Lung Cancer Research Q&A

To better understand the impact of lung cancer in women, the American Lung Association has created a new research award to examine gender differences in lung cancer. Sharad Goyal, MD is the first-ever recipient of The LUNG FORCE Research Innovation Project: Lung Cancer in Women Award, funded by the American Lung Association's LUNG FORCE initiative, which raises awareness of the impact of lung cancer in women and critical funds for lung cancer research.

Dr. Goyal is a radiation oncologist and Associate Professor at the Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School. I had a quick Q&A with Dr. Goyal to better understand the work his team will be doing through this new award.

Let's start at the beginning. How did you become interested in patient-oriented research? Can you tell us a bit about your career path and what led you to this investigational idea?

Early on in my career, I was attracted to clinical research and enrolled in a dual degree program at the University of Virginia. I received a Master of Science degree in Clinical Investigation in addition to my MD degree, and learned clinical trial design and database management. I currently serve as an Associate Professor and Director of Clinical & Translational Research within the Department of Radiation Oncology at Rutgers Cancer Institute of New Jersey. Much of my research has been inspired by the patients I see on a daily basis, many of whom ask about the long-term effects of radiation on their heart and lungs. When I saw the announcement of the Lung Cancer in Women award, I thought it was a perfect opportunity to marry my interests and help solve a burning question on the impact of medical procedures on lung cancer.

Can you explain exactly what your research is looking to uncover and the process you are undertaking? 

Almost 83 million adults in the United States have cardiovascular disease (CVD), which accounts for 33 percent of all deaths. Millions of patients in the U.S. undergo cardiac catheterization or percutaneous coronary intervention (PCI), procedures used to aid in the diagnosis and treatment of their CVD. These procedures use fluoroscopy, which means that X-rays are used to help guide the procedure. Each procedure typically exposes patients to an equivalent dose of ionizing radiation (IR) of 250 to 3,500 chest X-rays, which is a significant amount of radiation.

The rate of new lung cancer cases has almost doubled among women in the last 38 years, while falling 29 percent for men.  Mounting research suggests that lung cancer patterns differ between women and men, and that genetic and environmental factors may play a vital role in its development. A better understanding of these factors will advance practice and improve lung cancer outcomes. The LUNG FORCE Lung Cancer in Women Award focuses on the radiation exposure during cardiology procedures and how that affects the risk of developing lung cancer for women.

This project leverages two large, population-based data sets that include both cancer and cardiac information. Through these data sets, we will be able to evaluate the factors influencing the relative risk of developing lung cancer in a diverse, group of people after radiation exposure. This has not been previously studied, and will take two to three years to complete our analysis. 

Who will you be working with and how will this team effort help bring about results?

This project leverages the expertise and resources of the New Jersey State Cancer Registry (NJSCR), which is a National Cancer Institute Surveillance, Epidemiology and End Results database housed in the New Jersey Department of Health and Rutgers Cancer Institute of New Jersey, and collects data on all cancer cases diagnosed or treated in New Jersey since October 1, 1978. The NJSCR contains information on all cancer cases including the type of cancer, demographic information, first course of treatment and survival.

Myocardial Infarction Data Acquisition System (MIDAS) is a statewide database run through the Cardiovascular Institute of New Jersey  with 25 years of longitudinal information data on patients who were discharged with the diagnosis of acute myocardial infarction and cardiovascular diseases (e.g. stroke, heart failure and pulmonary embolism).  The database also includes all records of hospitalizations involving invasive cardiac procedures, thrombolytic infusion and cardiac ablation.

Linking these two sources of data will allow us to observe the relationship between these procedures and development of lung and other cancers. This team science approach will undoubtedly add to the success of this project and importance of the findings.

After the results are released, what changes in medical practice might occur? For example, how might the results assist clinicians in making decisions about recommendations of medical imaging studies?  

We believe that our project may lead to a reduction in the incidence of lung cancer in women within the next 10 years. At the very least, we expect that patient-specific risk estimates for cancer to assist clinicians in making real-time decisions about the risks, benefits and alternatives of medical imaging. The results of this project would be applicable not only to the fields of pulmonology and cardiology, but many other fields which use fluoroscopy including orthopedic surgery, vascular surgery, radiology and others.

Any final thoughts you want to share with our readers?

Research is critical to advancing our understanding of lung cancer. Advances in technology and medicines that we see today are a result of in-depth investigation that in some cases have taken years to come to fruition. Lung cancer is the leading cause of cancer death in both men and women, and it is imperative that research into this area is adequately funded so that scientific discoveries are quickly translated into clinical practice that saves lives. I'm so thankful that the American Lung Association has taken the proactive measures to fund this type of research and made research a cornerstone of their mission.

Learn more about The LUNG FORCE Research Innovation Project: Lung Cancer in Women Award.