Dr. Zauber's primary research focus is the impact of screening, surveillance, and chemoprevention on the national burden of colorectal cancer, using population based modeling to inform health policy. Dr. Zauber led a multi-center group of microsimulation modelers to address health policy questions in colorectal cancer screening posed by the United States Preventive Services Task Force (USPSTF) and by the Centers for Medicare and Medicaid Services. At the request of the USPSTF, microsimulation modeling of the United States population was used in a decision analysis to assess the age to begin, age to end, and the intervals of re-testing for colorectal cancer screening for the currently recommended tests. The analysis demonstrated that routine colorectal cancer screening examinations can be stopped at age 75 if the individual has been consistently screened since age 50 without any clinical findings over that time. These results were incorporated into the newest USPSTF recommendations for a stopping age for colorectal cancer. Also the Centers for Medicare and Medicaid Services requested a micro-simulation modeling of the cost-effectiveness of the CT colonography for colorectal cancer screening for the general population. This work demonstrated that CT colonography was not cost effective unless its cost was 22% to 41% that of colonoscopy or that adherence was differentially higher for CT colonography compared to other tests. These results were presented at the Medicare Evidence Development and Coverage Advisory Committee (MedCAC) for consideration of the National Coverage Determination for CT colonography in the average-risk population. This work is in collaboration with colleagues at Erasmus Medical Center in the Netherlands and with a second modeling group from the University of Minnesota and is part of the NCI Cancer Incidence and Surveillance Modeling Network (CISNET). Dr. Zauber has received renewed funding for a multi-center randomized controlled trial of screening colonoscopy compared to a program of annual testing with fecal occult blood tests. She continues her assessment of risk factors for adenoma recurrence in a study which has recently demonstrated that the greater efficacy of high-dose celecoxib compared with low-dose in preventing colorectal adenoma appears confined to individuals with slow-metabolizer CYP2C9 I359L genotypes. For the vast majority of individuals without this variant, high-dose treatment does not confer additional benefit. These data support the importance of genetic variability in susceptibility to the potential benefits and hazards of celecoxib.
Selected Bibliography:
Zauber AG. Quality control for flexible sigmoidoscopy: which polyps count? Gastroenterology 2004;126:1474-1477.
Zauber P, Sabbath-Solitare M, Marotta S, Zauber A, Bishop T. Comparative molecular pathology of sporadic hyperplastic polyps and neoplastic lesions from the same individual. J Clin Pathol 2004: 57:1084-1088
Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, Smith RA, Lieberman DA, Burt RW, Levin TR, Bond JH, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex DK. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer: and the American Cancer Society. Joint publication in Gastroenterology 2006:130:1872-85 and CA Cancer J Clin 2006;56:143-59.
Bertagnolli MM, Eagle CJ, Zauber AG, Redston M, Solomon SD, Kim KM, Tang J, Rosenstein RB., Janet Wittes, Ph.D., Donald Corle, M.S., Timothy M. Hess, M.S., G. Mabel Woloj, Ph.D., William F. Anderson, M.D., M.P.H., Jaye L. Viner, M.D., M.P.H., Donya Bagheri, M.S., D.A.B.T., Gary B. Gordon, M.D., Ph.D., Frederic Boisserie, John Burn, M.D., Daniel C. Chung, M.D., Thomas Dewar, M.D., T. Raymond Foley, M.D., Neville Hoffman, M.D., Finlay Macrae, M.D., Ronald E. Pruitt, M.D., John R. Saltzman, M.D., Bruce Salzberg, M.D., Thomas Sylwestrowicz, M.D., Ernest T. Hawk, M.D., M.P.H. for the Adenoma Prevention with Celecoxib (APC) Study Investigators. Prevention of Sporadic Colorectal Adenomas with Celecoxib: Results of a Randomized Trial .N Engl J Med 2006;355:873-84.
Vogelaar I, van Ballegooijen M, Schrag D, Boer R, Winawer SJ, Habbema JDF, Zauber AG. How much can current interventions reduce colorectal cancer mortality in the US? Mortality projections for scenarios of risk factor modification, screening and treatment. Cancer 2006;107:1624-33.
