Examining Early Life Risk Factors and Patterns of Screening for Early-Onset Colorectal Cancer

检查早期生命危险因素和早发性结直肠癌筛查模式

• 批准号: 10680160
• 负责人: Arfan Siddique
• 金额: $ 4.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-18 至 2025-08-17
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680160
• 关键词: Address; Adoption; Age; Age Years; Air; American; American Cancer Society; Atlases; Behavioral; Birth; Birth Records; Birth Weight; Blue Cross; Blue Shield; COVID-19 pandemic; California; Caring; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic Disease; Classification; Colorectal Cancer; Country; Data; Databases; Disparity; Early identification; Encapsulated; Enrollment; Environmental Risk Factor; Etiology; Event; Excision; Feces; Gastroenterologist; Genetic; Geographic Information Systems; Geographic Locations; Geography; Guidelines; Health; Health Services Research; Health Status; Healthcare; Hospital Referrals; Incidence; Individual; Insurance; Interruption; Intervention; Knowledge; Life; Life Style; Light; Link; Malignant Neoplasms; Maternal Age; Menstruation; Methodology; Minority; Modeling; National Cancer Institute; Neighborhoods; Nested Case-Control Study; Oncology; Onset of illness; Outcome; Pathology; Patients; Pattern; Persons; Physical environment; Population; Predisposition; Prevalence; Prevention strategy; Preventive service; Primary Prevention; Probability; Provider; Public Health; Recommendation; Research; Resources; Risk; Risk Assessment; Risk Factors; Sample Size; Sampling; Science; Secondary Prevention; Social Environment; Socioeconomic Status; Symptoms; Testing; Time; Time Series Analysis; Time trend; Training; United States; United States Environmental Protection Agency; United States Preventative Services Task Force; Update; Variant; age group; aged; aspirate; beneficiary; cancer diagnosis; cancer epidemiology; career; cohort; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; contextual factors; data registry; design; disorder risk; early onset; early onset colorectal cancer; early screening; epidemiology study; gastrointestinal; high risk; high risk population; improved; innovation; lifestyle factors; multidisciplinary; neoplasm registry; population based; pre-doctoral; response; screening; screening guidelines; social; sociodemographics; spatiotemporal; statistics; therapy design; uptake

PROJECT SUMMARY/ABSTRACT In the United States (US), the incidence of early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) diagnosed among individuals <50 years of age, has been increasing rapidly. Compared to late- onset CRC (i.e., CRC diagnosed among individuals ≥50 years of age), EOCRC is characterized by more aggressive pathology and distinct genetic profiles, indicating that the etiology of EOCRC may be distinct. There have been a limited number of studies examining the risk factors of EOCRC, and none have focused on early life risk factors, which could be particularly relevant to early-onset diseases. Over the past few years, the American Cancer Society and the US Preventative Services Task Force reduced the recommended age of CRC screening from 50 years to 45 years, and the COVID-19 pandemic influenced the provision of preventative services across the country. These events could impact the temporal and geographic patterns of screening for EOCRC, but no study has systematically assessed such impacts in a large sample of the US population. The proposed study aims to 1) identify early-life risk factors of EOCRC and 2) evaluate spatiotemporal patterns of EOCRC screening in the US. For the first aim, we will conduct a nested case-control study within the California birth cohort and compare the birth characteristics between 1200 EOCRC cases and 60,000 control subjects matched on year of birth. In addition, we will obtain birth address matched social, behavioral, lifestyle, and environmental factors from the Centers for Disease Control and Prevention and the Environmental Protection Agency and compare these neighborhood-level factors between the 1,200 cases and 60,000 controls. Two key methodological challenges will be addressed: a) spatial autocorrelation, the tendency of adjacent geographic units to share similar attributes; b) the modifiable areal unit problem, a biasing effect that occurs when observed associations between exposures and outcomes vary based on the scale of the chosen geographic unit. For the second aim, we will assess temporal patterns in EOCRC screening and identify factors associated with potential regional variation in screening by leveraging unique claims data from Blue Cross Blue Shield (BCBS), the largest insurance provider in the US that covers one-third of all Americans. Approximately 4 million beneficiaries aged 45-49 years are enrolled in BCBS each year, allowing us a great opportunity to assess both stool-based and structural CRC screening tests. With a rigorous design and unparalleled sample sizes, the proposed study addresses research questions with clear public health significance, is very innovative, and will probably yield a high impact on our knowledge about the etiology and screening of EOCRC – a critically understudied field according to the National Cancer Institute. In addition, by bringing together a multidisciplinary team of experts in cancer epidemiology, health services research, spatial statistics, gastrointestinal oncology, and geographic information systems science, this study will contribute to the training of a promising minority predoctoral fellow with aspirations to pursue a career in cancer epidemiology research and improve the health status for all.

项目摘要/摘要 在美国（美国），早期发作的结直肠癌（EOCRC）的事件被定义为结直肠癌 在<50岁的个体中诊断出的癌症（CRC）一直在迅速增加。与晚期相比 发作CRC（即，在≥50岁的个体中诊断出的CRC）的特征是更多 侵略性病理学和不同的遗传特征表明EOCRC的病因可能与众不同。那里 研究了EOCRC的危险因素的数量有限，没有一个专注于早期 生命危险因素，这可能与早期发作的疾病特别相关。在过去的几年中， 美国癌症协会和美国预防服务工作队降低了推荐的CRC年龄 筛查从50年到45年，Covid-19的大流行影响了预防性的提供 全国各地的服务。这些事件可能会影响筛查的临时和地理模式 EOCRC，但没有系统地评估了大量美国人口样本中的这种影响。这 拟议的研究目的是1）确定EOCRC的早期寿命危险因素和2）评估时空模式 在美国筛查。为了第一个目标，我们将在加利福尼亚州进行嵌套的病例对照研究 出生队列并比较1200个EOCRC案件和60,000个对照对象之间的出生特征 在出生年度匹配。此外，我们将获得与社会，行为，生活方式相匹配的出生地址，并且 疾病控制与预防中心和环境保护中心的环境因素 代理并比较了1,200例病例和60,000个对照之间的这些邻里级别因素。两个键 方法学挑战将被解决：a）空间自相关，相邻地理的趋势 分享类似属性的单位； b）可修改的面积单位问题，观察到时会发生偏见 暴露与结果之间的关联因所选地理单元的规模而异。为了 第二个目的，我们将评估EOCRC筛查中的临时模式，并确定与潜在的因素 筛选的区域差异通过利用蓝色十字蓝盾（BCB）的独特索赔数据（最大） 美国保险提供商覆盖了所有美国人的三分之一。大约有400万受益人 每年BCB招收45 - 49年，这使我们有一个很好的机会来评估凳子和 结构CRC筛选测试。拟议的研究具有严格的设计和无与伦比的样本量 以明确的公共卫生意义解决研究问题，具有很强的创新性，可能会产生 对我们对EOCRC的病因和筛查的知识的高度影响 - 一个非常了解的领域 根据国家癌症研究所的说法。此外，通过将一个多学科专家团队汇总在一起 癌症流行病学，卫生服务研究，空间统计，胃肠道肿瘤学和地理 信息系统科学，这项研究将有助于培训有望少数族裔研究员 渴望从事癌症流行病学研究的职业并改善所有人的健康状况。