Effectiveness of Screening Colonoscopy in Reducing Deaths from Colorectal Cancer

筛查结肠镜检查在减少结直肠癌死亡方面的有效性

基本信息

批准号：
8268570
负责人：
Chyke Abadama Doubeni
金额：
$ 13.12万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2016-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8268570
关键词：
Access to Information Address Adult Age Belief Biometry Body mass index Calendar California Cancer Etiology Cancer Research Network Caring Case-Control Studies Cessation of life Characteristics Clinical Colon Colon Carcinoma Colonoscopy Colorectal Cancer Communities Community Health Planning Complication Computerized Medical Record Data Databases Decision Making Diagnosis Diagnostic Diagnostic Procedure Effectiveness Enrollment Epidemiology European Evaluation Exclusion Exposure to Flexible fiberoptic sigmoidoscopy Gastroenterology Goals Guidelines Health Planning Health Policy Healthcare Healthy People 2010 Intestines Intubation Left Left colon Link Malignant Neoplasms Medical Records Methodology Methods Modeling National Cancer Institute Nested Case-Control Study Ontario Outcome Patients Performance Persons Policies Policy Maker Policy Research Population Preparation Preventive Primary Health Care Procedures Public Health Randomized Clinical Trials Recording of previous events Rectum Relative (related person)Relative Risks Reporting Research Research Infrastructure Research Personnel Research Priority Resources Right colon Risk Safety Sample Size Science Screening procedure Services Side Sigmoidoscopy Site Source Staging Study models System Techniques Testing Time Uncertainty United States adjudication aged base cancer care cancer diagnosis case control clinical practice cohort comparative effectiveness compare effectiveness cost design end of life experience follow-up health care delivery health care service utilization health disparity high risk improved member mortality prevent programs public health relevance randomized trial sex socioeconomics tumor

项目摘要

DESCRIPTION (provided by applicant): Cancers of the colon and rectum (CRC), the second leading cause of cancer death in the US, can be detected at an early, more curable, stage or even prevented using available screening techniques. Although some expert groups in the US consider colonoscopy to be the standard, there is currently only limited direct evidence to support its increasing use for screening in average risk adults. Colonoscopy has higher risks and costs than other screening tests. Recent studies reported that colonoscopy did not reduce mortality from right-sided colon cancers, the part of the colon that is beyond the reach of sigmoidoscopy. However, those findings were controversial because that study was unable to distinguish screening from diagnostic uses or accurately assess the completeness of colonoscopies. This project's goal is to inform clinical and policy decisions by providing evidence to show whether the purported benefits of colonoscopy are realized in practice. The primary specific aim is to estimate the effectiveness of screening colonoscopy in reducing death from CRC among average-risk adults when compared to no screening, overall and separately for right- and left-sided cancers. Our secondary aims are to: 1) determine the impact of the completeness of colonoscopy examinations on its effectiveness; and 2) compare the effectiveness of screening colonoscopy relative to sigmoidoscopy. We will use a case-control design nested in an historical cohort of persons receiving care at 3 sites participating in a research consortium, Cancer Research Network (CRN). These sites provide the full continuum of cancer care to their members ranging from screening through end of life care, and provide access to information on CRC screening that can be linked to diagnosis and cause-specific mortality data on large numbers of racially and socioeconomically diverse persons. We will identify at least 1,200 cases of CRC deaths between 2007 and 2014 among enrollees who were 52 years or older at the date of the diagnosis, each matched within each health plan to two randomly selected controls based on age, sex and enrollment history. We will identify screening history for a minimum of 10 years prior to cancer diagnosis, differentiating screening from diagnostic procedures, using standardized targeted chart reviews and other sources. The sample size will provide sufficient power for separate evaluations of tumors located in the right colon. This project will be carried out by an experienced interdisciplinary team representing epidemiology, case-control methodology, biostatistics, gastroenterology and primary care. Team members are national leaders in CRC screening research and policy. This project is in synergy with existing NCI and the CRN goals to: 1) develop methods and approaches to provide clinical, policy-relevant information; and 2) inform clinical and public health decisions on CRC screening. This application is also responsive to the NCI's priority to improve understanding of the effectiveness and comparative effectiveness of tests used in screening for CRC, a "health disparity condition", and addresses Healthy People 2010 goals to reduce cancer death. PUBLIC HEALTH RELEVANCE: Colon cancer is the second leading cause of cancer death in the United States, but many of these cancers can be detected at an early, more curable, stage or even prevented using available screening techniques. Although many people believe that colonoscopy is the best screening test, there is currently no scientific evidence to support that claim. The goal of our proposed study is to provide scientific evidence on whether current beliefs about the benefits of colonoscopy screening are realized in actual clinical practice in order to help patients, doctors, and policy makers make decisions about colon cancer screening.

描述（由申请人提供）：可以在早期，更可治愈的阶段检测到结肠和直肠（CRC）的癌症（CRC），是美国癌症死亡的第二大病因，甚至可以使用可用的筛查技术阻止。尽管美国一些专家群体认为结肠镜检查是标准的，但目前只有有限的直接证据支持其对平均风险成年人的筛查日益增长的使用。与其他筛查测试相比，结肠镜检查的风险和成本更高。最近的研究报告说，结肠镜检查并未降低右侧结肠癌的死亡率，右侧结肠癌是结肠的一部分，是超出乙状结肠镜检查的范围。但是，这些发现是有争议的，因为该研究无法将筛查与诊断用途区分开或准确评估结肠镜检查的完整性。该项目的目标是通过提供证据来证明在实践中是否实现了所谓的结肠镜检查好处，以告知临床和政策决策。主要目的是估计筛查结肠镜检查在减少普通风险成年人中CRC死亡的有效性，而不是筛查，整体和右侧癌症的整体和分别是分别的。我们的次要目的是：1）确定结肠镜检查完整性对其有效性的影响； 2）比较筛查结肠镜检查相对于乙状结肠镜检查的有效性。我们将使用嵌套在参与研究联盟，癌症研究网络（CRN）的3个地点的人群中的历史人群中的病例对照设计。这些站点为其成员提供了完整的癌症护理连续性，从筛查到生命终止，并提供有关CRC筛查的信息，这些信息可以与诊断有关，并与大量种族和社会经济多样性的人有关。我们将在2007年至2014年之间至少发现1200例CRC死亡病例，在诊断之日起52岁或以上的参与者中，每个健康计划中的每一个都与两个随机选择的对照匹配，该对照基于年龄，性别和注册历史。我们将使用标准化的目标图表审查和其他来源来确定至少10年的筛查病史，将筛查与诊断程序区分开。样本量将为位于右结肠的肿瘤单独评估提供足够的功率。该项目将由经验丰富的跨学科团队进行，代表流行病学，病例对照方法，生物统计学，胃肠病学和初级保健。团队成员是CRC筛查研究和政策领域的国家领导者。该项目与现有的NCI和CRN目标有协同作用：1）开发提供临床，政策相关信息的方法和方法； 2）有关CRC筛查的临床和公共卫生决定。该应用还响应NCI的优先事项，以提高对CRC筛查中使用的测试的有效性和比较有效性，“健康差异状况”，并解决了健康的人2010年的目标，以减少癌症死亡。公共卫生相关性：结肠癌是美国癌症死亡的第二大原因，但是可以在早期，更可治愈的阶段发现这些癌症中的许多癌症，甚至可以使用可用的筛查技术来检测。尽管许多人认为结肠镜检查是最好的筛查测试，但目前尚无科学证据支持该主张。我们拟议的研究的目的是提供科学证据，表明在实际临床实践中是否实现了当前对结肠镜检查益处的信念，以帮助患者，医生和政策制定者对结肠癌筛查做出决定。