||1R01CA247790-01A1 Interpret this number
||Columbia University Health Sciences
||A Personalized Approach to Targeted Esophageal Cancer Screening
The goal of the project is to diminish the morbidity and mortality associated with esophageal cancer as patients
with this cancer continue to suffer from extremely poor survival and high case-fatality rates. Esophageal
adenocarcinoma (EAC) is the most common histologic type of esophageal malignancy in the US and has
experienced an alarmingly rapid and largely unexplained rise in incidence over the past four decades in much
of the western world. Previous attempts to curb the morbidity and mortality associated with EAC in the US
have focused on an endoscopic screening, which is invasive and costly. However, innovative new technologies
for esophageal cancer screening that are both less invasive and costly have created the opportunity to lower
the bar for screening to where it could be a realistic option, particularly for those who are higher risk.
While the performance metrics of the device are important, equally critical are identifying and resolving barriers
to implementation. We propose to study potential factors for patients, providers and health care systems that
could impede screening programs.
This R01 proposal will leverage a previously developed and validated natural history simulation model of EAC.
The PI has made significant contributions to the fields of esophageal cancer screening, prevention and treatment
utilizing the EAC model to assess and analyze critical aspects of EAC cancer control. The prior work and model
will provide an exceptionally strong foundation for the current research project. The research team is comprised
of experienced investigators who provide the broad and complementary expertise necessary for this project and
have a track record of successful collaboration.
The overarching premise of our proposal is that novel approaches to esophageal cancer screening have the
potential to improve EAC mortality, but that the successful implementation and population impact will depend
on: 1) the screening modality characteristics; 2) patient, provider, and health system’s barriers; and 3) the
profile of the patients to be screened. We will accomplish these project goals by completing four specific aims.
In Aim 1 we will use our validated simulation model of esophageal cancer to test and assess whether a cell
sampling device can be cost-effective for population screening. In Aim 2 we will study potential patient,
provider and health system barriers to esophageal cancer screening. For Aim 3 we will personalize screening
by determining which patient profiles will benefit from screening. Finally, in Aim 4 will assess the population
cancer control impact of the potential implementation of the esophageal cancer screening strategy defined by
the prior aims.
By award period end, we will have developed a personalized approach to targeted EAC screening that is
rational and cost-effective.