Screening en Cáncer 2009

Transcripción

1 Screening en Cáncer 2009 Oncólogo Médico Trends in Five-year Relative Survival (%)* Rates, US, Site !! All sites !! Breast (female) !! Colon !! Leukemia !! Lung and bronchus !! Melanoma !! Non-Hodgkin lymphoma !! Ovary !! Pancreas 2 3 5!! Prostate !! Rectum !! Urinary bladder *5-year relative survival rates based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute,

2 2009 Estimated US Cancer Cases* Men 745,180 Women 692,000 Prostate 25% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Non-Hodgkin 5% lymphoma Melanoma of skin 5% Kidney & renal pelvis 4% Oral cavity 3% Leukemia 3% Pancreas 3% All Other Sites 20% 26% Breast 14% Lung & bronchus 10% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Thyroid 4% Melanoma of skin 3% Ovary 3% Kidney & renal pelvis 3% Leukemia 23% All Other Sites *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, Estimated US Cancer Deaths* Lung & bronchus 31% Prostate 10% Colon & rectum 8% Pancreas 6% Liver & intrahepatic 4% bile duct Leukemia 4% Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 24% Men 294,120 Women 26% Lung & bronchus 271,530 15% Breast 9% Colon & rectum 6% Pancreas 6% Ovary 3% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites ONS=Other nervous system. Source: American Cancer Society,

3 Lifetime Probability of Developing Cancer, Men, * Site Risk All sites 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 18 Urinary bladder 1 in 27 Melanoma 1 in 41 Non-Hodgkin lymphoma 1 in 46 Kidney 1 in 59 Leukemia 1 in 67 Oral Cavity 1 in 71 Stomach 1 in 88 * For those free of cancer at beginning of age interval. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version Statistical Research and Applications Branch, NCI, Lifetime Probability of Developing Cancer, Women, US, * Site Risk All sites 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 19 Uterine corpus 1 in 41 Non-Hodgkin lymphoma 1 in 53 Melanoma 1 in 61 Ovary 1 in 71 Pancreas 1 in 76 Urinary bladder 1 in 85 Uterine cervix 1 in 142 * For those free of cancer at beginning of age interval. All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Includes invasive and in situ cancer cases Source: DevCan: Probability of Developing or Dying of Cancer Software, Version Statistical Research and Applications Branch, NCI,

4 Cancer Death Rates*, for Men, US, Rate Per 100,000 Lung & bronchus Stomach Prostate 40 Colon & rectum 20 Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, Cancer Death Rates*, for Women, US, Rate Per 100, Uterus Breast Lung & bronchus 20 Stomach Colon & rectum Ovary 0 Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention,

5 Cancer Incidence Rates* for Women, Rate Per 100, Breast 100 Colon and rectum Lung & bronchus 50 Uterine Corpus Ovary Non-Hodgkin lymphoma *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2006.!"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++)$+('+.,2)"345#()+'

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10 !"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++)$+('+.,2)"345#()+' Trends in Five-year Relative Survival (%)* Rates, US, Site !! All sites !! Breast (female) !! Colon !! Leukemia !! Lung and bronchus !! Melanoma !! Non-Hodgkin lymphoma !! Ovary !! Pancreas 2 3 5!! Prostate !! Rectum !! Urinary bladder *5-year relative survival rates based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute,

11 Lifetime Probability of Developing Cancer, Women, US, * Site Risk All sites 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 19 Uterine corpus 1 in 41 Non-Hodgkin lymphoma 1 in 53 Melanoma 1 in 61 Ovary 1 in 71 Pancreas 1 in 76 Urinary bladder 1 in 85 Uterine cervix 1 in 142 * For those free of cancer at beginning of age interval. All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Includes invasive and in situ cancer cases Source: DevCan: Probability of Developing or Dying of Cancer Software, Version Statistical Research and Applications Branch, NCI, <=<>?@=AB=+!! ##!! ## 11

12 Adherencia a la mamografía, USA, All women 40 and older 50 Prevalence (%) Women with less than a high school education Women with no health insurance Year *A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavior Risk Factor Surveillance System CD-ROM ( , , 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005,

13 Chances of breast-cancer - related outcomes among 1000 women who undergo annual mammography for 10 years!! 8'#.&)2/+/,#+&#2':2+&':2%#0%G%U#7Y#%#?Y#%T/,"#!!!#D&>#*&,U#.%1.%:2B'#O#D2,-%12>%:2B'"#!! M/#&,#,-,323-3/#F9"# 13

14 !! Z'2:2%)#%#7Y#%T/,#:%+%#<#%T/,#L%,3%#?Y#%T/,"#!! M2'A['#&',%5/#L%#+&*/,3)%+/#,-#&=:%:2%"#!! H&%12>%)#.)&D2/#%#F9"# Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society 2009!! Mamografía anual desde los 40 años.!! Examen clínico mamario cada 3 años entre los 20 y 30 años, anual sobre los 40 años.!! Reportar cualquier anormalidad en forma precoz. Autoexamen mamario es una opción desde los 20 años.!! Considerar la resonancia en mujeres de alto riesgo menores de 40 años 14

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16 Trends in Five-year Relative Survival (%)* Rates, US, Site !! All sites !! Breast (female) !! Colon !! Leukemia !! Lung and bronchus !! Melanoma !! Non-Hodgkin lymphoma !! Ovary !! Pancreas 2 3 5!! Prostate !! Rectum !! Urinary bladder *5-year relative survival rates based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute,

17 Sobrevida según etapificación Stage I II IIIa IIIb IV CPYear Survival 60-80% 40-50% 25-30% 5-10% <1% C&#-).#0(0;D'+!! \'%#+&#1%,#.)2':2.%1&,#:%-,%,#+&#*-&)3&#./)#:6':&)#&'# NL21&"#!! F/)3%12+%+U##!7#./)#!YY"YYY#5#&'#%-*&'3/"#!! 8'3)&#CC#5#]C#%T/,"#!! ^/*0)&_*-G&)#`#<_!# 17

18 !"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++ )$+('+.,2)"345#()+'

19 B$%#-)$%#'+ Consumo de tabaco Incidencia por hbs. No fumadores cigarrillos/día 60 > 20 cigarrillos/día 217 Garfinkel L.,

20 /,0,12$%34(5(32"+6"("'()4#64+"%(0+$67'$#4%(89(,:4%()"( %".2$3$"'64;( :);,#.#)$/0+-)+E8+'60*+F+G,.'-0")*+H+)I+G,.'-0")*+H+$0+ G,.'-0")*+ a/114#e&3/#&3#%1# b)232,l#f&+#c"#7yy?d#<7eu#!c!v# 39 Cumulative risk at UK male 1990 rates BMJ 2000; 321:323!

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22 March 13, 2007 ESSAY How Two Studies on Cancer Screening Led to Two Results By H. GILBERT WELCH, STEVEN WOLOSHIN and LISA M. SCHWARTZ 22

23 Original Article The International Early Lung Cancer Action Program Investigators Survival of Patients with Stage I Lung Cancer Detected on CT Screening N Engl J Med Volume 355(17): October 26, 2006 Resumen!! 30,000 participantes fueron enrolados en un programa de screening para cáncer pulmonar basado en ct helicoidal.!! En 412 pctes se detectó un ca pulmonar etapa I su sobrevida a 10 años fue de un 90%. 23

24 I-ELCAP Participants, According to the Smoking Status, Exposure to Secondhand Smoke, and Occupational Exposures The International Early Lung Cancer Action Program Investigators. N Engl J Med 2006;355: Frequency Distribution of Lung-Cancer Diagnoses on Baseline and Annual CT Screening, According to Age and Median Pack-Years of Cigarette Smoking The International Early Lung Cancer Action Program Investigators. N Engl J Med 2006;355:

25 Kaplan-Meier Survival Curves for 484 Participants with Lung Cancer and 302 Participants with Clinical Stage I Cancer Resected within 1 Month after Diagnosis The International Early Lung Cancer Action Program Investigators. N Engl J Med 2006;355: Conclusion!! El screening con Tac helicoidal anual puede detectar un cáncer pulmonar en etapas curativas. 25

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29 !"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++ )$+('+.,2)"345#()+' Cancer Death Rates*, for Women, US, Rate Per 100, Uterus Breast Lung & bronchus 20 Stomach Colon & rectum Ovary 0 Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention,

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31 Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, All women 18 and older Prevalence (%) Women with no health insurance Women with less than a high school education Year * A Pap test within the past three years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for women 25 and older. Source: Behavior Risk Factor Surveillance System CD-ROM ( , , 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007.!! N/1./,:/.;%U##!! N/*.1&*&'3%)2/"#!! N&)D2:/A)%(;%U#!! Z*6A&'&,#(/3/A)6=:%,"#!! a&3&)*2'%:2b'#+&#le^u#!! 8'#EKE#%'/)*%1#'/#+A"#a&3&)*2'%:2B'#aMK"# 31

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33 Trends in Five-year Relative Survival (%)* Rates, US, Site !! All sites !! Breast (female) !! Colon !! Leukemia !! Lung and bronchus !! Melanoma !! Non-Hodgkin lymphoma !! Ovary !! Pancreas 2 3 5!! Prostate !! Rectum !! Urinary bladder *5-year relative survival rates based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute, 2007.!"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++ )$+('+.,2)"345#()+'

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37 Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, Prevalence (%) Total Less than a high school education No health insurance *A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM ( , 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.!! b-&'#:%'+2+%3/#.%)%#,:)&&'2'a"#!! F@3/+/,U##!! I%:3/#)&:3%1"#!! EQK#!! 8:/A)%(;%# 37

38 Trends in Five-year Relative Survival (%)* Rates, US, Site !! All sites !! Breast (female) !! Colon !! Leukemia !! Lung and bronchus !! Melanoma !! Non-Hodgkin lymphoma !! Ovary !! Pancreas 2 3 5!! Prostate !! Rectum !! Urinary bladder *5-year relative survival rates based on follow up of patients through Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control and Population Sciences, National Cancer Institute,

39 !! I%:3/#)&:3%1"#!! $%#*%5/);%#+&#1/,#:6':&)&,#.%1.%01&,#'/#,/'#:6':&)&,# 2'2:2%1&,"#!! EQKU#!! K13%#,&',20212+%+"#N/,3/#%:&.3%01&"#!! 8,.&:2=:2+%+#2*.&)(&:3%"##!! N/'+-:&#%#&9:&,/#+&#+2%A'B,32:/"# Original Article Mortality Results from a Randomized Prostate- Cancer Screening Trial Gerald L. Andriole, M.D., E. David Crawford, M.D., Robert L. Grubb, III, M.D., Saundra S. Buys, M.D., David Chia, Ph.D., Timothy R. Church, Ph.D., Mona N. Fouad, M.D., Edward P. Gelmann, M.D., Paul A. Kvale, M.D., Douglas J. Reding, M.D., Joel L. Weissfeld, M.D., Lance A. Yokochi, M.D., Barbara O'Brien, M.P.H., Jonathan D. Clapp, B.S., Joshua M. Rathmell, M.S., Thomas L. Riley, B.S., Richard B. Hayes, Ph.D., Barnett S. Kramer, M.D., Grant Izmirlian, Ph.D., Anthony B. Miller, M.B., Paul F. Pinsky, Ph.D., Philip C. Prorok, Ph.D., John K. Gohagan, Ph.D., Christine D. Berg, M.D., for the PLCO Project Team N Engl J Med Volume 360(13): March 26,

40 Study Overview!! 77,000 hombres.!! Efecto del screning con PSA y tacto rectal en la mortalidad por cáncer de próstata vs grupo control!!!! Seguimiento de 7 años. Characteristics of the Subjects at Baseline Andriole GL et al. N Engl J Med 2009;360:

41 Death Rates from Prostate Cancer per 10,000 Person-Years at 10 Years Andriole GL et al. N Engl J Med 2009;360: Causes of Death at 10-Year Follow-up Andriole GL et al. N Engl J Med 2009;360:

42 Conclusion!! Despues de 7 años de seguimiento la tasa de mortalidad del cáncer de próstata fue muy baja y no difiere significativamente del grupo en observación. Original Article Screening and Prostate-Cancer Mortality in a Randomized European Study Fritz H. Schröder, M.D., Jonas Hugosson, M.D., Monique J. Roobol, Ph.D., Teuvo L.J. Tammela, M.D., Stefano Ciatto, M.D., Vera Nelen, M.D., Maciej Kwiatkowski, M.D., Marcos Lujan, M.D., Hans Lilja, M.D., Marco Zappa, Ph.D., Louis J. Denis, M.D., Franz Recker, M.D., Antonio Berenguer, M.D., Liisa Määttänen, Ph.D., Chris H. Bangma, M.D., Gunnar Aus, M.D., Arnauld Villers, M.D., Xavier Rebillard, M.D., Theodorus van der Kwast, M.D., Bert G. Blijenberg, Ph.D., Sue M. Moss, Ph.D., Harry J. de Koning, M.D., Anssi Auvinen, M.D., for the ERSPC Investigators N Engl J Med Volume 360(13): March 26,

43 Study Overview!! Se evalúa el efecto de la medición del PSA en la reducción de la tasa de mortalidad por cáncer de próstata en más de 162,000 hombres entre 55 y 69 años en 7 países de europa. Enrollment and Outcomes, According to Age Group at Randomization Schroder FH et al. N Engl J Med 2009;360:

44 Cumulative Risk of Death from Prostate Cancer Schroder FH et al. N Engl J Med 2009;360: Death from Prostate Cancer, According to the Age at Randomization Schroder FH et al. N Engl J Med 2009;360:

45 Conclusion!! Screening con PSA disminuye el riesgo de muerte por cáncer de próstata en un 20%, pero asociado con un riesgo de sobrediagnóstico. 45

46 !! KNQU#^/*0)&,#,/0)&#CY#%T/,"#K'-%1*&'3&#)&%12>%)# EQK#5#IH"#!! K*&)2:%'#-)/1/A2:%1#%,/:2%32/'U#Q2*21%)# )&:/*&'+%:2B'#%#L/*0)&,#,/0)&#CY#%T/,#:/'# &,.&)%'>%#+&#D2+%#*%5/)#!Y#%T/,"#!! n3)%,#%,/:2%:2/'&,#'/#)&:/*2&'+%#&'#(/)*%#,2,3&*632:%u#!! M/#&92,3&'#&,3-+2/,#:/'3)/1%+/,"#!! a&,%))/11/#1&'3/"#n/'+-:3%#&9.&:3%'3&"##!! n0,&)d%:2b'#&'#.%:2&'3&,#*%5/)&,"#!! Q&#+&0&#+2,:-32)#:/'#&1#.%:2&'3&#1/,#)2&,A/,#5# 0&'&=:2/,#+&1#,:)&&'2'A"# 46

47 !! 8.2+&*2/1/A;%"#!! M/#&,3-+2/,#)%'+/*2>%+/,"#!! Z'%0%#5#:/1,#fc%.B'#!VVVgU#8,3-+2/#:/L/)3&"#a&*/,3)B# +2,*2'-:2B'#&'#7q#1%#*/)3%12+%+"#!! H2&:i&'#b#&3#%1U#Q-G&3/,#,/*&32+/,#%#8aK#:%+%#?4C#%T/,# f'`?yyyg"#m/#l-0/#+2(&)&':2%#&'#1%#*/)3%12+%+"#hh#%#!y# %T/,U#!4Y!"#!"#$%#&'()*+%',*'*+-)+.,)"/)*+&0"+%1$%)"++)$+('+.,2)"345#()+'

48 Cancer Death Rates*, for Women, US, Rate Per 100, Uterus Breast Lung & bronchus 20 Stomach Colon & rectum Ovary 0 Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention,

49 !! H&:/*&'+%:2B'U#!! E/01%:2B'#+&#)2&,A/#`#S%,3)232,#%3)B=:%4#%'&*2%#.&)'2:2/,%4#A%,3)&:3/*;%#.%):2%14#%+&'/*%,# &,./)6+2:/,4#./12./,2,#(%*212%)4#&3'2%#2'*2A)%'3&"# 49

50 Muchas Gracias 50