The molecular epidemiology of lung cancer in Africa is almost completely unknown, yet molecular profiling and institution of targeted therapy is now standardly used to influence care in patients with actionable mutations. HIV- infection is associated with a markedly increased risk of lung cancer, but its association with lung cancer and how it influences disease outcomes is not well studied. The capacity to correctly diagnose lung cancer on radiological images, tissue specimen acquisition, and subsequent histologic confirmation compounds the problem of under and misdiagnosis of lung cancer in Africa, especially with the prevalence and often presumptive clinical diagnosis of tuberculosis infection. In this consortium proposal, we therefore seek to address the above stated problems by 1) establishing national lung cancer diagnostic referral networks in Uganda and Tanzania, which will allow for improved detection of lung cancer and, hence decrease the lung cancer burden; 2) investigating the role of HIV-1 infection on the incidence and outcomes of lung cancer in the region; 3) determining the molecular profile of lung cancer in East African countries in order to facilitate advocacy for scale- up of targeted therapies (including immune-based therapies); 4) building capacity for lung cancer diagnosis and care in terms of improving imaging, pathology, radiology and tissue acquisition and clinical care of lung cancer 5) creating a lung cancer research collaboration that will build capacity through mentoring of junior researchers for future leadership in the field. At the end of this project, we envision an African-led lung cancer research network, clinical expertise for sample acquisition and care, improved pathology and radiology diagnostics services, a lung cancer screening program, and a large biorepository that should support lung cancer research in the region for many years to come.
We propose to study lung cancer in Uganda and Tanzania and the relationship to HIV-1 infection through three project-based and three cores. The results of these studies of the epidemiology, molecular characterization and imaging of lung cancer and the relationship to HIV infection will lead to technological transfer of instrumentation to characterize lung cancer and artificial intelligence algorithms to aid in discerning pulmonary granulomatous disease from lung cancer on radiological imaging. Findings herein may lead to the development of country-specific guidelines in the evaluation and management of lung cancer.
