The First Transatlantic Symposium on Colorectal Cancer Screening

 

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The First Transatlantic Symposium on Strategies to Increase Colorectal Cancer Screening was organized by the Felix Burda Foundation in cooperation with the International Digestive Cancer Alliance (IDCA), the Jay Monahan Center for Gastrointestinal Health (New York City), and the German Network Against Colorectal Cancer.

The keynote lecture was given by American television celebrity Katie Couric from CBS Evening News.

Katie Couric gives the keynote speech.

Katie Couric has been a prominent advocate for colorectal cancer (CRC) screening for 11 years, since her husband, Jay Monahan, died from CRC at the age of 42. She had learned about the disease while coordinating her husband’s treatment in the 9 months between the diagnosis of CRC and Jay Monohan’s death, and at that time she realized how little the public knew about CRC. It was for this reason that she co-founded the National Colorectal Cancer Research Alliance (NCCRA). Her efforts have two major goals: to find better prevention strategies for CRC and to raise money for research into treatment options and into public awareness about CRC screening. A few years ago, Katie Couric underwent a screening colonoscopy on national US television. This was followed by a 20 % boost in colonoscopy screening in the United States, often referred to as the “Couric effect”.

Christa Maar of the Felix Burda Foundation of Germany described the variety of work carried out by the Foundation since its inception in 2001.

Christa Maar of the Felix Burda Foundation

The Burda Foundation colorectal cancer awareness campaign in Germany includes media advertisements, a CRC awareness month, and cooperation with celebrities and media companies. German surveys show that in 2002, the number of screening colonoscopies increased by 25 % due to the awareness campaign. In the German population, general awareness about CRC screening tools increased from 24 % in 2002 to 72 % in 2008. However, according to Dr. Maar, to date only 3 % of the eligible population has participated in the German colonoscopy screening program.

David Lieberman from the University of Portland, Oregon lectured on screening in the general population. Dr. Lieberman reviewed recent CRC screening guidelines, and pointed out the differences between the recommendations. The United States Preventive Task Force now only recommends the new sensitive fecal occult blood tests (FOBTs), known as the fecal immunochemical tests (FITs), and DNA stool markers are recommended by only one of the guidelines. According to Dr. Lieberman, the unique opportunity to prevent CRC by detecting and removing adenomas makes preventive tools an attractive alternative to early-detection tools such as FOBT. Problems with imaging tests such as CT colonography include polyp thresholds, flat polyps, radiation exposure, extracolonic findings, and uncertainties about the optimal screening interval. Issues with colonoscopy that need to be resolved are its uncertain efficacy, quality of performance, missed lesions, and adverse events.

Hans F. A. Vasen from the University of Leiden, The Netherlands, gave a talk about the identification of individuals at high risk of CRC. Identification of these individuals and families is important to direct them to proper screening and surveillance.

Lawrence von Karsa from the International Agency for Research on Cancer (IARC), in Lyon, France described the current development of the first European Union (EU) guidelines for CRC screening which are to be published later this year. They will have an emphasis on the importance of a population-based approach to CRC screening, in line with EU policy for screening for other cancers.

Sidney Winawer from Memorial Sloan-Kettering Cancer Center in New York explained the new cascade guidelines for CRC screening. These guidelines include different screening recommendations for different resource levels, taking account of local contexts. If the appropriate resources are available, colonoscopy every 10 years is the recommended screening option. For the lowest resource level, the recommendation is annual FOBT screening.

Berndt Birkner, a gastroenterologist from the German Network Against Colorectal Cancer explained the German quality assurance system for screening colonoscopy. Quality markers include compliance and completion rates, adenoma detection rates, tumor stage, complication rates, patient satisfaction, and disinfection procedures. Failure to meet goals may result in withdrawal of the license to perform screening colonoscopies.

Current cost-effectiveness models identify CRC screening as a cost-effective screening method, compared with screening modalities for other diseases. However, a single best method of CRC screening cannot be defined at the present time, according to Michael Pignone from Chapel Hill, University of North Carolina.

M. BretthauerMD, PhD 

The New England Journal of Medicine

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