结肠镜检查随访和质量方面的种族差异对结直肠癌预后的影响。

IF 9.9 1区 医学 Q1 ONCOLOGY
Oguzhan Alagoz, Folasade P May, Chyke A Doubeni, A Mark Fendrick, Vahab Vahdat, Chris Estes, Travelle Ellis, Paul J Limburg, Durado Brooks
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引用次数: 0

摘要

背景:大肠癌(CRC)筛查项目的益处取决于非结肠镜检查异常时是否完成后续结肠镜检查,以及根据内镜医师的腺瘤检出率衡量的结肠镜筛查质量。现有数据显示,美国黑人的结肠镜随访率和腺瘤检出率大大低于美国白人。然而,尚未严格评估结肠镜检查随访率和腺瘤检出率的种族差异对 CRC 结果的影响:我们使用已建立并经过验证的 CRC 腺瘤发病率和死亡率(CRC-AIM)模型作为分析平台,并参考了已发表的文献,这些文献报告了黑人成人的后续结肠镜检查率和腺瘤检出率低于白人成人(分别低 15%和 10%)。我们模拟了每年一次粪便免疫化学检验、每三年一次多靶标粪便 DNA 以及每十年一次结肠镜检查的筛查方法,年龄介于 45 岁至 75 岁之间。我们报告了每 1000 名黑人成人的终生结果:结果:消除黑人与白人在结肠镜检查随访率方面的差异,可使 CRC 发病率和死亡率分别降低 5.2% 和 9.3%,并使通过筛查获得的寿命延长 3.4%。消除内镜医师腺瘤检出率方面的黑人与白人差异,将使 CRC 发病率和死亡率降低 9.4%,使获得的寿命延长 3.7%。消除这两种差异将使 CRC 发病率和死亡率分别降低 14.6% 和 18.7%,寿命延长 7.1%:这项建模研究预测,消除结肠镜随访率和结肠镜筛查质量方面的种族差异,将大大减少黑人与白人在 CRC 发病率和死亡率方面的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of racial disparities in follow-up and quality of colonoscopy on colorectal cancer outcomes.

Background: The benefits of colorectal cancer (CRC) screening programs rely on completing follow-up colonoscopy when a noncolonoscopy test is abnormal and on quality of colonoscopy screening as measured by the endoscopists' adenoma detection rate. Existing data demonstrate substantially lower follow-up colonoscopy rates and adenoma detection rate for Black Americans than White Americans. However, the contributions of racial differences in follow-up colonoscopy and adenoma detection rate on CRC outcomes have not been rigorously evaluated.

Methods: We used established and validated CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report lower follow-up colonoscopy rates and adenoma detection rate in Black adults compared with White adults (15% and 10% lower, respectively). We simulated screening with annual fecal immunochemical test, triennial multitarget stool DNA, and colonoscopy every 10 years between ages 45 and 75 years using real-world utilization of the screening modalities vs no screening. We reported lifetime outcomes per 1000 Black adults.

Results: Elimination of Black-White disparities in follow-up colonoscopy rates would reduce CRC incidence and mortality by 5.2% and 9.3%, respectively, and improve life-years gained with screening by 3.4%. Elimination of Black-White disparities in endoscopists' adenoma detection rate would reduce CRC incidence and mortality by 9.4% and improve life-years gained by 3.7%. Elimination of both disparities would reduce CRC incidence and mortality by 14.6% and 18.7%, respectively, and improve life-years gained by 7.1%.

Conclusions: This modeling study predicts eliminating racial differences in follow-up colonoscopy rates, and quality of screening colonoscopy would substantially reduce Black-White disparities in CRC incidence and mortality.

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来源期刊
CiteScore
17.00
自引率
2.90%
发文量
203
审稿时长
4-8 weeks
期刊介绍: The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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