With more than 1.3 million people dying of the disease annually, lung cancer continues to be the most common cause of cancer death worldwide. Active duty military personnel and war veterans are disproportionately affected by lung cancer. In addition to being up to 75% more likely to develop lung cancer than adults in the civilian population, veterans are also more likely to die from the disease. These facts underline the importance of addressing the veteran population when considering early detection of lung cancer.

The field of normal appearing airway around a cancer is called the "field of cancerization." It contains many, but not all, of the changes observed in the lung tumor. The overall hypothesis we are testing is that smoking-induced injury causes lungs to repair abnormally and that the resulting field of injury supports the development of lung cancer. Studying the associated events in the field will shed new light on the earliest changes occurring during lung cancer development and will promote the discovery of biomarkers for early detection and the development of novel therapies.

Ultimately, our goal is collect cells from the airways and/or nose and/or mouth to develop a test useful for early detection of lung cancer and screening of veterans. This test would be applicable to the 23 million veterans who are currently at high-risk for lung cancer and would also be relevant for the screening of all other high-risk populations, including current and former smokers. Early detection of lung cancer will likely have a significant impact on survival in lung cancer. Increasing our understanding of the biology of lung cancer development will also aid in the discovery of new strategies to prevent the formation of lung cancer. Risks include the possibility of diagnosing lung cancer when it is not present or missing a diagnosis. As we currently have no reliable method for early detection of lung cancer, this would still be a significant improvement for all patients. We predict that by the end of the 4 years of this proposal, we will have developed new biomarkers for the early detection of lung cancer and significantly improved our understanding of how lung cancer develops following smoking induced injury.