| Invited Lecture (JSGCS) |
| Thu. November 1st 15:50 - 16:30 Room 7: Portopia Hotel South Wing Ohwada C |
| Colorectal cancer screening - Achievements, challenges and opportunities | |||
| Stephen P. Halloran | |||
| Professor Emeritus, University of Surrey | |||
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| As diet and lifestyles change, the global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. 95% of those with CRC might not need to die if detected at an early stage. Bleeding remaining the hallmark of CRC and exploiting it as an early disease marker has taken us on a remarkable journey. The journey commenced with it providing a visual marker in a good medical history; it progressed to primitive laboratory detection using guaiac, a tree resin extract, we then exploited the exquisite analytical sensitivity and specificity of immunoassay with their 'Faecal Immunochemical Test' (FIT). Now we see FIT combining with a new generation of biomarkers and utilising artificial neural networks and machine learning in an era of risk algorithms. Japan was the birthplace of FIT but for it to reach the whole population in a systematic and organised manner it found its home in Europe. Initially in Italy but then embraced by the European Union it was enshrined in the 2010 European guidelines for quality assurance in colorectal cancer screening and diagnosis. Whilst the UK developed the population-based screening environment, the Netherlands put FIT under the 'microscope'; How many FIT measurements? How frequent? What FIT threshold and is screening cost-effective? The 2014/5 FIT pilot in England illustrated FITs ability to reach a socioeconomically diverse population and the Netherlands that participation rates of 73% are possible. So, what are the 2018 challenges and opportunities? With poor FIT participation and low uptake of colonoscopy endoscopy resources prove adequate but in the new era of high uptake and highly sensitive FIT thresholds we need to find more high-quality colonoscopy. We need to apply FIT in developing countries where sample refrigeration is not an option and sample instability is a challenge. We need FIT to succeed at very high sensitive thresholds where CRC ‘rule-out’ criteria are required to minimise colonoscopy in surveillance and primary care referrals. What future opportunities for FIT? It needs to find its niche within a personalised risk algorithm which incorporates age, sex, screening, medical and family history, and personal lifestyle risk markers. CRC screening has come a long way but with FIT it has still further to travel! |
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