Reduction of colorectal cancer incidence and mortality after endoscopic screening and evaluation of risk-adapted screening strategies

在达克斯的研究中，自2003年以来，在整个莱茵-内卡-奥登瓦尔德地区招募了结直肠癌患者和没有结直肠癌的对照组。该地区所有22家为结直肠癌患者提供初级治疗的诊所都参与了这项研究的招募。在这项以人群为基础的病例对照研究中，通过人口登记根据病例的年龄、性别和居住地的分布(使用频率匹配)来选择对照。招聘包括由训练有素的面试者进行广泛的个人面试和捐献血液样本。从参与者的医生那里获得了包括癌症诊断(病例)的详细信息和以前的大肠内窥镜检查报告(用于验证自我报告、病例和对照)的医疗记录。在之前的资助期间，申请者大幅扩展了DACHES研究的数据库，他们利用这个数据库对德国结肠镜检查后结直肠癌发病率的降低进行了各种分析，这在科学界以及在制定和更新国家和国际筛查指南时受到了极大的关注。此外，申请者还启动并建立了关于特定死因死亡的病例的系统后续行动。这一后续应用旨在进一步深入分析5000名结直肠癌患者和5000名对照的扩展数据集中结直肠癌发病率的降低情况。它还将首次能够对降低结直肠癌死亡率--结直肠癌筛查的最终和最重要的目标--进行深入分析。本项目的重点将放在降低特定风险群体的结直肠癌发病率和死亡率的详细分析上，这是由于样本量的大幅增加和研究人群的死亡率跟踪而首次实现的，对于未来发展基于证据、风险适应和成本效益的结直肠癌筛查策略至关重要。总之，该建议有以下目标：1.关于内窥镜筛查后结直肠癌发病率的详细分析，以及从循证的、风险适应的筛查策略的角度对优化结直肠癌筛查的潜在影响。首次分析了内窥镜筛查后结直肠癌死亡率的降低，以及在循证、风险适应筛查策略方面对结直肠癌筛查优化的潜在影响。

In the DACHS study, colorectal cancer patients and control persons without colorectal cancer are recruited in the entire Rhine-Neckar-Odenwald region since 2003. All 22 clinics in the region offering primary treatment of patients with colorectal cancer participate in recruitment for the study. Controls in this population-based case-control study are selected according to the distribution of age, sex and place of residence of the cases (using frequency matching) via population registries. Recruitment includes an extensive personal interview by trained interviewers and the donation of a blood sample. Medical records including detailed information on cancer diagnosis (cases) and reports of previous large bowel endoscopies (for validation of self-reports, cases and controls) are obtained from the physicians of the participants.During the preceding funding period, the applicants have substantially expanded the database of the DACHS study, and they have used this database for a variety of analyses on reduction of colorectal cancer incidence after colonoscopy in Germany which received much attention in the scientific community and in the formulation and update of national and international screening guidelines. The applicants have furthermore initiated and established a systematic follow-up of cases with respect to cause-specific mortality. This follow-up application aims to enable further in-depth analyses on reduction of colorectal cancer incidence in an extended dataset of 5,000 colorectal cancer patients and 5,000 controls. It shall furthermore enable to conduct, for the first time, in-depth analyses on reduction of colorectal cancer mortality - the ultimate and most significant goal of colorectal cancer screening. The focus of this project will be on detailed analyses on reduction of colorectal cancer incidence and mortality for specific risk groups, which are enabled for the first time due to the substantially increased sample size and the meanwhile established mortality follow-up of the study population and which are essential for future development of evidence-based, risk-adapted and cost-effective colorectal cancer screening strategies.In summary, the proposal has the following objectives:1. Detailed analyses on the reduction of colorectal cancer incidence following endoscopic screening and potential implications for the optimization of colorectal cancer screening in terms of evidence-based, risk-adapted screening strategies.2. First analyses on the reduction of colorectal cancer mortality following endoscopic screening and potential implications for the optimization of colorectal cancer screening in terms of evidence-based, risk-adapted screening strategies.