Assessing the Impact of Colorectal Cancer Screening

描述(由申请人提供)： 微模拟模型可以用来估计筛查和人群风险变化对结直肠癌(CRC)预后的影响，提供了比观察性或随机研究更深入的见解。在过去的两年里，我们为结直肠癌的自然历史建立了一个新的微观模拟模型，我们正在完善我们的筛选模型。我们建议使用我们的模型来评估结直肠癌筛查对观察到的结直肠癌发病率和死亡率的人口趋势的影响，扩大我们的关注点，以包括危险因素对观察到的和预测的结直肠癌结果的影响。 我们提议的工作围绕三个具体目标展开： 具体目标1：使用我们基于人群的微观模拟模型，评估筛查和息肉切除术对美国人群中结直肠癌发病率和死亡率趋势的影响。特别是，我们将研究筛查对结直肠癌结果的影响，以及不同指南建议的筛查策略对结直肠癌结果的潜在影响。 具体目标2：扩展我们的自然病史模型，以纳入个体风险因素(例如，吸烟、肥胖)对结直肠癌预后的影响，并扩展我们的筛查模型，以探索新技术对结直肠癌结果未来趋势的潜在影响。需要明确纳入风险因素，以评估未来风险因素变化对预后的影响，并评估我国降低结直肠癌发病率和死亡率的能力。我们将从评估假想风险因素的变化对结直肠癌预后的影响开始，提供有关风险因素与癌症预后之间关系的关键信息。最终，我们将通过将风险因素行为的长期趋势构建到我们的模型中来估计风险变化对CRC结果的影响。 具体目标3：与信息和通信技术网络成员和其他调查人员合作，解决与政策有关的问题。我们建议的工作最好是与癌症发病率和监测建模网络(CISNET)的同事合作进行。这个小组的积极协同作用使我们的团队能够快速开发和实施我们的CRC微观模拟模型。

DESCRIPTION (provided by applicant): Microsimulation models can be used to estimate the effect of screening and changes in population risk on colorectal cancer (CRC) outcomes, offering insights beyond those gained from either observational or randomized studies. Over the past two years, we have built a new microsimulation model for the natural history of CRC, and we are in the process of refining our screening model. We propose to use our model to estimate the impact of CRC screening on observed population trends in CRC incidence and mortality, expanding our focus to include the impact of risk factors on both observed and projected CRC outcomes. Our proposed work centers around three specific aims: Specific Aim 1: Estimating the effect of screening and polypectomy on trends in CRC incidence and mortality within the US population using our population-based microsimulation model. In particular, we will examine the impact of screening as practiced on CRC outcomes, and the potential impact of different guideline recommended screening strategies on CRC outcomes. Specific Aim 2: Extending our natural history model to incorporate the effects of individual risk factors (e.g., smoking, obesity) on CRC outcomes, and extending our screening model to explore the potential impact of new technologies on future trends in CRC outcomes. Explicit incorporation of risk factors is needed to estimate the effect of future changes in risk factors on outcomes, and to assess our Nation's ability to reduce CRC incidence and mortality. We will begin by estimating the effect of changes in a hypothetical risk factor on CRC outcomes, providing critical information about the relationship between risk factors and cancer outcomes. Ultimately, we will estimate the impact of changes in risk on CRC outcomes by building secular trends in risk factor behavior into our models. Specific Aim 3: Collaborating with both CISNET members and other investigators to address policy-relevant questions. Our proposed work is best carried out in collaboration with colleagues in the Cancer Incidence and Surveillance Modeling Network (CISNET). The positive synergy of this group has enabled our team to rapidly develop and implement our microsimulation model for CRC.