Research Summary: Biomarkers to improve clinical assessment of indeterminate lung nodules

Grant Recipient: Dr. York Miller
Title of Project: Biomarkers to improve clinical assessment of indeterminate lung nodules
Sponsoring Institution: University of Colorado Denver, AMC and DC

Lung cancer is the leading cause of cancer death in the world and has a dismal 16% 5 year survival rate. One reason for this discouraging statistic is that until recently, no early detection test had been validated. The National Lung Screening Trial (NLST) has recently demonstrated that CT screening results in a 20.3% decrease in lung cancer mortality compared to chest radiograph screening. It is now clear that CT scans will be increasingly used for lung cancer screening.

CT scans detect lung nodules in 20-50% of patients, while only 1-2% have lung cancer. Thus, CT scanning has low specificity (many false positive tests) for lung cancer. Patients and physicians are often put in the situation of having to decide between serial CT scans to look for nodule enlargement (which takes months) or an immediate biopsy strategy. Each approach has potential drawbacks: serial observation can result in delay in diagnosis and an immediate biopsy strategy can lead to unnecessary morbidity and expense. Biomarker based testing to determine risk for lung cancer is not currently available, but would be invaluable in aiding clinical decision making in this setting.

We propose to further refine and validate two promising risk biomarkers, abnormal chromosome numbers in sputum cells and a blood test assessing multiple bioactive proteins as guides to clinical decision making for patients and physicians confronted with indeterminate lung nodules and compare their performance to prediction models based on nodule and patient characteristics.