Colonoscopy in young onset colorectal cancer

年轻发病结直肠癌的结肠镜检查

• 批准号: 10083204
• 负责人: Joshua Brian Demb
• 金额: $ 6.64万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10083204
• 关键词: Address; Adult; Age; American Cancer Society; Biometry; Blood; Cancer Etiology; Cancer-Related Condition; Case Study; Cessation of life; Clinical; Colon; Colonoscopy; Colorectal Cancer; Data; Detection; Diagnosis; Effectiveness; Elderly; Electronic Health Record; Epidemiology; Exposure to; Family; Family history of; Feces; First Degree Relative; Guidelines; Hematochezia; Incidence; Individual; Integrated Health Care Systems; Intervention; Iron deficiency anemia; Learning; Light; Literature; Malignant Neoplasms; Methods; Outcome; Persons; Play; Population; Prevalence; Procedures; Randomized Controlled Trials; Recommendation; Recording of previous events; Rectal Cancer; Reporting; Research Personnel; Risk; Role; Rules of conduct; Signal Transduction; Signs and Symptoms; Study models; Testing; Time; United States; United States Department of Veterans Affairs; Update; Veterans; Veterans Health Administration; Work; base; cancer epidemiology; clinical practice; cohort; colorectal cancer risk; colorectal cancer screening; data warehouse; early onset colorectal cancer; early screening; evidence base; follow-up; improved; mortality; novel strategies; post-doctoral training; prevent; screening; screening guidelines; screening policy; skills; training opportunity; uptake; young adult

PROJECT SUMMARY Colorectal cancer (CRC) accounts for 8% of cancer incidence and 8% of cancer-related mortality in the United States. While CRC risk and CRC-related mortality overall have decreased in recent years, the proportion of CRC cases among adults ages <50—known as young onset colorectal cancer (YCRC)—has increased. One clinical strategy recommended to detect YCRC earlier is colonoscopy for adults presenting with conditions that might increase YCRC risk, such as iron deficiency anemia (IDA) or hematochezia (visible blood in stool). Colonoscopy in these cases is conducted rule out CRC and has been proven to be particularly effective among elderly adults. However, little evidence exists about the relative benefit among adults ages <50. In light of increased YCRC incidence, a second clinical strategy recommended by the American Cancer Society involves lowering the age of CRC screening initiation from 50 to 45, despite a paucity of evidence that early screening initiation improves CRC-related outcomes in adults ages <50. While previous guidelines advised CRC screening prior to age 50 only among adults with reported family history of CRC, this represents only 30% of all CRC cases, meaning that identification of adults ages <50 most likely to benefit from YCRC- related colonoscopy remains unclear. Furthermore, there are no imminent RCTs offering interventions like colonoscopy for work-up of CRC-related conditions or screening asymptomatic adults, highlighting an urgent need to learn about YCRC-related colonoscopy benefit among adults ages <50. Our study will use national electronic health records and claims-based data from the Veterans Affairs (VA) Corporate Data Warehouse (CDW) to address key gaps in the literature by evaluating these two clinical strategies for colonoscopy uptake to address YCRC incidence and mortality. First, we will examine the benefits of colonoscopy uptake among Veterans ages <50 with conditions (IDA or hematochezia) that may increase CRC risk by comparing CRC risk among adults exposed to IDA or hematochezia (Aim 1a), examining proportion of timely colonoscopy uptake ≤60 days of IDA or hematochezia identification (Aim 1b), and comparing YCRC incidence, stage at detection and mortality by colonoscopy uptake among Veterans with IDA or hematochezia (Aim 1c). Next, we will compare the impact of exposure to colonoscopy on YCRC benefits among all Veterans ages 18-49 (Aim 2). Our study will be the most comprehensive examination of early exposure to colonoscopy in the US to date and will have important implications on current clinical guidelines and contextualize current CRC screening policy. Major strengths include: (1) use of EHR and claims-based data from the largest integrated healthcare system in the US; (2) VA studies have played critical roles in US clinical practice changes; and (3) the largest assessment of colonoscopy uptake among adults ages <50 to date. Finally, this study offers a high-quality postdoctoral training opportunity to understand current methods of CRC detection using colonoscopy, and to develop key skills in cancer epidemiology and biostatistics to become a qualified independent investigator.

项目摘要 结直肠癌（CRC）占癌症发病率的8%，占癌症相关死亡率的8%。 美国的尽管近年来CRC风险和CRC相关死亡率总体下降， 年龄<50岁的成年人中CRC病例的比例-被称为年轻发病的结直肠癌（YCRC）- 增加建议早期检测YCRC的一种临床策略是对患有YCRC的成年人进行结肠镜检查 可能增加YCRC风险的疾病，如缺铁性贫血（IDA）或便血（可见） 粪便中有血）。在这些情况下进行结肠镜检查排除CRC，并已被证明是特别重要的。 对老年人有效。然而，几乎没有证据表明， <50。鉴于YCRC发病率的增加，美国癌症协会推荐的第二种临床策略 社会涉及降低年龄的CRC筛查开始从50至45，尽管缺乏证据， 早期筛查可改善<50岁成人的CRC相关结局虽然以前的准则 建议仅在有CRC家族史的成年人中在50岁之前进行CRC筛查，这代表 只有30%的CRC病例，这意味着年龄<50岁的成年人最有可能从YCRC中受益- 相关的结肠镜检查仍不清楚。此外，没有即将进行的RCT提供干预措施， 结肠镜检查用于CRC相关疾病的检查或筛查无症状的成年人，强调了 需要了解YCRC相关的结肠镜检查在50岁以下成人中的益处。我们的研究将使用国家 来自退伍军人事务部（VA）企业数据仓库的电子健康记录和基于索赔的数据 (CDW)通过评价这两种结肠镜检查摄取的临床策略来解决文献中的关键空白 以解决YCRC的发病率和死亡率问题。首先，我们将研究结肠镜检查摄取的益处， 退伍军人年龄<50岁，有可能增加CRC风险的条件（IDA或便血）， 在暴露于IDA或便血的成人中（目标1a），检查及时结肠镜检查摄取的比例 IDA或便血识别（目标1b）≤60天，并比较YCRC发生率、检测时分期 在患有IDA或便血的退伍军人中，通过结肠镜检查的死亡率（目标1c）。接下来我们就 在所有18-49岁的退伍军人中比较结肠镜检查对YCRC获益的影响（目标2）。 我们的研究将是迄今为止美国对结肠镜检查早期暴露的最全面的检查， 将对当前的临床指南产生重要影响，并将当前的CRC筛查政策纳入背景。 主要优势包括：（1）使用来自最大的综合医疗保健系统的电子健康记录和基于索赔的数据 （2）VA研究在美国临床实践变化中发挥了关键作用;（3）最大的 迄今为止，对年龄<50岁的成年人进行结肠镜检查摄取的评估。最后，这项研究提供了一个高质量的 博士后培训机会，了解使用结肠镜检查的CRC检测的当前方法，并 发展癌症流行病学和生物统计学的关键技能，成为一名合格的独立调查员。