This application is for a Cancer Prevention and Control Career Development Award (K07) for Minal Kale, a junior research faculty at Icahn School of Medicine at Mount Sinai. Dr. Kale's career goal is to improve and optimize the use of cancer screening and the delivery of appropriate cancer prevention and early detection services in primary care. The K07 award will provide Dr. Kale with the necessary resources to develop skills to 1) address the benefits and harms of lung cancer screening in individuals with COPD and 2) perform computer simulated decision analyses and cost-effectiveness analyses. Mount Sinai is a national leader in research and is one of the top 20 medical schools in NIH funding. It has one of the largest lung cancer screening research programs in the world. Dr. Kale has a mentorship team of established researchers: Dr. Juan Wisnivesky (primary mentor) is a Professor of Medicine at Icahn School of Medicine and an expert on lung cancer and COPD;Dr. Scott Braithwaite (co-mentor) is a Professor of Medicine at New York University School of Medicine and an expert in computer-simulated modeling and cost- effectiveness analysis. The results of the recently published National Lung Screening Trial demonstrated that low dose CT screening is the cancer screening intervention with the largest mortality benefit ever found. Thus, implementation of lung cancer screening is expected to have a major public health impact. Under the guidance of her mentorship team, Dr. Kale will evaluate whether patients with mild COPD can also benefit or potentially be harmed by this technology (Aim 1), a critical question for this population with an increased risk of lung cancer. She will also determine the best screening regimen (selection of screening candidates based on pack-years of smoking, age of initiation, frequency, and duration) that will be most beneficial for patients with COPD and will identify the subset of COPD patients who are less likely to benefit from screening due to severe disease (i.e., limited airway function) (Aim 2). Furthermore, the economic impact of widespread lung cancer screening is currently unknown. Examining the costs of this cancer prevention strategy in patients with COPD (Aim 3) will be an important advancement in determining the efficient and judicious allocation of this resource. These results will decrease physician and patient uncertainty about the potential role of lung cancer screening and thus, will likely translate into increased adoption of this life saving preventive measure.
Deciding which smokers to screen for lung cancer is an important public health challenge, and there is currently uncertainty as to how best to identify those at high-risk for lun cancer. Evaluating the potential harms and benefits of lung cancer screening among patients with COPD and assessing its cost-effectiveness will be critical as lung cancer screening becomes the standard of care for the US population, and will improve the delivery of this life-saving technology.