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仿真模型，以检查对观察到的筛查对观察到的结直肠癌趋势（CRC）发病率和死亡率的效果，该人群在西部华盛顿州的500,000多名群体保健合作社（GHC）的人群中有超过500,000名成员。 有关该人群的广泛信息，可从自动化的临床数据系统获得，这些数据系统捕获了多个医疗保健事件，包括实验室测试（FOBT）的日期和结果，内窥镜程序，药房利用，门诊医师的就诊和住院治疗。 GHC与Westem Washington Seer之间建立的联系将用于识别该定义人群中的CRC病例，并且将使用基于人群的GI病理学注册表来识别GHC成员中的非恶性结果（例如先进的腺瘤）。 拟议的研究将解决3个主要目标： AIM 1：开发一个描述自然历史，筛查，诊断和死亡率的大肠癌的微仿真模型：我们提出的模型将分布功能作为未知参数的输入，而不是固定值。 所提出的模型至少在以前的策略中至少具有四个关键优势：1）模型在模型输入中纳入不确定性； 2）它允许通过其分布形式在模型参数之间合并相关性； 3）它使用分布作为输入本质上是自动化的灵敏度分析，并具有比单变量灵敏度分析具有重要优势； 4）模型产生输出的分布估计，从而量化其不确定性。 AIM 2：建模筛查和多型切除术对50岁及50岁及以上的组健康人群中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的传播的数据，使我们能够检查GHC筛查与费率趋势之间的关系。 AIM 3：建模HRT，筛查和多型切除术对50岁及50岁以上女性健康人群中CRC发病率的趋势的综合作用。 HRT已被证明可以降低发生率，并可能改善结直肠癌的死亡率。 我们的第三个目标将使我们能够探索这种降低风险的机制，例如腺瘤息肉风险的变化，减少其向临床前癌的过渡以及索期时间的延长。