Examining Early Life Risk Factors and Patterns of Screening for Early-Onset Colorectal Cancer

检查早期生命危险因素和早发性结直肠癌筛查模式

• 批准号: 10680160
• 负责人: Arfan Siddique
• 金额: $ 4.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-18 至 2025-08-17
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680160
• 关键词: Address; Adoption; Age; Age Years; Air; American; American Cancer Society; Atlases; Behavioral; Birth; Birth Records; Birth Weight; Blue Cross; Blue Shield; COVID-19 pandemic; California; Caring; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic Disease; Classification; Colorectal Cancer; Country; Data; Databases; Disparity; Early identification; Encapsulated; Enrollment; Environmental Risk Factor; Etiology; Event; Excision; Feces; Gastroenterologist; Genetic; Geographic Information Systems; Geographic Locations; Geography; Guidelines; Health; Health Services Research; Health Status; Healthcare; Hospital Referrals; Incidence; Individual; Insurance; Interruption; Intervention; Knowledge; Life; Life Style; Light; Link; Malignant Neoplasms; Maternal Age; Menstruation; Methodology; Minority; Modeling; National Cancer Institute; Neighborhoods; Nested Case-Control Study; Oncology; Onset of illness; Outcome; Pathology; Patients; Pattern; Persons; Physical environment; Population; Predisposition; Prevalence; Prevention strategy; Preventive service; Primary Prevention; Probability; Provider; Public Health; Recommendation; Research; Resources; Risk; Risk Assessment; Risk Factors; Sample Size; Sampling; Science; Secondary Prevention; Social Environment; Socioeconomic Status; Symptoms; Testing; Time; Time Series Analysis; Time trend; Training; United States; United States Environmental Protection Agency; United States Preventative Services Task Force; Update; Variant; age group; aged; aspirate; beneficiary; cancer diagnosis; cancer epidemiology; career; cohort; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; contextual factors; data registry; design; disorder risk; early onset; early onset colorectal cancer; early screening; epidemiology study; gastrointestinal; high risk; high risk population; improved; innovation; lifestyle factors; multidisciplinary; neoplasm registry; population based; pre-doctoral; response; screening; screening guidelines; social; sociodemographics; spatiotemporal; statistics; therapy design; uptake

PROJECT SUMMARY/ABSTRACT In the United States (US), the incidence of early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) diagnosed among individuals <50 years of age, has been increasing rapidly. Compared to late- onset CRC (i.e., CRC diagnosed among individuals ≥50 years of age), EOCRC is characterized by more aggressive pathology and distinct genetic profiles, indicating that the etiology of EOCRC may be distinct. There have been a limited number of studies examining the risk factors of EOCRC, and none have focused on early life risk factors, which could be particularly relevant to early-onset diseases. Over the past few years, the American Cancer Society and the US Preventative Services Task Force reduced the recommended age of CRC screening from 50 years to 45 years, and the COVID-19 pandemic influenced the provision of preventative services across the country. These events could impact the temporal and geographic patterns of screening for EOCRC, but no study has systematically assessed such impacts in a large sample of the US population. The proposed study aims to 1) identify early-life risk factors of EOCRC and 2) evaluate spatiotemporal patterns of EOCRC screening in the US. For the first aim, we will conduct a nested case-control study within the California birth cohort and compare the birth characteristics between 1200 EOCRC cases and 60,000 control subjects matched on year of birth. In addition, we will obtain birth address matched social, behavioral, lifestyle, and environmental factors from the Centers for Disease Control and Prevention and the Environmental Protection Agency and compare these neighborhood-level factors between the 1,200 cases and 60,000 controls. Two key methodological challenges will be addressed: a) spatial autocorrelation, the tendency of adjacent geographic units to share similar attributes; b) the modifiable areal unit problem, a biasing effect that occurs when observed associations between exposures and outcomes vary based on the scale of the chosen geographic unit. For the second aim, we will assess temporal patterns in EOCRC screening and identify factors associated with potential regional variation in screening by leveraging unique claims data from Blue Cross Blue Shield (BCBS), the largest insurance provider in the US that covers one-third of all Americans. Approximately 4 million beneficiaries aged 45-49 years are enrolled in BCBS each year, allowing us a great opportunity to assess both stool-based and structural CRC screening tests. With a rigorous design and unparalleled sample sizes, the proposed study addresses research questions with clear public health significance, is very innovative, and will probably yield a high impact on our knowledge about the etiology and screening of EOCRC – a critically understudied field according to the National Cancer Institute. In addition, by bringing together a multidisciplinary team of experts in cancer epidemiology, health services research, spatial statistics, gastrointestinal oncology, and geographic information systems science, this study will contribute to the training of a promising minority predoctoral fellow with aspirations to pursue a career in cancer epidemiology research and improve the health status for all.

项目总结/摘要 在美国（US），早发性结直肠癌（EOCRC）（定义为结直肠癌）的发病率 在<50岁的个体中诊断出的癌症（CRC）已经迅速增加。相比之下，晚- 初发CRC（即，在≥50岁的个体中诊断的CRC），EOCRC的特征是更多 侵袭性病理和独特的遗传特征，表明EOCRC的病因可能是不同的。那里 研究EOCRC风险因素的研究数量有限，没有一项研究关注早期 生命风险因素，这可能与早发性疾病特别相关。在过去几年中， 美国癌症协会和美国预防服务工作组降低了CRC的推荐年龄 从50岁到45岁的筛查，以及COVID-19大流行影响了预防措施的提供。 全国各地的服务。这些事件可能会影响筛查的时间和地理模式， EOCRC，但没有研究系统地评估了美国人口的大样本中的这种影响。的 拟议的研究旨在1）确定EOCRC的早期危险因素，2）评估EOCRC的时空模式， 在美国进行EOCRC筛查。对于第一个目标，我们将在加州进行一项嵌套病例对照研究。 出生队列，比较1200例EOCRC病例和60，000例对照组的出生特征 与出生年份相符此外，我们还将获得出生地址匹配的社会，行为，生活方式， 来自疾病控制和预防中心以及环境保护中心的环境因素 机构，并比较这些邻里水平的因素之间的1,200例和60,000对照。两个关键 方法上的挑战将得到解决：a）空间自相关，邻近地理的趋势， 共享相似属性的单位; B）可修改的面积单位问题，观察时发生的偏差效应 暴露与结果之间的关联因所选地理单位的规模而异。为 第二个目标，我们将评估EOCRC筛查的时间模式，并确定与潜在的 通过利用来自蓝十字蓝盾（BCBS）的独特索赔数据， 美国的保险公司，覆盖了三分之一的美国人。约400万受益人， 45-49岁的人每年都参加BCBS，这使我们有很好的机会评估粪便和 结构CRC筛选测试。通过严格的设计和无与伦比的样本量，拟议的研究 解决了具有明确公共卫生意义的研究问题，非常具有创新性，并且可能会产生 对我们关于EOCRC病因学和筛查的知识有很大影响-这是一个严重不足的领域 据国家癌症研究所称。此外，通过召集一个多学科专家小组， 癌症流行病学、卫生服务研究、空间统计学、胃肠道肿瘤学和地理 信息系统科学，这项研究将有助于培养一个有前途的少数民族博士前研究员 渴望从事癌症流行病学研究，改善所有人的健康状况。