Gastric Cancer Prevention: Evaluating U.S. Risk Factor Trends and New Technology

描述（申请人提供）：拟议研究的目标是确定有效的胃癌预防计划，改善癌症预后，减少差异，并提高美国胃癌预防的成本效益。这将通过构建一个灵活的决策来实现-胃癌的分析模拟模型，能够估计危险因素模式对胃癌趋势的贡献并评估成本，一级（戒烟）和二级（监测）预防战略的效益和成本效益。由于有几个因素正在改变胃癌控制的前景，包括更好地了解疾病的自然史，危险因素对疾病进展的作用，以及新的无创内镜技术来检测和治疗癌前病变和癌性病变，该模型将综合可用的临床，流行病学和经济数据来预测长期结果并指导临床研究设计。我们的具体目标是：（1）建立胃癌的自然史模型，包括危险因素对疾病进展的作用。该模型将使用美国特定年龄的癌前病变和癌症的流行病学数据进行经验校准;（2）估计胃癌发病率的下降可归因于H.幽门螺杆菌，吸烟和其他危险因素。使用基于人群的胃癌模型，我们将纳入危险因素趋势的数据，以预测胃癌的发病率和死亡率;（3）评估基于技术的监测和治疗策略对癌前病变患者的成本效益。我们将评估内镜和血清学为基础的诊断和治疗技术对异型增生和无症状癌性病变的有效性;（4）比较替代胃癌控制策略的相对有效性差异。我们将为特定种族/民族，移民和其他选定的亚组开发自然史模型，纳入人口统计学趋势，并评估预防和治疗策略的影响，以改善癌症结局并减少差异。总之，本研究将综合现有的最佳数据，改进现有的建模框架，并开发一套新的分析工具来估计和预测胃癌趋势;为胃癌前病变患者建立管理指南;并提供与不同胃癌预防和控制策略相关的相对成本，收益和风险的见解。我的职业目标是成为一名独立的研究者，致力于应用多学科的决策分析方法来改善癌症预防和控制政策。结合辅助数据分析，高级决策分析方法和流行病学的额外培训，在多学科和高度协作的环境中执行这项拟议的指导研究将提供成功过渡到研究独立所需的额外经验，知识和技能。

DESCRIPTION (provided by applicant): The goal of the proposed research is to identify effective gastric cancer prevention programs that improve cancer outcomes, reduce disparities, and enhance the cost-effectiveness of gastric cancer prevention in the U.S. This will be accomplished by constructing a flexible decision-analytic simulation model of gastric cancer capable of estimating the contribution of risk factor patterns on gastric cancer trends and assessing the costs, benefits, and cost-effectiveness of primary (smoking cessation) and secondary (surveillance) prevention strategies. As several factors are changing the landscape of gastric cancer control, including a better understanding of the disease natural history, role of risk factors on disease progression, and new noninvasive endoscopic technology to detect and treat precancerous and cancerous lesions, this model will synthesize available clinical, epidemiologic, and economic data to project long-term outcomes and guide clinical study design. Our specific aims are: (1) to develop a natural history model of gastric cancer, including the role of risk factors on disease progression. This model will be empirically calibrated using U.S. epidemiologic data on age-specific prevalence and incidence of precancerous lesions and cancer; (2) to estimate the decline in gastric cancer incidence attributable to declining prevalence of H. pylori, smoking, and other risk factors. Using a population-based model of gastric cancer we will incorporate data on risk factor trends to forecast gastric cancer incidence and mortality; (3) to assess the cost-effectiveness of technology-based surveillance and treatment strategies for patients with precancerous lesions. We will evaluate the effectiveness of endoscopic and serology-based diagnostic and therapeutic technologies for dysplastic and asymptomatic cancerous lesions; (4) to compare the relative effectiveness of alternative gastric cancer control strategies on disparities. We will develop natural history models for specific race/ethnicity, immigrant, and other select subgroups, incorporate demographic trends, and assess the impact of prevention and treatment strategies to improve cancer outcomes and reduce disparities. In summary, this research will synthesize the best available data, improve upon an existing modeling framework, and develop a new set of analytic tools to estimate and project gastric cancer trends; establish management guidelines for patients with gastric precancerous lesions; and provide insight on the relative costs, benefits, and risks associated with different gastric cancer prevention and control strategies. My career goal is to become an independent investigator dedicated to the application of multidisciplinary, decision- analytic methods to improve cancer prevention and control policies. In conjunction with additional training in secondary data analysis, advanced decision-analytic methods, and epidemiology, the execution of this proposed mentored research in a multidisciplinary and highly-collaborative environment will provide the additional experience, knowledge, and skills needed to successfully transition to research independence.