The overall goal of the Research Center is the creation of a research unit that can evaluate the complete colorectal cancer (CRC) screening process. The specific goal is the characterization of remediable failures of the two most commonly used screening tests (optical colonoscopy and fecal immunochemical tests [FIT]). Two important problems in CRC are over-screening and under-diagnosis: 1) >95% of people will not die of CRC, thus, for most patients, screening results only in worry & risk; yet 2) many CRC deaths occur despite CRC screening (i.e. in persons with prior screening). It is unclear how many deaths result from remediable failures of the screening process. Our center will evaluate a community-based cohort that includes detailed CRC screening and medical data for >2 million screening-eligible people/year; >10 years of data; large numbers of outcomes (38,000 cancers); geographic diversity (>35 medical centers across California); demographic diversity (140,000 African Americans, 320,000 Hispanics, and 200,000 Asian-Americans among current members); socioeconomic diversity; diversity of screening methods; access to tissue/cancer blocks; and a full spectrum of individual cancer risk. Project 1 will evaluate FIT, an effective and efficient noninvasive screening method. Project 2 will evaluate colonoscopy, a sensitive, widely used test that is the final common exam for all CRC screening strategies. Projects 1 & 2 will both evaluate patterns of use, especially: screening failures (cancers diagnosed despite screening); surveillance failures, and surveillance over-use. We will investigate physician and patient components for these failures using a recently developed systematic process that includes establishing bases for interventions that target barriers in healthcare settings. Project 1 will also evaluate clinically available genetic markers to evaluate for potential biological differences between FIT detected vs. screen failure cancers. Project 3 will model the effectiveness of colonoscopy vs. FIT utilizing community-based data from the full screening process acquired in Projects 1 & 2, in collaboration with a proven NCI consortium Cancer Intervention and Surveillance Modeling Network (CISNET) site, including different screening strategies for different patient populations, tailored to risk. The Center includes a trans-disciplinary group of researchers including gastroenterologists, oncologists, family physicians, population scientists, modeling experts, quality experts, behavioral experts, and experts in health care delivery. The Center can efficiently evaluate the full screening process and can provide substantial human, institutional, and patient resources for collaborative projects within the PROSPR network.

Public Health Relevance

Non-invasive screening with the FIT offers an important means of early detection of CRC and adenomas and is suitable for mass population screening. Understanding the magnitude and predictors of false negative FIT results, and examining alternative molecular markers for CRC detection are Important steps toward optimizing non-invasive CRC screening.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA163262-02
Application #
8555518
Study Section
Special Emphasis Panel (ZCA1-SRLB-R (O1))
Project Start
2011-09-26
Project End
2016-05-31
Budget Start
2012-09-01
Budget End
2013-05-31
Support Year
2
Fiscal Year
2012
Total Cost
$330,586
Indirect Cost
$58,415
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Levin, Theodore R; Corley, Douglas A; Jensen, Christopher D et al. (2017) Genetic Biomarker Prevalence Is Similar in Fecal Immunochemical Test Positive and Negative Colorectal Cancer Tissue. Dig Dis Sci 62:678-688
Hillyer, Grace Clarke; Jensen, Christopher D; Zhao, Wei K et al. (2017) Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. Cancer 123:3744-3753
Fedewa, Stacey A; Corley, Douglas A; Jensen, Christopher D et al. (2017) Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program. Am J Prev Med 53:335-344
Rutter, Carolyn M; Kim, Jane J; Meester, Reinier G S et al. (2017) Effect of Time to Diagnostic Testing for Breast, Cervical, and Colorectal Cancer Screening Abnormalities on Screening Efficacy: A Modeling Study. Cancer Epidemiol Biomarkers Prev :
Balasubramanian, Bijal A; Garcia, Michael P; Corley, Douglas A et al. (2017) Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems. Medicine (Baltimore) 96:e6326
Chao, Chun; Silverberg, Michael J; Becerra, Tracy A et al. (2017) Human papillomavirus vaccination and subsequent cervical cancer screening in a large integrated healthcare system. Am J Obstet Gynecol 216:151.e1-151.e9
Lee, Alexander; Jensen, Christopher D; Marks, Amy R et al. (2017) Endoscopist fatigue estimates and colonoscopic adenoma detection in a large community-based setting. Gastrointest Endosc 85:601-610.e2
Chubak, Jessica; Garcia, Michael P; Burnett-Hartman, Andrea N et al. (2016) Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems. Cancer Epidemiol Biomarkers Prev 25:344-50
McCarthy, Anne Marie; Kim, Jane J; Beaber, Elisabeth F et al. (2016) Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity. Am J Prev Med 51:507-12
Klabunde, Carrie N; Zheng, Yingye; Quinn, Virginia P et al. (2016) Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly. Am J Prev Med 51:e67-75

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