colorectal cancer screening committee virtual meeting

May 20, 2021 Virtual

www.worldendo.org

Colorectal Cancer Screening Committee Virtual Meeting:Program and Abstracts

Program and abstracts WEO Colorectal Cancer (CRC) Screening Committee Meeting

Overview of content

• Program main meeting

• Overview of supporters

• Faculty overview

• Abstracts (in sequence of program)

Program Colorectal Cancer Screening Committee (CRC SC): Virtual Meeting

Thursday, May 20, 2021 – 4.00pm - 8.00pm (Central Europe, Amsterdam, Berlin)

Corresponding Eastern Time: 10.00am – 2.00pm Corresponding Pacific Time: 7.00am – 11.00am Corresponding Singapore Time: 10.00pm – 2.00am

Virtual meeting via Zoom Webinars, registered participants have received link for meeting.

Conveners: Evelien Dekker (Netherlands), Global Chair

Robert Schoen (USA), North America Co-Chair

Themes: COVID-19/risk stratification

Quality Colonoscopy Multi-cancer screening with ctDNA/methylation markers

Goals of the meeting: To provide updates on recent advances in CRC screening

To seek advice and comments on future initiatives To reach consensus on controversial areas

Session 1: COVID-19/risk stratification Chairs: Han-Mo Chiu (Taiwan), Roque Sáenz (Chile) Time: 4.00pm – 5.05pm

4.00 pm Welcome from CRC SC Regional Chair Robert Schoen Robert Schoen (USA)

4.05 pm Effect of COVID-19 on Colorectal Cancer Screening Karen Canfell (Australia)

4.17 pm Risk stratified intervals for FIT screening Iris Lansdorp-Vogelaar (Netherlands)

4.29 pm Risk stratification for screening in the wake of COVID-19 Marco Zappa (Italy)

4.41 pm Incorporating demographic algorithms to improve FIT screening

Patrick Bossuyt (Netherlands)

4.53 pm Q+A

5.05 pm Break (10 minutes)

Session 2: Quality Chairs: Aasma Shaukat (USA), Evelien Dekker (Netherlands) Time: 5.15pm – 6.03pm

5.15 pm AI for quality assurance of colonoscopy Prateek Sharma (USA)

5.27 pm Transforming colorectal cancer research findings into policy action Gloria Coronado (USA)

5.39 pm Improving screening quality in Ontario, Canada Catherine Dubé (Canada)

5.51 pm Q+A


WEO CRC SC Virtual Meeting, May 20, 2021 Program

For more information please contact the WEO secretariat at: [email protected]

Session 3: Colonoscopy Chairs: Rolf Hultcrantz (Sweden), Jason Dominitz (USA) Time: 6.18pm – 7.18pm

6.18 pm Systematic review on tailoring surveillance of high-risk lesions

Sandra Baile-Maxia (Spain)

6.30 pm PCCRC – auditing report from the UK Roland Valori (UK)

6.42 pm Is colonoscopy less effective in the right colon? Ulrike Haug (Germany)

6.54 pm Analysis and categorization of PCCRCs using the WEO guidelines

Matthew Rutter (UK)

7.06 pm Q+A


Session 4: Multi-cancer screening with ctDNA/methylation markers Chairs: David Ransohoff (USA), Robert Benamouzig (France) Time: 7.28pm – 8.05pm

7.28 pm Review and reports from the latest studies Robert Schoen (USA)

7.40 pm Design of trials going forward Carlo Senore (Italy)

7.52 pm Q+A

8.00 pm Wrap up Evelien Dekker (Netherlands)

8.05 pm Meeting adjourns

We would like to thank the following partners for their support:

Faculty Overview Professor Karen Canfell Director, The Daffodil Centre, Professor & NHMRC Leadership Fellow, Faculty of Medicine and Health, The University of Sydney, Australia Dr Iris Lansdorp-Vogelaar Associate Professor, Erasmus MC, Department of Public Health Rotterdam, The Netherlands Dr Marco Zappa Director of the Italian National Screening Monitoring Centre (Osservatorio Nazionale Screening) Florence, Italy Dr Patrick Bossuyt Professor of Clinical Epidemiology Amsterdam University Medical Centers Amsterdam, The Netherlands Professor Prateek Sharma Professor of Medicine University of Kansas School of Medicine Kansas City, USA Dr Gloria Coronado Epidemiologist and Mitch Greenlick Endowed Distinguished Investigator in Health Disparities Research Kaiser Permanente Center for Health Research Portland, USA Dr Catherine Dubé, MD, MSc, FRCPC Clinical Lead, ColonCancerCheck Associate Professor, Department of Medicine, Division of Gastroenterology, University of Ottawa Ottawa, Canada

Sandra Baile-Maxia Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL Alicante, Spain Dr Roland Valori Gloucestershire Hospitals NHS Foundation Trust Gloucester, United Kingdom Professor Ulrike Haug Leibniz Institute for Prevention Research and Epidemiology – BIPS Bremen, Germany Professor Matthew Rutter Consultant Gastroenterologist, University Hospital of North Tees Stockton-on-Tees, United Kingdom Dr Robert Schoen Professor of Medicine and Epidemiology, University of Pittsburgh Medical Center Pittsburgh, USA Dr Carlo Senore Epidemiology and Screening Unit – CPO Piemonte; University Hospital Città della Salute e della Scienza, Turin, Italy Director, Piedmont Region cancer screening program President of the Italian Group for ColoRectal cancer Screening (GISCoR)

WEO 2021 CRC Screening Committee Abstracts

This presentation discusses the work of the Covid and Cancer Global Modelling Consortium (GGGMC) in relation to colorectal cancer (CRC) screening. The CCGMC aims to configure modelling platforms and to estimate the potential impact of COVID-19 on cancer in relation to the impact of the crisis in three main areas – cancer treatment and outcomes, cancer screening and cancer risk and prevention. The aims of the CCGMC CRC screening work are:

1) To harness established and validated microsimulation model platforms in countries for which these are available, and to simulate the short- and long-term impact of CRC disruptions on cancer incidence and mortality considering a number of scenarios for disruption extent and duration. As detailed data on disruptions become available, we also aim to dynamically incorporate such information to update model predictions; 2) To evaluate the effectiveness (and cost-effectiveness) of possible recovery strategies considering situations where resources and capacity to enable ‘catch-up’ are unconstrained, or (more realistically) where prioritisation decisions need to be made for screening or referrals to colonoscopy; and 3) To extend these methods to inform a responsive multi-country platform, by using detailed modelling in a few countries to inform pre-disruption screening modelling for countries with similar programs, combined with country-level burden-of-disease and emergent disruption information.

Findings from our work on a three-country, four-model initial comparative analysis will be presented considering a range of disruption scenarios in Canada, Australia, and The Netherlands. We also present results from an evaluation of a novel approach to prioritising referrals to colonoscopy Modelling had already demonstrated its importance to pre-pandemic policy-making, but that the crisis has emphasised the importance of timely access to information on screening program metrics. As the data become available it can be used to update and improve modelled predictions. From the modelling performed to date, we conclude that it is crucial that, if disrupted, screening programmes ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, since this could mitigate the impact on colorectal cancer deaths. Disruptions to colonoscopy referrals for screen-positive individuals are predicted to have a major impact, so novel prioritisation strategies for colonoscopy deserve consideration. A silver lining is that this approach to prioritisation changes the framing (and might accelerate) consideration of implementing risk-based screening approaches. Acknowledgements: This work is presented on behalf of the Colorectal Cancer Screening Project team within Working Group 2 of the COVID and Cancer Global Modelling Consortium (CCGMC). Thanks to all members, especially co-chair Dr. I. Lansdorp-Vogelaar and the leads of the technical modelling teams – Dr. Veerle Coupe, Dr Jean Yong and Dr Eleonora Feletto, and the CCGMC Secretariat.

WEO Colorectal Cancer (CRC) Screening Committee Meeting Thursday, May 20, 2021 Title: The Effect of Covid-19 on Colorectal Cancer Screening Author: Karen Canfell on behalf of CCGMC collaborators


Colorectal cancer (CRC) screening has been demonstrated to reduce CRC incidence and mortality. However, besides such benefits, CRC screening is also associated with potential harmful effects. In an ideal world, screening would only be directed to the small proportion of the population that might potentially benefit. Risk-based screening can be seen as a first step towards this ideal world, by redistributing screening resources from low-risk to high-risk individuals. In theory, this should result in scarce resources being used in individuals who benefit most, while intensity of screening is reduced in individuals who benefit less, hence improving the benefit-harm ratio among all invitees.

Available strategies that have been proposed for risk-based CRC screening include using information on age, sex, prior screening history, lifestyle and/or genetic information. An important drawback of approaches based on lifestyle and/or genetic information, is that these require additional data collection from the target population which may prove an additional hurdle for participation in screening. Age, sex and prior screening history may therefore be more promising initial candidates for risk-based screening, especially for FIT-based screening programmes.

Several studies and programs have shown that faecal haemoglobin concentration below the cut-off level of a positive FIT is a strong predictor of advanced neoplasia detection at subsequent rounds. In this presentation, I will present the latest evidence concerning FIT concentration and risk of advanced neoplasia and discuss how this information may be used to tailor intervals for FIT screening.

WEO Colorectal Cancer (CRC) Screening Committee Meeting

Thursday, May 20, 2021

Title: Risk stratified intervals for FIT screening Author: Iris Lansdorp-Vogelaar


Due the SARS COVID-19 pandemic, the number of screening tests for colorectal cancer was dramatically

reduced during 2020. This reduction was due to two different factors:

1) Time limited suspension of screening services (during the first wave of covid pandemic) and

thereafter a reduced activity caused by several factors (resources diverted to COVID, longer time for

colonoscopy, and so on…)

2) Decrease in the subject’s willingness to be screened

For example in Italy we observed a decrease of 32% of invitations and of 45%% of performed tests in 2020

compared to 2019. This means that the adhesion to invitation is decreased approximatly of 20% .

How to recover the delay?

First of all the choice depends on the forecast of the lenght of pandemic crisis. If we assume that the

pandemic is almost over, we could accept an interval of more than two years (let say 2,5- 3 year), and

thereafter start again with a two year interval.If the delay is still increasing, we have to act. For example

at the end of 2020 In Italy the delay was still increasing. Such an estimate is based on “standard months

of delay” (i.e. the” number of “standard working months” needed to recover the delay (assuming the

same monthly activity of 2019)

Two options:

1) Expand the resources dedicated to screening (however, it is difficult to enroll skilled workforce

expecially for colonscopy in a short time).

2) Redefine the target population in order to prioritize individuals at higher risk. In such a way a more

efficient and probably more fair results could be obtained. More efficient because the Positive

Predictive Value (PPV) for colonscopy depends on the prevalance of the lesions, more fair because

people at higher risk are prioritized. A risk stratified screening could achieve a better balance between

benefits and harms and a better cost/outcome ratio.

What are the criteria for selecting people at higher risk?

- People with a previous positive FIT not followed by colonscopy

- People with the most elevated F-HB concentration

- Males and older people

- People not regularly attending screening invitations

- Cumulative F-HB concentration over two consecutive FITs

Caution: It should be considered that this approch is difficult to be managed expecially in a Covid period. Moreover, a subjects defined at lower risk (for example people regularly attending the screening) might feel abandoned by the programme. There is need for a proper communication strategy



Title: Risk stratification for screening in the wake of COVID-19 Author: Marco Zappa former Director of Italian Centre for Screening Monitoring ISPRO Florence Italy

Summary of presentation


Many colorectal cancer (CRC) screening programs rely on quantitative fecal

immunochemical tests (FITs). These tests measure human hemoglobin

concentrations in the stool. Screening participants with a FIT result that exceeds a

prespecified positivity threshold are invited for colonoscopy.

Programs vary in their FIT positivity thresholds for FIT. A value of 20 μg

hemoglobin/g faeces seems to be quite common, but thresholds range from 10 to

47 μg hemoglobin/g faeces. Selection of the threshold is typically guided by

considerations about the available resources for colonoscopy.

Most programs use a common threshold for all invitees. Yet it is now well

established, in a range of studies and systematic reviews, that using a single

threshold for all invitees leads to differences between men and women, and to

differences between age subgroups in screening participants.

In principle, it would be possible to vary the FIT positivity threshold by age and sex,

to reduce some of these differences. Yet this raises the question which differences

should be primarily reduced: differences in proportion of FIT positives, in FIT

sensitivity and specificity, in FIT positive predictive value, or in life years gained in

case of detecting CRC neoplasia at colonoscopy.

We will argue – and demonstrate – that including demographic information to

minimize differences in FIT positive predictive value would be the best approach to

guarantee equity, to balance the benefits and harms of colonoscopy, and to

improve screening efficiency.



Title: Incorporating demographic information to improve FIT screening

Author: Patrick M Bossuyt



The use of artificial intelligence (AI) in gastroenterology and endoscopy has become a novel and quickly advancing frontier, predominantly in computer aided detection (CADe) systems of colorectal polyps. The first iterations of convoluted neural network (CNN) systems were built on endoscopy images and videos and efficacy was measured on these post-procedure recordings. However, improvement in quality of colonoscopies will occur only when applied to real time procedure with the goal to improve the nearly 27% missed adenoma rate and improve adenoma detection rates1. The move in building and improving AI systems for this task was made swiftly. Current CADe polyp detection systems in live endoscopies improve adenoma detection rate and decrease reaction time of endoscopists2-4. Further, there are efforts to improve polyp characterization with computer aided diagnosis (CADx) systems. Use of AI imaging on colonoscopies can improve detection and differentiation of neoplastic lesions 5. Multiple systems are now being evaluated to improve the quality in colonoscopy and reduce morbidity and mortality of colorectal cancer.

References: 1. Zhao S , Wang S , Pan P , et al . Magnitude, risk factors, and factors associated with adenoma miss

rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019;156:1661–74.doi:10.1053/j.gastro.2019.01.260

2. Wang P, Berzin TM, Romek Glissen Brown J et al. Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: A prospective randomised controlled study. Gut 2019; 68: 1813– 9.

3. Hassan C, Wallace MB, Sharma P et al. New artificial intelligence system: First validation study versus experienced endoscopists for colorectal polyp detection. Gut 2020; 69: 799– 800.

4. Gong, Dexin et al. “Detection of colorectal adenomas with a real-time computer-aided system (ENDOANGEL): a randomised controlled study.” The lancet. Gastroenterology & hepatology vol. 5,4 (2020): 352-361. doi:10.1016/S2468-1253(19)30413-3

5. Kudo S, Misawa M, Mori Y et al. Artificial intelligence-assisted system improves endoscopic identification of colorectal neoplasms. Clin Gastroenterol Hepatol 2020; 18: 1874– 81.

WEO Colorectal Cancer (CRC) Screening Committee Meeting Thursday, May 20, 2021 Title: AI and Quality in Colonoscopy Author: Prateek Sharma, MD


Colorectal cancer (CRC) screening can reduce incidence and mortality by over 50%. Nevertheless, screening rates are suboptimal in the United States and are particularly low in Medicaid-enrolled adults (46% vs. 70% for Medicare-insured). Medicaid recipients are 50% more likely to present with late-stage CRC or die from it than adults with commercial or Medicare insurance. This disparity affects over 15 million Medicaid-insured adults. Notably, Medicaid enrollement has increased in recent years, particuarly among adults age 50-64. This increase has been spurred by Medicaid expansion and COVID-19-related job loss.

Over the past 8 years, the state of Oregon, United States, has adopted policies to reduce barriers to CRC screening and follow-up. One of these polices provided monetary incentives to state’s Medicaid health plans for meeting performance or improvement targets set by the state. This talk reviews Oregon policies related to CRC screening and provides data to demonstrate the success of these policies.

In addition, our research team conducted a study that partnered with Medicaid insurance plans in Washington and Oregon to mail fecal immunochemical test (FIT) kits to over 12,000 ernolees not up to date with CRC screening recommendations (BeneFIT). Despite similar success in both states, the Washington plan dropped the BeneFIT program in the second year, attributing the decision to the lack of a required reporting of CRC screening performance among Medicaid enrollees. This finding, and advocacy on the part of a BeneFIT lead scientist, a California-based CRC coaltition, and the National Colorectal Cancer Roundtable, led to a proposal to include CRC screening as part of the core measure set for Medicaid nationally. The proposal was approve in May 2021. We anticipate that this required reporting of CRC screening rates in Medicaid health plans will increase CRC screening rates and reduce observed disparities in screening among Medicaid-enrolled adults.

WEO Colorectal Cancer (CRC) Screening Committee Meeting Thursday, May 20, 2021 Title: Transforming colorectal cancer research findings into policy action Author: Gloria D. Coronado, PhD; Beverly B. Green, MD, MPH

Improving screening and colonoscopy quality in Ontario, Canada

Presented by Catherine Dubé, Clinical lead, ColonCancerCheck program

This presentation describes the approach to quality management in colorectal cancer screening and

colonoscopy in Ontario.

The Ontario screening and colonoscopy quality management program was built over time, through the

interplay of five key design elements: 1) a strong scientific basis that underpins all other activities; 2)

funding of hospital-based endoscopic procedures; 3) quality reporting using measurable indicators; 4)

quality improvement activities at the facility and individual practice level; and 5) a governance structure

that creates accountabilities at the regional, hospital and individual level.

The quality management program delivers quality standards and guidelines, quality reports and quality

improvement interventions through an established clinical leadership structure. The presentation

further describes the facility-level and physician-level quality reporting and the evidence basis used for

their development, as well as the use of facilitated feedback to coach endoscopists for change and the

development of achievable learning plans. Trends of process-related and outcomes-related indicators

are also presented.

Challenges with the quality management program and its future goals will be discussed.

WEO Colorectal Cancer (CRC)

Screening Committee Meeting



Introduction: High-risk adenomas (HRA) are defined according to their multiplicity, size, high grade dysplasia (HGD) and villous structure. However, some of these characteristics may relate to a higher risk of metachronous advanced lesions that the others, and therefore some patients with HRA may not require endoscopic surveillance.

Aims and methods: We performed a systematic review and meta-analysis to assess which specific adenoma attributes relate with a high risk of development of metachronous colorectal cancer (CRC) or advanced adenomas (AA). We systematically searched Pubmed, EMBASE and Cochrane for cohort, case-control and clinical trials that detailed CRC or AA incidence at surveillance stratified according to baseline lesion’s characteristics. We calculated pooled relative risks (RR) using a random-effects model. Heterogeneity was assessed with the I2 statistic.

Results: 68 studies were included in the final analysis, with a total of 731,000 patients (mean age 60.3 years, 63% of males) with a mean follow-up of 5.1 years. The incidence of CRC per 1,000 person-years was 2.0 (95% CI 1.7 – 2.3) for AA, 1.3 (1.2 – 1.4) for HRA, 2.6 (2.1 – 3.0) for adenomas ≥20mm, 1.6 (1.2 – 1.9) for adenomas≥10mm, 1.2 (0.3 – 1.9) for ≥5 adenomas, 1.4 (0.8 – 2.3) for ≥3 adenomas, 2.1 (1.8 –2.3) for villous component and 2.8 (2.3 – 3-3) for HGD. Metachronous CRC incidencewas higher in patients with baseline AA than in those with non-advanced adenoma(NAA) (RR 3.04, 95% CI 2.39–3.85), in adenomas ≥20mm than in adenomas 10-20mm (RR 2.08, 95% CI 1.20-3.61), in adenomas 10-20mm than in adenomas <10 mm(RR 1.73, 95% CI 1.31-2.29), in HGD than in low-grade dysplasia (RR 2.94, 95% CI1.97-4.39) and in villous component than in tubular adenomas (RR 1.75, 95% CI 1.35-2.24). No differences in metachronous CRC risk were found in patients with ≥5adenomas with respect to those with 3-4 (RR 1.07, 95% CI 0.44-2.57), nor in patientswith ≥3 adenomas with respect to 1-2 (RR 1.60, 95% CI 0.94-2.74). MetachronousCRC risk for each risk group in comparison with patients with normal colonoscopy was2.89 (95% CI 1.74-4.78) for AA, 2.60 (95% CI 1.91-3.53) for adenoma ≥10mm, 6.5(95% CI 4.52-9.34) for HGD, 3.55 (95% CI 2.16-5.82) for villous component and 1.91(95% CI 0.86-4.25) for ≥3 adenomas. The number needed to scope to prevent 1 CRCin comparison with patients with NAA was the lowest for adenoma size ≥20mm (480)and HGD (511) and the highest for adenoma number ≥3 (1581) and ≥5 (1722).

Conclusions: Metachronous CRC risk is significatively higher in patients with baseline adenomas with HGD, villous component or size >10mm. However, multiplicity does not seem substantially related with a higher CRC risk and therefore these patients may not benefit from endoscopic surveillance.



Title: RISK FACTORS FOR METACHRONOUS COLORRECTAL CANCER OR ADVANCED POLYPS AFTER ENDOSCOPIC RESECTION OF PREMALIGNANT LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS Author: Sandra Baile Maxía


Various types of observational studies suggested a substantially lower (relative) effectiveness of screening colonoscopy in reducing CRC incidence in the right vs. the left part of the colon. However, a critical appraisal of these studies regarding self-inflicted biases is lacking. The first part of this talk will use a certain type of cohort study as an example to illustrate the relevance of self-inflicted biases. In this example, persons are asked at baseline about colonoscopies performed in the past and – based on this information – assigned as exposed or unexposed. Persons with CRC detected before

baseline are excluded. In other words, treatment is assigned before time zero and eligibility is determined at time zero. A colonoscopy that detected CRC before baseline will result in the individual being excluded from the analysis. As a result, the cumulative incidence in the colonoscopy group is artificially) (i.e. via the study design) lowered and the effectiveness of screening is thus overestimated. Given that the vast majority of CRCs diagnosed at the typical starting age of screening are in the left-sided colon, this type of selection bias mainly affects left-sided CRC, i.e. effectiveness of colonoscopy in reducing incidence of left-sided CRC is mainly overestimated due to this bias, while right-sided CRCs are less affected by this bias. This also means that the difference in the effectiveness of colonoscopy regarding left- vs. right-sided CRC is overestimated due to this bias.

The second part of this talk presents preliminary results of a study on the effectiveness of colonoscopy in reducing left- vs. right-sided CRC using a target trial approach, i.e. a method that avoids this type of bias. We used a German claims database covering 20% of the German population and included persons aged 55-69 years. Exclusion criteria similar to RCTs were applied. Based on the methodology described by Garcia-Albeniz et al. (2017)*, we estimated the observational analogue of the intention-to-screen effect of screening colonoscopy on 11-year risk of right-sided and left-sided CRC. We adjusted for baseline confounders using inverse probability of treatment weighting. The final analysis included 198,389 (non-unique) persons in the screening group and 349,092 in the control group. The 11-year relative risk of CRC in the colonoscopy vs. the control group was 0.64 (95% CI: 0.54-0.73) for left-sided CRC and 0.73 (95% CI: 0.59-0.95) for right-sided CRC. The cumulative incidence curves crossed after ~6 years follow-up for left-sided CRC (same in men and women) and after about ~7.5 years for right-sided CRC (later in men than in women).

In conclusion, it seems plausible that self-inflicted biases in existing observational studies led to overestimating the effectiveness of colonoscopy in preventing left-sided CRC. The results of our emulated target trial approach avoiding this type of bias suggest that there is only a minor difference in the relative effectiveness of colonoscopy in preventing left- vs right-sided CRC. They also suggest that it requires a longer follow-up for right-sided than for left-sided CRC to measure the preventive effect (particularly in men). * García-Albéniz X, Hsu J, Bretthauer M, Hernán MA. Effectiveness of screening colonoscopy to prevent colorectal cancer among Medicare beneficiaries aged 70 to 79 Years: A prospective observational study. Ann Intern Med. 2017;166(1):18-26.

WEO Colorectal Cancer (CRC) Screening Committee Meeting Thursday, May 20, 2021 Title: Is colonoscopy less effective in the right colon? Author: Prof. Dr. Ulrike Haug, Bremen, Germany.



I will present an overview of the difference between interval cancers and PCCRCs,(1) and will describe the WEO PCCRC guideline analyses,(2) focusing on the two individual case (root cause) analyses:

1. Most plausible explanation2. PCCRC interval/non-interval subtype categorisation

I shall use our latest publication to illustrate how these analyses should be done at a local level, and what the implications of these analyses are.(3)

References

1. Sanduleanu S, le Clercq CM, Dekker E, Meijer GA, Rabeneck L, Rutter MD, et al.Definition and taxonomy of interval colorectal cancers: a proposal for standardisingnomenclature. Gut. 2015;64(8):1257-67.

2. Rutter MD, Beintaris I, Valori R, Chiu HM, Corley DA, Cuatrecasas M, et al. WorldEndoscopy Organization Consensus Statements on Post-Colonoscopy and Post-Imaging Colorectal Cancer. Gastroenterology. 2018.

3. Beaton D, Beintaris I, Rutter MD. Utilization and Reproducibility of WorldEndoscopy Organization (WEO) Post-Colonoscopy Colorectal Cancer (PCCRC)Algorithms - Retrospective analysis. Endoscopy. 2021.



Title: Analysis and categorisation of PCCRCs using the WEO guidelines Author: Prof Matt Rutter


Blood based screening for cancer is on the horizon. Multiple companies are pursuing testing based on detection of circulating tumor DNA, epi-genetic changes such as methylation, protein targets and DNA fragmentation. An emerging critical dichotomy is whether to develop blood based tests for single cancers, such as for colorectal cancer, or whether to pursue pan-cancer testing, where many cancers are sought with a single blood specimen. The pursuit of pan-cancer testing has implications for the design and implementation of studies to validate efficacy. There are a number of methodologic challenges and protocols for follow-up that must be accounted for and considered when developing blood based screening. A discussion and review of the DETECT-A trial, which is the largest pan-cancer blood based study performed thus far, will be included.

WEO Colorectal Cancer (CRC) Screening Committee Meeting Thursday, May 20, 2021 Title: Blood-Based Screening for Cancer Detection Author: Robert E. Schoen


1) they may target a cancer for which a validated screening test is available: phasedcomparative evaluation with established tests can be planned in such cases.2) they may detect other cancers, for which screening tests are not currently available: thebenefit of screening in increasing survival and reducing mortality needs to be proven.Open issues when planning evaluation studies of multi-cancer tests include: the definition ofthe target population (average versus high-risk subjects), the definition of the optimalscreening interval for blood tests and the most appropriate/efficient approach to theintegration of standard of care screening and multi-cancer screening tests.



Title: Design of trials going forward

Author: Carlo Senore


Screening aims to reduce mortality through early detection of cancer, and/or reduction of incidence through detection of pre-cancer lesions, without adversely affecting the health status of participants. The gold standard for assessing the effectiveness of screening is represented by population RCTs with mortality as the outcome. According to the new framework proposed by the WEO EWG “Evaluation of new tests” (Young G et al. Cancer 2016) cancer-specific mortality is not essential as an endpoint, provided that the mortality benefit of the comparator has been demonstrated and that the biologic basis of detection is similar. Adoption of a new screening test would then require evidence of effectiveness relative to a proven comparator test following a phased comparative evaluation process. The protective effect of screening is the result of the combination of the test characteristics, the positivity threshold and the screening interval. Multi-cancer screening tests are under evaluation. Two scenarios can be considered:

INDUSTRY COOPERATION 2021

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colorectal cancer screening committee virtual meeting

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