Esophageal Adenocarcinoma Policy Model: Trends, Risk Factors and Screening

项目总结/摘要 食管腺癌的发病率一直以惊人的速度上升 在过去的三十年里。虽然每年EAC病例的绝对数量也保持不变， 筛查一般人群偏低，可适当进行针对性筛查。胃灼热 胃食管反流病（GERD）的主要症状，影响6000万美国人， 可导致巴雷特食管（BE），这是一种与最大的 发展EAC的风险（30- 125倍）。由于受影响的人数众多， GERD和BE，这些患者的管理已成为一个公共卫生问题。然而，在这方面， 尚未提出一个可接受的EAC筛查或监测计划。 该提案的广泛的长期目标是确定一个有效和负担得起的 针对EAC的早期识别和干预计划的有针对性的筛查策略， 将减轻这种疾病的负担。 这些研究目标将通过开发和分析食管癌疫苗来实现。 腺癌政策模型（EACMo）。丰富的互补方法组合， 最先进的模拟技术将是必要的，以实现众多的项目 目标.数据来源广泛，包括监测、流行病学和最终结果 （SEER）、临床试验数据和已发表文献将用于开发模拟 模型校准方法将用于系统地微调模型参数， 产生目标终点（例如癌症发病率）。验证将通过以下方式实现： 模型重现了其他已公布的数据。 具体目标是： 目标1：开发和验证EACMo 目的2：估计关键风险因素对美国EAC发病率上升的贡献。 目的3：识别EAC高风险个体：Barrett食管的预测因子 目的4：评估合理食管扩张术的有效性、成本和成本-效果 腺癌筛查和管理计划 该项目的健康相关性将是使用结果来设计临床试验， 指导政策决定并为循证实践指南提供信息。多学科 为这个项目组建的研究小组在模拟疾病的各个方面都有专业知识 建模，EAC的临床方面，以及经过验证的研究和合作历史。

Project Summary/Abstract The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past three decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 60 million Americans and can lead to Barrett's esophagus (BE), a pre-malignant condition associated with the greatest risk (30-125x) of developing EAC. Because of the significant number of individuals affected with GERD and BE, the management of these patients has become a public health issue. However, an accepted screening or surveillance program for EAC has not been proposed. The broad, long-term objectives of the proposal are to identify an effective and affordable targeted screening strategy for EAC with early identification and an intervention program which will diminish the burden of this disease. These research goals will be accomplished developing and analyzing an Esophageal AdenoCarcinoma Policy Model (EACMo). A rich mix of complementary methodologies and state of the art simulation techniques will be necessary to achieve the numerous project objectives. Data from numerous sources including Surveillance Epidemiology and End Results (SEER), clinical trial data and the published literature will be used to develop a simulation model. Calibration methodology will be used to systematically fine tune model parameters to produce targeted endpoints (e.g. cancer incidence). Validation will be achieved by having the model reproduce other published data. The specific aims are: Aim 1: Develop and validate the EACMo Aim 2: Estimate contributions of pivotal risk factors to the rise in EAC incidence in the U.S. Aim 3: Identify individuals at high risk for EAC: predictors of Barrett's esophagus Aim 4: Estimate the effectiveness, cost and cost-effectiveness of plausible esophageal adenocarcinoma screening and management programs The health relatedness of the project will be to use the results to design clinical trials, guide policy decisions and inform evidence-based practice guidelines. The multidisciplinary research team assembled for this project has expertise in all aspects of simulation disease modeling, clinical aspects of EAC, and a proven history of research and collaborations.