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.

项目摘要/摘要 在美国，早发性结直肠癌(EOCRC)的发病率，定义为结直肠癌 在50岁的人群中确诊的癌症(CRC)一直在迅速增加。与晚些时候相比- 起病的结直肠癌(即在50岁的个体中确诊的结直肠癌)，≥的特点是 侵袭性病理和不同的基因特征，表明EOCRC的病因可能是不同的。那里 研究EOCRC的风险因素的研究数量有限，没有一项研究集中在早期 生命风险因素，这可能与早发性疾病特别相关。在过去几年里， 美国癌症协会和美国预防服务工作组降低了结直肠癌的推荐年龄 筛查年龄从50岁到45岁，新冠肺炎大流行影响了预防性免疫的提供 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，但还没有研究在美国人口的大样本中系统地评估这种影响。这个 拟议的研究旨在1)确定EOCRC的早期生命危险因素，2)评估EOCRC的时空模式 在美国进行EOCRC筛查。对于第一个目标，我们将在加利福尼亚州进行嵌套病例对照研究。 1200例EOCRC患者与6万例对照出生队列及出生特征比较 与出生年份相匹配。此外，我们将获得与出生地址相匹配的社交、行为、生活方式和 疾病预防控制中心的环境因素与环境保护 在1200个病例和60,000个对照中，机构并比较这些邻里层面的因素。两把钥匙 将解决方法学上的挑战：a)空间自相关性，即相邻地理位置的趋势 单位共享相似的属性；b)可修改的面积单位问题，即观察时发生的偏向效应 暴露与结果之间的关联因所选地理单位的规模而异。对于 第二个目标，我们将评估EOCRC筛查的时间模式，并确定与潜在风险相关的因素 通过利用来自最大的蓝十字蓝盾(BCBS)的独特索赔数据进行筛选的地区差异 覆盖三分之一美国人的美国保险提供商。大约400万名老年人 每年有45-49岁的学生参加BCBS，这让我们有很好的机会评估基于大便的和 结构CRC筛查试验。凭借严谨的设计和无与伦比的样本量，拟议的研究 解决具有明确公共卫生意义的研究问题，非常具有创新性，可能会产生 高度影响我们对EOCRC的病因和筛查的知识-一个严重不足的研究领域 根据国家癌症研究所的数据。此外，通过将多学科专家团队聚集在一起， 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学 信息系统科学，这项研究将有助于培养有前途的少数民族博士后研究员 有志于从事癌症流行病学研究，改善所有人的健康状况。