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Grant Details

Grant Number: 5UM1CA222035-03 Interpret this number
Primary Investigator: Corley, Douglas
Organization: Kaiser Foundation Research Institute
Project Title: Optimizing Colorectal Cancer Screening Precision and Outcomes in Community-Based Populations (PRECISE)
Fiscal Year: 2020


Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Most deaths are preventable through early detection, but failures of screening completion and quality substantially impair test effectiveness. This proposal unites the productive PROSPR I CRC Centers into a single collaboration to address key questions and pilot interventions to improve CRC screening outcomes. In PROSPR I, we developed a strong transdisciplinary, multisite collaboration. We collected 316 data elements, performed validation studies, created high-quality pooled data sets to identify patient, provider, and system gaps in the CRC screening process factors and published >60 manuscripts. Our unified PROSPR II Research Center (PRC) will use these proven collaborations and >10 years of longitudinal data for >8.9 million screen-eligible people (~ 1 of 40 eligible people in the US), large numbers of screening exposures (>8.4 million fecal immunochemical tests [FIT] and >1.9 million colonoscopies), and outcomes (>28,000 CRCs). Our PRC is geographically, demographically and economically diverse (three states, >800,000 African Americans, 1.6 million Hispanics, and 1 million Asian Americans). The health systems have different CRC screening patterns, different modalities, and include all major insurance/reimbursement methods (safety net, Medicare, Medicaid, high-deductible and pre-paid/fee-for-service, staff-model and incentivized providers). Our PROSPR I research identified major deficiencies in three areas of CRC screening: who should get screening and surveillance and when; why people do not complete recommended screening, surveillance or follow-up of positive tests; and how test quality and accuracy can be improved. Project 1 will identify on whom and when screening should be performed, particularly for those with conflicting recommendations (e.g., African Americans aged 40-49 years, and patients 76-85 years old). Project 2 will evaluate when surveillance should occur after a precancerous polyp diagnosis, using baseline colonoscopy results and precise new 10-year risk estimates for CRC. Project 3 will explore long-term screening patterns and multilevel drivers of why screening and surveillance are not appropriately completed, especially in understudied patients who never screen, fail to re-screen, use surveillance inappropriately or fail to follow up after a positive screening test. Project 4 will evaluate how to increase the effectiveness of FIT and colonoscopy by optimizing age- and sex-stratified quantitative FIT abnormal ranges, establishing precise adenoma detection thresholds for quality improvement and evaluating drivers of adenoma detection. We will use results from these observational studies, behavioral science methods, and stakeholder involvement to develop and pilot test multilevel interventions. Our transdisciplinary team of scientists, physicians, and healthcare experts will also provide leadership and data for trans-PROSPR, multiple-organ collaborations. The proposed research can substantially decrease the burden of CRC by reducing disparities and identifying ways to improve screening completion and effectiveness.



Publications

Primary Care Provider Beliefs and Recommendations About Colorectal Cancer Screening in Four Healthcare Systems.
Authors: Ghai N.R. , Jensen C.D. , Merchant S.A. , Schottinger J.E. , Lee J.K. , Chubak J. , Kamineni A. , Halm E.A. , Skinner C.S. , Haas J.S. , et al. .
Source: Cancer prevention research (Philadelphia, Pa.), 2020 Nov; 13(11), p. 947-958.
EPub date: 2020-07-15.
PMID: 32669318
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Challenges and Approaches to Measuring Repeat Fecal Immunochemical Test for Colorectal Cancer Screening.
Authors: Murphy C.C. , Halm E.A. , Skinner C.S. , Balasubramanian B.A. , Singal A.G. .
Source: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2020 Aug; 29(8), p. 1557-1563.
EPub date: 2020-05-26.
PMID: 32457184
Related Citations

Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population.
Authors: Lee J.K. , Jensen C.D. , Levin T.R. , Doubeni C.A. , Zauber A.G. , Chubak J. , Kamineni A.S. , Schottinger J.E. , Ghai N.R. , Udaltsova N. , et al. .
Source: Gastroenterology, 2020 03; 158(4), p. 884-894.e5.
EPub date: 2019-10-04.
PMID: 31589872
Related Citations

Morbidity and Mortality After Surgery for Nonmalignant Colorectal Polyps: A 10-Year Nationwide Analysis.
Authors: Ma C. , Teriaky A. , Sheh S. , Forbes N. , Heitman S.J. , Jue T.L. , Munroe C.A. , Jairath V. , Corley D.A. , Lee J.K. .
Source: The American journal of gastroenterology, 2019 11; 114(11), p. 1802-1810.
PMID: 31634261
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Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study.
Authors: Selby K. , Jensen C.D. , Lee J.K. , Doubeni C.A. , Schottinger J.E. , Zhao W.K. , Chubak J. , Halm E. , Ghai N.R. , Contreras R. , et al. .
Source: Annals of internal medicine, 2018-10-02; 169(7), p. 439-447.
EPub date: 2018-09-18.
PMID: 30242328
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