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Table of Contents
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
136 pages (1,447
KB) in PDF format
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