Colonoscopy in young onset colorectal cancer

年轻发病结直肠癌的结肠镜检查

• 批准号: 10501623
• 负责人: Joshua Brian Demb
• 金额: $ 3.49万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10501623
• 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

NOTE: the below is unchanged from the original application. 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.

注意：下面的原始应用程序没有变化。 项目摘要 结直肠癌（CRC）占癌症事件的8％，与癌症相关的死亡率的8％占该癌症的死亡率 美国。尽管CRC风险和与CRC相关的死亡率总体上有所提高，但 年龄在50岁的成年人中的CRC病例比例（称为年轻的结直肠癌（YCRC）） 增加。建议先前检测YCRC的一种临床策略是成年人的结肠镜检查 可能会增加YCRC风险的情况，例如铁缺乏贫血（IDA）或Hematochezia（可见 粪便中的血液）。在这些情况下，结肠镜检查是CRC的规则，已被证明是尤其是 在老年人中有效。但是，几乎没有证据表明成年人之间的相对利益 <50。鉴于YCRC事件增加，美国癌症推荐的第二种临床策略 社会涉及将CRC筛查倡议的年龄从50降低到45，目的地很少证据表明证据表明 早期筛查计划改善了与CRC相关的成年人<50的结果。而先前的指南 建议在50岁以前的CRC筛查仅在报告的CRC家族史的成年人中，这代表 在所有CRC病例中，只有30％，这意味着年龄<50的成年人的鉴定最有可能受益于YCRC- 相关的结肠镜检查尚不清楚。此外，没有即将提供干预措施的RCT 结肠镜检查，用于与CRC相关疾病或筛查渐近成年人的检查，突出了紧急 需要了解与YCRC相关的结肠镜检查的益处<50。我们的研究将使用国家 电子健康记录和资深人士事务（VA）公司数据仓库的基于索赔的数据 （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差距 解决YCRC事件和死亡率。首先，我们将研究结肠镜检查的好处 退伍军人年龄<50岁的条件（IDA或Hematochezia）可能通过比较CRC风险来增加CRC风险 在暴露于IDA或Hematochezia的成年人中（AIM 1A），检查了及时的结肠镜检查比例 ≤60天的IDA或Hematochezia识别（AIM 1B），并比较YCRC事件， 与IDA或Hematochezia的退伍军人之间的结肠镜检查死亡率（AIM 1C）。接下来，我们会的 比较暴露于18-49岁的所有退伍军人对结肠镜检查对YCRC益处的影响（AIM 2）。 我们的研究将是迄今为止美国早期接触结肠镜检查的最全面的检查， 将对当前的临床准则具有重要意义，并将当前的CRC筛查政策背景化。 主要优势包括：（1）最大综合医疗系统中使用EHR和基于索赔的数据 在美国； （2）VA研究在美国临床实践变化中起着关键作用； （3）最大的 迄今为止，年龄在50岁的成年人的结肠镜检查评估。最后，这项研究提供了高质量的 博士后训练机会，使用结肠镜检查了解当前的CRC检测方法，并 发展癌症流行病学和生物统计学的关键技能成为合格的独立研究者。