Effectiveness of screening for colorectal cancer in average risk adults: Colonoscopy vs FIT

平均风险成人结直肠癌筛查的有效性：结肠镜检查与 FIT

• 批准号: 10689561
• 负责人: Chyke Abadama Doubeni
• 金额: $ 9.7万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-10 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10689561
• 关键词: Effectiveness; screening; colorectal; cancer; average

PROJECT SUMMARY: Cancers of the colon and rectum are the second leading cause of cancer deaths in the United States, but are potentially preventable through early detection of invasive or precancerous lesions. Of the currently recommended tests for screening average risk people, colonoscopy is the most commonly used in the United States, but stool-based tests such as fecal immunochemical tests (FIT), are the most commonly used globally. However, there is currently no strong evidence to inform highly consequential decisions on these competing screening strategies, which contributes to conflicting recommendations from policy groups including a Canadian task force recommendation against using colonoscopy for routine screening. Microsimulation studies report that FIT and colonoscopy can achieve similar overall lifetime effectiveness, but are based on assumptions of efficacy and adherence to regular screening that are not attainable in real practice. An added challenge is the paucity of well-developed statistical approaches that can account for varying levels of adherence, patterns of use such as cross-overs, and time-dependent confounding when estimating the effectiveness of colorectal cancer (CRC) screening tests. Our proposed series of studies aim to: 1) estimate the effectiveness of FIT in reducing the risk of dying from CRC when compared with no screening, and 2) compare the effectiveness of FIT in reducing the risk of dying from CRC relative to screening colonoscopy. We will also assess for potential effect modification by race/ethnicity, sex, and socioeconomic status. We will use a nested case-control design with about 2000 cases and 8000 controls between 2014 and 2018 in a historical cohort of about 2 million screening-eligible people receiving care at Kaiser Permanente Northern and Southern California. Cases for the study will be men and women who were 52-89 years old at the date of death from CRC, each matched within health plan to four randomly selected controls based on age, sex, enrollment history, and geographic region. As secondary methodological aims, we will: 1) apply novel statistical methods to estimate FIT-colonoscopy comparative effectiveness in varying real-life screening patterns including imperfect adherence and crossover from FIT to colonoscopy; and 2) assess the use of a case-cohort design to inform future studies. As an exploratory aim, we will characterize the resources required to screen with FIT or colonoscopy as inputs for future microsimulation studies. Our study sites provide the full continuum of cancer care ranging from screening through end of life, and provide access to information on CRC screening that can be linked to diagnosis and cause-specific mortality data on large numbers of people. We will identify receipt of screening colonoscopy and screening FIT in the 10-year window prior to the reference date, differentiating screening from diagnostic procedures with selected chart audits to confirm colonoscopy screening indications. This will be the first observational study to address these critical scientific, clinical, and policy questions. The project will be implemented by an experienced team of high-impact scientists.

项目摘要：结肠和直肠的癌症是癌症死亡的第二大原因 美国，但可以通过早期发现侵入性或癌前病变来预防。的 目前建议的筛查平均风险人的测试，结肠镜检查是最常用的 在美国，但基于粪便的测试，例如粪便免疫化学测试（FIT），是最常见的 全球使用。但是，目前尚无强有力的证据来告知这些决定 竞争筛查策略，这有助于政策群体的相互矛盾的建议 加拿大工作队建议不要使用结肠镜检查进行常规筛查。微仿真 研究报告，拟合和结肠镜检查可以实现相似的整体寿命效率，但基于 在实际实践中无法实现的疗效和遵守定期筛查的假设。一个添加 挑战是不足发达的统计方法，可以解释不同水平的 依从性，使用模式（例如交叉跨境）以及时间依赖于时间的混杂在估计 结直肠癌（CRC）筛查测试的有效性。我们提出的一系列研究旨在：1）估计 与没有筛查相比，适合降低CRC死亡风险的有效性，2） 比较拟合在降低CRC相对于筛查结肠镜检查中死亡的风险中的有效性。我们 还将评估种族/种族，性别和社会经济地位的潜在影响修改。我们将使用一个 嵌套的病例对照设计，在2014年至2018年之间，有大约2000例病例和8000个对照 在Kaiser Permanente Northern和Southern接受护理的大约200万符合筛查的人群 加利福尼亚。该研究的病例将是在死亡之日52-89岁的男人和女人 CRC，每个人都在健康计划中与基于年龄，性别，入学的四个随机选择的控件匹配 历史和地理区域。作为次要方法论目的，我们将：1）应用新颖的统计方法 估计在不同的现实筛查模式中的拟合授权比较有效性 从拟合到结肠镜检查不完善的依从性和交叉； 2）评估使用案例 - 霍特设计的使用 告知未来的研究。作为探索性目的，我们将表征适合或适合筛选所需的资源 结肠镜检查作为未来微仿真研究的输入。我们的研究地点提供了癌症的完整连续性 护理从筛查到生命的尽头，并提供有关CRC筛查信息的访问 与大量人有关的诊断和引起特定的死亡率数据有联系。我们将确定收据 在参考日期之前的10年窗口中筛选结肠镜检查和筛选拟合 通过选定的图表审核从诊断程序进行筛选，以确认结肠镜检查筛查适应症。 这将是第一个解决这些关键科学，临床和政策问题的观察性研究。这 项目将由经验丰富的高影响力科学家团队实施。

项目成果

In Screening for Colorectal Cancer, Is the FIT Right for the Right Side of the Colon?

• DOI: 10.7326/m18-2444
• 发表时间: 2018-11-06
• 期刊: ANNALS OF INTERNAL MEDICINE
• 影响因子: 39.2
• 作者: Doubeni, Chyke A.;Levin, Theodore R.
• 通讯作者: Levin, Theodore R.

The effect of using fecal testing after a negative sigmoidoscopy on the risk of death from colorectal cancer.

• DOI: 10.1177/0969141320921427
• 发表时间: 2021-06
• 期刊: Journal of medical screening
• 影响因子: 2.9
• 作者: Doubeni CA;Corley DA;Jensen CD;Schottinger JE;Lee JK;Ghai NR;Levin TR;Zhao WK;Saia CA;Wainwright JV;Mehta SJ;Selby K;Doria-Rose VP;Zauber AG;Fletcher RH;Weiss NS
• 通讯作者: Weiss NS

Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer.

腺瘤检测对粪便检测与结肠镜检查对结直肠癌的益处的影响。

• DOI: 10.1002/ijc.30933
• 发表时间: 2017
• 期刊: International journal of cancer
• 影响因子: 6.4
• 作者: Meester,ReinierGS;Doubeni,ChykeA;Zauber,AnnG;vanBallegooijen,Marjolein;Corley,DouglasA;Lansdorp-Vogelaar,Iris
• 通讯作者: Lansdorp-Vogelaar,Iris

RE: "ESTIMATING THE EFFECT OF PREVENTIVE SERVICES WITH DATABASES OF ADMINISTRATIVE CLAIMS: REASONS TO BE CONCERNED".

回复：“利用行政索赔数据库评估预防服务的效果：需要关注的理由”。

• DOI: 10.1093/aje/kwz050
• 发表时间: 2019
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Weiss,NoelS

Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death.

结直肠癌筛查过程中可改变的失败及其与死亡风险的关联。

• DOI: 10.1053/j.gastro.2018.09.040
• 发表时间: 2019-01
• 期刊: Gastroenterology
• 影响因子: 29.4
• 作者: Doubeni CA;Fedewa SA;Levin TR;Jensen CD;Saia C;Zebrowski AM;Quinn VP;Rendle KA;Zauber AG;Becerra-Culqui TA;Mehta SJ;Fletcher RH;Schottinger J;Corley DA
• 通讯作者: Corley DA