Optimizing Colonscopy & Fecal Immunochemical Tests for Community-Based Screening

描述（由申请人提供）：本申请的目标是在现有的PROSPR中心内建立一个宫颈癌数据和研究部门，可以全面评估宫颈癌筛查过程并积极参与PROSPR合作项目。通过适当的筛查，宫颈癌在很大程度上是可以预防的，但新技术的实施，如人类乳头状瘤病毒（HPV）检测，在如何优化新的筛查方法方面带来了重大挑战，通过了解筛查失败的发生方式和原因，最大限度地减少筛查失败；减少过度筛查（因为对99%的女性来说，筛查只会带来担忧和风险）。拟议的单位，在凯撒永久机构北加州和南加州现有的生产性普洛斯合作下，可以利用三个优势解决这些关键问题。1)一个非常大的社区队列，仅2010-2013年就有480万符合筛查条件的妇女；显著的人口多样性（约有133万西班牙裔、58.9万亚裔和39万非裔美国人）；详细的筛查数据(270万份巴氏涂片，210万份HPV检测，以及

DESCRIPTION (provided by applicant): This application's goal is the creation of a Cervical Cancer Data & Research Unit, within an existing PROSPR Center, that can completely evaluate the cervical cancer screening process and actively engage in PROSPR collaborative projects. Cervical cancer is largely preventable with appropriate screening, yet the implementation of new techniques, such as human papilloma virus (HPV) testing, has created important challenges regarding how to: optimize new screening methods, minimize screening failures by understanding how and why they occur; and diminish overscreening (since, for >99% of women, screening results in only worry and risk). The proposed Unit, within an existing productive PROSPR collaboration of Kaiser Permanente Northern California and Southern California, can address these critical questions using three strengths. 1) A very large community-based cohort with, for the years 2010-2013 alone: >4.8 million screening eligible women; marked demographic diversity (>1,330,000 Hispanic, 589,000 Asian, and 390,000 African American members); detailed screening data (>2.7 million Pap smears, 2.1 million HPV tests, and 600,000 HPV vaccinations); large numbers of rare outcomes (>800 invasive cancers); socioeconomic diversity (including >54,000 with safety-net payors such as Medicaid); health plan and provider diversity (>35 medical centers, >4000 primary care/OB-GYN physicians throughout California); and a full spectrum of high-quality individual cancer risk data within readily accessible electronic laboratory, pharmacy and pathology data sources extending to before 2005. 2) A successful existing PROSPR colorectal cancer center that has been productive within and across the PROSPR network, delivered this year 192 different screening data elements on almost 2.6 million screening-eligible patients, co-led the development of new data elements across PROSPR centers for exam indications and comorbidities and already published high impact PROSPR manuscripts. 3) An expert team in cervical cancer screening, led by two co-Principal Investigators funded in cervical cancer screening research, complemented by a transdisciplinary group of researchers and expert consultants in obstetrics/gynecology, cancer and infectious disease epidemiology, oncology, pathology, modeling, cohort biostatistics, screening quality, and health care delivery. Together, the new Unit can efficiently evaluate the full cervical cancer screening and follow-up - process, put screening actions within the context of comprehensive health care data, and lead PROSPR collaborative studies, such as those described in the Research Plan, that can evaluate the comparative effectiveness of different screening strategies, identify causes of screening failures, and examine the impact of HPV vaccination on screening uptake and outcomes.