Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling
使用决策分析模型优化艾滋病毒感染者中基于年龄的肛门癌筛查
基本信息
- 批准号:9886218
- 负责人:
- 金额:$ 50.05万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2019
- 资助国家:美国
- 起止时间:2019-03-05 至 2023-02-28
- 项目状态:已结题
- 来源:
- 关键词:Acquired Immunodeficiency SyndromeAddressAdoptionAgeAgingAlgorithmsAmericanAnusAreaBiologicalCD4 Lymphocyte CountCancer EtiologyCellsCervical Cancer ScreeningClinicalClinical TrialsCollaborationsColorectal CancerCytologyDataDatabasesDetectionDiagnosisDiseaseEpidemiologyEtiologyFrequenciesFutureGoalsGuidelinesHIVHPV-High RiskHuman PapillomavirusHuman papilloma virus infectionIncidenceIndividualLife ExpectancyLiteratureMalignant NeoplasmsMalignant Squamous Cell NeoplasmMalignant neoplasm of anusMalignant neoplasm of cervix uteriMalignant neoplasm of prostateMass ScreeningMathematicsMeasuresMethodsModelingMorbidity - disease rateNatural HistoryOutcomes ResearchPatient-Focused OutcomesPersonsPoliciesPopulationPreventionPreventive healthcareQuality of lifeRandomized Clinical TrialsRecurrenceRegimenResearchResearch DesignRiskScreening for cancerSex BehaviorSquamous intraepithelial lesionSurvival RateTreatment EffectivenessTreatment EfficacyUncertaintyUnited StatesUnited States Department of Veterans AffairsViralWomanWorkbasecancer preventionclinical careclinical decision-makingclinical practiceclinically significantcohortcomparative effectivenesscostcost effectivecost effectivenessdata warehouseexperiencehigh riskimprovedinnovationmalignant breast neoplasmmathematical modelmenmen who have sex with menmodels and simulationmortalitymultiple datasetsolder menpreventpublic health prioritiesscreeningscreening guidelinesscreening policysexvirtual
项目摘要
PROJECT SUMMARY/ABSTRACT
Anal cancer is the second most common non-AIDS defining cancer and a leading cause of morbidity among
HIV-infected (HIV+) persons in the United States (US). The incidence of anal cancer increases with age. With
nearly 50% HIV+ persons are now 50-years or older, preventative health care in the form of screening is a
major public health priority to decrease their risk of developing anal cancer. Because anal cancer is biologically
similar to cervical cancer, current guidelines (inferred from cervical cancer literature) recommend screening
HIV+ men and women using anal cytology for detection of high-grade squamous intraepithelial lesions (the
anal cancer precursor); however, optimal screening regimen (age to start and stop screening as well as
optimal screening frequency) for the prevention of anal cancer still remains unknown. Due to the lack of clear
understanding of harms versus benefits of screening, only 11% of HIV+ persons had an anal cytology in the
preceding year, leading to 50% of diagnoses occurring at stage III or worse when the 5-year survival rate is
less than 40%.
The goal of the proposed research is to identify appropriate candidates for screening and determine age-
specific screening algorithms to reduce anal cancer morbidity and mortality among HIV+ men and women. We
will integrate evidence from two large clinical trials and several large databases into mathematical modeling,
a complementary approach to randomized clinical trials. In Aim 1, we will measure the impact of age and HIV
disease status (i.e., HIV viral suppression, CD4 count) on the incidence of anal HSIL, HSIL recurrence, and
progression to anal cancer. In Aim 2, we will develop a clinically-valid mathematical model of anal cancer
natural history in HIV+ men and women and use it to determine optimal age-specific anal cancer screening
algorithm. Finally, in Aim 3, we propose to determine the minimum necessary efficacy (by age) of anal HSIL
treatment for HIV+ men and women to provide clinically significant benefits for screening and finally determine
areas of future research to improve the value of anal cancer screening.
The proposed research is innovative because it applies advanced modeling approach with multiple datasets to
address a problem that has not been solved by empirical methods. The research team is ideally suited, with an
established track record in HIV and HPV epidemiology, cancer outcomes research, and clinical care, having
substantial experience in developing mathematical models to inform clinical decision making. The end results
of the proposed study will be age-specific anal cancer screening recommendations for HIV+ men and women
that will inform anal cancer prevention policies and practice and ultimately reduce morbidity and mortality.
项目总结/摘要
肛门癌是第二种最常见的非艾滋病定义的癌症,也是其中发病的主要原因。
美国(US)的HIV感染者(HIV+)。肛门癌的发病率随着年龄的增长而增加。与
近50%的艾滋病毒阳性者现在是50岁或以上,以筛查形式提供的预防性卫生保健是一种
降低他们患肛门癌的风险是主要的公共卫生优先事项。因为肛门癌在生物学上
与子宫颈癌相似,目前的指南(从子宫颈癌文献推断)建议进行筛查,
使用肛门细胞学检测高度鳞状上皮内病变的HIV阳性男性和女性(
肛门癌前体);然而,最佳筛查方案(开始和停止筛查的年龄以及
最佳的检查频率),以预防肛门癌仍然是未知的。由于缺乏明确的
了解筛查的利弊,只有11%的艾滋病毒阳性者在2011年进行了肛门细胞学检查。
前一年,导致50%的诊断发生在III期或更糟的5年生存率时,
低于40%。
拟议研究的目标是确定适当的候选人进行筛选,并确定年龄-
具体的筛查算法,以减少肛门癌的发病率和死亡率之间的艾滋病毒阳性的男子和妇女。我们
将把两个大型临床试验和几个大型数据库的证据整合到数学模型中,
随机临床试验的补充方法。在目标1中,我们将衡量年龄和艾滋病毒的影响
疾病状态(即,HIV病毒抑制、CD 4计数)对肛门HSIL发生率、HSIL复发率和
发展成肛门癌在目标2中,我们将开发一个临床有效的肛门癌数学模型
HIV+男性和女性的自然史,并使用它来确定最佳的年龄特异性肛门癌筛查
算法最后,在目标3中,我们建议确定肛门HSIL的最低必要疗效(按年龄)
为HIV阳性男性和女性提供治疗,为筛查提供临床显著益处,并最终确定
未来的研究领域,以提高肛门癌筛查的价值。
所提出的研究是创新的,因为它采用了先进的建模方法与多个数据集,
解决一个尚未被经验方法解决的问题。研究团队非常适合,
在HIV和HPV流行病学、癌症结局研究和临床护理方面建立了良好的记录,
在开发数学模型以指导临床决策方面拥有丰富的经验。最终结果
这项研究的一部分将是针对HIV阳性男性和女性的年龄特异性肛门癌筛查建议,
这将为肛门癌预防政策和实践提供信息,并最终降低发病率和死亡率。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Ashish A. Deshmukh其他文献
Trends in Cancer Mortality in Persistently Poor US Counties, 1990–2020
- DOI:
10.1007/s11606-024-09187-7 - 发表时间:
2024-11-04 - 期刊:
- 影响因子:4.200
- 作者:
Kalyani Sonawane;Haluk Damgacioglu;Poria Dorali;Macelyn Batten;Gerard A. Silvestri;Evan M. Graboyes;Ashish A. Deshmukh - 通讯作者:
Ashish A. Deshmukh
P059 RACIAL VARIATION IN MYELOSUPPRESSION HOSPITALIZATIONS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS
- DOI:
10.1053/j.gastro.2019.01.116 - 发表时间:
2019-02-01 - 期刊:
- 影响因子:
- 作者:
Ryan Suk;Ashish A. Deshmukh;Kalyani B. Sonawane;Jihee Song;Jinhai Huo - 通讯作者:
Jinhai Huo
MSR112 Can Multi-Cancer Early Detection Tests Reduce Cancer Mortality?
- DOI:
10.1016/j.jval.2025.04.1264 - 发表时间:
2025-07-01 - 期刊:
- 影响因子:6.000
- 作者:
Jade Xiao;Andrew ElHabr;Christopher Tyson;Xiting Cao;Sana Raoof;A Mark Fendrick;Burak Ozbay;Paul Limburg;Tomasz M. Beer;Ashish A. Deshmukh;Andrew Briggs;Jag Chhatwal - 通讯作者:
Jag Chhatwal
Contemporary Patterns in HPV-Associated Cancer Incidence Among Young US Men
- DOI:
10.1007/s11606-022-07755-3 - 发表时间:
2022-08-11 - 期刊:
- 影响因子:4.200
- 作者:
Haluk Damgacioglu;Chi-Fang Wu;Yueh-Yun Lin;Ana Patricia Ortiz;Kalyani Sonawane;Ashish A. Deshmukh - 通讯作者:
Ashish A. Deshmukh
Ashish A. Deshmukh的其他文献
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{{ truncateString('Ashish A. Deshmukh', 18)}}的其他基金
The effectiveness, cost-effectiveness, and budget impact of interventions to improve the delivery of cervical cancer screening in Puerto Rico.
波多黎各改善宫颈癌筛查的干预措施的有效性、成本效益和预算影响。
- 批准号:
10718886 - 财政年份:2023
- 资助金额:
$ 50.05万 - 项目类别:
Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling
使用决策分析模型优化艾滋病毒感染者中基于年龄的肛门癌筛查
- 批准号:
10775089 - 财政年份:2022
- 资助金额:
$ 50.05万 - 项目类别:
Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling
使用决策分析模型优化艾滋病毒感染者中基于年龄的肛门癌筛查
- 批准号:
10350629 - 财政年份:2019
- 资助金额:
$ 50.05万 - 项目类别:
Optimizing Age-based Anal Cancer Screening Among People Living with HIV using Decision Analytic Modeling
使用决策分析模型优化艾滋病毒感染者中基于年龄的肛门癌筛查
- 批准号:
10116312 - 财政年份:2019
- 资助金额:
$ 50.05万 - 项目类别:
Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico
完整项目 2:为居住在波多黎各的艾滋病毒感染者确定最佳的肛门癌预防策略
- 批准号:
10020949 - 财政年份:2002
- 资助金额:
$ 50.05万 - 项目类别:
Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico
完整项目 2:为居住在波多黎各的艾滋病毒感染者确定最佳的肛门癌预防策略
- 批准号:
10249300 - 财政年份:2002
- 资助金额:
$ 50.05万 - 项目类别:
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