|Grant Number:||5U01CA151736-03 Interpret this number|
|Primary Investigator:||Doubeni, Chyke|
|Organization:||Univ Of Massachusetts Med Sch Worcester|
|Project Title:||Effectiveness of Screening Colonoscopy in Reducing Deaths From Colorectal Cancer|
DESCRIPTION (provided by applicant): Cancers of the colon and rectum (CRC), the second leading cause of cancer death in the US, can be detected at an early, more curable, stage or even prevented using available screening techniques. Although some expert groups in the US consider colonoscopy to be the standard, there is currently only limited direct evidence to support its increasing use for screening in average risk adults. Colonoscopy has higher risks and costs than other screening tests. Recent studies reported that colonoscopy did not reduce mortality from right-sided colon cancers, the part of the colon that is beyond the reach of sigmoidoscopy. However, those findings were controversial because that study was unable to distinguish screening from diagnostic uses or accurately assess the completeness of colonoscopies. This project's goal is to inform clinical and policy decisions by providing evidence to show whether the purported benefits of colonoscopy are realized in practice. The primary specific aim is to estimate the effectiveness of screening colonoscopy in reducing death from CRC among average-risk adults when compared to no screening, overall and separately for right- and left-sided cancers. Our secondary aims are to: 1) determine the impact of the completeness of colonoscopy examinations on its effectiveness; and 2) compare the effectiveness of screening colonoscopy relative to sigmoidoscopy. We will use a case-control design nested in an historical cohort of persons receiving care at 3 sites participating in a research consortium, Cancer Research Network (CRN). These sites provide the full continuum of cancer care to their members ranging from screening through end of life care, and provide access to information on CRC screening that can be linked to diagnosis and cause-specific mortality data on large numbers of racially and socioeconomically diverse persons. We will identify at least 1,200 cases of CRC deaths between 2007 and 2014 among enrollees who were 52 years or older at the date of the diagnosis, each matched within each health plan to two randomly selected controls based on age, sex and enrollment history. We will identify screening history for a minimum of 10 years prior to cancer diagnosis, differentiating screening from diagnostic procedures, using standardized targeted chart reviews and other sources. The sample size will provide sufficient power for separate evaluations of tumors located in the right colon. This project will be carried out by an experienced interdisciplinary team representing epidemiology, case-control methodology, biostatistics, gastroenterology and primary care. Team members are national leaders in CRC screening research and policy. This project is in synergy with existing NCI and the CRN goals to: 1) develop methods and approaches to provide clinical, policy-relevant information; and 2) inform clinical and public health decisions on CRC screening. This application is also responsive to the NCI's priority to improve understanding of the effectiveness and comparative effectiveness of tests used in screening for CRC, a "health disparity condition", and addresses Healthy People 2010 goals to reduce cancer death. PUBLIC HEALTH RELEVANCE: Colon cancer is the second leading cause of cancer death in the United States, but many of these cancers can be detected at an early, more curable, stage or even prevented using available screening techniques. Although many people believe that colonoscopy is the best screening test, there is currently no scientific evidence to support that claim. The goal of our proposed study is to provide scientific evidence on whether current beliefs about the benefits of colonoscopy screening are realized in actual clinical practice in order to help patients, doctors, and policy makers make decisions about colon cancer screening.
Approaches for classifying the indications for colonoscopy using detailed clinical data.
Authors: Fassil H, Adams KF, Weinmann S, Doria-Rose VP, Johnson E, Williams AE, Corley DA, Doubeni CA
Source: BMC Cancer, 2014 Feb 15;14, p. 95.
EPub date: 2014 Feb 15.
Uncontrolled confounding in studies of screening effectiveness: an example of colonoscopy.
Authors: Eldridge RC, Doubeni CA, Fletcher RH, Zauber AG, Corley DA, Doria-Rose VP, Goodman M
Source: J Med Screen, 2013 Dec;20(4), p. 198-207.
EPub date: 2013 Oct 21.
Commentary: case-control studies of screening for colorectal cancer: tailoring the design and analysis to the specific research question.
Authors: Weiss NS
Source: Epidemiology, 2013 Nov;24(6), p. 894-7.
Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study.
Authors: Doubeni CA, Weinmann S, Adams K, Kamineni A, Buist DS, Ash AS, Rutter CM, Doria-Rose VP, Corley DA, Greenlee RT, Chubak J, Williams A, Kroll-Desrosiers AR, Johnson E, Webster J, Richert-Boe K, Levin TR, Fletcher RH, Weiss NS
Source: Ann Intern Med, 2013 Mar 5;158(5 Pt 1), p. 312-20.
Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs.
Authors: Corley DA, Jensen CD, Marks AR, Zhao WK, de Boer J, Levin TR, Doubeni C, Fireman BH, Quesenberry CP
Source: Clin Gastroenterol Hepatol, 2013 Feb;11(2), p. 172-80.
EPub date: 2012 Sep 14.
Contribution of behavioral risk factors and obesity to socioeconomic differences in colorectal cancer incidence.
Authors: Doubeni CA, Major JM, Laiyemo AO, Schootman M, Zauber AG, Hollenbeck AR, Sinha R, Allison J
Source: J Natl Cancer Inst, 2012 Sep 19;104(18), p. 1353-62.
EPub date: 2012 Sep 5.
Obesity, weight change, and risk of adenoma recurrence: a prospective trial.
Authors: Laiyemo AO, Doubeni C, Badurdeen DS, Murphy G, Marcus PM, Schoen RE, Lanza E, Smoot DT, Cross AJ
Source: Endoscopy, 2012 Sep;44(9), p. 813-8.
EPub date: 2012 Aug 27.
Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study.
Authors: Doubeni CA, Laiyemo AO, Major JM, Schootman M, Lian M, Park Y, Graubard BI, Hollenbeck AR, Sinha R
Source: Cancer, 2012 Jul 15;118(14), p. 3636-44.
EPub date: 2012 Jan 3.
Neighborhood socioeconomic status and use of colonoscopy in an insured population--a retrospective cohort study.
Authors: Doubeni CA, Jambaulikar GD, Fouayzi H, Robinson SB, Gunter MJ, Field TS, Roblin DW, Fletcher RH
Source: PLoS One, 2012;7(5), p. e36392.
EPub date: 2012 May 2.
Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study.
Authors: Higgins AY, Doubeni AR, Phillips KL, Laiyemo AO, Briesacher B, Tjia J, Doubeni CA
Source: BMC Gastroenterol, 2012 Mar 21;12, p. 23.
EPub date: 2012 Mar 21.
Factors associated with inadequate colorectal cancer screening with flexible sigmoidoscopy.
Authors: Laiyemo AO, Doubeni C, Pinsky PF, Doria-Rose VP, Sanderson AK 2nd, Bresalier R, Weissfeld J, Schoen RE, Marcus PM, Prorok PC, Berg CD
Source: Cancer Epidemiol, 2012 Aug;36(4), p. 395-9.
EPub date: 2011 Nov 22.
Health status, neighborhood socioeconomic context, and premature mortality in the United States: The National Institutes of Health-AARP Diet and Health Study.
Authors: Doubeni CA, Schootman M, Major JM, Stone RA, Laiyemo AO, Park Y, Lian M, Messer L, Graubard BI, Sinha R, Hollenbeck AR, Schatzkin A
Source: Am J Public Health, 2012 Apr;102(4), p. 680-8.
EPub date: 2011 Nov 28.
Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study Cohort.
Authors: Lian M, Schootman M, Doubeni CA, Park Y, Major JM, Stone RA, Laiyemo AO, Hollenbeck AR, Graubard BI, Schatzkin A
Source: Am J Epidemiol, 2011 Oct 1;174(7), p. 828-38.
EPub date: 2011 Aug 11.
Likelihood of missed and recurrent adenomas in the proximal versus the distal colon.
Authors: Laiyemo AO, Doubeni C, Sanderson AK 2nd, Pinsky PF, Badurdeen DS, Doria-Rose VP, Marcus PM, Schoen RE, Lanza E, Schatzkin A, Cross AJ
Source: Gastrointest Endosc, 2011 Aug;74(2), p. 253-61.
EPub date: 2011 May 6.
Primary care, economic barriers to health care, and use of colorectal cancer screening tests among Medicare enrollees over time.
Authors: Doubeni CA, Laiyemo AO, Young AC, Klabunde CN, Reed G, Field TS, Fletcher RH
Source: Ann Fam Med, 2010 Jul-Aug;8(4), p. 299-307.
Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities.
Authors: Laiyemo AO, Doubeni C, Pinsky PF, Doria-Rose VP, Bresalier R, Lamerato LE, Crawford ED, Kvale P, Fouad M, Hickey T, Riley T, Weissfeld J, Schoen RE, Marcus PM, Prorok PC, Berg CD
Source: J Natl Cancer Inst, 2010 Apr 21;102(8), p. 538-46.
EPub date: 2010 Mar 31.