A Personalized Approach to Targeted Esophageal Cancer Screening

该项目的目标是减少食道癌患者的发病率和死亡率。 在这种情况下，癌症继续遭受极低的存活率和高病死率。食道 腺癌(EAC)是美国最常见的食道恶性肿瘤组织学类型， 在过去的40年里，经历了令人震惊的快速和基本上无法解释的发病率上升 西方世界的。以前在美国试图控制与EAC相关的发病率和死亡率 都专注于内窥镜筛查，这是侵入性的，成本也很高。然而，创新的新技术 对于侵袭性更小、成本更高的食道癌筛查来说，创造了降低 筛查的门槛可能是一个现实的选择，特别是对于那些风险较高的人。 虽然设备的性能指标很重要，但识别和解决障碍同样重要 到实施。我们建议研究患者、提供者和医疗保健系统的潜在因素 可能会阻碍筛查计划。 这份R01提案将利用之前开发和验证的EAC自然历史模拟模型。 食道癌协会在食管癌筛查、预防和治疗领域做出了重大贡献 利用EAC模型评估和分析EAC癌症控制的关键方面。前人工作和模式 将为当前的研究项目提供非常强大的基础。研究小组由以下人员组成 由经验丰富的调查人员组成，他们为该项目提供必要的广泛和补充的专业知识 有成功协作的记录。 我们建议的首要前提是食道癌筛查的新方法具有 有可能改善EAC死亡率，但成功实施和对人口的影响将取决于 关于：1)筛查方式特征；2)患者、提供者和卫生系统的障碍；以及3) 要筛查的患者的个人资料。我们将通过完成四个具体目标来实现这些项目目标。 在目标1中，我们将使用我们经过验证的食道癌模拟模型来测试和评估细胞 抽样设备可用于人口筛查，具有成本效益。在目标2中，我们将研究潜在患者， 食道癌筛查的提供者和卫生系统障碍。对于Aim 3，我们将进行个性化的筛选 通过确定哪些患者资料将从筛查中受益。最后，在目标4中将评估人口 食道癌筛查策略的潜在实施对癌症控制的影响 优先目标。 到获奖期结束时，我们将开发一种个性化的方法进行有针对性的EAC筛查，即 理性和成本效益。

The goal of the project is to diminish the morbidity and mortality associated with esophageal cancer as patients with this cancer continue to suffer from extremely poor survival and high case-fatality rates. Esophageal adenocarcinoma (EAC) is the most common histologic type of esophageal malignancy in the US and has experienced an alarmingly rapid and largely unexplained rise in incidence over the past four decades in much of the western world. Previous attempts to curb the morbidity and mortality associated with EAC in the US have focused on an endoscopic screening, which is invasive and costly. However, innovative new technologies for esophageal cancer screening that are both less invasive and costly have created the opportunity to lower the bar for screening to where it could be a realistic option, particularly for those who are higher risk. While the performance metrics of the device are important, equally critical are identifying and resolving barriers to implementation. We propose to study potential factors for patients, providers and health care systems that could impede screening programs. This R01 proposal will leverage a previously developed and validated natural history simulation model of EAC. The PI has made significant contributions to the fields of esophageal cancer screening, prevention and treatment utilizing the EAC model to assess and analyze critical aspects of EAC cancer control. The prior work and model will provide an exceptionally strong foundation for the current research project. The research team is comprised of experienced investigators who provide the broad and complementary expertise necessary for this project and have a track record of successful collaboration. The overarching premise of our proposal is that novel approaches to esophageal cancer screening have the potential to improve EAC mortality, but that the successful implementation and population impact will depend on: 1) the screening modality characteristics; 2) patient, provider, and health system’s barriers; and 3) the profile of the patients to be screened. We will accomplish these project goals by completing four specific aims. In Aim 1 we will use our validated simulation model of esophageal cancer to test and assess whether a cell sampling device can be cost-effective for population screening. In Aim 2 we will study potential patient, provider and health system barriers to esophageal cancer screening. For Aim 3 we will personalize screening by determining which patient profiles will benefit from screening. Finally, in Aim 4 will assess the population cancer control impact of the potential implementation of the esophageal cancer screening strategy defined by the prior aims. By award period end, we will have developed a personalized approach to targeted EAC screening that is rational and cost-effective.