Optimizing Colonoscopy & Fecal Immunochemical Tests for Community-Based Screening

优化结肠镜检查

• 批准号: 8221787
• 负责人: DOUGLAS Allen CORLEY
• 金额: $ 159.77万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8221787
• 关键词: Adherence; Advisory Committees; African American; American Cancer Society; Asian Americans; Behavioral; Biological; Biological Markers; California; Cancer Detection; Cancer Intervention and Surveillance Modeling Network; Carcinoma; Cessation of life; Characteristics; Clinical Trials; Collaborations; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Neoplasms; Communities; Complement; Computerized Medical Record; DNA; DNA Methylation; Data; Data Collection; Databases; Detection; Diagnosis; Diagnostic; Diagnostic Neoplasm Staging; Distal; Effectiveness; Endoscopy; Environmental Risk Factor; Excision; Failure; Family Physicians; Fecal occult blood; Feces; Formalin; Foundations; Gastroenterologist; Genetic Crossing Over; Genetic Markers; Goals; Guaiac; Healthcare; Healthcare Systems; Hemoglobin; Hispanics; Human; Incidence; Individual; Instruction; Intervention; Lesion; Literature; Mails; Malignant Neoplasms; Medical; Medical center; Methods; Modeling; Molecular; Oncologist; Optics; Outcome; Paraffin Embedding; Patients; Pattern; Persons; Pharmaceutical Preparations; Physicians; Population; Preventive; Process; Property; Publishing; Recording of previous events; Registries; Reporting; Research; Research Personnel; Resources; Risk; Scientist; Screening Result; Screening procedure; Services; Site; Specimen; Staging; System; Test Result; Testing; Tissues; Tumor stage; Vimentin; adenoma; base; cancer diagnosis; cancer risk; cohort; colorectal cancer screening; community setting; demographics; dietary restriction; health care delivery; lifestyle factors; member; molecular marker; mortality; multimodality; outreach; outreach program; patient population; population based; pre-clinical; programs; rural area; socioeconomics; suburb; tumor

The overall goal of the Research Center is the creation of a research unit that can evaluate the complete colorectal cancer (CRC) screening process. The specific goal is the characterization of remediable failures of the two most commonly used screening tests (optical colonoscopy and fecal immunochemical tests [FIT]). Two important problems in CRC are over-screening and under-diagnosis: 1) >95% of people will not die of CRC, thus, for most patients, screening results only in worry & risk; yet 2) many CRC deaths occur despite CRC screening (i.e. in persons with prior screening). It is unclear how many deaths result from remediable failures of the screening process. Our center will evaluate a community-based cohort that includes detailed CRC screening and medical data for >2 million screening-eligible people/year; >10 years of data; large numbers of outcomes (38,000 cancers); geographic diversity (>35 medical centers across California); demographic diversity (140,000 African Americans, 320,000 Hispanics, and 200,000 Asian-Americans among current members); socioeconomic diversity; diversity of screening methods; access to tissue/cancer blocks; and a full spectrum of individual cancer risk. Project 1 will evaluate FIT, an effective and efficient noninvasive screening method. Project 2 will evaluate colonoscopy, a sensitive, widely used test that is the final common exam for all CRC screening strategies. Projects 1 & 2 will both evaluate patterns of use, especially: screening failures (cancers diagnosed despite screening); surveillance failures, and surveillance over-use. We will investigate physician and patient components for these failures using a recently developed systematic process that includes establishing bases for interventions that target barriers in healthcare settings. Project 1 will also evaluate clinically available genetic markers to evaluate for potential biological differences between FIT detected vs. screen failure cancers. Project 3 will model the effectiveness of colonoscopy vs. FIT utilizing community-based data from the full screening process acquired in Projects 1 & 2, in collaboration with a proven NCI consortium Cancer Intervention and Surveillance Modeling Network (CISNET) site, including different screening strategies for different patient populations, tailored to risk. The Center includes a trans-disciplinary group of researchers including gastroenterologists, oncologists, family physicians, population scientists, modeling experts, quality experts, behavioral experts, and experts in health care delivery. The Center can efficiently evaluate the full screening process and can provide substantial human, institutional, and patient resources for collaborative projects within the PROSPR network.

该研究中心的总体目标是建立一个能够评估完整的结直肠癌（CRC）筛查过程的研究单位。具体目标是表征两种最常用的筛查试验（光学结肠镜检查和粪便免疫化学试验[FIT]）的可补救失败。CRC的两个重要问题是过度筛查和诊断不足：1)95%的人不会死于CRC，因此，对大多数患者来说，筛查只带来担忧和风险；2)尽管进行了结直肠癌筛查，但仍发生了许多结直肠癌死亡（即先前进行过筛查的人）。目前尚不清楚有多少死亡是由于筛查过程中可补救的失误造成的。我们的中心将评估一个以社区为基础的队列，包括详细的结直肠癌筛查和医疗数据，每年筛查200万符合条件的人；bbb10年数据；大量的结果（38,000例癌症）；地理多样性（加州有35个医疗中心）；人口多样性（现任会员中有14万非洲裔美国人、32万西班牙裔美国人和20万亚裔美国人）；社会经济多样性;筛选方法的多样性；进入组织/癌症块；以及所有的个人癌症风险。项目1将评估FIT，一种有效、高效的无创筛查方法。项目2将评估结肠镜检查，这是一种敏感的，广泛使用的测试，是所有CRC筛查策略的最终常见检查。项目1和项目2都将评估使用模式，特别是：筛查失败（尽管筛查仍诊断出癌症）；监督失败，监督过度使用。我们将使用最近开发的系统流程调查这些失败的医生和患者因素，其中包括为针对医疗保健设置障碍的干预措施建立基础。项目1还将评估临床可用的遗传标记，以评估FIT检测到的癌症与筛查失败癌症之间的潜在生物学差异。项目3将利用项目1和项目2中获得的基于社区的全筛查过程数据，与一个成熟的NCI联盟癌症干预和监测建模网络（CISNET）站点合作，对结肠镜检查与FIT的有效性进行建模，包括针对不同患者群体的不同筛查策略，针对风险进行量身定制。该中心包括一个跨学科的研究小组，包括胃肠病学家、肿瘤学家、家庭医生、人口科学家、建模专家、质量专家、行为专家和卫生保健提供专家。该中心可以有效地评估整个筛查过程，并为prosper网络内的合作项目提供大量的人力、机构和患者资源。