Optimizing the Impact of Aspirin for Chemoprevention

项目摘要/摘要 候选人的长期职业目标是成为“精确癌症预防”的学术领军者，通过 将临床和流行病学危险因素与新的分子标记联系起来，并应用决策和 实施工具，将卫生保健资源用于最有效和最实用的预防战略 适当的风险群体。美国预防服务工作组(USPSTF)最近发布了新的 支持使用小剂量阿司匹林作为成人结直肠癌和心血管疾病一级预防的建议 年龄50-59岁，有一定的心血管疾病风险特征。然而，每天使用小剂量阿司匹林的有效性的证据 在老年人中缺乏，净收益没有在基线CRC风险的背景下考虑。在……里面 在实施2016年USPSTF指导方针方面的补充、影响和挑战，并有可能更加完善 基于精确度的建议尚未得到调查。以候选人的桥牌热情为基础 证据与政策，以改善现实世界的实践，以及她以前在 癌症流行病学和阿司匹林化学预防，候选人寻求通过以下方式填补这些知识空白 这项新的高影响力的研究项目旨在1)检查每日低剂量饮食的整体益处和危害 阿司匹林在65岁及以上成年人中的大型随机对照试验中的使用，并估计阿司匹林的 根据结直肠癌筛查和临床和遗传学预测的基线结直肠癌风险预测对结直肠癌的疗效 敏感性(目标1)；2)细化50岁及以上成年人使用低剂量阿司匹林的净效益 根据CRC和CVD风险整合RCT和分层分析的结果，使用决策 建模(目标2)；3)利用国家调查审查2016年USPSTF建议的影响，以及 通过访谈确定在提供者和患者层面实施的障碍和促进者(目标3)。 应聘者将发展必要的技能，通过多学科的指导进行这项工作 委员会，由国际公认的癌症预防和实施科学专家组成 (Graham Colditz博士)，阿司匹林化学预防(Andrew Chan博士)，决策建模(Ann Zauber博士)，以及 健康行为(艾米·詹姆斯博士)。候选人还将接受约翰博士的承诺指导 莫纳什大学的麦克尼尔和密歇根伊拉斯谟大学的爱丽斯·兰斯多普-沃格拉尔博士，并与Dr。 BJC医疗集团的内森·摩尔。除了有指导的研究外，候选人还将受益于 通过讲授课程、参加科学会议、发表同行评议的出版物等方式进行正式培训 期刊，以及R01拨款的提交。这一指导和深入培训在决策科学和 实施科学以及国家和国际合作，将对候选人来说至关重要 开发新的、跨学科的和独特的专业领域，并建立强大的研究网络， 从癌症流行病学扩展到政策制定再到执行，这将对她起到重要作用 转变为一名独立的研究人员，并成为癌症预防领域的新兴领导者。

PROJECT SUMMARY / ABSTRACT The candidate's long-term career goal is to become an academic leader in “precision cancer prevention”, by linking clinical and epidemiological risk factors with novel molecular markers, and applying decision and implementation tools to direct heathcare resources to the most effective and practical prevention strategies in the appropriate risk groups. The U.S. Preventive Services Task Force (USPSTF) recently released new recommendations supporting the use of low-dose aspirin for the primary prevention of CRC and CVD in adults aged 50-59 with certain CVD risk profiles. However, evidence for the efficacy of daily low-dose aspirin use among older people are lacking, and net benefits were not considered in the context of baseline CRC risk. In addition, impact and challenges in implementing the 2016 USPSTF guideline, and potential more refined precision-based recommendations have not been investigated. Building on the candidate's passion to bridge evidence with policy to improve practice in real world settings, as well as her prior research experience in cancer epidemiology and aspirin chemoprevention, the candidate seeks to fill these knowledge gaps through this novel and high impact research project to 1) examine the overall benefits and harms of low-dose daily aspirin use in a large randomized controlled trial among adults aged 65 and above, and estimate aspirin's efficacy on CRC according to CRC screening and baseline CRC risk predicted by clinical and genetic susceptibility (Aim 1); 2) refine the net benefits of low-dose aspirin use among adults aged 50 and above according to both CRC and CVD risk integrating findings from the RCT and stratified analyses using decision modeling (Aim 2); 3) examine the impact of 2016 USPSTF recommendations using national survey, and identify the barriers and facilitators for implementation at provider and patient level through interviews (Aim 3). The candidate will develop the necessary skills to conduct this work through a multidisciplinary mentoring committee, consisting of internationally recognized experts in cancer prevention and implementation science (Dr. Graham Colditz), aspirin chemoprevention (Dr. Andrew Chan), decision modeling (Dr. Ann Zauber), and health behaviors (Dr. Aimee James). The candidate will also receive committed mentorship from Dr. John McNeil at Monash University and Dr. Iris Lansdorp-Vogelaar from Erasmus MC, and collaborate with Dr. Nathan Moore from BJC Medical Group. In addition to mentored research, the candidate will also benefit from formal training through didactic coursework, attendance at scientific meetings, publication in peer-reviewed journals, and submission of an R01 grant. This mentoring and in-depth training in decision science and implementation science as well as national and international collaborations, will be critical for the candidate to develop new, interdisciplinary, and unique areas of expertise, and establish a strong research network that expands from cancer epidemiology to policy making to implementation, which will be instrumental for her transition to an independent investigator and as an emerging leader in cancer prevention.