Gastric Cancer Epidemiology Initiative in Central America

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DESCRIPTION (provided by applicant): Candidate: Douglas Morgan, MD MPH is an assistant professor of Medicine and Gastroenterology at the University of North Carolina. Career Development Plan: the candidate will conduct mentored research and participate in coursework to develop vital skills in translational research and implementation, to develop academic leadership. The candidate will be positioned to become leader in gastric cancer epidemiology in the U.S. and Latin America. Immediate Objective: to acquire expertise in cancer, nutrition, and genetic epidemiology methods with a focus upon gastric cancer. Long-term Objective: to decrease gastric cancer mortality in Latin America and the U.S. Latino population, through an in-depth epidemiology initiative in a high incidence region in Central America. Specific Aims: 1) Delineate the gastric cancer genetic susceptibility of the study population. 2) Determine if the H. pylori cagA virulence moiety is an independent risk factor. 3) Appraise dietary factors associated with gastric cancer in the region. Research Methods: case-control population-based study in Western Honduras, a region of high incidence (39 and 21 per 100K/year, M and F, respectively). Our preliminary data suggests that the region is a distinct epidemiologic niche, with unique gastric cancer genetic and environmental susceptibility. In aim 1, we will determine the host risk proinflammatory cytokine profile (IL-1B, IL-10, TNFa, IL-8). In aim 2, we will delineate the H. pylori and cagA virulence prevalence, and association with gastric cancer. In aim 3, we will assess dietary risk factors. We will construct multivariate models to assess the interaction between genetic, H. pylori and dietary factors, to our knowledge the first such investigation. Cumulative target enrollment is 500 cases and 500 controls. Environment: incident cases are recruited at the sole district hospital in Western Honduras, the site of an established, successful collaboration over the past 4 years. Population-based controls are recruited from villages, in the region. Data reduction and analysis, specimen processing, and specimen banking is within the UNC Center for Gastrointestinal Biology and Disease. Mentorship: primary mentorship will be provided Robert Sandier, MD MPH, a national leader in gastrointestinal cancer epidemiology. Secondary mentorship is facilitated with three successful researchers: an international leader in bacterial and H. pylori virulence (Dr Richard Peek, Vanderbilt University), a nutrition cancer epidemiologist (Dr Jessie Satia, UNC School of Public Health), and a genetic epidemiologist (Dr. Kari North, UNC School of Public Health). Relevance: gastric cancer is the second leading cause of global cancer mortality, important in Latin America, and preventable through initiatives in screening, bacterial eradication, and/or dietary intervention. This study, through systematic epidemiology, will provide detailed etiologic information, to target intervention programs in Latin America and possibly the growing U.S. Latino population.