Effectiveness of Screening Colonoscopy in Reducing Deaths from Colorectal Cancer

筛查结肠镜检查在减少结直肠癌死亡方面的有效性

• 批准号: 8242807
• 负责人: Chyke Abadama Doubeni
• 金额: $ 86.95万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8242807
• 关键词: Access to Information; Address; Adult; Age; Belief; Biometry; Body mass index; Calendar; California; Cancer Etiology; Cancer Research Network; Caring; Case-Control Studies; Cessation of life; Characteristics; Clinical; Colon; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Communities; Community Health Planning; Complication; Computerized Medical Record; Data; Databases; Decision Making; Diagnosis; Diagnostic; Diagnostic Procedure; Effectiveness; Enrollment; Epidemiology; European; Evaluation; Exclusion; Exposure to; Flexible fiberoptic sigmoidoscopy; Gastroenterology; Goals; Guidelines; Health Planning; Health Policy; Healthcare; Healthy People 2010; Intestines; Intubation; Left; Left colon; Link; Malignant Neoplasms; Medical Records; Methodology; Methods; Modeling; National Cancer Institute; Nested Case-Control Study; Ontario; Outcome; Patients; Performance; Persons; Policies; Policy Maker; Policy Research; Population; Preparation; Preventive; Primary Health Care; Procedures; Public Health; Randomized Clinical Trials; Recording of previous events; Rectum; Relative (related person); Relative Risks; Reporting; Research; Research Infrastructure; Research Personnel; Research Priority; Resources; Right colon; Risk; Safety; Sample Size; Science; Screening procedure; Services; Side; Sigmoidoscopy; Site; Source; Staging; Study models; System; Techniques; Testing; Time; Uncertainty; United States; adjudication; aged; base; cancer care; cancer diagnosis; case control; clinical practice; cohort; comparative effectiveness; compare effectiveness; cost; design; end of life; experience; follow-up; health care delivery; health care service utilization; health disparity; high risk; improved; member; mortality; prevent; programs; public health relevance; randomized trial; sex; socioeconomics; tumor

DESCRIPTION (provided by applicant): Cancers of the colon and rectum (CRC), the second leading cause of cancer death in the US, can be detected at an early, more curable, stage or even prevented using available screening techniques. Although some expert groups in the US consider colonoscopy to be the standard, there is currently only limited direct evidence to support its increasing use for screening in average risk adults. Colonoscopy has higher risks and costs than other screening tests. Recent studies reported that colonoscopy did not reduce mortality from right-sided colon cancers, the part of the colon that is beyond the reach of sigmoidoscopy. However, those findings were controversial because that study was unable to distinguish screening from diagnostic uses or accurately assess the completeness of colonoscopies. This project's goal is to inform clinical and policy decisions by providing evidence to show whether the purported benefits of colonoscopy are realized in practice. The primary specific aim is to estimate the effectiveness of screening colonoscopy in reducing death from CRC among average-risk adults when compared to no screening, overall and separately for right- and left-sided cancers. Our secondary aims are to: 1) determine the impact of the completeness of colonoscopy examinations on its effectiveness; and 2) compare the effectiveness of screening colonoscopy relative to sigmoidoscopy. We will use a case-control design nested in an historical cohort of persons receiving care at 3 sites participating in a research consortium, Cancer Research Network (CRN). These sites provide the full continuum of cancer care to their members ranging from screening through end of life care, and provide access to information on CRC screening that can be linked to diagnosis and cause-specific mortality data on large numbers of racially and socioeconomically diverse persons. We will identify at least 1,200 cases of CRC deaths between 2007 and 2014 among enrollees who were 52 years or older at the date of the diagnosis, each matched within each health plan to two randomly selected controls based on age, sex and enrollment history. We will identify screening history for a minimum of 10 years prior to cancer diagnosis, differentiating screening from diagnostic procedures, using standardized targeted chart reviews and other sources. The sample size will provide sufficient power for separate evaluations of tumors located in the right colon. This project will be carried out by an experienced interdisciplinary team representing epidemiology, case-control methodology, biostatistics, gastroenterology and primary care. Team members are national leaders in CRC screening research and policy. This project is in synergy with existing NCI and the CRN goals to: 1) develop methods and approaches to provide clinical, policy-relevant information; and 2) inform clinical and public health decisions on CRC screening. This application is also responsive to the NCI's priority to improve understanding of the effectiveness and comparative effectiveness of tests used in screening for CRC, a "health disparity condition", and addresses Healthy People 2010 goals to reduce cancer death. PUBLIC HEALTH RELEVANCE: Colon cancer is the second leading cause of cancer death in the United States, but many of these cancers can be detected at an early, more curable, stage or even prevented using available screening techniques. Although many people believe that colonoscopy is the best screening test, there is currently no scientific evidence to support that claim. The goal of our proposed study is to provide scientific evidence on whether current beliefs about the benefits of colonoscopy screening are realized in actual clinical practice in order to help patients, doctors, and policy makers make decisions about colon cancer screening.

描述（由申请人提供）：结肠癌和直肠癌 (CRC) 是美国癌症死亡的第二大原因，可以使用现有的筛查技术在早期、更可治愈的阶段进行检测，甚至进行预防。尽管美国的一些专家组认为结肠镜检查是标准检查，但目前只有有限的直接证据支持其在普通风险成年人中越来越多地用于筛查。结肠镜检查比其他筛查测试具有更高的风险和成本。最近的研究报告称，结肠镜检查并不能降低右侧结肠癌的死亡率，而右侧结肠癌是乙状结肠镜检查无法触及的部分结肠。然而，这些发现存在争议，因为该研究无法区分筛查和诊断用途，也无法准确评估结肠镜检查的完整性。该项目的目标是通过提供证据来证明结肠镜检查所声称的好处是否在实践中得到实现，从而为临床和政策决策提供信息。主要具体目的是评估与不进行筛查相比，结肠镜筛查在减少平均风险成人 CRC 死亡方面的有效性，无论是总体还是单独筛查右侧和左侧癌症。我们的次要目标是：1）确定结肠镜检查的完整性对其有效性的影响； 2) 比较结肠镜检查与乙状结肠镜检查的筛查效果。我们将使用病例对照设计，嵌套在参与研究联盟癌症研究网络 (CRN) 的 3 个地点接受护理的历史队列中。这些网站为其成员提供从筛查到临终关怀的全方位癌症护理，并提供有关 CRC 筛查的信息，这些信息可与大量种族和社会经济背景不同的人的诊断和特定原因死亡率数据相关联。我们将在 2007 年至 2014 年间确定至少 1,200 例 CRC 死亡病例，这些病例都是诊断时年龄为 52 岁或以上的登记者，每个病例在每个健康计划中与根据年龄、性别和登记史随机选择的两个对照相匹配。我们将使用标准化的目标图表审查和其他来源，确定癌症诊断前至少 10 年的筛查历史，将筛查与诊断程序区分开来。样本量将为位于右结肠的肿瘤的单独评估提供足够的能力。该项目将由代表流行病学、病例对照方法、生物统计学、胃肠病学和初级保健的经验丰富的跨学科团队执行。团队成员是 CRC 筛查研究和政策领域的国家领导者。该项目与现有 NCI 和 CRN 目标相协同：1) 开发提供临床、政策相关信息的方法和途径； 2) 为 CRC 筛查的临床和公共卫生决策提供信息。该应用程序还响应了 NCI 的优先任务，即提高对用于筛查 CRC（一种“健康差异状况”）的测试的有效性和比较有效性的了解，并实现了 Healthy People 2010 减少癌症死亡的目标。 公共健康相关性：结肠癌是美国癌症死亡的第二大原因，但其中许多癌症可以在早期、更可治愈的阶段被发现，甚至可以使用现有的筛查技术进行预防。尽管许多人认为结肠镜检查是最好的筛查测试，但目前没有科学证据支持这一说法。我们提出的研究的目的是提供科学证据，证明当前关于结肠镜检查筛查益处的信念是否在实际临床实践中得到实现，以帮助患者、医生和政策制定者做出有关结肠癌筛查的决策。