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( / 0DTimes New Roman PIn@^UVҾrkܯ<1m7w,zLqߞYx>y[Xn;V;=//. zEMYǡYch(EAo¦,9ǣP7Z׏e Iؔ#ht&h7lo$@A>=dAo$b|ǥ'' zLz681k哅qy,,90,lo<::eN(|QB|7) Fda{#E$d Mu|EIguz$d@''뗫|@8}W-Tސ== >Y: oIDATYлDς) Fn} ''{ix)$';FN$dAoe$dGudG!,S༔츾c<Ɇ No>YG&>Y7)q?e/3dUܟZK^[,AF?4GBPsdAo;Tl6,F5e1ZgO+Nsda{ךތ>Y7Os++y}\,V ||6O6} 9zT4@@Uz κwxL>]]("U10r$əgT'{ʊN!zG*~JTqcϓ=OW C,UFF٧,ǎiUR/V '<ѓ~qct`NIz{^\sv';v(;ӡR ' _'ԺGتn޾u$Up$Z(2^zoĔq}lw*w+xN{۠Ǥ7w(K9yv[)ߘpmf+wFRD%Mb/y(8ޣBګcAo = Ad~ (F܏(E0j.\Kąy0s΍ w:R_Q=@8M8HOb=zrW`k:Go#nАX1YU"8y[No gqޗwx]O "TιSHmlSc>Jb '~{Now4SJpG/=ٱjЏ/S@;*t'(V =$vZ@YI b1g t~{[]z;6Hb:;Bo}8V̜͉Hu/{P4 ۳^R3'.VIuXw:o(O9NW(i$#IDATIPU5әU/:2OH\e^DtqjCyKOqpBxtz{<Ӟyguc]|dNoitٕ"ttUyFZw<|_*4zʳ'W rco)%M-N's zp9߳ʝn_!*uՅ\Gv xIQVtb;kh@`?cXp\Ƌ=ᱷRZ1`.V[# *+Ri"ʕ=#s>8@sz d$-tłtݵI=41]֣b؞gCo/vI^bw ”{s쌽C##SfgҗeSoqg?DTq#uK'eqg\R8k`Y#c5kq ޢ=5l89x =OQ:Z\[[b] ='-et2m. s: o Jzcax۞iq;ϼ4~=n~[@0~j~֞g=?FW?- U`Z,l<)#z']1k{gVM8󴡷l?? uҕC!,Z:YIW3:qA']oqs/x=ǖCs4G G{wjvs7g=&zN>k<; xgvuǃHnL LRm-=9 N).ΓǦMeޒC{|{gQ({p 6N\,/y" = BSLQc5Ыɠa);^QZĩ+ƹmSID0L1'?o *ESk9rVSLl]mc{~xz}Y{xyzz{}>=?`"DIDAT+l:ieu wE{Ntjǚieޟ~МVv̽vUzb7`sZ(ѫDҾOŨ(gEf_QsEK쿢:ie?gtoS@ie͵tGgcMǪ*\u_cZs9|#T>'Sg2걪 O^2Rw։vd]UxL|K*VKSpb1rrD[YЛ T&\jtp*“3U&_ipuVVF5ՙxkF݅(5}dy^\}è;Fz贽UymRl<5L*IfrZ5|o՚z~h̡S_%{9s^5\LcA?TT5d5bLӍ(NꙡuӀMM[9Hz/BUԉd N4YwJzz7LJP @(P @(m .^ܻR$;xyp0(: V-S'g{"UNIDAT!8_5mj 5ZX\KP@Px< &3 7I&V& ifS!gD_@3X|Acڸ+7`" "k+(6)'[LRhbAzEV<zkKV wѬDѤ&1QXIm`,c#ˬ}\R NuZ &+@A*+~dIHP @(P @(P @(P @(P @(УufIENDB`l     @ ,,b$;)m|J@c $@8guʚ;2Nʚ;g4\d\dn` ppp@ <4!d!d@@gʚ;<4dddd@@gʚ; (h___PPT2001D<4X___PPTMac11@f   hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography    hnamd` Arial&Monotype Typography ? %Colon Cancer Screening /Jennifer E. Guss, MD Baylor College of MedicineColon Cancer Screening A healthy 50 year old woman at average risk for colorectal cancer( i.e. age is her only risk factor) is scheduled to undergo a periodic examination. Which screening test for colorectal cancer should be recommended?   Colon Cancer Statistics_#2 leading cause cancer related death in US Rate of colon cancer increases with increasing age   Colon Cancer StatisticsScreening can reduce death rate, screening rates are low Fewer than 30% patients are screened compared with 71% pts getting mammograms, 80% getting paps Why are rates low? MD s, pt s, system resistantColon Cancer ScreeningChoice of test for screening is controversial i.e. no consensus Differing opinions based on cost, logistics involved, pt preference, accuracy of results/kColon Cancer Screening RecsUniform consensus is still in flux, however there is now firm support for screening. 10 years ago, there was not. Variation in recommendations is not due to lack of evidence, but rather to different perspectives More aggressive recs of specialists reflect their fear of missing even one case of cancer Broader, population-based perspective reflects trade-offs with respect to cost, availability, quality $ZZScreening recsOffer options to your patients when they have a choice Give your opinion when you are directly asked In HCHD we are limited Strategies and choices are not equal in terms of evidence of effectiveness, magnitude of effectiveness, risk, or upfront costs First Step:Risk StratificationjHas pt had colorectal cancer of adenomatous polyp? Has pt had a 1st degree family member with a colorectal cancer or adenomatous polyp? If so, at what age? Does FHx suggest one of the genetic syndromes(fam. Adenomatous polyposis or hereditary non-polyposis colorectal cancer)? Answer YES to any of these = Increased Risk Answer NO to any of these = Average Risk 0kZA ( Recs for Average Risk PatientsnStart at 50 years old Choices: FOBT, Sigmoidoscopy, BA enema, colonoscopy, some combination of the modalities  Screening tests for CRCHCRC Screening Tests and Recommended Intervals for Average Risk PatientsII Screening for CRCAll patients with positive FOBT must progress directly to colonoscopy In HCHD, our choice for average risk patients is yearly FOBT, if positive referral to GI for colonoscopySummaryAll patients need to be screened as to their risk level for colon cancer Patients at average risk should be screened for colon cancer beginning at age 50 There is no expert consensus yet as to the best way to screen patient for colon cancer The MD and pt should discuss together the choices and make the best decision for the patient and taking into account effectiveness of each choice, cost, burden to the patient, risk, and availabilityZI50 yo woman at average risk in your office to discuss crc screening testsJI$@/Discuss options She has choices If she has good insurance and wants the most sensitive and specific test, colonoscopy should be ordered If finances are an issue, yearly FOBT with appropriate f/u tests are a good optionZ a` 33PP` 3333` ___MMM` 13` 333fpKNāvI` j@v۩ῑ΂H` Q_{>?" dd@,?n<d@ `7 `2@`7``2 n?" dd@   @@``PR    @ ` ` p>> T L  ` ( B ` ` <8" @  ` Tp8d" @  ` <8"U_ @  ` Tб8d">& @  ` N8"P @  ` < 8"p @  ` S ~@8?d?"" @   ` 68 "U  T Click to edit Master title style! !$  ` 08 "   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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