PROSPR 2 Individual Research Center Projects

As part of the requirements of funding, the following research projects will be conducted by cancer type to identify factors that may be modified to improve the screening process and outcomes. The research projects are designed to be initially observational in nature to identify potential targets to intervene on the screening process. Results of the observational work will lead to the design of at least one intervention that can be pilot-tested at each of the component healthcare systems within the PROSPR Research Centers.

Cervical

• Evaluate multilevel variation in receipt of screening and time to follow-up for abnormal screening.
• Assess the impact of multilevel programs and policies on adherence to screening and management guidelines for average-risk women.
• Optimize precision screening for key groups with altered risk, including HPV-vaccinated and immunocompromised women.
• Design and implement pilot interventions leveraging IT-enabled tools to address key failures in the screening process and reduce disparities.

Colorectal

• Identify whom should be screened and when by estimating test yield (polyps and cancer), benefits (reduced CRC incidence and mortality), and harms. Special emphasis will be placed on evaluating risks and benefits among African-Americans aged 40-49 years, and patients older than usual screening ages (76-85 years).
• Evaluate surveillance test yield and harms among patients with precancerous polyps, to inform surveillance recommendations.
• Explore long-term screening patterns (including both overuse and underuse) and identify multilevel, modifiable drivers of why screening and surveillance are not appropriately completed.
• Evaluate how to increase the effectiveness of FIT and colonoscopy by establishing appropriate quantitative cutoffs for abnormal FIT results, identifying adenoma detection thresholds associated with CRC risk, and identifying and validating multilevel drivers of colonoscopy adenoma detection rates.

Lung

• Evaluate multilevel determinants several aspects of lung cancer screening, including:
  • uptake and patterns of screening over time in screen-eligible individuals;
  • benefits, harms, and costs; and
  • use of smoking cessation therapies before and after screening implementation.
• Evaluate precision lung cancer screening approaches to optimize risk stratification and reduce false positivity rates through the development of risk-prediction models that incorporate patient characteristics, smoking history, and imaging biomarkers.