Methodologic Innovations in Cancer Epidemiology

癌症流行病学的方法创新

• 批准号: 10655958
• 负责人: Bernard A Rosner
• 金额: $ 48.69万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10655958
• 关键词: Advanced Development; Age; Alcohol consumption; Aspirin; Beta Carotene; Biological; Birth; Body mass index; Breast; Breast Cancer Risk Factor; Cancer Model; Cancer Patient; Cessation of life; Colonoscopy; Colorectal Cancer; Complex; Contraceptive Usage; Data; Development; Diagnosis; Diagnostic; Disease; Exogenous Hormone Therapy; Exposure to; Folic Acid; Future; Goals; High Risk Woman; Hormone replacement therapy; Incidence; Intake; Interruption; Lesion; Literature; Malignant Neoplasms; Malignant neoplasm of ovary; Mammographic screening; Measures; Methodology; Methods; Modeling; Natural History; Nurses' Health Study; Oral Contraceptives; Outcome Assessment; Patients; Physical activity; Polyps; Postmenopause; Predictive Factor; Predisposing Factor; Predisposition; Pregnancy Histories; Premenopause; Prevention; Probability; Process; Processed Meats; Prospective Studies; Psychosocial Stress; Public Health; Recording of previous events; Research Personnel; Risk; Risk Estimate; Risk Factors; Smoking; Specific qualifier value; Survival Analysis; Time; Update; Woman; Work; adenoma; aged; calcium intake; cancer diagnosis; cancer epidemiology; cancer risk; cancer survival; carcinogenicity; colorectal cancer progression; colorectal cancer risk; colorectal cancer screening; follow-up; improved; innovation; interest; malignant breast neoplasm; modifiable risk; mortality; parity; premalignant; prognostic model; risk prediction; risk prediction model; screening

Project Summary Cancers take many years to develop, and death due to a cancer may occur many years after diagnosis. Therefore, it is important to use innovative methods of analysis to make optimal use of all exposure data both before and after diagnosis. We propose four types of innovations in the current application. Lethal cancer models: Of highest public health interest is what risk factors predispose a disease-free subject to die due to a specific cancer in the future. We have previously developed models for lethal cancer by integrating models for cancer incidence with models for prognosis after a cancer diagnosis. In this application, we propose to extend this approach in the case of colorectal cancer (CRC) by considering three stages in the carcinogenic process: (a) development of advanced polyp, (b) development of incident CRC after advanced polyp have been identified and removed, and (c) death due to CRC among patients with incident CRC. Latency models: Some prospective studies have risk factor data available at several points in time. One issue is how these data should be optimally used to predict cancer incidence. One approach is to use the most recent exposure; a 2nd approach is to use the total duration of exposure; a 3rd approach is to introduce a lag between exposure and outcome assessment. In this application, we propose a latency model to estimate the optimal weighting of previous exposures to predict cancer incidence; these models enhance understanding of biological mechanisms for specific risk factors. Cure Models: There have been many studies of risk factors predicting mortality among cancer patients. However, for some cancers, if patients do not die from their cancer over a given period of time (e.g., within 5 years for CRC), then they are unlikely to ever die due to their cancer, and will probably die due to another cause (i.e., they are cured). But what are the risk factors that predict cure? Although cure models have been used before, they mostly are based on post-diagnostic risk factors. To our knowledge, this is the 1st proposal to consider pre-diagnostic risk factors as predictors of cure. Assessing Effects of Screening on CRC risk models: Colonoscopy is the current standard for CRC screening. It is unique, in that if pre-cancerous lesions (i.e., adenomas) are found, then they are removed, and the natural history of CRC progression is interrupted. However, even if these lesions are removed, for some subjects, these lesions are more likely to develop again at a future time. Thus, it is challenging how to control for effects of screening in CRC risk models. In this application, we propose an innovative approach to control for screening by both assessing effects of a risk factor on adenoma incidence, and effects of adenoma incidence on CRC risk.

项目概要 癌症需要很多年才能形成，并且癌症导致的死亡可能会在诊断后很多年发生。 因此，使用创新的分析方法来充分利用所有暴露数据非常重要 诊断前和诊断后。我们在当前的应用中提出了四种类型的创新。 致命的癌症模型：公众健康最关心的是哪些危险因素容易导致无病患者 将来可能会因某种特定癌症而死亡。我们之前开发过致命模型 通过将癌症发病率模型与癌症诊断后的预后模型相结合来治疗癌症。在 在此应用中，我们建议将这种方法扩展到结直肠癌（CRC）的情况： 考虑到致癌过程的三个阶段：(a) 发展为晚期息肉，(b) 发现并切除晚期息肉后发生结直肠癌事件，以及 (c) 由于死亡 CRC 患者中发生 CRC 的情况。 延迟模型：一些前瞻性研究在多个时间点提供了可用的风险因素数据。一 问题是如何最好地利用这些数据来预测癌症发病率。一种方法是使用 最近的曝光；第二种方法是使用总暴露持续时间；第三种方法是 在暴露和结果评估之间引入滞后。在此应用中，我们提出了延迟 模型估计先前暴露的最佳权重以预测癌症发病率；这些 模型增强了对特定风险因素的生物学机制的理解。 治愈模型：已经有许多关于预测癌症患者死亡率的危险因素的研究。 然而，对于某些癌症，如果患者在给定的时间内没有死于癌症（例如， CRC 的 5 年内），那么他们不太可能因癌症而死亡，并且可能会因癌症而死亡 到另一个原因（即，他们被治愈了）。但预测治愈的风险因素有哪些呢？虽然治愈了 以前已经使用过模型，它们大多基于诊断后的风险因素。据我们所知， 这是第一个将诊断前风险因素视为治愈预测因素的提案。 评估筛查对 CRC 风险模型的影响：结肠镜检查是 CRC 的现行标准 筛选。它的独特之处在于，如果发现癌前病变（即腺瘤），那么它们就会被 去除，CRC 进展的自然史被中断。然而，即使这些损伤 去除后，对于某些受试者来说，这些病变更有可能在未来再次出现。因此，它是 如何控制 CRC 风险模型中筛查的影响具有挑战性。在这个应用中，我们提出了一个 通过评估风险因素对腺瘤的影响来控制筛查的创新方法 发病率以及腺瘤发病率对 CRC 风险的影响。