Optimizing Colonoscopy & Fecal Immunochemical Tests for Community-Based Screening

优化结肠镜检查

基本信息

批准号：
8715701
负责人：
DOUGLAS Allen CORLEY
金额：
$ 165.94万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
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/8715701
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 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 screening socioeconomics suburb tumor

项目摘要

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.

研究中心的总体目标是创建一个可以评估完整结直肠癌（CRC）筛查过程的研究单元。具体目标是表征两个最常用的筛查测试（光学结肠镜检查和粪便免疫化学测试[FIT]）的可补救失败。 CRC中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，对于大多数患者而言，筛查结果只会导致忧虑和风险； 2）尽管CRC筛查（即，在先前筛查的人）中仍会发生许多CRC死亡。目前尚不清楚筛查过程的可补救失败导致了多少死亡。我们的中心将评估一个基于社区的队列，其中包括详细的CRC筛查和> 200万符合筛查资格的人/年的详细医疗数据； > 10年的数据；大量结果（38,000个癌症）；地理多样性（>加利福尼亚州的35个医疗中心）；人口多样性（140,000名非裔美国人，32万西班牙裔和200,000名亚裔美国人）；社会经济多样性；筛选方法的多样性；进入组织/癌症块；以及各种个人癌症风险。项目1将评估FIT，这是一种有效而有效的无创筛查方法。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考试。项目1和2都将评估使用模式，尤其是：筛查失败（尽管筛查诊断出癌症）；监视失败和监视过度使用。我们将使用最近开发的系统过程来调查这些失败的医师和患者组件，其中包括建立针对医疗机构中障碍的干预措施的基础。项目1还将评估临床上可用的遗传标志物，以评估检测到的拟合发现与筛查癌症之间的潜在生物学差异。项目3将与项目1＆2中获得的完整筛选过程中的基于社区的数据进行结肠镜检查与拟合的有效性，并与经过验证的NCI财团癌症癌症干预和监视模型网站（CISNET）网站合作，包括针对风险量身定制的不同患者群体的不同筛查策略。该中心包括一个跨学科研究人员组，包括胃肠病医生，肿瘤学家，家庭医生，人口科学家，建模专家，质量专家，行为专家以及医疗保健提供专家。该中心可以有效地评估完整的筛选过程，并为PROSPR网络中的协作项目提供大量的人，机构和患者资源。