Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Cancer: early detection or ‘Big C to little c’ © General Reinsurance AG Brief > Early Detection > Diagnostic techniques and prevention – less invasive ways of diagnosing Screening programmes & impact on claims Geographical factors & impact. Environmental factors > Claims have requested: > Screening programmes: we are aware of breast, cervical, bowel, prostate, are there others planned > How effective are the programmes (bearing in mind recent publicity re false positives, and number of people receiving possibly unnecessary treatment) Does more screening = more claims queries? > What impact might the following factors have: age, family history, geography? > UW have requested: > Prostate cancers - They are aware of recent developments in treatment; including genetic testing and hormone treatments that aren't covered by the manuals. An update on these developments would be very useful as would help on establishing stagings > Family history - A family history of 2 or more family members with cancer is an area not fully covered by the manuals. Instruction here would be useful as would details of any familial links that we should know about. Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 2 Improving outcomes: a strategy for cancer > The late diagnosis of cancer is seen as the key reason for this, which is why £450 million of the £750 million will be used to improve early diagnosis. > This funding will: > give GPs increased access to, and support in, interpreting key diagnostic tests > support GPs in commissioning cancer services > cover the increase in testing and the treatment costs in secondary care as more people are diagnosed > support campaigns that raise awareness of the signs and symptoms of cancer as well as getting symptomatic patients to see their GP earlier Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 3 Cancer survival Despite recent improvements in cancer care, survival rates in England are still lagging behind other countries Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 4 Why is early diagnosis important? > 90% of cancers present with symptoms > Many at an advanced stage > Principle that earlier diagnosis will mean: • more diagnosed at earlier stage • Easier to treat • Less mortality • Less morbidity less cost • ‘lives saved’ Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 5 Delays to diagnosis Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 6 Delayed diagnosis of cancer Thematic review Data from the first Scottish Primary Care Group report showing the average number of days delay in cancer diagnosis in primary care. This shows that patients have symptoms for a significant period of time before seeking help and that there can be considerable delay in Gen Re LifeHealth – Presentation for [client/prospect], [date] referral, particularly for some tumour typ © General Reinsurance AG 7 Percentages of cases by stage of selected cancer sites diagnosed in 2009 in the East of England Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 8 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 9 Lead time or increase in life expectancy Cancer starts Detectable by screening Symptoms Death Time Survival after diagnosis from symptoms Survival after diagnosis from screening Apparent increase in survival Presentation for [client/prospect] | [date] © General Reinsurance AG 12 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 13 Improving early detection > > > > Public education re symptoms Faster referral to hospital Faster appointment times– 2 week targets Faster investigation > Screening Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 14 Presentation for [client/prospect] | [date] © General Reinsurance AG 15 Screening Principles > > > > > > > > The condition is an important health problem Its natural history is well understood It is recognisable at an early stage Treatment is better at an early stage A suitable test exists An acceptable test exists Adequate facilities exist to cope with abnormalities detected Screening is done at repeated intervals when the onset is insidious > The chance of harm is less than the chance of benefit > The cost is balanced against benefit Presentation for [client/prospect] | [date] © General Reinsurance AG 16 Cancer Screening UK > Breast > Colorectal 1988 - Mammography every 3 years from age 47 to 73 1989 - Smears from age 25 every 3 years, from age 50 every 5 years 2006 - Faecal Occult blood test every 2 years 60-68 > Prostate No screening in place > Cervical > Lung cancer Watch this space! Presentation for [client/prospect] | [date] © General Reinsurance AG 17 Cervical Screening > 73.6% have been screened in the previous 3.5 years > 97% were of satisfactory quality. > 90.8% had a negative result, > 7.9% had a low grade cell change > the remaining 1.3% had high grade cell changes. Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 20 Cervical cancer incidence Scotland Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 21 Cervical Screening England Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 22 Time from screening to availability of report (%) Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 23 Relative risk of cervical cancer as a function of time since last operationally negative smear. doi:10.1038/sj.bjc.6600974 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 24 Cervical screening turnaround times 50 45 Q1 Q2 Q3 Q4 Average turnaround time (days) 40 35 30 25 20 15 10 5 0 Scotland (Former) Argyll & Clyde* Ayrshire & Arran Fife Forth Valley Grampian Greater Glasgow* Highland* Lanarkshire Lothian Tayside http://www.isdscotland.org/Health-Topics/Cancer/Cervical-Screening/ Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 25 Breast Cancer screening http://femaleimagination.files.wor Presentation for [client/prospect] | [date] dpress.com/2011/02/paulettesedgwick-breast-cancer.jpg © General Reinsurance AG 26 Breast Cancer Screening Scotland Standard Attendance rate (percentage of women invited) Appointment type5 All routine appointments Routine- Initial screen (Prevalent) in response to first Invasive cancer detection rate (per 1000 invitation women screened) Routine- Subsequent screen (Incident) (previous screen within 5 years) Routine- Initial screen (Prevalent) in response to first Small (<15mm) invasive cancer invitation detection rate (per 1000 women Routine- Subsequent screen screened) (Incident) (previous screen within 5 years) Routine- Initial screen (Prevalent) in response to first Non-invasive cancer detection rate (per invitation 1000 women screened) Routine- Subsequent screen (Incident) (previous screen within 5 years) Standardised Detection Ratio (SDR) Routine-All initial screens (observed invasive cancers detected (Prevalent) and Subsequent divided by the number expected given screen (Incident) (previous the age distribution of the population) screen within 5 years) Routine- Initial screen (Prevalent) in response to first Presentation for [client/prospect] | [date] invitation Benign biopsy rate (per 1000 women © General Reinsurance AG screened) Routine- Subsequent screen Age group Minimum Standard Target Results 2010/11 50-70 years >= 70% 80% 74.7%* 50-52 years >= 2.7 >= 3.6 5.8* 53-70 years >= 3.1 >= 4.2 7.4* 50-52 years >= 1.5 >= 2.0 3.1* 53-70 years >= 1.7 >= 2.3 4.1* 50-52 years >= 0.4 - 1.6* 53-70 years >= 0.5 - 1.6* 50-70 years >= 0.85 >= 1.0 1.69* 50-52 years < 3.6 < 1.8 1.5* 27 Breast cancer overdiagnosis http://jms.rsmjournals.com/content/17/1/25 /F2.large.jpg Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 28 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 29 Breast Cancer Mortality Scotland Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 30 http://www.bmj.c om/highwire/files tream/423608/fie ld_highwire_frag ment_image_l/0.j pg Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 31 Prostate cancer screening UK Conclusions > The harms from prostate cancer screening using PSA are currently likely to outweigh the benefits. > In this circumstance screening for prostate cancer cannot be justified on the current evidence. > The main reasons are: > • PSA is a poor test for prostate cancer and a more specific and sensitive test is needed > • Currently we are unable to correctly identity those cancers which will progress and those which are indolent and may be safely watched. > • The data relating to incidence prevalence and treatments is poor and renders planning very difficult. Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 32 Prostate cancer screening - US latest Presentation for [client/prospect] | [date] © General Reinsurance AG 33 Lung Cancer screening Scotland 2012 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 34 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 35 > Joe is a 60–year old male who began smoking cigarettes in college at age 18. While his smoking habits have fluctuated over the years, for the most part Joe has consistently smoked 20 cigarettes (a pack) a day for 42 years and continues to do so. > When Joe reviewed the Male 5-Year Risk Table he needed to identify how many pack years he had smoked. To do that, Joe followed the following formula: > Number of packs smoked per day x Number of years he smoked 1 pack per day x 42 years of smoking (Age 18 to 60) Total number of pack years = 42 > Joe’s Current Age 60 Joe’s Pack Years 42 Joe’s Current Status Still smoking Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 36 > In Joe’s case with a 4.3% (4%) risk for his age and smoking history group a positive result indicated: > 1 out of 14.3 people who test positive from a CT diagnostic imaging scan will truly have the presence of lung cancer. > 1 out of 7 people with positive results from the EarlyCDT™-Lung test will truly have the presence of lung cancer. > 1 out of 4.3 people who test positive from both the EarlyCDT™Lung test and a CT scan will truly have the presence of lung cancer. Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 37 > How Does a Positive for my Risk Group compare to a Low Risk Group? > When Joe compared his Risk Group or 4.3% to a lower Risk Group of 0.2% he clearly understood the difference in PPV between the two risk groups. > Low Risk Group of 0.2% PPV for CT Scan only of 1 in 278.2 PPV for EarlyCDT™-Lung only of 1 in 125.8 PPV for EarlyCDT™-Lung and CT Scan of 1 in 70.3 > Joe’s Risk Group of 4.3% PPV for CT Scan only of 1 in 14.3 PPV for EarlyCDT™-Lung only of 1 in 7 PPV for EarlyCDT™-Lung and CT Scan of 1 in 4.3 Gen Re LifeHealth – Presentation for [client/prospect], [date] © General Reinsurance AG 38 Disclaimer This presentation is protected by copyright. All the information contained in it has been very carefully researched and compiled to the best of our knowledge. Nevertheless, no responsibility is accepted for its accuracy, completeness or currency. In particular, this information does not constitute legal advice and cannot serve as a substitute for such advice. It may not be duplicated or forwarded without the prior consent of the Gen Re. Diese Präsentation ist urheberrechtlich geschützt. Alle hierin enthaltenen Informationen sind sehr sorgfältig recherchiert und nach unserem besten Wissen zusammengestellt. Dennoch können wir keine Haftung hinsichtlich ihrer Genauigkeit, Vollständigkeit oder Aktualität übernehmen. Insbesondere stellen diese Informationen keine Rechtsberatung dar und können auch nicht als Ersatz für eine solche Beratung dienen. Eine Vervielfältigung oder Weiterleitung ist nur mit vorheriger Zustimmung der Gen Re gestattet. Presentation for [client/prospect] | [date] © General Reinsurance AG 39