1. Translational and Personalized Medicine Initiative: Quality of Care Project Report

2. Translational and Personalized Medicine Initiative: Quality of Care Project Report Newfoundland Labrador Colorectal Cancer Owen Parfrey BBA, MBS October 8, 2015

3. Newfoundland Labrador Colorectal Cancer - Background TPMI QoC Quarterly Report NL has the highest mortality rate of CRC in Canada NL has the highest rate of familial CRC in the world. 30% of first time CRC cases have at least 1 family member with CRC 12% of CRC has been associated with high risk family histories including Lynch Syndrome. Although 70% of first case CRC are sporadic, nonetheless family members have a lifetime risk of 14%, twice that of the general population.

4. Newfoundland Labrador Colorectal Cancer - Background TPMI QoC Quarterly Report First Case CRC < 75 Years CRC Mutations 4% High Risk 8% Familial 18% Sporadic 70% Life time risk in family members 40-50%40%20%0% Extensive Screening at a Young Age Frequent Screening at a Later Age CRC ScreeningPopulation Based Screening Recommendations

5. Newfoundland Labrador Colorectal Cancer – NL vs ONT Incidence Rates TPMI QoC Quarterly Report

6. Newfoundland Labrador Colorectal Cancer – Methodology TPMI QoC Quarterly Report First patients seen April, 2011 Two Regions: St. John’s & GFW CRC, ovarian and endometrial first time cancer cases from 2008 are invited to attend. Each proband asked to complete FHQ and family risk is determined

7. Colorectal Cancer - Objectives Provide recommendations on colonoscopy screening to the families of patients with CRC defined by family risk Identify families with Lynch Syndrome TPMI QoC Quarterly Report

8. Colorectal Cancer – Figures and Data Visualisation 52%

9. Colorectal Cancer – Figures and Data Visualisation

10. 30%

11. Colorectal Cancer – Observations 1.The low risk are dealt with relatively quickly and effectively – more specific 2.70% of participants recommended to see a GC are still waiting for an appointment, up to 18 months TPMI QoC Quarterly Report

12. Colorectal Cancer – Next Phase Intervention Recommendations 1.Use an electronic decision tree to provide screening recommendations to families. Only refer those at the highest risk to a Genetic Counsellor 2.In diagnosing Lynch Syndrome, we recommend a pathology first approach rather than a family first approach. Refer patients with IHC negative for MMR protein for further genetic workup. TPMI QoC Quarterly Report

13. Colorectal Cancer Questions? TPMI QoC Quarterly Report