A Registry

1
A Registrys Contribution to the UK Colorectal
Cancer Screening Programme

• Vichi Madurasinghe, Gill Lawrence, Cheryl
  Livings,
• Catherine Thomson
• catherine.thomson_at_wmciu.nhs.uk
• UKACR NCR Conference, Amsterdam
• 19-10-2006

2
Colorectal cancer incidence and mortality
1979-2004, GB
35,000 new cases in UK each year 5-yr survival
lt50 2nd biggest cancer killer in UK
3
Colorectal cancer age profile 2002 GB
4
Colorectal cancer screening UK

• Randomised trial faecal occult blood testing
  (FOBT), Nottingham 1981-1995, ages 45-74
• Randomised trial one-off flexible sigmoidoscopy,
  multi-centre 1996-1999, ages 55-64
• Pilot of national screening programmes FOBT, 4
  PCTs in West Midlands 3 areas in Scotland, 1st
  (prevalence) round 2000-2002 2nd (incidence)
  round 2003-2004, ages 50-69
• National bowel cancer screening programme in
  England FOBT introduced 2006, ages 60-69
• (Scotland from 2007, but ages 50-74)

5
WMCIU involvement

• Provided data to support follow-up and monitoring
  of the colorectal cancer screening studies
• Flexible Sigmoidoscopy Trial
• FOBT pilots
• Halo study
• Halo study to investigate suggestion that
  introduction of screening programme and
  associated publicity may have a knock-on
  beneficial effect in non-screening group

6
WMCIU involvement

• Identification of patients diagnosed with
  colorectal cancer in the study populations, via
  matching techniques
• to allow interval cancer rates to be calculated
  for screening pilots
• to provide comparison of cancer rates and stage
  distribution in control and intervention arms in
  flexi-sig trial
• providing pathology data such as node status,
  stage, date of diagnosis, as well as date and
  cause of death
• Provision and analysis of incidence and mortality
  data to examine the effects of the pilots on
  trends/stage distributions/age-specific effects

7
Numbers of cases identified by WMCIU matching
results
Based on 1st round of screening, population
invited 09/2000 - 06/2002 With only cancers
diagnosed 09/2000 - 12/2002 of interest Number
invited includes those screened or in
intervention arm, plus those invited for
screening or as controls in the trial
8
Halo study

• Investigate suggestion that introduction of
  screening programme and associated publicity may
  have a knock-on beneficial effect in
  non-screening group
• increased colonoscopy activity in non-pilot
  groups also
• increased awareness of symptoms in all groups
• So does screening influence both target and
  non-target populations?
• Examine Dukes stage distributions
• Used stage A or B as outcome
• Study examine the impact of the FOBT screening
  pilot on symptomatic colorectal cancers diagnosed
  
• in West Midlands excluding pilot area

9
Stage distribution West Mids 1996-1999 and
2000-2004, ages 50 - 69
Excluding DCO cases cases having neo-adjuvant
trt so invalid stage at diagnosis Again a
beneficial effect of screening seen in Pilot area
when both rounds included (5 change A or B), and
especially when focus on Stage A (8 change)
10
Change in Stage A or B West Mids before to
after pilot, ages 50 - 69
Excluding DCO cases cases having neo-adjuvant
trt so invalid stage at diagnosis Not big stage
shift for males for A and B together (only 2)
larger effect for females (9)
11
Incidence 1980-2004, West Mids,males aged 50-69
Prevalent peak seen for 2000-2002 in pilot area
as anticipated in Halo study but not in Rest of
West Midlands
12
Incidence 1980-2004, West Mids,females aged
50-69
Pattern for women not as expected - reason for
this not yet understood - possibly because of
polyps (5 of pilot cases vs 2 of non-pilot
cases not included in Dukes staging )
13
What next?

• Will exclude the Flexi-sig postcode areas from
  the rest groups
• Will look at
• numbers of polyps/adenomas identified
• trends in incidence/mortality - all
  ages/50-69/70
• Dukes stage and polyp distributions over time
• poisson regression modelling of rates - eg age,
  sex, deprivation, ethnicity
• Continue collaborative project with Scotland to
  compare in more detail the epidemiological
  changes due to the two screening programmes
  pilots

14
Thanks to

• Vichi Madurasinghe, Gill Lawrence, Cheryl
  Livings,
• Lou Gonsalves, Stacey Croft, Mike Porter
• at WMCIU and Vicky Hammersley, Edinburgh
  University as they have done all the work on
  these studies so far!