Evaluating the Effectiveness of Lung Cancer Screening in Patients with COPD

描述(由申请人提供)：此申请是为西奈山伊坎医学院的初级研究人员米纳尔·凯尔颁发的癌症预防和控制职业发展奖(K07)。Kale博士的职业目标是改进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奖项将为Kale博士提供必要的资源，以发展以下技能：1)解决慢性阻塞性肺病患者肺癌筛查的益处和危害；2)进行计算机模拟决策分析和成本效益分析。西奈山在研究方面处于全国领先地位，也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导师团队：Juan Wisnivesky博士(主要导师)是伊坎医学院的医学教授，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。最近发表的全国肺部筛查试验的结果表明，低剂量CT筛查是迄今发现的死亡率效益最大的癌症筛查干预措施。因此，实施肺癌筛查预计将对公众健康产生重大影响。在她的指导团队的指导下，Kale博士将评估患有轻度COPD的患者是否也可以受益于或可能受到这种技术的伤害(Aim 1)，这是这个肺癌风险增加的人群面临的一个关键问题。她还将确定最佳筛查方案(根据吸烟年限、开始年龄、频率和持续时间来选择筛查候选方案)，这将对COPD患者和 将确定因严重疾病(即，呼吸道功能受限)而不太可能从筛查中受益的COPD患者子集(目标2)。此外，广泛的肺癌筛查的经济影响目前尚不清楚。检查COPD患者癌症预防策略的成本(目标3)将是确定这一资源的有效和明智分配的重要进展。这些结果将减少医生和患者对肺癌筛查潜在作用的不确定性，因此，很可能转化为更多地采用这种挽救生命的预防措施。

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.