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Cancer Control Study ExamplesStudy Examples | Key Publications | Intro Here are just a few examples of the many research projects now underway at Group Health Center for Health Studies (CHS) on cancer prevention, screening, surveillance, and care:
Michigan Center for Health Communications Research
Group Health members routinely receive information about cancer prevention from care providers, mass media, and other sources. But information alone is not enough to change health behaviors, nor prevent cancer. Research has demonstrated that tailoring health information to an individual's circumstances (for example, motivational style, home environment, and gender) is far more effective than generic health information at modifying risky behaviors. Yet why tailoring works is not fully understood. This study is designed to determine what types of health communication messages most influence behavior change and cancer prevention. The study includes three research projects, each addressing a different aspect of cancer prevention: quitting smoking, eating fruits and vegetables, and how to present women with information about breast cancer risk to help them make informed choices about preventive strategies. Group Health will receive $2.6 million over five years for its participation in this innovative undertaking, which will move cancer communication science in new directions. Making Effective Nutritional Choices for Cancer Prevention (MENU)
The MENU Choices Study is developing and evaluating an individually tailored, Web-based program to help prevent cancer by encouraging members of health plans to eat more fruits and vegetables on a daily basis. Previous research has established that materials promoting healthy behaviors are most effective when geared to the characteristics of each individual person. The Web makes it easy to develop and disseminate such tailored messages. But this study is among the first to assess how well people respond to this information when delivered online, with or without email messages from a nutritional counselor. This study is a core project of the National Cancer Institute's (NCI) Cancer Research Network. CHS is a participant in this six-site study, and will receive $430,000 over the four years of this project. Gene Copy Number Changes in Breast Cancer Survival
A five-year, $210,000 grant from the NCI will fund CHS’ collaboration on a study of the way genetic changes in breast epithelial cells are related to differences in breast cancer survival between African American and white women. This project brings together an interdisciplinary team skilled in genomics, pathology, epidemiology, biostatistics, and clinical research. This study will use a new method to identify duplicated or deleted chromosomal regions in a previously identified population of breast cancer patients from Atlanta, GA. The identification of altered chromosomal regions in breast tumors and their relation to breast cancer risk factors and tumor growth characteristics is an important step toward understanding the underlying biology and clinical behavior of the disease in African American and white women. Multicenter Study of Pancreatic Cancer Etiology (PACIFIC)
Pancreatic cancer is the fifth leading cause of cancer death in the United States, with a median survival of six months or less and a five-year survival of only 4 percent. Risk factors for pancreatic cancer are not well-established; and improved understanding of risk and the molecular events leading to the development of pancreatic cancer is imperative for effective strategies for prevention and early diagnosis. Under a five-year, $5.6 million grant that the NCI has awarded to CHS, researchers are conducting one of the largest and most comprehensive studies of pancreatic cancer undertaken in the United States to investigate a wide range of environmental and genetic factors. This study will enroll 745 newly diagnosed cases and 1,041 controls from two large health plan populations. Colon Cancer Pathways: Hyperplastic Polyps and Adenomas
Polyps that are hyperplastic (with cells multiplying more than usual) have long been considered benign lesions with limited, if any, malignant potential. Closer examination of these polyps on molecular, anatomic, and epidemiological levels suggests that they may actually represent one of the first stages in the continuum from polyps to cancers. With a five-year, $900,000 grant from the NCI, CHS researchers will collaborate with scientists from the FHCRC to describe the epidemiology of hyperplastic polyps and compare their biological and genetic features with those of adenomas, which are known precursors to colorectal carcinoma. The goal is to increase understanding of the biology and prevention of colorectal cancer by determining whether hyperplastic polyps are markers for future development of adenomas or carcinomas. Assessing the Impact of Colorectal Cancer Screening
Microsimulation models are computer models that operate at the level of a smaller individual entity, such as a person, but can simulate large representative populations to draw conclusions. This project began by building a new microsimulation model for the natural history of colorectal cancer (CRC). Now Center researchers are using this model to estimate the effect of screening, polypectomy, and changes in population risk (such as smoking and obesity) on CRC outcomes, gaining insights beyond those from either observational or randomized studies. Their goal is to use the model to compare the impact of CRC screening, polypectomy, and risk factors on both projected and observed population trends in CRC incidence and mortality within the United States population. In collaboration with colleagues in the Cancer Intervention and Surveillance Modeling Network (CISNET), they aim to compare the impact of screening—as practiced—with the potential impact of different guideline-recommended screening strategies on CRC outcomes. This project is funded as part of a four-year, $1 million grant from the NCI for studying the development, prevention, and treatment of colorectal cancer. Population-Based Colonoscopy Screening Feasibility Trial
Colonoscopy is considered the "gold standard" for detecting CRC, and it can even clear the colon of pre-cancerous polyps, thus helping to prevent cancer. However, colonoscopy is not commonly used as a screening test, partly because it is an invasive procedure usually performed under anesthetic. Instead, the most commonly used screening test for CRC is the fecal occult blood test (FOBT). This randomized trial first assessed the feasibility of colonoscopy screening compared to usual care. The study is comparing colonoscopy to annual testing by FOBT and to newer immunochemical and genomics based tests. This 10-year NCI-sponsored trial includes over $1.8 million to CHS. Understanding Variability in Community Mammography
Until breast cancer can be prevented, early detection and prompt treatment remain the most effective ways for women to protect themselves. Yet the mammographic readings on which this strategy depends are prone to variability in interpretation. This study is measuring the extent of several possible sources for this variability in the interpretation of 500,000 screening and diagnostic mammograms—specifically, individual radiology staff at 91 health care facilities in three geographic regions (Washington, New Hampshire, and Colorado). The researchers are paying special attention to staff members' fiscal incentives, legal factors, and personal characteristics, as well as to each facility's fiscal, legal, and community practice environments. The Agency for Healthcare Research and Quality (AHRQ) is funding this study for three years with $400,000 to CHS. READ: Radiology Evaluation and Breast Density
When breast tissue is dense, it makes mammograms difficult to interpret. So reducing breast density at the time of a mammogram might help improve breast cancer detection. The $600,000 READ study, funded by the U.S. Department of Defense, is designed to test the hypothesis that among women who use hormone replacement therapy (HRT), stopping HRT one or two months before a screening mammogram will improve its performance by decreasing breast density. This trial includes 1,500 women who are assigned randomly to: stop HRT two months before their screening mammography; stop HRT one month before it; or keep using HRT up through it. A computer-assisted method is measuring breast density; and an expert radiologist, blinded to the participants’ HRT status, is reviewing the mammograms. If this short-term intervention works, it could reduce the uncertainty of mammography by as much as 50 percent among women over age 50 who use HRT. Statistical Coordinating Center for the Breast Cancer Surveillance Consortium (BCSC)
The Statistical Coordinating Center (SCC) organizes the collection, management, and analysis of data from seven mammography registries that make up the Breast Cancer Surveillance Consortium (BCSC), funded by the NCI. The SCC also develops and implements novel statistical methodology to characterize the process of breast cancer screening. It maintains a data management system that facilitates pooled analyses and rapid development of new projects. And it provides scientific guidance for publications, enhances communication and cooperation among BCSC members, and facilitates the use of BCSC data by investigators outside the BCSC. The BCSC aims to make breast cancer screening more effective at detecting tumors while limiting unnecessary follow-up due to false positive examinations. It provides population-based information on breast cancer screening, examines the role of practice patterns and biological factors on outcomes, and evaluates mammography’s efficacy in reducing breast cancer morbidity and mortality. Breast Cancer Surveillance in a Defined Population
Group Health currently maintains independent automated clinical systems to track mammography, pathology, cost, and breast cancer risk factors among more than 90,000 women who get mammograms at the health plan. The researchers can link mammogram results to cancer risk factors, clinical breast exams, and pathology specimens—as well as cancer outcomes from the Seattle–Puget Sound Surveillance, Epidemiology, and End Results (SEER) registry. This project lets the investigators identify ways to make breast cancer screening more effective and affordable. In this study, funded by the NCI with $7 million to CHS over nine years, investigators are studying the following issues, which they expect can also help develop successful models for tracking and preventing other forms of cancer:
Breast Cancer Treatment Effectiveness in Older Women
While deaths from breast cancer have declined among women younger than 70, they remain stable among those in their 70s and are actually rising in women aged 80 and older. Older women may receive less than standard therapy, for instance not being offered as chemotherapy or radiation therapy after breast cancer surgery. This may happen because of physicians' assumptions that the risks of such therapy rise with age and that women over age 80 are likely to die of a cause other than breast cancer. Using the CRN, the researchers are conducting a historical cohort study of women aged 65 and older who were newly diagnosed with early-stage breast cancer between 1990 and 1994. This study compares the effectiveness of standard primary tumor therapy with any treatment other than standard in reducing the risk of recurrence. It aims to determine how additional systemic adjuvant therapy—for instance, with tamoxifen—modifies the effectiveness of treatment in reducing breast cancer recurrences. The NCI provides CHS with $500,000 over four years for its part in this study. Optimizing Breast Cancer Outcomes
The American Cancer Society has awarded CHS a three-year, $430,000 grant for two observational studies of factors associated with breast cancer recurrence and death from breast cancer. One study concerns the relationship between body mass index (BMI) and the risk of recurrence and death. The second focuses on medical information about women with early-stage breast cancer, comparing the treatment they receive with current clinical guidelines; this study is identifying characteristics of women who do not get care consistent with the guidelines. This, in turn, may help physicians target these types of women to ensure appropriate treatment in the future. Cancer Care Outcomes Research and Surveillance (CanCORS)
The Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) aims to improve ways of monitoring the quality of care delivered to patients newly diagnosed with lung or colorectal cancer. CanCORS investigators are examining patterns of care, health outcomes, costs, and patient-centered issues such as symptom control and quality of life. Another aspect of the study measures costs associated with different treatment strategies. Five CRN sites, including Group Health, contribute data to CanCORS on a total of 6,500 patients with these two cancers. With such a large number of diverse patients being treated at different kinds of delivery systems spread across the country, a particular focus is to track variations in care, with an eye toward reducing disparities and ensuring universally excellent care. CHS receives $1.3 million for its CanCORS research over five years.
Study Examples | Key Publications | Intro |
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