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Principal Investigator:
Ann G. Zauber
Institution:
Sloan-Kettering Institute for Cancer Research
Grant Number: 5U01CA097426-04
Awarded under CA-02-010
Abstract: 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 colorectal cancer 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.
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