2005 Oncology Services Annual Report

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2005Oncology ServicesAnnual Report
SAMC Colorectal Cancer Awareness, Prevention and
Early Detection Efforts

• William Podolsky, MD, Ph.D, FACRO C. Dawn
  DeLozier, Ph.D., Medical GenetistEllen Malek,
  CTR
• Saint Agnes Cancer Program1303 East Herndon
  AvenueFresno, CA 93720559 450-3000www.samc.com
  

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1994-2004 SAMC Colorectal Cancer 11 Year Review
Incidence by Age and TNM Stage Group
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Source SAMC Cancer Registry
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Source SAMC Cancer Registry
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Source SAMC Cancer Registry
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Comparison Data/Benchmark
Sources SAMC Cancer Registry California Cancer
Facts Figures, 2006
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2000-2004 SAMC Colorectal Cancer Site of
Diagnosis Flexible Sigmoidoscopy versus
Colonoscopy

• Sites usually reached by flexible sigmoidoscopy,
  Rectum, Rectosigmoid, Sigmoid, Descending colon,
  Splenic Flexure, Overlapping and Colon, NOS
  equaled approximately 58.
• The remainder of the colon including Transverse
  colon, Hepatic Flexure, Ascending colon, Cecum,
  equaled approximately 42.
• Why go half way when 42 of the observed colon
  cancers were detected in the right colon?
• A colonoscopy offers the opportunity to
  visualize, sample and/or remove lesions while
  also providing a complete examination through to
  the right colon, Cecum.
• This point may be more important for Women. When
  looking at colorectal site by sex we observed
  remarkable female predominance for occurrences in
  the right colon (49). The specific sub-site was
  Cecum (22).
• The specific sub-site for Men was Rectum (26).
• A twenty year period 1985-2004 by five year
  intervals demonstrated left to right colon shift,
  for both sexes but clearly demonstrated the
  female predominance of diagnosis in the right
  colon.
• Comparison data was then requested from Kaweah
  Delta District Hospital.

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Comparison Saint Agnes Medical Center Kaweah
Delta Health Care District 1985-2004
Observational Data, Right, Left Colon Rectum
Cancer, by Sex
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Comparison SAMC KDHCD1985-2004 Observational
Data, Right, Left Colon Rectum Cancer, by Sex

• Definitions
• Right Colon included Transverse Colon, Hepatic
  Flexure, Ascending Colon, Appendix and Cecum.
• Left Colon included Splenic Flexure, Descending
  Colon, Sigmoid Colon, Colon of Overlapping and
  NOS sites, and Rectosigmoid Junction.
• Rectum
• Note-Right/Left Colon assignments were
  determined based on sites that can be reached by
  sigmoidoscopy. Therefore, Splenic Flexure was
  included in Left Colon.

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Comparison SAMC KDHCD1985-2004 Observational
Data, Right, Left Colon Rectum Cancer, by Sex

• SAMC and KDHCD data appear to confirm the
  observation that there has been a decrease in
  Left Colon cancer incidence and an increase in
  the diagnosis of Right Colon cancers. This trend
  appeared to begin during 1990-1994. 
• Both Sexes showed the decrease incidence of Left
  Colon cancer.
• The diagnosis of Right Colon cancer appeared to
  be more prominent in Females, indicating a 9.5
  (KDHCD) to 12 (SAMC) higher rate of occurrence
  compared to Men during the 20 year period.
• The Specific Sub-site for Females, as calculated
  over the 20 year period from both facilities, was
  Cecum (SAMC 21, KDHCD 22.5). Data from both
  facilities indicated that a shift occurred from
  the Specific Sub-site Sigmoid colon to Cecum.
  This occurrence was observed earlier at KDHCD
  beginning during 1990-1994. SAMC data reflected
  that this trend began in 1995-1999.
• The Specific Sub-site for Men, as calculated over
  the 20 year period from both facilities, was
  Rectum. KDHCD data indicated that during the 5
  year interval 1985-1989 the Specific Sub-site was
  Sigmoid colon/Rectum, 1990-1994 Sigmoid colon
  and, interestingly, during 1995-1999 the Specific
  Sub-site was Cecum/Rectum and 2000-2004 it was
  Rectum.
• Men appeared to have a 4.5 (KDHCD) to 6 (SAMC)
  higher incidence of Left Colon cancer than Women.
  
• KDHCD data noted Male incidence of Right colon
  cancer became higher than the incidence of Left
  Colon cancer during the period 1995-1999. During
  2000-2004 there was a 1 percentage point
  difference between the Right/Left Colon
  incidence. SAMC data indicated that Left Colon
  cancer rate remained higher but moved to only a
  difference of 4.
• Both facilities noted an increase incidence of
  Rectal cancer in Men over the observed period.
  The incidence of Rectal cancer for Men was found
  to be 5-6 higher compared to that of Women.

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When Considering Your Recommendations for Routine
Colon Cancer Screening Is a change warranted?

• Are increased Awareness and Prevention efforts
  responsible for the observed decrease incidence
  of Left Colon cancers?
• Is the decreased incidence of Left Colon cancers
  reflective of routine screening Sigmoidoscopy
  recommendations and indicative of better
  detection and treatment of pre-malignant colon
  polyps?
• Would the recommendation for routine screening
  Colonoscopy translate into prevention of more
  colon cancers, not just Left Colon cancers?
• Would YOU consider offering your patients Age 50
  Older a Colon Cancer Prevention Kit at their
  next office visit?

American Cancer Society educational tool.
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More Proof ?
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Right, Left Colon and Rectum Cancer, 1988-2003
in Fresno County, by Sex

• Data from the California Cancer Registry was
  generated by Dr. Paul Mills, Epidemiologist.
• The previous criteria for Right/Left Colon and
  Rectum was utilized.
• The data showed decreased incidence in Left-sided
  Colon cancer for both sexes especially in the
  last 5 years or so.

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SAMC 2000-2004 Colorectal Cancer N871
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SAMC 2000-2004 Colorectal Cancer Personal
History
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SAMC 2000-2004 Colorectal Cancer Assessment of
Risk Factors Race/Ethnicity
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SAMC 2000-2004 Colorectal Cancer Assessment of
Risk Factors History of Smoking
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SAMC 2000-2004 Colorectal Cancer Assessment of
Risk Factors History of Alcohol Use
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SAMC 2004 (only) Colorectal Cancer Assessment
of Risk Factors Obesity
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SAMC 2000-2004 Colorectal Cancer Family
History of Cancer
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Comparison 2000-2004 SAMC Colorectal Cancer
Family History of Colorectal Cancer to Lifetime
Risk of Colorectal Cancer
Source SAMC Cancer Registry
Source SAMC Cancer Registry
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SAMC 2000-2004 Colorectal Cancer Multiple
Primary Cases (N249/28.5)
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SAMC 2000-2004 Colorectal Cancer Diagnosis of
Colorectal Cancer Age 50 Under (N55/6)
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