Colorectal Cancer Screening:Evaluating Trends & Outcomes

结直肠癌筛查：评估趋势

• 批准号: 6645390
• 负责人: CAROLYN M RUTTER
• 金额: $ 26.7万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-15 至 2006-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6645390
• 关键词: adenomatous polyps; biopsy; cancer risk; clinical research; colon surgery; colorectal neoplasms; cooperative study; endoscopy; female; hormone therapy; human data; human mortality; managed care; mass screening; mathematical model; model design /development; neoplasm /cancer diagnosis; neoplasm /cancer epidemiology; outcomes research; women's health

DESCRIPTION (provided by applicant)The proposed research develops microsimulation models to examine the effect of screening as practiced on observed trends in colorectal cancer (CRC) incidence and mortality in a defined population of over 500,000 members of Group Health Cooperative (GHC), a large HMO in western Washington. Extensive information about this population is available from automated clinical data systems that capture multiple health care events, including dates and results of laboratory tests (FOBT) and endoscopy procedures, pharmacy utilization, outpatient physician visits and hospitalizations. An established link between GHC and the westem Washington SEER will be used to identify CRC cases in this defined population and a population-based registry of GI pathology will be used to identify non-malignant outcomes (e.g. advanced adenomas) among GHC members. The proposed research will address 3 primary aims: Aim 1: Develop a microsimulation model for colorectal cancer that describes natural history, screening, diagnosis, and mortality: The model we propose takes distributional functions as inputs for unknown parameters, rather than fixed values. The proposed model has at least four key advantages over previous strategies: 1) The model incorporates uncertainty in model inputs; 2) It allows incorporation of correlation between model parameters through their distributional forms; 3) Its use of distributions as inputs essentially automates sensitivity analyses and offers an important advantage over univariate sensitivity analysis; and 4) The model produces distributional estimates for outputs, quantifying their uncertainty. Aim 2: Model the effect of screening and polypectomy on the trends in CRC incidence and mortality within the Group Health Population aged 50 and older. Our model will use data describing dissemination of screening within this population, allowing us to examine the relationship between screening at GHC and trends in rates. Aim 3: Model the combined effect of HRT, screening and polypectomy on trends in CRC incidence within the female Group Health Population aged 50 and older. HRT has been shown to reduce the incidence and perhaps improve mortality from colorectal cancer. Our third aim will allow us to explore mechanisms for this reduction in risk, such as changes in the risks for adenomatous polyps, decreases in their transition to preclinical cancer, and lengthening of sojourn time.

描述（由申请人提供）拟议的研究开发了微观模拟模型，以检验筛查对团体健康合作社 (GHC) 超过 500,000 名成员的特定人群中观察到的结直肠癌 (CRC) 发病率和死亡率趋势的影响。 HMO 位于华盛顿西部。 自动化临床数据系统可以获取有关该人群的大量信息，该系统捕获多种医疗保健事件，包括实验室测试 (FOBT) 和内窥镜检查程序的日期和结果、药房利用率、门诊医生就诊和住院治疗。 GHC 和西华盛顿 SEER 之间已建立的联系将用于识别该定义人群中的 CRC 病例，并且基于人群的胃肠道病理登记将用于识别 GHC 成员中的非恶性结果（例如晚期腺瘤）。 拟议的研究将解决 3 个主要目标： 目标 1：开发结直肠癌的微观模拟模型，描述自然病程、筛查、诊断和死亡率：我们提出的模型采用分布函数作为未知参数的输入，而不是固定值。 与之前的策略相比，所提出的模型至少具有四个关键优势：1）该模型纳入了模型输入的不确定性； 2）它允许通过模型参数的分布形式合并模型参数之间的相关性； 3) 它使用分布作为输入，本质上实现了敏感性分析的自动化，并且比单变量敏感性分析具有重要优势； 4) 该模型生成输出的分布估计，量化其不确定性。 目标 2：模拟筛查和息肉切除术对 50 岁及以上健康人群中 CRC 发病率和死亡率趋势的影响。 我们的模型将使用描述该人群中筛查传播情况的数据，使我们能够检查 GHC 筛查与比率趋势之间的关系。 目标 3：模拟 HRT、筛查和息肉切除术对 50 岁及以上女性群体健康人群中 CRC 发病率趋势的综合影响。 激素替代疗法已被证明可以降低结直肠癌的发病率，并可能提高死亡率。 我们的第三个目标将使我们能够探索降低风险的机制，例如腺瘤性息肉风险的变化、减少其向临床前癌症的转变以及延长逗留时间。