Evaluating the Effectiveness of Lung Cancer Screening in Patients with COPD

描述（由申请人提供）：本申请是为西奈山伊坎医学院的初级研究教员Minal Kale申请癌症预防和控制职业发展奖（K07）。她的职业目标是改善和优化癌症筛查的使用，并在初级保健中提供适当的癌症预防和早期检测服务。K07奖将为Kale博士提供必要的资源，以开发以下技能：1)解决COPD患者肺癌筛查的利弊；2)进行计算机模拟决策分析和成本效益分析。西奈山医学院在研究方面处于全国领先地位，是美国国立卫生研究院资助的前20所医学院之一。它拥有世界上最大的肺癌筛查研究项目之一。Kale博士有一个由知名研究人员组成的指导团队：Juan Wisnivesky博士（主要导师）是伊坎医学院（Icahn School of Medicine）的医学教授，也是肺癌和COPD方面的专家；Scott Braithwaite博士（共同导师）是纽约大学医学院的医学教授，也是计算机模拟建模和成本效益分析方面的专家。最近发表的国家肺部筛查试验的结果表明，低剂量CT筛查是迄今为止发现的死亡率最大的癌症筛查干预措施。因此，实施肺癌筛查预计将对公共卫生产生重大影响。在她的指导团队的指导下，Kale博士将评估轻度COPD患者是否也能从这项技术中获益或受到潜在的伤害（Aim 1），这对肺癌风险增加的人群来说是一个关键问题。她还将确定对慢性阻塞性肺病和慢性阻塞性肺病患者最有利的最佳筛查方案（根据吸烟包年、开始吸烟年龄、频率和持续时间选择筛查候选者）

DESCRIPTION (provided by applicant): 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.