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。结直肠癌（CRC）是美国第四大常见癌症，也是癌症相关死亡的第二大常见原因。筛查结直肠癌及其前病变-腺瘤性息肉，可有效降低癌症发病率和死亡率。粪便潜血试验（FOBT）筛查结直肠癌的随机试验显示，癌症发病率降低20%，癌症死亡率降低15%至33%。观察性研究表明，内镜息肉切除术可以显着降低结直肠癌的发病率和死亡率，随机对照试验的筛查与软乙状结肠镜目前在该领域。尽管CRC筛查的益处已得到证实，但只有50%的推荐筛查的美国人群（即，50岁或以上的人）坚持当前的筛查指南。计算机断层结肠成像（CTC）是一种很有前途的技术，用于结直肠癌筛查。利用CTC，可以重建结肠的二维和三维图像，以使可能代表腺瘤或癌症的异常可视化。最近的研究表明，CTC对大腺瘤和癌症的敏感性与结肠镜检查相似。CTC的侵入性也比结肠镜检查小，这可能使其更容易被患者接受。然而，与结肠镜检查不同的是，可疑病变可以在手术过程中进行活检或切除，CTC上发现的可疑病变需要患者进行第二次手术（结肠镜检查）进行活检或切除。一些研究已经评估了CTC用于常规CRC筛查的成本效益。结论根据CTC与之相比的策略而有所不同，尽管大多数人发现CTC的成本必须大大低于结肠镜检查。

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