A Genetic Screening Policy Model for Colorectal Cancer

As our knowledge of the role of genetic and environmental factors in colorectal cancer grows, population screening and prevention efforts can be modified to incorporate this information. The goal of this study is to develop a framework for evaluating the clinical and economic tradeoffs that occur when considering gene-based strategies directed towards identifying persons at increased risk for colon cancer. We propose to use a unique and valuable resource - the Colorectal Cancer Family Registry (Seattle) - to inform our model. The specific aims are as follows:
-Develop a robust, flexible simulation model for estimating the clinical, economic, and humanistic impact of using genetic testing to identify polymorphisms that are associated with increased risk for developing colorectal cancer. In addition to clinical and epidemiological information related to genetic and environmental factors, the model will incorporate other important factors that will influence outcomes under genetic testing, including:
-quality of life effects related to the use of genetic testing to assess risk;
-traditional and novel strategies for genetic counseling (and their cost);
-adherence to colorectal cancer screening recommendations and other behavioral changes to reduce the risk of colon cancer, as it is influenced by (a) and (b) above.
-Inform the model using a population-based cancer registry: the Colorectal Cancer Family Registry - Seattle
-Using a consensus-based process among members of the investigator team and an Expert Panel, create clinical algorithms for polymorphism testing to detect those at increased risk for colorectal cancer. As part of this process, identify ethical, legal, and social issues that could influence quality of life for each clinical testing strategy.
-Use the model to develop preliminary estimates of the cost-effectiveness of alternative clinical algorithms of population testing for polymorphisms linked to colorectal cancer. (co-fund with NCI)