Who benefits from Colorectal Cancer Screening? A subgroup Analysis of the Minnes

谁从结直肠癌筛查中受益？

• 批准号: 7912983
• 负责人: Aasma Shaukat
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7912983
• 关键词: Adenomatous Polyps; Age; Aspirin; Attention; Body mass index; Cancer Control; Categories; Cause of Death; Characteristics; Clinical; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Comorbidity; Consumption; Controlled Study; Data; Data Files; Databases; Diet; Dietary Factors; Double contrast barium enema; Effectiveness; Elderly; Fecal occult blood; Fiber; Flexible fiberoptic sigmoidoscopy; Gender; Goals; Guidelines; Healthcare Systems; Incidence; Individual; Intake; Lesion; Life Expectancy; Long-Term Effects; Malignant Neoplasms; Meta-Analysis; Methods; Minnesota; Non-Steroidal Anti-Inflammatory Agents; Nutritional; Outcome; Participant; Patients; Polypectomy; Population; Questionnaires; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk; Screening procedure; Specific qualifier value; Subgroup; Target Populations; Testing; Time; Update; Veterans; Vital Status; Woman; age group; colorectal cancer screening; design; experience; healthy volunteer; high risk; improved; interest; lifestyle factors; men; mortality

1. To determine the effect of fecal occult blood testing (FOBT) screening on colorectal cancer mortality, non- colorectal cancer mortality and all-cause mortality in the Minnesota Colon Cancer Control Study, (MCCCS) updated to 2006 2. To determine the effect of FOBT screening on colorectal cancer mortality and non-colorectal cancer mortality by age (by 5 and 10 year age groups) and gender in the MCCCS updated to 2006 3. To determine the independent influence of baseline characteristics on colorectal cancer mortality and non-colorectal cancer mortality in the MCCCS. Significance: Most guidelines recommend starting screening for colorectal cancer at age 50 years for average risk individuals. The earliest and most tested strategy among these is FOBT, supported by four large randomized clinical trials that established the effectiveness of colorectal cancer screening. The Minnesota Colon Cancer Control Study was conducted in Minnesota, US. The trial recruited healthy volunteers between the ages of 50 to 80. The trials have not reported results stratified by age and gender. Additionally, the effects of other baseline variables, such as co-morbidities and intake of aspirin on outcomes have not been reported. A recent meta-analysis of these trials confirmed a reduction in colorectal cancer mortality (RR 0.87; 95% CI 0.8-0.95), but also reported an increase in non-colorectal cancer mortality of approximately equal absolute magnitude (RR 1.02; 95% CI 1.00-1.04) so that overall mortality was nearly identical (RR 1.002, 95% CI 0.989-1.015). Why non-CRC mortality would be increased is unclear, but one possibility is that the FOBT trials included some individuals that benefited from CRC screening, and other individuals who experienced net harm. Therefore, detailed sub-group analyses of the FOBT trial data, to separate out sub- groups that benefit from screening from those who may potentially be harmed would be important. For example, patients over age 70 or 75 might derive less benefit and more harm from screening, in which case screening this population may need to be re-considered. The goals of this research are to evaluate if effects of screening on colorectal cancer mortality seen 18 years after randomization (reported in 1999) in the Minnesota Colon Cancer Control Study persist, or are different 28-30 years after randomization (when updated to year 2006), and whether effect of screening for colorectal cancer varies in age and gender sub- groups. We also wish to evaluate the influence of baseline characteristics, such as diet, aspirin use and body mass index on these outcomes. Project Design and methods: This project involves updating the vital status and cause of death of all participants from the Minnesota Colon Cancer Control Study up to 2006 and calculating CRC, non-CRC and all-cause mortality estimates. We plan to compare colorectal cancer (CRC) mortality and non-colorectal cancer mortality rates between the screened and unscreened groups, by age categories at time of randomization of 5 year (50-54, 55-59, 60-64, 65-69, 70-74, 75-80) and 10 year (50-59, 60-69, 70-80) intervals. We will also stratify the above analyses by gender subgroups. No patient baseline data other than age and gender has been analyzed or reported from the Minnesota Colon Cancer Control Study. A 4-page, 56-item baseline questionnaire was completed by participants. We will perform a quality check on the existing data files to determine if re-entry is required for all or a subset of the questions on the baseline questionnaire. We are interested in exploring the relationship between consumption of NSAIDs, high fiber diet and BMI as effect modifiers of effectiveness of screening.

1. 目的探讨粪便潜血试验（FOBT）筛查对结直肠癌死亡率的影响