Early diagnosis

Cancer

California's strong anti-smoking policies and tobacco taxes have led to declining incidences of tobacco-related cancers over the past three decades. But because cancer takes years to develop, even in smokers who have quit, tobacco-related cancers — particularly lung cancer — continue to exact a public health burden, and will for years to come.

Given the complex genomic landscape of cancer, the best chance for making an impact on cancer mortality is by focusing on the early detection of disease (Science: Cancer Genome Landscapes). The next generation of TRDRP cancer research support will focus on early diagnosis and secondary prevention of tobacco-related cancers.

We're interested in funding research on non-invasive tests and imaging technologies that use molecular biomarkers to identify patients most at risk, or for early diagnostic and prognostic screening purposes. Example of relevant research topics include:

• Identification of early detection biomarkers of carcinoma in situ
• Clinical validation of known diagnostic biomarkers of disease
• Development of precision analytical techniques to reliably and economically measure trace levels of biomarkers in non-invasive tissue samples such as blood, serum, expired air, saliva, and urine
• Identification of genetic signatures that can be reliably associated with variations in disease susceptibility among users of tobacco products
• Mechanisms of pathogenesis with the potential to inform early diagnostic approaches

NOTE: California researchers interested in this area should utilize new information and molecular data from NIH-funded efforts such as the Cancer Genome Atlas and Early Detection Research Network in their proposals, as we believe these resources illuminate new opportunities for the early detection of tobacco-related cancers.

Early detection of lung cancer in California's disproportionately impacted populations

As part of our work, we administer contributions to the California Cancer Research Fund (box number 413 on California state income taxes). These funds support research on causes and treatments for cancer, community-based cancer education, and culturally sensitive and appropriate prevention and awareness activities targeted to communities disproportionately at risk or afflicted by cancer.

On recommendation of the TRDRP-convened Strategic Visioning Committee, CCRF funds have been allocated to support a limited number of pilot or exploratory study proposals into the early detection of lung cancer in disproportionately impacted California groups.

We welcome proposals for research into the following issues for African American, Hispanic and Asian American ethnic groups in California:

• Best practices for early lung cancer detection, especially in resource-limited treatment settings
• Overcoming barriers to lung cancer screening, such as healthcare access issues and/or fatalistic beliefs about screening and positive diagnosis
• Appropriate follow-up procedures following a positive screen
• Culturally sensitive health communications on discussing detection and lung cancer
• Overcoming financial and other barriers to lung cancer screening and follow-up care
• Identification of psychosocial and biological correlates of lung cancer detection
• Cost/benefit analysis of lung cancer screening in disproportionately impacted communities

Chronic obstructive pulmonary disease (COPD)

The only effective ways to prevent COPD — and the only avenues for alleviating its debilitating symptoms — are abstaining from smoking and minimizing exposure to environmental tobacco smoke. Unfortunately, for those diagnosed with COPD who have moderate to severe pulmonary dysfunction, the symptoms are essentially irreversible, even if the patient quits smoking.

COPD, also known as chronic obstructive lung disease, is currently the third leading cause of death in the US. Understanding how smoking causes COPD can inform earlier diagnosis, more effective treatment and perhaps someday reversal of the disease process.

Examples of relevant research topics include:

• The role of inflammation and oxidative stress in COPD pathogenesis
• Improved methodologies for early detection
• Biomarkers of susceptibility and progression

Cardiovascular disease

Tobacco smoking and secondhand smoke exposure have long been recognized as prominent risk factors for cardiovascular disease. However, the specific ways that toxicants in tobacco products increase the risk of cardiovascular disease is still a promising area of research.

This is particularly true in light of the FDA's responsibility to evaluate and regulate tobacco products. Examples of relevant research topics include:

• The effects and mechanism of action of tobacco toxicants and oxidative stress on endothelial function
• The identification of toxicants responsible for platelet activation
• The mechanism by which tobacco toxicants contribute to the development of insulin resistance