Who benefits from Colorectal Cancer Screening? A subgroup Analysis of the Minnes

谁从结直肠癌筛查中受益？

• 批准号: 8391076
• 负责人: Aasma Shaukat
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8391076
• 关键词: Adenomatous Polyps; Age; Aspirin; Attention; Body mass index; Cancer Control; Categories; Cause of Death; Characteristics; Clinical; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Comorbidity; Consumption; Controlled Study; Data; Data Files; Databases; Diet; Dietary Factors; Double contrast barium enema; Effectiveness; Elderly; Fecal occult blood; Fiber; Flexible fiberoptic sigmoidoscopy; Gender; Goals; Guidelines; Healthcare Systems; Incidence; Individual; Intake; Lesion; Life Expectancy; Long-Term Effects; Malignant Neoplasms; Meta-Analysis; Methods; Minnesota; Non-Steroidal Anti-Inflammatory Agents; Nutritional; Outcome; Participant; Patients; Polypectomy; Population; Questionnaires; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk; Specific qualifier value; Subgroup; Target Populations; Testing; Time; Update; Veterans; Vital Status; Woman; age group; colorectal cancer screening; design; experience; healthy volunteer; high risk; improved; interest; lifestyle factors; men; mortality; screening

1. To determine the effect of fecal occult blood testing (FOBT) screening on colorectal cancer mortality, non- colorectal cancer mortality and all-cause mortality in the Minnesota Colon Cancer Control Study, (MCCCS) updated to 2006 2. To determine the effect of FOBT screening on colorectal cancer mortality and non-colorectal cancer mortality by age (by 5 and 10 year age groups) and gender in the MCCCS updated to 2006 3. To determine the independent influence of baseline characteristics on colorectal cancer mortality and non-colorectal cancer mortality in the MCCCS. Significance: Most guidelines recommend starting screening for colorectal cancer at age 50 years for average risk individuals. The earliest and most tested strategy among these is FOBT, supported by four large randomized clinical trials that established the effectiveness of colorectal cancer screening. The Minnesota Colon Cancer Control Study was conducted in Minnesota, US. The trial recruited healthy volunteers between the ages of 50 to 80. The trials have not reported results stratified by age and gender. Additionally, the effects of other baseline variables, such as co-morbidities and intake of aspirin on outcomes have not been reported. A recent meta-analysis of these trials confirmed a reduction in colorectal cancer mortality (RR 0.87; 95% CI 0.8-0.95), but also reported an increase in non-colorectal cancer mortality of approximately equal absolute magnitude (RR 1.02; 95% CI 1.00-1.04) so that overall mortality was nearly identical (RR 1.002, 95% CI 0.989-1.015). Why non-CRC mortality would be increased is unclear, but one possibility is that the FOBT trials included some individuals that benefited from CRC screening, and other individuals who experienced net harm. Therefore, detailed sub-group analyses of the FOBT trial data, to separate out sub- groups that benefit from screening from those who may potentially be harmed would be important. For example, patients over age 70 or 75 might derive less benefit and more harm from screening, in which case screening this population may need to be re-considered. The goals of this research are to evaluate if effects of screening on colorectal cancer mortality seen 18 years after randomization (reported in 1999) in the Minnesota Colon Cancer Control Study persist, or are different 28-30 years after randomization (when updated to year 2006), and whether effect of screening for colorectal cancer varies in age and gender sub- groups. We also wish to evaluate the influence of baseline characteristics, such as diet, aspirin use and body mass index on these outcomes. Project Design and methods: This project involves updating the vital status and cause of death of all participants from the Minnesota Colon Cancer Control Study up to 2006 and calculating CRC, non-CRC and all-cause mortality estimates. We plan to compare colorectal cancer (CRC) mortality and non-colorectal cancer mortality rates between the screened and unscreened groups, by age categories at time of randomization of 5 year (50-54, 55-59, 60-64, 65-69, 70-74, 75-80) and 10 year (50-59, 60-69, 70-80) intervals. We will also stratify the above analyses by gender subgroups. No patient baseline data other than age and gender has been analyzed or reported from the Minnesota Colon Cancer Control Study. A 4-page, 56-item baseline questionnaire was completed by participants. We will perform a quality check on the existing data files to determine if re-entry is required for all or a subset of the questions on the baseline questionnaire. We are interested in exploring the relationship between consumption of NSAIDs, high fiber diet and BMI as effect modifiers of effectiveness of screening.

1. 为了确定粪便隐血试验 (FOBT) 筛查对结直肠癌死亡率的影响，非 明尼苏达结肠癌控制研究中的结直肠癌死亡率和全因死亡率， (MCCCS)更新至2006年 2. 确定 FOBT 筛查对结直肠癌和非结直肠癌死亡率的影响 MCCCS 中按年龄（按 5 岁和 10 岁年龄组）和性别划分的死亡率更新至 2006 年 3. 确定基线特征对结直肠癌死亡率的独立影响和 MCCCS 中的非结直肠癌死亡率。 意义：大多数指南建议在 50 岁时开始筛查结直肠癌 平均风险个体。其中最早、最受考验的策略是 FOBT，得到四大支持 确定结直肠癌筛查有效性的随机临床试验。明尼苏达号 结肠癌控制研究在美国明尼苏达州进行。该试验招募了健康志愿者 年龄在 50 岁至 80 岁之间。试验尚未报告按年龄和性别分层的结果。此外， 其他基线变量（例如合并症和阿司匹林摄入量）对结果的影响尚未得到研究 报道称。最近对这些试验的荟萃分析证实结直肠癌死亡率降低（RR 0.87； 95% CI 0.8-0.95），但也报告称非结直肠癌死亡率的增加大致相同 绝对量级（RR 1.02；95% CI 1.00-1.04），因此总体死亡率几乎相同（RR 1.002， 95% CI 0.989-1.015）。为什么非结直肠癌死亡率会增加尚不清楚，但一种可能是， FOBT 试验包括一些受益于 CRC 筛查的个体，以及其他受益于 CRC 筛查的个体。 经历过网络伤害。因此，对 FOBT 试验数据进行详细的亚组分析，以分离出亚组 从对可能受到伤害的人进行筛查中受益的群体非常重要。为了 例如，70 岁或 75 岁以上的患者可能从筛查中获得的益处较少，而危害较大，在这种情况下 可能需要重新考虑对这一人群进行筛查。本研究的目的是评估效果 随机分组后 18 年（1999 年报告）中结直肠癌死亡率筛查的比例 明尼苏达结肠癌控制研究持续存在，或者在随机化后 28-30 年有所不同（当 更新至2006年），以及结直肠癌筛查的效果是否因年龄和性别的不同而不同 组。我们还希望评估基线特征的影响，例如饮食、阿司匹林使用和身体状况 这些结果的质量指数。 项目设计和方法：该项目涉及更新所有人员的生命状况和死因 截至 2006 年明尼苏达结肠癌控制研究的参与者并计算 CRC、非 CRC 和 全因死亡率估计。我们计划比较结直肠癌 (CRC) 死亡率和非结直肠癌死亡率 按年龄类别划分的筛查组和未筛查组之间的癌症死亡率 5 年（50-54、55-59、60-64、65-69、70-74、75-80）和 10 年（50-59、60-69、70-80）随机化 间隔。我们还将按性别亚组对上述分析进行分层。除以下数据外，没有患者基线数据 明尼苏达结肠癌控制研究对年龄和性别进行了分析或报告。 4页， 参与者完成了 56 项基线调查问卷。我们将对产品进行质量检查 现有数据文件，以确定基线上的全部或部分问题是否需要重新输入 调查问卷。我们有兴趣探索非甾体抗炎药的消费与高纤维之间的关系 饮食和体重指数作为筛查有效性的影响调节剂。