, Jass JR. Hyperplastic
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8.1.2 Sigmoidoscopy: rigid versus f
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For radiological imaging of the lar
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8.2.3 Staging for distant metastase
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The feelings and fears of the patie
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18. Rex DK, Cutler CS, Lemmel GT et
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52. Liu SK, Church JM, Lavery IC, F
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strong family history of Colorectal
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A screening interval of 4-6 years i
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BRAF mutation, particularly when mu
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18. Jass JR, Young J, Leggett BA. E
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52. Jass JR, Young J, Leggett BA. H
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What is the role of the stomal ther
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What happens if a blood transfusion
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References 1. Bass EM, Del Pino A,
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32. The National Working Party on t
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CHAPTER 11 ELECTIVE SURGERY FOR COL
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Total or subtotal colectomy may be
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11.12 Self-expanding metal stents f
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18. Gall FP, Tonak J, Altendorf A.
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etween 1993 and 1999. The local rec
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When should local excision of recta
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What factors influence sphincter pr
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It has been demonstrated that there
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References 1. Smith TJ, Hillner BE,
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36. Vernava AM, III, Moran M, Rothe
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69. Pimentel JM, Duarte A, Gregorio
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A clinical diagnosis of large bowel
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When should primary anastomosis be
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17. Deans GT, Krukowski ZH, Irwin S
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Table 14.1 Clinicopathological stag
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The ACPS system embodies the simpli
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14.4 Translation between staging sy
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16. Shepherd NA, Baxter KJ, Love SB
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CHAPTER 15 ADJUVANT CHEMOTHERAPY FO
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isk of death-favouring treatment (H
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improvement in survival at five yea
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There has been one trial 55 of intr
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References 1. National Institute of
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30. Zaniboni A, Labianca R, Marsoni
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57. Gastrointestinal Tumour Study G
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CHAPTER 16 ADJUVANT THERAPY FOR REC
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preoperative RT 45Gy over 5 weeks s
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This suggests that a policy of preo
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Mortality from non-cancer causes wa
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References 1. Fu KK. Interactions o
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29. Swedish Rectal Cancer Trial. Im
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Rates of intraluminal recurrence an
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Ultrasonographic screening Ultrason
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References 1. Nava HR, Pagana TJ. P
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Dates 1 January 1998 to June 2004 S
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Dates Update of 1999 document from
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Search terms MeSH terms were ‘col
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Chapter 20 — The role of systemic
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Search terms Colorectal Cancer, soc
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However, in some cases it was also
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Professor James St John Gastro ente
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Working party on emergency surgery
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Dr Russel Stitz Surgeon, Royal Bris
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14. Dr Michael Izard Radiation Onco
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Mrs Avis Mcphee Consumer (June 9 an
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DVT deep venous thrombosis ECOG Eur
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TNM tumour, node, metastasis stagin
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Chemotherapy The use of drugs (whic
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Malignant Cancerous Malignant cells
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with a specific disease might survi
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