Colorectal Cancer Screening:Evaluating Trends & Outcomes

结直肠癌筛查：评估趋势

• 批准号: 6950014
• 负责人: CAROLYN M RUTTER
• 金额: $ 27.38万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-15 至 2006-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6950014
• 关键词: adenomatous polyps; biopsy; cancer risk; clinical research; colon surgery; colorectal neoplasms; cooperative study; endoscopy; female; hormone therapy; human data; human mortality; managed care; mass screening; mathematical model; model design /development; neoplasm /cancer diagnosis; neoplasm /cancer epidemiology; outcomes research; women' s health

DESCRIPTION (provided by applicant)The proposed research develops microsimulation models to examine the effect of screening as practiced on observed trends in colorectal cancer (CRC) incidence and mortality in a defined population of over 500,000 members of Group Health Cooperative (GHC), a large HMO in western Washington. Extensive information about this population is available from automated clinical data systems that capture multiple health care events, including dates and results of laboratory tests (FOBT) and endoscopy procedures, pharmacy utilization, outpatient physician visits and hospitalizations. An established link between GHC and the westem Washington SEER will be used to identify CRC cases in this defined population and a population-based registry of GI pathology will be used to identify non-malignant outcomes (e.g. advanced adenomas) among GHC members. The proposed research will address 3 primary aims: Aim 1: Develop a microsimulation model for colorectal cancer that describes natural history, screening, diagnosis, and mortality: The model we propose takes distributional functions as inputs for unknown parameters, rather than fixed values. The proposed model has at least four key advantages over previous strategies: 1) The model incorporates uncertainty in model inputs; 2) It allows incorporation of correlation between model parameters through their distributional forms; 3) Its use of distributions as inputs essentially automates sensitivity analyses and offers an important advantage over univariate sensitivity analysis; and 4) The model produces distributional estimates for outputs, quantifying their uncertainty. Aim 2: Model the effect of screening and polypectomy on the trends in CRC incidence and mortality within the Group Health Population aged 50 and older. Our model will use data describing dissemination of screening within this population, allowing us to examine the relationship between screening at GHC and trends in rates. Aim 3: Model the combined effect of HRT, screening and polypectomy on trends in CRC incidence within the female Group Health Population aged 50 and older. HRT has been shown to reduce the incidence and perhaps improve mortality from colorectal cancer. Our third aim will allow us to explore mechanisms for this reduction in risk, such as changes in the risks for adenomatous polyps, decreases in their transition to preclinical cancer, and lengthening of sojourn time.

描述(申请人提供)建议的研究开发微模拟模型，以检验在华盛顿州西部的大型保健组织团体健康合作社(GHC)超过500,000名成员的确定人口中，筛查对结直肠癌(CRC)发病率和死亡率的观察趋势的影响。有关这一群体的广泛信息可从自动化临床数据系统中获得，该系统可捕获多个医疗保健事件，包括实验室测试(FOBT)和内窥镜检查程序的日期和结果、药房利用、门诊医生就诊和住院。GHC和华盛顿SEER西部之间已建立的联系将被用来识别这一定义人群中的CRC病例，基于人群的GI病理登记将被用来识别GHC成员中的非恶性结果(例如晚期腺瘤)。拟议的研究将涉及三个主要目标： 目的1：建立一个描述自然病史、筛查、诊断和死亡率的结直肠癌微观模拟模型：我们提出的模型以分布函数作为未知参数的输入，而不是固定值。与以前的策略相比，该模型至少有四个关键优点：1)该模型包含了模型输入中的不确定性；2)它允许通过模型参数的分布形式包含模型参数之间的相关性；3)它使用分布作为输入基本上自动化了灵敏度分析，并提供了比单变量灵敏度分析更重要的优势；4)该模型产生输出的分布估计，量化其不确定性。 目的2：模拟筛查和息肉切除术对50岁及以上健康人群中结直肠癌发病率和死亡率趋势的影响。我们的模型将使用描述筛查在这一人群中传播的数据，使我们能够检查GHC筛查与发病率趋势之间的关系。 目的3：模拟激素替代疗法、筛查和息肉切除术对50岁及以上女性健康人群中结直肠癌发病率趋势的联合影响。HRT已被证明可以降低结直肠癌的发病率，甚至可能提高死亡率。我们的第三个目标将使我们能够探索降低风险的机制，例如腺瘤性息肉风险的变化，向临床前癌症过渡的减少，以及逗留时间的延长。