||5U01CA265729-02 Interpret this number
||Columbia University Health Sciences
||Comparative Modeling of Gastric Cancer Disparities and Prevention in the Us and Globally
Gastric cancer (GC), specifically gastric adenocarcinoma, is the fifth most common cancer and the third
leading cause of cancer death globally and has been categorized as a neglected cancer by the World Health
Organization. In the U.S., there are stark disparities, with Blacks, Hispanics and Asians having a nearly two-
fold greater risk of developing or dying from GC compared to Whites, reflecting differences in risk factors, such
as Helicobacter pylori (H. pylori) infection and smoking, as well as access to primary prevention and care.
Several factors are changing the landscape of GC prevention, including a better understanding of the disease
natural history, new evidence on prevention from prospective studies, and anticipated results from randomized
controlled trials. As early GC detection can improve survival by allowing for curative surgical or noninvasive
endoscopic resection, new targeted approaches to GC prevention have the potential to markedly improve
population health and reduce GC disparities within the U.S. Although H. pylori has been the primary focus of
global GC prevention efforts to date, substantial variation by subpopulation in H. pylori prevalence in the U.S.
and the world has accentuated the need to optimize H. pylori screen-and-treat interventions for vulnerable
groups. One approach is targeted endoscopic screening of high-risk individuals. For instance, persons found to
have gastric intestinal metaplasia, a precursor lesion associated with a high progression risk to gastric
neoplasia, are recommended to undergo endoscopic surveillance in many countries. A critical need exists to
identify effective and cost-effective strategies to address these clinical challenges in the U.S., as well
as globally. This proposed work builds upon prior GC work spanning GC and H. pylori simulation modeling
studies, GC secondary database analyses, and relevant methodologic and global cancer modeling
publications. The research team for this proposal has a vast collective experience in simulation and
comparative modeling for cancer control, clinical expertise across the spectrum of GC prevention and care,
and a demonstrated track record and commitment to informing cancer care and policy. The proposed three
modeling groups are well-positioned to perform and successfully complete the highly relevant project aims.
The overarching goal of the proposed research is to produce innovative and paradigm-shifting
changes to cancer care through a disparities-focused modeling approach targeting the most
vulnerable, high-risk populations that bear the greatest burden of GC in the US, and the world. We will
accomplish this goal by performing comparative modeling and completing the following aims: 1) Develop GC
simulation models to estimate GC outcomes for subgroups by race and ethnicity in the U.S.; 2) Assess the
impact of risk factor trends and primary prevention strategies on GC disparities; 3) Evaluate targeted
secondary prevention strategies for reducing early onset-related mortality and GC disparities, and 4) Adapt the
models to evaluate GC prevention policies in the global setting.
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