Incorporation of Genetic Expression of Airway Epithelium With CT Screening for Lung Cancer

Lung cancer, largely the result of cigarette smoking, is the leading cause of cancer death in
the United States, killing over 160,000 people in 2010, more than breast, colorectal, and
prostate cancer combined. Since only 10% of heavy smokers develop lung cancer and 20% of lung
cancers develop in nonsmokers, it is thought that genetic predisposition plays an important
role.

Without screening, lung cancer is only detected at an early stage 10% of the time,
translating into a 7% cure rate. Published studies of screening for lung cancer using CT
scans show that it is detectable at an early stage 85% of the time, translating into a cure
rate over 60%. However, in a sample population of 1000 smokers over the age of 60 (high risk
individuals), 233 will have suspicious abnormalities on CT scans, but only 27 had lung
cancer. Two concerns are apparent. First, among the 233 individuals with suspicious
abnormalities on CT, how does one choose the ones suspicious enough for biopsy, surgery, or
other invasive procedures? Generally, follow-up CT scans over several months are used to
assess the abnormalities for growth, since growth is a characteristic of malignancy.
Unfortunately, repeated CT scans involve financial cost and potential radiation risk. An
additional technique which is able to predict predisposition to lung cancer, if combined with
the ability of CT scans to detect abnormalities in real time, could prove to be a powerful
platform to efficiently screen for lung cancer and reduce its mortality.

Lung cancer develops as a consequence of a series of genetic injuries to the cells lining the
airways which cause these bronchial cells to grow in a malignant manner, unchecked, resistant
to normal homeostatic controls. By studying the gene expression signature of airway
(bronchial) lining cells, differences are observed between normal nonsmokers, individuals
exposed to smoke second-hand, and smokers who have developed COPD (chronic bronchitis and
emphysema). Some genetic changes in bronchial lining cells near a lung cancer are specific to
lung cancer --- the "field effect." Obtaining bronchial lining cells for genetic analysis
requires an invasive and expensive procedure, fiberoptic bronchoscopy, and therefore
bronchoscopically acquired bronchial lining cells are not suitable for screening of the
public for lung cancer.

The lining cells of the nose, the nasal epithelium, which is part of the human airway, have
many similarities to bronchial epithelium, but they are much more accessible. A gentle
scraping of the nasal lining involves no risk to the patient, less cost, and, it is hoped,
will provide the same genetic information as the bronchial lining cells.

This study proposes to examine the genetic correlation between nasal and bronchial epithelium
in the hopes of developing an office-based test to identify a patient's risk for lung cancer.
It is hoped that the genetic analysis of nasal epithelium may be combined with the other risk
factors for lung cancer such as cigarette smoking, age over 50 years, and an obstructive
ventilatory impairment noted on pulmonary function tests to find the ideal (or enriched)
population to screen with CT to detect early lung cancer, thus reducing the financial cost,
radiation exposure, and risk of invasive procedures to a minimum, furthering the ultimate
goal of "personalized medicine."

Inclusion Criteria:

HEALTHY VOLUNTEER RESEARCH SUBJECTS

- All study subjects should be able to provide informed consent

- Males or females ages 18 years and older

- Must provide HIV informed consent

VOLUNTEER RESEARCH SUBJECTS WITH LUNG DISEASE

- Must provide informed consent

- Males and females age 18 years and older

- Lung disease proven by at least one of the following: symptoms consistent with
pulmonary disease; (2) chest X-rays consistent with lung disease; (3) pulmonary
function tests consistent with lung disease; (4) lung biopsy consistent with lung
disease; (5) family history of lung disease; and/or (6) diseases of organs with known
association with lung disease

- Must provide HIV informed consent

Exclusion Criteria:

HEALTHY VOLUNTEER RESEARCH SUBJECTS

- Individuals not deemed in good overall health by the investigator will not be accepted
into the study.

- Habitual use of drugs and/or alcohol within the past six months (Acceptable: -
Marijuana one time in three months; average of two alcoholic beverages per day; drug
and/or alcohol abuse is defined as per the DSM-IV Substance Abuse Criteria).

- Individuals with history of chronic lung disease, including asthma or with recurrent
or recent (within three months) acute pulmonary disease will not be accepted into the
study.

- Individuals with allergies to atropine or any local anesthetic will not be accepted
into the study.

- Individuals with allergies to pilocarpine, isoproterenol, terbutaline, atropine or
aminophylline will not be accepted into the study.

- Females who are pregnant or nursing will not be accepted into the study

VOLUNTEER RESEARCH SUBJECTS WITH LUNG DISEASE

- Any history of allergies to xylocaine, lidocaine, versed, valium, atropine,
pilocarpine, isoproterenol, terbutaline, aminophylline, or any local anesthetic will
not be included in the study.

- Habitual use of drugs and/or alcohol within the past six months (Acceptable: Marijuana
one time in three months; average of two alcoholic beverages per day; drug and/or
alcohol abuse is defined as per the DSM-IV Substance Abuse Criteria)

- Females who are pregnant or nursing