Extension to the HTAN Pre-Cancer Atlas Project

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For many cancer types, the wide-spread adoption of cancer screening has increased the detection of pre-malignant lesions (PML). Despite such efforts, screening has had limited impact on overall survival. Clinical guidelines vary widely from watchful waiting (e.g., prostate) to radical surgery and adjuvant treatment (e.g., breast). In absence of reliable progression risk biomarkers and models, these interventions may have deleterious consequences at the two clinical extremes: delay in life-saving treatment or overtreatment. The study of pre-malignant lesions (PML) at molecular level present significant challenges: PML are small, generally archived in formalin. Moreover, the clinical significance of any identified marker can only be assessed after long follow- up, limiting the translational studies to retrospective collections. These hurdles have prevented the development and application of precision medicine approaches and unbiased biomarker to develop models of progression. The current proposal will extend the MCL Pre-Cancer Atlas Pilot Project (PCAPP initiated in September 2017) with the goal to build multi-modal profiles of highly characterized pre-malignant lesions from the 4 target organs (Lung, Breast, Prostate and Pancreas). The four organs included represent a diverse spectrum of histology - pure histology or mixed with invasive lesions - and clinical settings - treatment or active surveillance. Similarly, the selected profiling methods are as comprehensiveas for invasive tumors atlas (whole transcriptome gene expression or DNA mutations) but also innovative, focusing on micro- environment and exploring spatial heterogeneity (multiplex IHC) and, for a few cases, cellular heterogeneity (single-nuclei sequencing). The propose extension will support the completion of the PCAPP and enable a uniform data analysis and sharing with the community.