The US Black population has higher colorectal cancer (CRC) incidence rates and worse CRC survival... more The US Black population has higher colorectal cancer (CRC) incidence rates and worse CRC survival than the US White population, as well as historically lower rates of CRC screening. The Surveillance, Epidemiology, and End Results incidence rate data in people diagnosed between the ages of 20 and 45 years, before routine CRC screening is recommended, were analyzed to estimate temporal changes in CRC risk in Black and White populations. There was a rapid rise in rectal and distal colon cancer incidence in the White population but not the Black population, and little change in proximal colon cancer incidence for both groups. In 2014-2018, CRC incidence per 100 000 was 17.5 (95% confidence interval [CI] = 15.3 to 19.9) among Black individuals aged 40-44 years and 16.6 (95% CI = 15.6 to 17.6) among White individuals aged 40-44 years; 42.3% of CRCs diagnosed in Black patients were proximal colon cancer, and 41.1% of CRCs diagnosed in White patients were rectal cancer. Analyses used a race...
Cancer Epidemiology, Biomarkers & Prevention, 2021
Background: Models can help guide colorectal cancer screening policy. Although models are careful... more Background: Models can help guide colorectal cancer screening policy. Although models are carefully calibrated and validated, there is less scrutiny of assumptions about test performance. Methods: We examined the validity of the CRC-SPIN model and colonoscopy sensitivity assumptions. Standard sensitivity assumptions, consistent with published decision analyses, assume sensitivity equal to 0.75 for diminutive adenomas (<6 mm), 0.85 for small adenomas (6–10 mm), 0.95 for large adenomas (≥10 mm), and 0.95 for preclinical cancer. We also selected adenoma sensitivity that resulted in more accurate predictions. Targets were drawn from the Wheat Bran Fiber study. We examined how well the model predicted outcomes measured over a three-year follow-up period, including the number of adenomas detected, the size of the largest adenoma detected, and incident colorectal cancer. Results: Using standard sensitivity assumptions, the model predicted adenoma prevalence that was too low (42.5% versu...
BACKGROUND There is a lack of research on the effectiveness of online peer support groups for red... more BACKGROUND There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and the past research has mixed results. OBJECTIVE We tested whether military caregivers who joined a new online peer support community and/or engaged with an existing online community experienced decreased perceived social isolation and improved depressive symptoms over six-months. METHODS We conducted a longitudinal study of military caregivers who had newly joined an online community and those who were members of other military caregiver groups. Multiple indicators of perceived social isolation along with depressive symptoms were assessed at baseline and three and six months later. RESULTS Relative to the comparison group, caregivers who joined the new group experienced less perceived social isolation at three months, but this effect did not persist at six months. Those who engaged more with new or existing groups experi...
A large body of research demonstrates that colorectal cancer screening is an effective method for... more A large body of research demonstrates that colorectal cancer screening is an effective method for reducing colorectal cancer mortality.1 Screening can detect cancer at an earlier stage, before it becomes symptomatic, and the detection and removal of adenomas can prevent cancer. Rates of colorectal cancer screening had increased until 2010, at which time approximately 60% of eligible US adults participated in colorectal cancer screening; however, screening has not increased since that time.2 Colonoscopy is the most commonly used colorectal cancer screening test, but it is an invasive procedure and can be both costly and inconvenient for patients. Many patients prefer less-invasive tests.3 Increased use of the fecal immunochemical test (FIT) has the potential to expand the use of colorectal cancer screening to a broader range of patients. However, the effectiveness of FIT depends on several layers of adherence including the initial screening test, repeated annual screening among those with negative test results, and follow-up colonoscopy among patients with positive test results.
An important quality of meta‐analytic models for research synthesis is their ability to account f... more An important quality of meta‐analytic models for research synthesis is their ability to account for both within‐ and between‐study variability. Currently available meta‐analytic approaches for studies of diagnostic test accuracy work primarily within a fixed‐effects framework. In this paper we describe a hierarchical regression model for meta‐analysis of studies reporting estimates of test sensitivity and specificity. The model allows more between‐ and within‐study variability than fixed‐effect approaches, by allowing both test stringency and test accuracy to vary across studies. It is also possible to examine the effects of study specific covariates. Estimates are computed using Markov Chain Monte Carlo simulation with publicly available software (BUGS). This estimation method allows flexibility in the choice of summary statistics. We demonstrate the advantages of this modelling approach using a recently published meta‐analysis comparing three tests used to detect nodal metastasis ...
The US Black population has higher colorectal cancer (CRC) incidence rates and worse CRC survival... more The US Black population has higher colorectal cancer (CRC) incidence rates and worse CRC survival than the US White population, as well as historically lower rates of CRC screening. The Surveillance, Epidemiology, and End Results incidence rate data in people diagnosed between the ages of 20 and 45 years, before routine CRC screening is recommended, were analyzed to estimate temporal changes in CRC risk in Black and White populations. There was a rapid rise in rectal and distal colon cancer incidence in the White population but not the Black population, and little change in proximal colon cancer incidence for both groups. In 2014-2018, CRC incidence per 100 000 was 17.5 (95% confidence interval [CI] = 15.3 to 19.9) among Black individuals aged 40-44 years and 16.6 (95% CI = 15.6 to 17.6) among White individuals aged 40-44 years; 42.3% of CRCs diagnosed in Black patients were proximal colon cancer, and 41.1% of CRCs diagnosed in White patients were rectal cancer. Analyses used a race...
Cancer Epidemiology, Biomarkers & Prevention, 2021
Background: Models can help guide colorectal cancer screening policy. Although models are careful... more Background: Models can help guide colorectal cancer screening policy. Although models are carefully calibrated and validated, there is less scrutiny of assumptions about test performance. Methods: We examined the validity of the CRC-SPIN model and colonoscopy sensitivity assumptions. Standard sensitivity assumptions, consistent with published decision analyses, assume sensitivity equal to 0.75 for diminutive adenomas (<6 mm), 0.85 for small adenomas (6–10 mm), 0.95 for large adenomas (≥10 mm), and 0.95 for preclinical cancer. We also selected adenoma sensitivity that resulted in more accurate predictions. Targets were drawn from the Wheat Bran Fiber study. We examined how well the model predicted outcomes measured over a three-year follow-up period, including the number of adenomas detected, the size of the largest adenoma detected, and incident colorectal cancer. Results: Using standard sensitivity assumptions, the model predicted adenoma prevalence that was too low (42.5% versu...
BACKGROUND There is a lack of research on the effectiveness of online peer support groups for red... more BACKGROUND There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and the past research has mixed results. OBJECTIVE We tested whether military caregivers who joined a new online peer support community and/or engaged with an existing online community experienced decreased perceived social isolation and improved depressive symptoms over six-months. METHODS We conducted a longitudinal study of military caregivers who had newly joined an online community and those who were members of other military caregiver groups. Multiple indicators of perceived social isolation along with depressive symptoms were assessed at baseline and three and six months later. RESULTS Relative to the comparison group, caregivers who joined the new group experienced less perceived social isolation at three months, but this effect did not persist at six months. Those who engaged more with new or existing groups experi...
A large body of research demonstrates that colorectal cancer screening is an effective method for... more A large body of research demonstrates that colorectal cancer screening is an effective method for reducing colorectal cancer mortality.1 Screening can detect cancer at an earlier stage, before it becomes symptomatic, and the detection and removal of adenomas can prevent cancer. Rates of colorectal cancer screening had increased until 2010, at which time approximately 60% of eligible US adults participated in colorectal cancer screening; however, screening has not increased since that time.2 Colonoscopy is the most commonly used colorectal cancer screening test, but it is an invasive procedure and can be both costly and inconvenient for patients. Many patients prefer less-invasive tests.3 Increased use of the fecal immunochemical test (FIT) has the potential to expand the use of colorectal cancer screening to a broader range of patients. However, the effectiveness of FIT depends on several layers of adherence including the initial screening test, repeated annual screening among those with negative test results, and follow-up colonoscopy among patients with positive test results.
An important quality of meta‐analytic models for research synthesis is their ability to account f... more An important quality of meta‐analytic models for research synthesis is their ability to account for both within‐ and between‐study variability. Currently available meta‐analytic approaches for studies of diagnostic test accuracy work primarily within a fixed‐effects framework. In this paper we describe a hierarchical regression model for meta‐analysis of studies reporting estimates of test sensitivity and specificity. The model allows more between‐ and within‐study variability than fixed‐effect approaches, by allowing both test stringency and test accuracy to vary across studies. It is also possible to examine the effects of study specific covariates. Estimates are computed using Markov Chain Monte Carlo simulation with publicly available software (BUGS). This estimation method allows flexibility in the choice of summary statistics. We demonstrate the advantages of this modelling approach using a recently published meta‐analysis comparing three tests used to detect nodal metastasis ...
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Papers by Carolyn Rutter