Post-polypectomy Surveillance for Reducing Colon Cancer Incidence and Mortality

息肉切除术后监测以降低结肠癌发病率和死亡率

• 批准号: 10078600
• 负责人: Samir Gupta
• 金额: $ 52.49万
• 依托单位: VETERANS MEDICAL RESEARCH FDN/SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078600
• 关键词: Address; Adenomatous Polyps; Adherence; Advanced Malignant Neoplasm; Advisory Committees; Age; Cancer Etiology; Cessation of life; Characteristics; Clinical; Clinical Trials; Cohort Studies; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Detection; Effectiveness; Ensure; Excision; Exposure to; Guideline Adherence; Guidelines; Hemorrhage; Incidence; Incidence Study; Individual; Intervention; Investments; Knowledge; Malignant Neoplasms; Manuals; Measures; Medical Records; Neoplasms; Observational Study; Outcome; Patients; Perforation; Policies; Polypectomy; Polyps; Precancerous Polyp; Prevention strategy; Public Health; Reporting; Research; Risk; Risk Reduction; Sampling; Societies; Testing; Time; United States; United States Department of Veterans Affairs; Veterans; abstracting; adenoma; base; cancer prevention; cohort; colorectal cancer risk; colorectal cancer screening; comorbidity; cost; design; follow-up; indexing; mortality; neoplasm registry; novel strategies; premalignant; randomized trial; screening; study population; surveillance strategy; uptake

PROJECT SUMMARY Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. Research has consistently shown that screening reduces risks for CRC incidence and mortality. Effectiveness of screening has generally been attributed to detection and removal of precancerous polyps and curable cancers. In usual practice, routine follow up for many patients with polyps removed at baseline includes repeat surveillance colonoscopy to detect and resect additional polyps and cancer. However, the incremental benefit of surveillance colonoscopy over baseline colonoscopy with polyp removal is unclear. Indeed, prior research has not focused on effectiveness of surveillance and has not specifically determined whether a clinical strategy of systematic surveillance after baseline polypectomy reduces the risk of developing or dying from colorectal cancer, compared to no surveillance. Despite this gap in knowledge, current guidelines recommend routine surveillance colonoscopy for the majority of patients with polyps. Since colonoscopy is a burden on patients, associated with risks such as bleeding, and costly, it is imperative to establish whether surveillance reduces CRC risk. Our Specific Aims are to determine whether post polypectomy surveillance colonoscopy reduces CRC incidence (Aim 1) and mortality (Aim 2). To accomplish these aims, we will utilize a previously established cohort of over 400,000 individuals who had colonoscopy with polyp removal within the Department of Veterans Affairs (VA). Using a case-cohort design, all individuals with incident CRC identified by the VA Central Cancer Registry, all individuals with fatal CRC identified by the National Death Index, as well as a random sample of those who had polyps removed at baseline will be selected for study inclusion. We will use medical record review to determine exposure to surveillance colonoscopy and measure other factors that may influence CRC risk. Observed occurrence and timing of surveillance colonoscopy delivered will be summarized using a time- dependent exposure variable that characterizes adherence to post-polypectomy surveillance guidelines. CRC incidence, as well as CRC mortality will be compared among individuals exposed versus unexposed to surveillance colonoscopy, taking into account other factors that may influence CRC risk.

项目总结