Optimal early colorectal cancer screening initiation

项目总结 在中国，结直肠癌(CRC)占癌症发病率的8%，占癌症相关死亡的9% 美国(美国)。大约11%的结直肠癌病例是在50岁之前确诊的，也就是所谓的早发性结直肠癌 (EOCRC)-2005-2014年间，发病率和死亡率每年分别增长1.6%和1%， 亚裔、美国印第安人/阿拉斯加原住民、黑人和西班牙裔种族/民族之间的负担不平等 那些有医疗补助或没有保险的人。EOCRC不断增加的负担促使美国预防服务工作组 FORCE(USPSTF)建议从45岁开始在平均风险成年人中启动结直肠癌筛查， 而不是50美元。这项建议将把结直肠癌筛查扩大到2100万美国人，其中400万人 每年都有更多的人年满45岁。缺乏证据来说明如何优化结直肠癌筛查的影响。 在45-49岁的成年人中。具体地说，有三个关键的知识差距：1)我们缺乏信息 关于45-49岁人群中结直肠癌筛查的可接受性，并且没有调查以下因素 可能会影响这些新符合条件的人群对结直肠癌筛查的接受，2)有人担心结直肠癌 年龄在≥50岁的成年人中存在的筛查差距很可能出现在这个没有 有针对性的筛查策略和3)尚不清楚这一年龄段是否会对目前的结直肠癌筛查做出反应 实践或更积极的外展。这项建议的中心目标是开发有针对性的CRC筛查 在45-49岁的成年人中最大限度地增加筛查摄入量和预防癌症差异的战略。我们的研究将 招募在大型卫生系统中接受护理的45-49岁成年人来回答这些问题。首先，我们将 通过运行试点试验来确定更大规模试验的可行性，从而表征CRC筛查的可接受性 (目标1a)，并就影响结直肠癌筛查的因素进行调查和访谈(目标1b)，以 强调在45-49岁的成年人中实施筛查的有效战略。接下来，我们将使用这些试点 主动外展策略的相对有效性的随机对照试验数据 包括邮寄粪便免疫化学测试和常规护理，以优化摄取和预防出现 消除结直肠癌筛查差异(目标2)。这项研究计划与培训计划相辅相成，以加强 申请人在流行病学和生物统计学方面的背景，并接受过1)随机对照试验方面的新培训 方法论，2)健康行为和医疗决策研究，3)健康公平和差异 研究和4)调查研究和质的研究方法。我们的研究将是最全面的 对美国迄今为止启动的早期结直肠癌筛查的审查，并将为更新的结直肠癌提供背景 筛查政策和在成年人中更广泛地实施早期结直肠癌筛查的潜在框架 45比49。它还提供了一个高质量的职业发展机会，以发展成为合格的关键技能 独立调查员。

PROJECT SUMMARY Colorectal cancer (CRC) accounts for 8% of cancer incidence and 9% of cancer-related mortality in the United States (US). About 11% of CRC cases are diagnosed before age 50—known as early age onset CRC (EOCRC)—with incidence and mortality rates increasing 1.6% and 1% per year between 2005-2014, and an unequal burden among Asian, American Indian/Alaska Native, Black and Hispanic racial/ethnic groups and those with Medicaid or uninsured. The increasing EOCRC burden informed a US Preventive Services Task Force (USPSTF) recommendation to initiate CRC screening among average risk adults starting at age 45, rather than 50. This recommendation would expand CRC screening to 21 million Americans, with 4 million more turning 45 each year. There is a lack of evidence to inform how to optimize impact of CRC screening among adults ages 45-49. Specifically, there are three critical knowledge gaps: 1) we lack information regarding acceptability of CRC screening among those ages 45-49 and have not investigated factors that might influence CRC screening uptake among this newly eligible population, 2) there are concerns that CRC screening disparities that exist among adults ages ≥50 are likely to emerge in this younger age group without a targeted screening strategy and 3) it is unclear whether this age group will respond to current CRC screening practice or more active outreach. The central objective of this proposal is to develop a targeted CRC screening strategy among adults ages 45-49 to maximize screening uptake and prevent cancer disparities. Our study will recruit adults ages 45-49 receiving care within a large health system to answer these questions. First, we will characterize the acceptability of CRC screening by running a pilot trial to establish feasibility of a larger trial (Aim 1a) and conduct surveys and interviews regarding factors influencing CRC screening uptake (Aim 1b) to highlight effective strategies for implementing screening among adults ages 45-49. Next, we will use these pilot data to inform a randomized controlled trial of the comparative effectiveness of an active outreach strategy including mailed fecal immunochemical test versus usual care for optimizing uptake and preventing emergence of CRC screening disparities (Aim 2). This research plan is complemented by a training plan to enhance the applicant’s background in epidemiology and biostatistics, with new training in 1) randomized controlled trials methodology, 2) health behavior and medical decision making research, 3) health equity and disparities research and 4) survey and qualitative research methods. Our study will be the most comprehensive examination of early CRC screening initiation in the US to date and will provide context to the updated CRC screening policy and a potential framework for wider implementation of earlier CRC screening in adults ages 45-49. It also offers a high-quality career development opportunity to develop key skills to become a qualified independent investigator.