WEO CRC SC EWG 'FIT for Screening' Slide presentations 15 May 2015, Washington DC, USA 9. Yoko Saito, COLORECTAL CANCER (CRC) SCREENING IN Introduction IBARAKI PREFECTURE, JAPAN. • In Japan, CRC screening has been a national policy for both sexes over 40 THE COMPARISON WITH MALES AND FEMALES years old since 1992. USING A TWO-DAY SAMPLING METHOD • A two days sampling method through fecal immunochemical blood test (FIT) has been widely accepted for CRC annual screening program. • In Ibaraki prefecture, population-based screening program from 2007 to Y. Saito*1,2, H. Suzuki3, I. Hyodo2,3, M. Kaneko4 2012, (FIT) participants over 40 years of age were screened with 2 samples of stool measured by the OC-SENSOR (Eiken, Japan) with a cut-off 1)Ibarakiken Medical Center, Mito, value of 100ng/mL(20μg Hb/g stool). 2)Sub-committee for Colorectal Cancer, Ibaraki Prefectural Council for • The government aims the participation rate will be 40%. Controlling and Preventing Life Style-related Disease, • Until 2005, the participation rate was only 10%. 3)Department of Gastroenterology, University of , Tsukuba, • The current participation rate is about 35%. 4)Research committee of mass screening for gastroenterological cancer in Ibaraki Health Service Association, Mito, Japan 1 2

Goal of the study AIMS and METHOD • Cancer detection rates and PPV for FIT are lower for females than for males. • The purpose of this study is to evaluate FIT positivity, cancer detection rates with intra-mucosal cancers, positive • Concern that the test was failing to find CRC in females and some proposed that cut off should be changed in females. predictive values(PPV) with intra-mucosal cancers, invasive cancer detection rates, invasive cancer PPV, and Dukes classification for males and females. • Is the performance of FIT in females a reflection of less cancer or the characteristics of the test? • The data were assessed based on the χ2 test. • The difference between two groups was judged to be • Should a cut-off value for determining a positive FIT be changed statistically significant when p-value was less than 0.05. between males and females for more efficient CRC screening?

3 4 WEO CRC SC EWG 'FIT for Screening' Slide presentations 15 May 2015, Washington DC, USA 9. Yoko Saito, Japan Population-based CRC Screening System in Ibaraki Prefecture THE LOCATION OF IBARAKI PREFECTURE IN JAPAN Participants Fukushima 2 sampling bottles

Undergone FIT results Municipalities work-up exam. rate: 74% Ibaraki, Mito Center: Ibaraki Health Service Prefecture Association (FIT) Population:3.0 million results Area: 6,000km2 Capital: Mito Hospitals or Clinics (work-up exam.) 5 6

The number of participants by gender and age for 5 years The FIT positivity(%) by age, gender and method (2007-2012) % 100,000 12.00 ☆ The age group for 50-74-year-old ☆：p=0.0000 10.00 ☆ 80,000 ☆ ☆ Male Female 8.00 ☆ 60,000 72.0% 76.0% ☆ ☆ ☆ 6.00 ☆ ☆ (215,469/299,275)(318,906/419,804) ☆ 40,000 ☆ 4.00 20,000 2.00 0 0.00 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75- 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75- Male Female 7 Male(2-day) Female(2-day) Male(1-day) Female(1-day)8 WEO CRC SC EWG 'FIT for Screening' Slide presentations 15 May 2015, Washington DC, USA 9. Yoko Saito, Japan Cancer Detection rates(%) by age, gender and PPV(%) by age, gender and method % method ☆ 0.350 4.50 *:p＜0.05 *** ☆：p=0.0000 4.00 :p＜0.01 ** 0.300 ☆ ☆ ** *** ☆ ☆ 3.50 ***:p＜0.005 ☆ :p＜0.001 * * **** 0.250 ☆ p=0.0003 3.00 **** 0.200 2.50 0.150 2.00 0.100 1.50 1.00 0.050 0.50 0.000 0.00 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75- 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-

Male(2-day) Female(2-day) Male(1-day) Female(1-day)9 Male(2-day) Female(2-day) Male(1-day) Female(1-day)10

Invasive Cancer Detection rates(%) by age, gender and Invasive Cancer PPV(%) by age, gender and method

method % % 0.2000 *:p＜0.05 2.500 **:p＜0.01 **** ***:p＜0.005 0.1500 ****:p＜0.001 **** **** 2.000 *** *** ＜ 1.500 *:p 0.05 *** * 0.1000 * 1.000

0.0500 * 0.500 0.000 0.0000 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75- 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75- Male(2-day) Female(2-day) Male(1-day) Female(1-day) Male(2-day) Female(2-day) Male(1-day) Female(1-day)11 12 WEO CRC SC EWG 'FIT for Screening' Slide presentations 15 May 2015, Washington DC, USA 9. Yoko Saito, Japan Dukes classification by gender CONCLUSIONS

Dukes Male % Female % • The positivity was lower in females than in males. A intra mucosal CRC 273 50.5 p<0.05 178 43.6 • The incidence of total cancers was lower in females > 60 years than in males > 60 years of age. Invasive CRC 266 49.2 p<0.05 230 56.4 • The incidence of invasive cancers was lower in females than in males at the A 139 119 age group of sixties. B 61 46 • The PPV for all cancers was lower in females than in males at the age group of sixties. C 60 50 • The PPV for invasive cancers was the same between females and males. D 6 p<0.05 15 • The proportion of invasive cancers was higher in females than in males. unknown 2 0 • Therefore, a cut-off value should not be changed between males and females. total 541 408 13 14

Thank you.

Kobuntei with plum blossoms in Mito city 15