Comparative modeling of gastric cancer disparities and prevention in the US and globally

胃癌(GC)，特别是胃腺癌，是第五大常见癌症，也是第三大常见癌症。 是全球癌症死亡的主要原因，已被世界卫生组织列为被忽视的癌症 组织。在美国，存在着明显的差异，黑人、西班牙裔和亚洲人几乎有两个- 与白人相比，患GC或死于GC的风险要高出一倍，反映出风险因素的差异，如 例如幽门螺杆菌感染和吸烟，以及获得初级预防和护理的机会。 有几个因素正在改变GC预防的格局，包括对疾病的更好理解 自然历史，前瞻性研究预防的新证据，以及随机研究的预期结果 对照试验。因为早期的GC检测可以通过手术或非侵入性治疗来提高存活率 内窥镜切除是预防胃癌的新的靶向方法，有可能显著改善 人群健康和减少美国境内的GC差异，尽管幽门螺杆菌一直是 迄今为止，全球预防胃癌的努力，在美国的幽门螺杆菌流行率因亚群而有很大差异。 世界已经强调了优化对弱势人群的幽门螺杆菌筛查和治疗干预的必要性 组。一种方法是对高危个体进行有针对性的内窥镜筛查。例如，被发现有以下行为的人 有胃肠上皮化生，这是一种与胃部高进展风险相关的前驱病变 在许多国家，建议接受内窥镜监测。迫切需要 确定有效且具有成本效益的策略，以应对美国的这些临床挑战 在全球范围内。这项拟议的工作建立在先前的GC工作的基础上，该工作跨越GC和H.Pylori模拟建模 研究、GC二级数据库分析以及相关的方法学和全球癌症建模 出版物。这项提案的研究团队在模拟和 癌症控制的比较模型，GC预防和护理领域的临床专业知识， 以及证明的记录和承诺，为癌症护理和政策提供信息。建议的三项 建模小组处于有利地位，能够执行并成功完成高度相关的项目目标。 拟议研究的首要目标是产生创新和范式转换。 通过以差异为重点的建模方法改变癌症护理 脆弱的高危人群在美国和世界上背负着GC的最大负担。我们会 通过执行比较建模并完成以下目标来实现这一目标：1)开发GC 模拟模型以评估美国按种族和民族划分的亚组的GC结果；2)评估 风险因素趋势和一级预防策略对GC差异的影响；3)有针对性的评估 减少早发相关死亡率和GC差异的二级预防战略，以及4)调整 在全球背景下评估GC预防政策的模型。

Gastric cancer (GC), specifically gastric adenocarcinoma, is the fifth most common cancer and the third leading cause of cancer death globally and has been categorized as a neglected cancer by the World Health Organization. In the U.S., there are stark disparities, with Blacks, Hispanics and Asians having a nearly two- fold greater risk of developing or dying from GC compared to Whites, reflecting differences in risk factors, such as Helicobacter pylori (H. pylori) infection and smoking, as well as access to primary prevention and care. Several factors are changing the landscape of GC prevention, including a better understanding of the disease natural history, new evidence on prevention from prospective studies, and anticipated results from randomized controlled trials. As early GC detection can improve survival by allowing for curative surgical or noninvasive endoscopic resection, new targeted approaches to GC prevention have the potential to markedly improve population health and reduce GC disparities within the U.S. Although H. pylori has been the primary focus of global GC prevention efforts to date, substantial variation by subpopulation in H. pylori prevalence in the U.S. and the world has accentuated the need to optimize H. pylori screen-and-treat interventions for vulnerable groups. One approach is targeted endoscopic screening of high-risk individuals. For instance, persons found to have gastric intestinal metaplasia, a precursor lesion associated with a high progression risk to gastric neoplasia, are recommended to undergo endoscopic surveillance in many countries. A critical need exists to identify effective and cost-effective strategies to address these clinical challenges in the U.S., as well as globally. This proposed work builds upon prior GC work spanning GC and H. pylori simulation modeling studies, GC secondary database analyses, and relevant methodologic and global cancer modeling publications. The research team for this proposal has a vast collective experience in simulation and comparative modeling for cancer control, clinical expertise across the spectrum of GC prevention and care, and a demonstrated track record and commitment to informing cancer care and policy. The proposed three modeling groups are well-positioned to perform and successfully complete the highly relevant project aims. The overarching goal of the proposed research is to produce innovative and paradigm-shifting changes to cancer care through a disparities-focused modeling approach targeting the most vulnerable, high-risk populations that bear the greatest burden of GC in the US, and the world. We will accomplish this goal by performing comparative modeling and completing the following aims: 1) Develop GC simulation models to estimate GC outcomes for subgroups by race and ethnicity in the U.S.; 2) Assess the impact of risk factor trends and primary prevention strategies on GC disparities; 3) Evaluate targeted secondary prevention strategies for reducing early onset-related mortality and GC disparities, and 4) Adapt the models to evaluate GC prevention policies in the global setting.