Study of Lung Cancer in Appalachian Kentucky: The Role of Environmental Carcinogens

Appalachian Kentucky has one of the highest incidence rates of lung cancer in the United States. The disproportionately high incidence is not explained by tobacco alone. Preliminary analysis of trace element content in toenail samples reveals higher levels of arsenic, chromium and nickel in Appalachian Kentucky residents than elsewhere in Kentucky. Trace elements are known to promote carcinogenesis by increased oxidative stress, inflammation, DNA damage, and reduced DNA repair efficiency. These findings justify further investigation of the role that trace elements play in the development of lung cancer in this region. Hypothesis: The unexpectedly high rate of lung cancer in Appalachian Kentucky is associated with exposure to environmental carcinogens that increase oxidative stress and DNA damage.

Specific Aims Aim 1: Conduct a case-control study of lung cancer and matched controls in the 5th Congressional District of Kentucky to compare rates of moderate to high arsenic in lung cancer cases and controls.

Aim 2: Create a specimen repository of biologic and environmental samples from these subjects and their residences for analysis of DNA repair markers and, in the future, markers of oxidative stress and inflammation.

Aim 3: Fund four pilot projects which will utilize collected data from Aim 1 to develop investigators focused on lung cancer research in this study population and to generate preliminary data that will lead to independent funding.

Study Design: This is a population-based, case-control study encompassing the 5th Congressional District of Kentucky.

Relevance: This translational research and repository will fundamentally improve our understanding of the causes of the disproportionately high incidence of lung cancer in Appalachian Kentucky, foster collaboration among scientists dedicated to the study of lung cancer and provide a permanent resource to be used for future research.

The following eligibility criteria are required for study entry and participation.

Inclusion (Lung cancer cases):

• Living persons with histologically or cytologically confirmed primary carcinoma of the lung (International Classification of Diseases-9, 162.2-162.9) between October 17, 2011 and October 16, 2013
• Age greater than 17
• Must be residents of the 5th Congressional District
• No prior history of any cancer (other than stage I and II non-melanomatous skin cancer)
• Must have a working phone
• Ability to participate in an in-person interview
• English speaking will be eligible for the study (no proxy respondents will be used)

Inclusion (Control cases):

• Age greater than 17
• No prior history of any cancer (other than stage I and II non-melanomatous skin cancer)
• Must be residents of the 5th Congressional District at the time they are matched to the case.
• Must have a working phone
• Ability to participate in an in-person interview
• English speaking will be eligible for the study (no proxy respondents will be used)

Exclusion:

• History of any cancers other than those listed above
• Non-residents of the 5th congressional district of Kentucky
• Age 17 years or less