Despite recent declines in both mortality and incidence, colorectal cancer is currently the third most common cancer diagnosed and the third leading cause of cancer death in the United States for both men and women. It is not known to what extent this decline is attributable to changes in use of screening, changes in exposures to """"""""lifestyle"""""""" risk and protective factors, changes in treatment, or combinations of these factors. Theoretically more than 50% of colorectalcancer could be prevented by modification in screening, lifestyle, and chemoprevention practices. Mathematical modeling of the colorectal cancer incidence and mortality rates over time can estimate the separate and joint effects of screening, lifestyle changes, and changes in treatment for different subgroups of the population. The Department of Public Health, Erasmus University Rotterdam, has developed a comprehensive micro-simulation model of the adenoma-carcinoma sequence for colorectal cancer (MISCAN) which has been used to assess the potential effects of screening interventions and can incorporate varying risk groups in its description and outcomes. This model simulates a full dynamic population which makes it particularly suitable for surveillance of population trends. We will refine this model further to include more flexibility for risk strata and to incorporate the advanced adenoma as the intermediate marker for colorectal cancer risk, and to allow for differential survival post-diagnosis based on treatment. The key question we plan to address concerns the impact of colorectal cancer screening on mortality trends.
The specific aims of this study are to 1) update and refine the MISCAN model with best estimates of risk factors, screening, and treatment practices; 2) use the MISCAN microsimulation model to estimate the absolute and relative contribution of colorectal cancer screening, risk factors, and improved therapy on observed colorectal cancer incidence and mortality trends; 3) use the MISCAN model to predict how changes in colorectal cancer screening and treatment practices will affect future incidence and mortality. This study will provide an understanding of the absolute and relative contribution of screening, lifestyle factors, and improved therapy on incidence and mortality trends. This is essential for directing medical and public health resources to the most effective interventions in the appropriate risk groups.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01CA097426-04
Application #
6931929
Study Section
Special Emphasis Panel (ZCA1-SRRB-D (M1))
Program Officer
Feuer, Eric J
Project Start
2002-09-13
Project End
2006-08-31
Budget Start
2005-09-01
Budget End
2006-08-31
Support Year
4
Fiscal Year
2005
Total Cost
$257,948
Indirect Cost
Name
Sloan-Kettering Institute for Cancer Research
Department
Type
DUNS #
064931884
City
New York
State
NY
Country
United States
Zip Code
10065
Lansdorp-Vogelaar, Iris; Goede, S Lucas; Bosch, Linda J W et al. (2018) Cost-effectiveness of High-performance Biomarker Tests vs Fecal Immunochemical Test for Noninvasive Colorectal Cancer Screening. Clin Gastroenterol Hepatol 16:504-512.e11
Zauber, Ann G (2015) The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci 60:681-91
Goede, Simon Lucas; Rabeneck, Linda; Lansdorp-Vogelaar, Iris et al. (2015) The impact of stratifying by family history in colorectal cancer screening programs. Int J Cancer 137:1119-27
Goede, Simon L; Kuntz, Karen M; van Ballegooijen, Marjolein et al. (2015) Cost-Savings to Medicare From Pre-Medicare Colorectal Cancer Screening. Med Care 53:630-8
Saini, Sameer D; van Hees, Frank; Vijan, Sandeep (2014) Smarter screening for cancer: possibilities and challenges of personalization. JAMA 312:2211-2
Lansdorp-Vogelaar, Iris; Gulati, Roman; Mariotto, Angela B et al. (2014) Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits. Ann Intern Med 161:104-12
Lansdorp-Vogelaar, Iris; Fedewa, Stacey; Lin, Chun Chieh et al. (2014) Utilization of surveillance after polypectomy in the medicare population--a cohort study. PLoS One 9:e110937
O'Mahony, James F; van Rosmalen, Joost; Zauber, Ann G et al. (2013) Multicohort models in cost-effectiveness analysis: why aggregating estimates over multiple cohorts can hide useful information. Med Decis Making 33:407-14
Zauber, Ann G; Winawer, Sidney J; O'Brien, Michael J et al. (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366:687-96
Lansdorp-Vogelaar, Iris; Kuntz, Karen M; Knudsen, Amy B et al. (2012) Contribution of screening and survival differences to racial disparities in colorectal cancer rates. Cancer Epidemiol Biomarkers Prev 21:728-36

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