Award

Targeted Approach to Upper Gastrointestinal Cancer Screening

Description: This project will evaluate the potential benefits, harms, and costs of combined screening for esophageal and stomach cancers (upper gastrointestinal [UGI] cancers) using esophagogastroduodenoscopy (EGD). When considered together, 48,000 individuals are diagnosed UGI cancers in the US annually; this represents the 6th most common cause of cancer death. These cancers are detected at an advanced stage and thus have poor outcomes, with 5-year survival at only 22-36%. When detected at an early stage, treatment options include minimally invasive endoscopic resection, which may be curative. In contrast, major surgery and toxic chemoradiotherapy is required for advanced-stage disease, which can impact quality of life long-term. EGD are widely available, safe, and EGD screening programs in East Asia for early detection of UGI cancer have demonstrated a decrease in cancer-related death. This has not been evaluated in the US since fewer cases of UGI cancers arise in the US, as screening the general population may result in more harm than benefit and carry a prohibitive cost. However, UGI cancers disproportionally affect racial and ethnic minority individuals; for example, the risk of gastric cancer is at least 2-fold higher in Black, Hispanic and Asian groups compared to Non-Hispanic White individuals and is the top- and second-ranking cancer type for disparities in cancer related death for Hispanic and Black Americans, respectively. We hypothesize that targeted screening for UGI cancer in higher risk populations, using established risk factors (such as sex, race, ethnicity, obesity, H. pylori infection, acid reflux, smoking, alcohol use), can improve outcomes and be cost-effective. This proposal is innovative in that it 1) jointly considers esophageal and gastric cancers for simultaneous screening, and 2) applies state-of-the-art simulation modeling to evaluate how to optimally screen certain high-risk populations, and 3) involves novel modeling techniques. We will develop an accurate mathematical representation of UGI cancer development, management, and outcomes, with data derived from large, national databases and published literature. We will generate multiple patient risk profiles (all possible combinations of the above listed risk factors) and simulate multiple randomized controlled trials in our mathematical model. This model will allow us to efficiently test large numbers of screening strategies and lay the groundwork for potential future trials. This study will identify the specific risk profiles and screening strategies that best balance the benefits and harms of UGI cancer screening, providing a potential method for reducing the burden, improving outcomes, and reducing disparities of UGI cancers.

Funder: American Cancer Society

Amount: $729,000

Funding type: award

Start date: 2025-01-01

End date: 2029-12-31

Investigator: Ji Yoon Yoon

Institution: The Mount Sinai Hospital

Topic: Esophageal Cancer Research and Treatment

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

Funded outputs count: 3