Optimizing Colonoscopy & Fecal Immunochemical Tests for Community-Based Screening

优化结肠镜检查

• 批准号: 8338833
• 负责人: DOUGLAS Allen CORLEY
• 金额: $ 114.18万
• 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 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8338833
• 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创建一个能够评估完整的结直肠癌(CRC)筛查过程的研究单位。具体目标是确定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])的可补救故障的特征。结直肠癌的两个重要问题是筛查过度和诊断不足：1)95%的人不会死于结直肠癌，因此，对大多数患者来说，筛查只会带来担忧和风险；2)尽管进行了结直肠癌筛查，但仍有许多结直肠癌死亡(即，在以前进行过筛查的人中)。目前尚不清楚有多少死亡是由于筛查过程中可补救的失败造成的。我们中心将评估以社区为基础的队列，包括详细的CRC筛查和医疗数据；200万符合筛查条件的人/年；&gt；10年数据；大量结果(38,000例癌症)；地理多样性(加州35个医疗中心)；人口多样性(现有成员中有140,000名非洲裔美国人、320,000名西班牙裔美国人和200,000名亚裔美国人)；社会经济多样性；筛查方法的多样性；获得组织/癌症块；以及个人癌症风险的全面范围。项目1将评估FIT，一种有效和高效的非侵入性筛查方法。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，是所有结直肠癌筛查策略的最终常见检查。项目1和2都将评估使用模式，特别是：筛查失败(尽管筛查仍被诊断为癌症)；监测失败，以及监测过度使用。我们将使用最近开发的系统流程来调查这些故障的医生和患者组件，其中包括为针对医疗保健环境中的障碍的干预建立基础。项目1还将评估临床可用的遗传标记，以评估适合检测到的癌症与筛查失败的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中获得的全筛查过程中基于社区的数据，与经过验证的NCI联盟癌症干预和监测建模网络(CISNET)网站合作，模拟结肠镜检查与FIT的有效性，包括针对不同患者群体的不同筛查策略，根据风险定制。该中心包括一个跨学科的研究小组，包括胃肠病专家、肿瘤学家、家庭医生、人口科学家、建模专家、质量专家、行为专家和医疗保健提供方面的专家。该中心可以有效地评估整个筛查过程，并可以为PROSPR网络内的协作项目提供大量的人力、机构和患者资源。