CT Colonoscopy Screening for CRC:Comparative Effectiveness vs Traditional Models

描述(由申请人提供)：本申请涉及广泛的挑战领域(05)：比较有效性研究和特定挑战主题05-CA-102：癌症筛查的比较有效性研究。在美国，结直肠癌(CRC)是第四大常见癌症，也是第二大癌症相关死亡原因。筛查结直肠癌及其前驱病变--腺瘤性息肉，可以有效地降低癌症的发病率和死亡率。用粪便潜血试验(FOBT)筛查结直肠癌的随机试验表明，癌症发病率降低了20%，癌症死亡率降低了15%至33%。观察性研究表明，内窥镜息肉切除术可以显著降低结直肠癌的发病率和死亡率，目前该领域正在进行柔性乙状结肠镜筛查的随机对照试验。尽管结直肠癌筛查显示了这一好处，但只有50%的建议筛查的美国人口(即50岁或以上的人)遵守当前的筛查指南。计算机体层摄影(CTC)是一种很有前途的结直肠癌筛查技术。使用CTC，可以重建结肠的二维和三维图像，以便可视化可能代表腺瘤或癌症的异常。最近的研究表明，CTC对大腺瘤和癌症的敏感性与结肠镜相似。CTC也比结肠镜检查侵袭性小，这可能使它更容易被患者接受。然而，与结肠镜检查不同的是，可疑病变可以在手术过程中活检或移除，而CTC上发现的可疑病变需要患者接受第二次手术(结肠镜检查)以进行活检或移除。几项研究评估了CTC用于常规结直肠癌筛查的成本效益。根据所比较的战略，结论各不相同，尽管大多数人发现，四氯化碳的成本必须大大低于结肠癌

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and Specific Challenge Topic 05-CA-102: Comparative Effectiveness Research on Cancer Screening. Colorectal cancer (CRC) is the fourth most common cancer and the second most common cause of cancer- related death in the US. Screening for colorectal cancer and its precursor lesion, the adenomatous polyp, can effectively reduce cancer incidence and mortality. Randomized trials of colorectal cancer screening with a fecal occult blood test (FOBT) show a 20% reduction in cancer incidence and a 15% to 33% reduction in cancer mortality. Observational studies show that endoscopic polypectomy can markedly reduce colorectal cancer incidence and mortality, and randomized controlled trials of screening with flexible sigmoidoscopy are currently in the field. Despite this demonstrated benefit of CRC screening, only 50% of the US population for whom screening is recommended (i.e., those age 50 or older) adheres to current screening guidelines. Computed tomographic colonography (CTC) is a promising technique for colorectal cancer screening. With CTC, two- and three-dimensional images of the colon are reconstructed to allow the visualization of abnormalities that might represent adenomas or cancer. Recent studies have demonstrated that the sensitivity of CTC for large adenomas and cancer is similar to that of colonoscopy. CTC is also less invasive than colonoscopy, which may make it more acceptable to patients. However, unlike colonoscopy, where suspicious lesions can be biopsied or removed during the procedure, suspicious lesions identified on CTC require the patient to undergo a second procedure (colonoscopy) for biopsy or removal. Several studies have assessed the cost-effectiveness of CTC for routine CRC screening. The conclusions have varied depending upon the strategies that CTC is compared to, although most find that a CTC must cost substantially less than a colonosco