Colonoscopy in young onset colorectal cancer

年轻发病结直肠癌的结肠镜检查

基本信息

批准号：
10083204
负责人：
Joshua Brian Demb
金额：
$ 6.64万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-01 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10083204
关键词：
Address Adult Age American Cancer Society Biometry Blood Cancer Etiology Cancer-Related Condition Case Study Cessation of life Clinical Colon Colonoscopy Colorectal Cancer Data Detection Diagnosis Effectiveness Elderly Electronic Health Record Epidemiology Exposure to Family Family history of Feces First Degree Relative Guidelines Hematochezia Incidence Individual Integrated Health Care Systems Intervention Iron deficiency anemia Learning Light Literature Malignant Neoplasms Methods Outcome Persons Play Population Prevalence Procedures Randomized Controlled Trials Recommendation Recording of previous events Rectal Cancer Reporting Research Personnel Risk Role Rules of conduct Signal Transduction Signs and Symptoms Study models Testing Time United States United States Department of Veterans Affairs Update Veterans Veterans Health Administration Work base cancer epidemiology clinical practice cohort colorectal cancer risk colorectal cancer screening data warehouse early onset colorectal cancer early screening evidence base follow-up improved mortality novel strategies post-doctoral training prevent screening screening guidelines screening policy skills training opportunity uptake young adult

项目摘要

PROJECT SUMMARY Colorectal cancer (CRC) accounts for 8% of cancer incidence and 8% of cancer-related mortality in the United States. While CRC risk and CRC-related mortality overall have decreased in recent years, the proportion of CRC cases among adults ages <50—known as young onset colorectal cancer (YCRC)—has increased. One clinical strategy recommended to detect YCRC earlier is colonoscopy for adults presenting with conditions that might increase YCRC risk, such as iron deficiency anemia (IDA) or hematochezia (visible blood in stool). Colonoscopy in these cases is conducted rule out CRC and has been proven to be particularly effective among elderly adults. However, little evidence exists about the relative benefit among adults ages <50. In light of increased YCRC incidence, a second clinical strategy recommended by the American Cancer Society involves lowering the age of CRC screening initiation from 50 to 45, despite a paucity of evidence that early screening initiation improves CRC-related outcomes in adults ages <50. While previous guidelines advised CRC screening prior to age 50 only among adults with reported family history of CRC, this represents only 30% of all CRC cases, meaning that identification of adults ages <50 most likely to benefit from YCRC- related colonoscopy remains unclear. Furthermore, there are no imminent RCTs offering interventions like colonoscopy for work-up of CRC-related conditions or screening asymptomatic adults, highlighting an urgent need to learn about YCRC-related colonoscopy benefit among adults ages <50. Our study will use national electronic health records and claims-based data from the Veterans Affairs (VA) Corporate Data Warehouse (CDW) to address key gaps in the literature by evaluating these two clinical strategies for colonoscopy uptake to address YCRC incidence and mortality. First, we will examine the benefits of colonoscopy uptake among Veterans ages <50 with conditions (IDA or hematochezia) that may increase CRC risk by comparing CRC risk among adults exposed to IDA or hematochezia (Aim 1a), examining proportion of timely colonoscopy uptake ≤60 days of IDA or hematochezia identification (Aim 1b), and comparing YCRC incidence, stage at detection and mortality by colonoscopy uptake among Veterans with IDA or hematochezia (Aim 1c). Next, we will compare the impact of exposure to colonoscopy on YCRC benefits among all Veterans ages 18-49 (Aim 2). Our study will be the most comprehensive examination of early exposure to colonoscopy in the US to date and will have important implications on current clinical guidelines and contextualize current CRC screening policy. Major strengths include: (1) use of EHR and claims-based data from the largest integrated healthcare system in the US; (2) VA studies have played critical roles in US clinical practice changes; and (3) the largest assessment of colonoscopy uptake among adults ages <50 to date. Finally, this study offers a high-quality postdoctoral training opportunity to understand current methods of CRC detection using colonoscopy, and to develop key skills in cancer epidemiology and biostatistics to become a qualified independent investigator.

项目概要结直肠癌 (CRC) 占癌症发病率的 8%，占癌症相关死亡率的 8% 尽管近年来 CRC 风险和 CRC 相关死亡率总体有所下降，但年龄 <50 岁的成年人中结直肠癌病例（称为年轻发病结直肠癌 (YCRC)）的比例建议早期发现 YCRC 的一种临床策略是对成人进行结肠镜检查。患有可能增加 YCRC 风险的疾病，例如缺铁性贫血 (IDA) 或便血（可见）在这些病例中进行结肠镜检查可排除结直肠癌，并且已被证明特别有效。然而，很少有证据表明成年人之间的相对获益。 <50 鉴于 YCRC 发病率增加，美国癌症协会推荐的第二种临床策略社会将结直肠癌筛查的起始年龄从 50 岁降低至 45 岁，尽管缺乏证据表明早期筛查可改善 50 岁以下成年人的 CRC 相关结果，而之前的指南则有所不同。建议仅在有 CRC 家族史的成年人中在 50 岁之前进行 CRC 筛查，这代表仅占所有 CRC 病例的 30%，这意味着年龄 <50 岁的成年人最有可能受益于 YCRC- 此外，目前还没有提供类似结肠镜检查等干预措施的随机对照试验。结肠镜检查用于检查 CRC 相关病症或筛查无症状成人，这凸显了迫切需要解决的问题需要了解年龄 <50 岁的成年人中与 YCRC 相关的结肠镜检查的益处，我们的研究将使用国家标准。来自退伍军人事务部 (VA) 公司数据仓库的电子健康记录和基于索赔的数据（CDW）通过评估这两种结肠镜检查的临床策略来解决文献中的关键空白为了解决 YCRC 的发病率和死亡率，我们将研究结肠镜检查的好处。通过比较 CRC 风险，年龄 <50 岁且患有可能增加 CRC 风险的疾病（IDA 或便血）的退伍军人在暴露于 IDA 或便血的成年人中（目标 1a），检查及时进行结肠镜检查的比例 ≤ 60 天的 IDA 或便血鉴定（目标 1b），并比较 YCRC 发病率、检测时的阶段患有 IDA 或便血的退伍军人中结肠镜检查的死亡率和死亡率（目标 1c）。比较所有 18-49 岁退伍军人接受结肠镜检查对 YCRC 福利的影响（目标 2）。我们的研究将是美国迄今为止对早期结肠镜检查最全面的检查将对当前的临床指南产生重要影响，并结合当前的 CRC 筛查政策。主要优势包括：(1) 使用来自最大综合医疗保健系统的 EHR 和基于索赔的数据在美国；(2) VA 研究在美国临床实践的变化中发挥了关键作用；(3) 规模最大的最后，这项研究提供了迄今为止 50 岁以下成年人接受结肠镜检查的高质量结果。博士后培训机会，了解当前使用结肠镜检查进行结直肠癌检测的方法，并培养癌症流行病学和生物统计学的关键技能，成为一名合格的独立调查员。