As temperatures rise and more time is spent outdoors, dermatologists urge everyone to pay closer attention to their skin. According to the American Cancer Society, melanoma — the deadliest form of skin cancer — is expected to be diagnosed in more than 112,000 Americans this year as invasive disease, a figure that has climbed nearly 47% in the past decade. When caught early, melanoma is among the most treatable cancers, with a five-year survival rate around 99% for localized disease. 

A vast majority of melanoma cases are linked to ultraviolet exposure from sunlight, making it largely preventable. Risk factors include fair skin, a history of sunburns (especially in childhood), numerous moles, and a family history of melanoma. But melanoma does not discriminate; it can develop in people of all skin tones and in areas that rarely see the sun. 

Dermatologists recommend the ABCDE rule as a guide for self-examination: 

• Look for Asymmetry (one half of a mole doesn’t match the other),
• irregular Borders,
• uneven Color,
• a Diameter larger than a pencil eraser, and
• an Evolving shape, size or color.

Any spot that looks different from the moles around it — the so-called ugly duckling — also warrants professional evaluation. The most important step you can take is scheduling a routine skin check with a board-certified dermatologist. 

“Early detection saves lives, and it starts with knowing your own skin,” says Allison Hanlon, MD, PhD, Professor and Chair of the Department of Dermatology at Vanderbilt Health. “When melanoma or another skin cancer is found early, our Mohs surgery team can often remove it completely in a single outpatient visit while preserving as much healthy tissue as possible.” 

Mohs micrographic surgery is widely considered the gold standard for treating many skin cancers. Unlike standard excision, the Mohs technique examines 100% of the tissue margin under a microscope, layer by layer, until no cancer cells remain. The result is a cure rate of up to 99% for new skin cancers and the smallest possible wound, which is especially important for tumors on the face, ears, hands, and other cosmetically or functionally sensitive areas. 

Vanderbilt Health’s Mohs Micrographic Surgery program brings together a fellowship-trained team of four Mohs surgeons: Hanlon; Anna Clayton, MD, Associate Professor of Dermatology and Director of the Micrographic Surgery and Dermatologic Oncology Fellowship; Stacy McMurray, MD, Assistant Professor of Dermatology and Associate Program Director for the Mohs Fellowship; and Emily Merkel, MD, Assistant Professor of Dermatology. The team collaborates with surgical and medical oncology specialists to develop individualized plans for even the most complex cases. 

Mohs surgery at Vanderbilt Health is performed at Vanderbilt Dermatology, located at Vanderbilt Health One Hundred Oaks, 719 Thompson Lane in Nashville. 

To schedule a skin cancer screening or learn more about Mohs surgery services, call 615-322-6485 or visit the Vanderbilt Health Dermatology website. 

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Vanderbilt-Ingram Cancer Center has named Richard Peek Jr., MD, a Co-Leader of its Gastrointestinal (GI) Cancer Research Program, joining Kristen Ciombor, MD, MSCI, who assumed leadership of the program in 2025.

Peek is Professor of Medicine and Director of the Division of Gastroenterology, Hepatology and Nutrition at Vanderbilt Health, where he holds the Mina Cobb Wallace Chair in Immunology. He is an internationally recognized expert in Helicobacter pylori pathogenesis and host-microbial interactions. Peek has led the Division of Gastroenterology, Hepatology and Nutrition since 2004, during which time it has tripled in size and grown its National Institutes of Health (NIH) research portfolio to more than $11 million annually.

“I am beyond excited to be able to serve in this role for the Vanderbilt-Ingram Cancer Center and to have the opportunity to work with such an exceptionally talented and dedicated physician as Kristen Ciombor,” Peek said. “Vanderbilt-Ingram has always supported my career unequivocally, particularly when they provided pilot funding that presaged our successful P01 grant on Helicobacter pylori and gastric cancer. I am honored to take on this responsibility.”

Peek’s individual research program has been funded by the NIH for more than 30 years and includes R01 and P01 funding from the National Cancer Institute. He has been elected to the American Society for Clinical Investigation, the Association of American Physicians, the American Association for the Advancement of Science, the American Clinical and Climatological Association, and was a charter member of the NIH Gastrointestinal Mucosal Pathobiology Study Section.

He also served as chair of the American Gastroenterological Association (AGA) Council, co-editor-in-chief of Gastroenterology, as a member of the NIH National Institute of Diabetes and Digestive and Kidney Disease Advisory Council and was recently selected to be president President-Elect of the AGA World Gastroenterology Organization.

Ciombor is Associate Professor of Medicine in the Division of Hematology and Oncology at Vanderbilt, where she has been a faculty member since 2017. A board-certified medical oncologist specializing in gastrointestinal cancers, she leads multiple national investigator-initiated clinical trials in colorectal cancer. She is a co-investigator on the Vanderbilt-Ingram GI SPORE grant and leads the National Clinical Trials Network Lead Academic Participating Site grant at Vanderbilt. She also serves as chair of the Colorectal/Anal Working Group for the Eastern Cooperative Oncology Group and is a member of the NCI GI Steering Committee, among other roles.

“I am delighted that Dr. Peek has been selected to co-lead the Vanderbilt-Ingram GI Cancer Research Program,” Ciombor said. “He is a world-renowned gastroenterologist and expert in H. pylori pathogenesis and a true asset to the Vanderbilt research community. I am thrilled to work with him as we continue to strengthen the GI cancer research collaborations at Vanderbilt.”

“GI cancer incidence and mortality rates in our catchment area are worse than the national average, and screening for diseases like colorectal cancer also are lower in Tennessee than in many other states,” said Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology and Director of Vanderbilt-Ingram. “GI cancers have been a long-standing priority of the Vanderbilt-Ingram Cancer Center, in part because of the burden of GI cancers in our area, but also because of the exceptional expertise here at Vanderbilt.

“Together, Drs. Peek and Ciombor bring deep knowledge and experience to optimize and personalize the prevention, diagnosis and treatment of GI malignancies. The GI cancer research program at Vanderbilt-Ingram will flourish under their strong co-leadership.”

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Vanderbilt-Ingram Cancer Center has named Fabien Maldonado, MD, MSc, and Evan Osmundson, MD, PhD, as co-leaders of its Thoracic Oncology Program, reflecting the center’s commitment to expanding disease-specific cancer care for patients across the region.

As co-leaders, Maldonado and Osmundson will identify gaps and opportunities to improve prevention, detection and treatment of lung cancer. They will build collaborative bridges across thoracic specialties — including thoracic surgery, pulmonology, radiology, pathology, and medical and radiation oncology — recognizing that lung cancer treatment frequently requires a coordinated, multimodal approach.

They will also work to expand access to innovative technologies, including robotic bronchoscopy, which enables biopsy of previously unreachable areas of the lung; advanced local therapies such as minimally invasive surgery and adaptive radiotherapy; and targeted systemic treatments tailored to each patient’s tumor. This work will reduce wait times, improve diagnostic accuracy, lower toxicity and deliver personalized therapy within a multidisciplinary, team-based model of care.

“Lung cancer is a top priority for our cancer center because Tennessee has among the highest rates of lung cancer mortality in the country,” said Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology and Director of Vanderbilt-Ingram. “The number of Tennesseans who smoke is higher than the national average, and our screening rates are lower — a combination that disproportionately affects our communities. The best way to cure lung cancer is to catch it early. Under the leadership of Drs. Maldonado and Osmundson, we are rebooting our Thoracic Oncology Program to bring together lung cancer researchers, care providers and trainees across Vanderbilt-Ingram in an even more collaborative way. That collaboration will drive higher-impact research and discoveries that translate quickly into meaningful benefit for our patients and the people of Tennessee.”

Maldonado, Professor of Medicine, Thoracic Surgery and Mechanical Engineering, focuses his research on clinical trials in interventional pulmonology, CT-based quantitative imaging for lung cancer and robotic bronchoscopy.

“Major advances in lung cancer care, including lung cancer screening and minimally invasive diagnostic and therapeutic interventions, have improved lung cancer survival rates by more than 25% over the past five years; however, much work remains, and we are excited to continue building the most patient-centered, data-driven, and technologically advanced lung cancer program in the state of Tennessee,” said Maldonado, who holds the Pierre Massion Directorship in Lung Cancer Research.

Osmundson, Associate Professor and Vice Chair of Clinical Operations in the Department of Radiation Oncology, where he serves as medical director, is board-certified in radiation oncology. He specializes in thoracic malignancies and lymphoma and leads several investigator-initiated clinical trials designed to enhance the synergy between radiation therapy and immunotherapy, with funding from the National Institutes of Health and other entities. He has also become a leading voice for patients facing barriers to care, with research advocating for prior authorization reform to reduce treatment delays in oncology.

“Thoracic oncology has entered a remarkable era of personalized medicine, in which therapies tailored to each patient’s individual cancer are producing outcomes we couldn’t have imagined even a decade ago. Patients are living longer and, importantly, living better than ever before, yet we know there’s still much further to go,” said Osmundson. “At Vanderbilt, our innovative research and clinical programs have helped drive this revolution, and our team-based care brings these discoveries to patients today. I’m more excited than ever to extend this care across our region and to discover what comes next.”

Together, the co-leaders bring complementary expertise aimed at delivering the most innovative and advanced options for patients at all stages of lung and other thoracic cancers. The goal of the Thoracic Oncology Program is to improve survival and quality of life — personalizing treatment for every patient, regardless of when they arrive at Vanderbilt-Ingram.

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A new urine test performed better than PSA-based testing and MRI for monitoring low-risk prostate cancers on active surveillance. Use of the test to determine the need for repeat “monitoring” biopsies would have avoided up to 64% of unnecessary biopsies while maintaining timely detection of higher-grade cancers that merit treatment, according to a study published in The Journal of Urology.

The test, called MyProstateScore 2.0 – Active Surveillance (MPS2-AS), was evaluated in over 300 patients on active surveillance for Grade Group (GG) 1 prostate cancer, according to lead author Jeffrey Tosoian, MD, MPH, assistant professor in the Department of Urology at Vanderbilt Health.

“For patients undergoing monitoring of low-grade prostate cancer, these findings suggest that use of the urine test can reduce the need for invasive biopsies without compromising prompt detection of higher-grade cancers that require treatment,” Tosoian said.

Active surveillance is widely used in men with low-risk prostate cancer to avoid unnecessary treatment of cancers unlikely to cause harm. Because some patients will later be found to “upgrade” to higher-risk cancers, however, surveillance entails careful monitoring. Due to the limitations of existing tools, the current approach to surveillance requires repeat prostate biopsies, usually every two to three years. The urine test offers a noninvasive option to determine which patients truly need to undergo a biopsy and which can avoid a potentially unnecessary and invasive procedure.

Other noninvasive tests have been studied in active surveillance, but none have had sufficient accuracy to rule out the need for repeat biopsies. Tosoian said the study team is optimistic that these findings reflect a significant step forward for the field, and, most importantly, for patients. 

Prostate cancer grading uses the Gleason score (6-10) and Grade Group (1-5) systems to estimate cancer aggressiveness based on how the cells look under a microscope. Higher numbers indicate faster-growing, more aggressive cancer.

In patients previously diagnosed with low-grade cancers (Gleason score 6, Grade Group 1) pursuing active surveillance, MPS2-AS correctly predicted the presence of high-grade (GG≥3) cancer in 97% of cases. The test was found to have a 99% negative predictive value for GG≥3 upgrading, meaning that patients with a negative test had only a 1% chance of having GG≥3 cancer detected on biopsy. For the vast majority of patients, that is low enough to confidently forgo the biopsy altogether, Tosoian said.

Tosoian, also the director of Translational Cancer Research in the Department of Urology, said next steps for the collaborative research team will include studying the use of this testing approach to improve other aspects of prostate cancer care, such as detecting recurrence after treatment.

The study was supported by the National Institutes of Health (grant U2CCA271854).

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Immunotherapy has become a standard of care in treating high-risk, early-stage breast cancers, yet it has had limited success in shrinking tumors. New biomarkers that can improve outcomes for patients are urgently needed.

Now, a study led by researchers at the Vanderbilt-Ingram Cancer Center has found that repeated blood sampling — essentially, a liquid biopsy — can assess and predict the evolving antitumor immune response to therapy.

This minimally invasive and cost-effective alternative to tissue biopsy offers “an accessible tool for tailoring treatment strategies in breast cancer,” they reported April 22 in the journal Science Translational Medicine.

The researchers performed RNA sequencing on 546 peripheral blood samples from 160 patients with high-risk, stages 2 or 3 breast cancers negative for human epidermal growth factor receptor 2 (HER2) during treatment with either chemotherapy alone or in combination with immunotherapy.

Justin Balko, PhD, PharmD, professor of Medicine and Pathology, Microbiology and Immunology at Vanderbilt Health and the paper’s corresponding author, acknowledged several co-authors — investigators from the nationwide I-SPY2 clinical trial — who, among other contributions to the study, provided the blood samples.

Molecular profiles of tissue plus circulating tumor DNA can better guide cancer care

Co-author Laura Esserman, MD, MBA, director of the Breast Care Center at the University of California, San Francisco, is principal investigator of the I-SPY2 trial, which is assessing novel treatment strategies for subsets of breast cancer based on their molecular characteristics (biomarker signatures). Vanderbilt Health is among 42 trial locations.

Cell-free DNA testing, another form of liquid biopsy, is routinely used clinically for detection, diagnosis and therapeutic monitoring of a variety of malignancies.

Balko and his colleagues sampled the transcriptome, the transcription of genes involved in the clonal expansion and activation of antitumor immune cells called T cells. They found it predicted response to the immunotherapy drug pembrolizumab.

While validation is needed, this new liquid biopsy has the potential to “guide immunotherapy decision-making, tailor treatment regimens, and advance precision oncology, not only in (breast cancer) but potentially in other solid tumors as well,” the researchers concluded.

The paper’s first author, Xiaopeng Sun, PhD, is now at Merck. Co-authors at Vanderbilt Health are Andres Ocampo, Jacey Marshall and Julia Steele, graduate students in the Vanderbilt Program in Cancer Biology, and Susan Opalenik, PhD, senior research supervisor in the Balko lab.

The study was supported in part by National Institutes of Health grants P50CA098131, PO1CA210961, R01CA255442, U54CA274502, P30CA082103, P30CA068485 and NIH/NCI Imaging grant 28XS197 P-0518835), a Department of Defense Era of Hope Award, the Breast Cancer Research Foundation, Breast Cancer Research — Atwater Trust, Stand Up To Cancer, the California Breast Cancer Research Program and Give Breast Cancer the Boot.

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Black women in the United States are less likely than white women to be diagnosed with breast cancer, yet they are more likely to die from the disease.

In a study of more than 1,000 women, researchers at Vanderbilt Health and Agendia, which specializes in genomic testing, found that Black women were more likely to have early, high-risk breast cancer that is hormone receptor positive (HR+) and negative for the human epidermal growth factor receptor 2 (HER2-).

These findings, reported March 19 in the Nature partner journal npj Breast Cancer, highlight the critical need for tumor genomic testing for all patients to identify those with high-risk tumors, which occur more frequently in Black women, and which require more aggressive treatment to prevent recurrence.

“By moving beyond traditional clinicopathologic features and incorporating genomic classification, we can more accurately identify biologically aggressive disease and tailor more precise, personalized treatment,” said the paper’s corresponding author, Sonya Reid, MD, MPH, associate professor of Medicine at Vanderbilt Health.

“The risk of recurrence of breast cancer in Black women has often been underestimated by traditional clinical features, driven largely by their underrepresentation in clinical trials,” study co-author William Audeh, MD, Agendia’s Chief Medical Officer, said in a news release.

“By providing a genomic assessment of tumor biology, we can ensure that women with breast cancer will receive individualized care that improves their long-term outcomes,” Audeh said. The collaboration with Vanderbilt Health “underscores our shared commitment to bringing precision medicine to all women.”

The research included 1,018 women with HR+, HER2- early-stage breast cancer who were enrolled in the Breast Cancer Etiology, Survival and Treatment Outcomes (BEST) study, and the Full-genome Data Linked with Clinical Data to Evaluate New Gene Expression Profiles (FLEX) study.

The BEST study is a population-based observational cohort of women identified through state cancer registries in Florida and Tennessee who were diagnosed with breast cancer between 2005 and 2015. FLEX is a multicenter, prospective observational study of genomic profiling and its impact on prognosis, treatment decisions and clinical outcomes.

The researchers applied two RNA-based technologies developed by Agendia to evaluate tumors: “MammaPrint,” which analyzes the 70 most important genes associated with breast cancer recurrence, and “BluePrint,” which classifies tumors into subtypes based on an expression profile of 80 different genes.

They found that Black women had a higher proportion of genomically high-risk luminal B and basal-type tumors compared to white women and that survival at three years was determined by the molecular subtype of their tumors.

“Understanding the biological and tumor genomic differences by race could improve treatment decisions and promote optimal care for Black females with early-stage breast cancer,” the researchers concluded, “ultimately improving long-term outcomes.”

Co-authors from Vanderbilt Health were Lindsay Venton, Jennifer Whisenant, PhD, Anne Weidner, MPH, and Tuya Pal, MD.

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When Dan Hannon, 72, received guidance to have part of a lung taken out whether nodules were cancerous or not, he wanted a second opinion to see if he would indeed live the rest of his life without a full set of lungs.

After incidentally learning of a suspicious spot in his lungs while getting imaging to diagnose a kidney stone in 2025, he was advised to get his lungs checked. Several months later, he had a diagnostic PET scan under the care of a Georgia pulmonologist near his home in Buford, Georgia.

Some spots “lit up,” indicating metabolic activity, which often means cancer but may be due to infection or inflammation. He went on to get a bronchoscopy, a minimally invasive procedure using a camera on a thin tube to examine his lungs and obtain biopsy tissue.

He and his wife, Janice, learned the areas that were successfully biopsied were benign, but there were two additional areas the physician couldn’t reach.

Thus came the recommendation for an open surgery to remove the undefined tissue for biopsy. It was also advised that Hannon have a sizeable portion of his affected lung removed while still under anesthesia, regardless of the biopsy results.

That didn’t sit well with the couple, so they drove four hours to Vanderbilt Health in Nashville. Their son had been successfully treated for cancer there in the past.

“The prior lack of knowledge of whether I had cancer or not, and being told I should have surgery and get part of my lung cut out — whether it was cancer or not — was very bothersome,” Hannon said. “I decided to get a second opinion. I wanted all the information I could get to make a good decision, and that’s exactly what’s happened.”

At Vanderbilt Health, a new approach to a difficult diagnosis

The Hannons met with Fabien Maldonado, MD, MSc, professor of Medicine and Thoracic Surgery and director of Interventional Pulmonology at the Vanderbilt Lung Institute. Maldonado told them he was pretty confident he could reach those areas for biopsy using robotic bronchoscopy, the standard of care at Vanderbilt University Hospital.

“Robotic bronchoscopy, combined with cone-beam CT, has transformed the way we do things,” said Maldonado, who holds the Pierre Massion Directorship in Lung Cancer Research. “Ninety-five percent of people with lung nodules don’t have cancer, but for the 5% that do, they need to receive a diagnosis and get treatment as soon as possible.

Inside the robotic bronchoscopy advancing lung care

During a robotic bronchoscopy, physicians use a controller to precisely guide a bronchoscopy tube, which is typically smaller and more flexible than traditional tubes. The additional agility allows access into the lung’s harder-to-reach peripheral structures so biopsy tissue can be obtained. A 3D, high-resolution image of the lung obtained through cone-beam computed tomography (CBCT) is displayed on a monitor to guide the interventional pulmonologist’s progress.

At Vanderbilt Health, the four board-certified interventional pulmonologists who do the robotic bronchoscopies have all completed a fellowship and an additional year of interventional pulmonology training before receiving board certification from the American Association for Bronchology and Interventional Pulmonology.

Oncologist Mohamed Shanshal, MBChB, assistant professor of Medicine, said robotic bronchoscopy significantly improves getting patients the appropriate treatment as soon as possible, reducing their anxiety and improving care.

To expand access to the diagnostic procedure, the Vanderbilt Health Interventional Pulmonology program recently bought two additional robot and CBCT systems, making it one of the largest interventional pulmonology programs in the South. Four state-of-the-art bronchoscopy suites are slated to open later this year.

“This reduces diagnostic uncertainty and helps us move more quickly from suspicion to confirmed diagnosis,” Shanshal said. “Earlier and more accurate tissue diagnosis allows us to initiate treatment sooner, including surgery, targeted therapy, immunotherapy or clinical trials. In lung cancer, timing and adequate tissue for molecular testing are critical to optimizing outcomes.”

Maldonado explained that the Interventional Pulmonology program is a national leader in testing new technologies for safety and results.

“Many new technologies related to lung nodule biopsies have come on the market without any data to prove their benefit,” Maldonado said. “We are doing the randomized controlled trials here to prove whether something new is better than what we’re already doing. We study these technologies carefully and quickly, and within six months to a year, we know if the new is more beneficial and needs to be adopted.”

From uncertainty to action: What Hannon’s biopsy uncovered

For the Hannons, having the assurance that the robotic bronchoscopy would reach the spots in his lung and offer clearer details about their makeup was important.

“With the help of the robot, Dr. Maldonado was able to get what he needed, and it came back as adenocarcinoma,” Hannon said. “He was awesome when he explained his findings and everything we needed to do.”

Hannon has mucinous adenocarcinoma, a rare, non-small cell lung cancer that accounts for 2-10% of all lung adenocarcinomas and is most often found in the outer regions of the lung.

During a return visit to Nashville in late February, Hannon had a pulmonary function test, and met with Konrad Hoetzenecker, MD, PhD, professor of Thoracic Surgery, who will soon surgically remove the cancerous spots, and with Shanshal, his new oncologist.

“We’ve had a fantastic experience at Vanderbilt, and we’ve got a fantastic team of medical professionals we’re working with,” Hannon said. “We’re prepared for surgery and any future treatment because of the consultations we’ve had with Dr. Maldonado, Dr. Hoetzenecker and Dr. Shanshal. This has given me confidence in what has to happen.”

And as the Hannons move with hope toward healing, they’re looking forward to future cruises and travels to visit family.

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Children with sickle cell disease are more likely than other children to develop a clonal growth of precancerous blood cells called clonal hematopoiesis (CH), which is associated in older people with a higher risk of blood cancer, according to new research from Vanderbilt Health.  

However, the clones in children with sickle cell disease did not expand as readily as they do in older people with CH, suggesting that they may be more transitory and have different health consequences, the researchers reported March 26 in the journal Blood.  

In addition, hydroxyurea, which reduces painful episodes and the need for blood transfusions in people with sickle cell disease, did not increase the risk of developing CH. That is good news for patients for whom hydroxyurea is “an essential therapy,” the researchers reported.  

While questions remain about the link between CH and sickle cell disease, these findings shed light on disruptions in normal blood cell development (hematopoiesis) that may be shared by both diseases.  

Chronic hematopoietic stress within the hypoxic (low oxygen), inflammatory bone marrow environment of sickle cell disease may predispose to the accumulation of somatic mutations (in nonreproductive cells) and/or the outgrowth of affected hematopoietic stem cell clones at an earlier age, the researchers hypothesized.  

The researchers used a highly sensitive sequencing technique to determine the prevalence of CH in 1,025 children with sickle cell disease, and in a matched control group of 2,957 children without the disease. The results were validated in an independent cohort of 1,293 children with sickle cell disease.  

Jessica Ulloa, a graduate student in the Vanderbilt Human Genetics Program, is the paper’s first author.   

Contributing equally to the study were the paper’s corresponding author, Alexander Bick, MD, PhD, the Edward Claiborne Stahlman Professor and director of the Division of Genetic Medicine and Clinical Pharmacology at Vanderbilt Health; Michael DeBaun, MD, MPH, the J.C. Peterson, MD Professor of Pediatrics and director of the Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Santosh Saraf, MD, University of Illinois; and Mitchell Weiss, MD, PhD, St. Jude Children’s Research Hospital.  

Other co-authors from Vanderbilt Health were Kristin Wuichet, PhD, Yash Pershad, and Connor Shore.  

Support for the study was provided in part by National Institutes of Health grants R01HL168179, T32GM145734 and T32GM007347, and the Vanderbilt Undergraduate Summer Research Program.  

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The clonal growth of precancerous blood cells known as CHIP (clonal hematopoiesis of indeterminate potential) occurs in 1 in 10 people over age 70. It is known to increase the risk of blood cancer and death from cardiovascular, lung and liver disease.

Last year, researchers at Harvard’s Massachusetts General Hospital reported that CHIP also dramatically increased the risk of inflammatory heart disease. Their study analyzed genomic and health records data from more than 335,000 participants in the England-based UK Biobank.

To validate these findings, Vanderbilt Health researchers analyzed data from more than 361,000 participants in two large U.S. biobanks — one of them, BioVU, based at Vanderbilt Health, and the other, part of the National Institutes of Health’s All of Us Research Program.

Their report, published March 18 in the journal JAMA Cardiology, identified a specific link between CHIP and pericarditis, a potentially life-threatening inflammation of the thin sac surrounding the heart. It suggests that treating patients for the blood condition could reduce their risk of heart inflammation.

“Both CHIP and pericarditis are thought to be a result of the same types of inflammation,” said the paper’s first author, Yash Pershad, an MD/PhD student in the lab of Alexander Bick, MD, PhD. “Targeting CHIP-associated inflammation may represent a therapeutic strategy for preventing or treating pericardial inflammation in some at-risk individuals.”

Each year in the United States, an estimated 160,000 people develop pericarditis, which can cause sharp chest pain and often requires hospitalization. The condition, which also is associated with autoimmune disease, cardiac procedures, and infections, can lead to a dangerous buildup of fluid around the heart that impairs heart function.

CHIP is thought to fuel inflammation through specific molecular pathways — including a cellular alarm system called the NLRP3 inflammasome and a signaling protein called interleukin-1beta — that are also central to pericarditis.

Drugs that block these pathways are already approved to treat recurrent pericarditis and potentially could be used as preventive therapy, Pershad noted.

Bick, the paper’s corresponding author, directs the Division of Genomic Medicine and Clinical Pharmacology at Vanderbilt Health. Other co-authors are Kun Zhao, PhD, a postdoctoral researcher in the Bick lab, and Brett Heimlich, MD, PhD, assistant professor of Medicine. The research was supported by National Institutes of Health grants DP5OD029586, R01AG088657 and K08HL171833, a Burroughs Wellcome Fund Career Award for Medical Scientists, a Pew-Stewart Scholar for Cancer Research award, and a Hevolution/AFAR New Investigator Award in Aging Biology and Geroscience Research.

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Lung screenings are an important diagnostic tool for early detection of cancer, but low-dose CT scans cannot determine whether the pulmonary nodules identified in the imaging are cancerous or benign.

Specially trained radiologists, pulmonologists and thoracic surgeons analyze the imaging and then decide whether invasive biopsies are warranted to make that determination — a process called risk stratification of indeterminate pulmonary nodules.

An estimated 10% to 15% of the resections of these nodules turn out to be surgeries for benign tissue. Risk prediction software using artificial intelligence, such as the Lung Cancer Prediction Score, which was developed by Optellum, a lung health technology company, and approved by the Food and Drug Administration in 2021, aids clinicians in determining whether surgical resections are necessary. In a recent study, Vanderbilt Health researchers determined that AI-assisted decision-making with this software is cost-effective compared to clinician assessment alone.

The study, published March 5 in PLOS ONE, showed that AI-assisted decision-making resulted in an incremental cost-effective ratio of $4,485 per life year gained.

“Artificial intelligence-based tools offer promising assistance to busy clinicians who evaluate suspicious lung nodules and seem to be cost-effective,” said the study’s corresponding author, Eric Grogan, MD, MPH, Ingram Professor of Cancer Research and professor of Thoracic Surgery at Vanderbilt Health.

To determine cost-effectiveness, the researchers constructed a decision model assuming guideline-based care from a payer perspective with a lifetime horizon. The base case is a 1.1 centimeter indeterminate pulmonary nodule in a 60-year-old patient who benefits from surgery. This nodule’s risk for lung cancer is about 65%. The model classified patients as low, medium or high risk using either clinician reasoning or clinician-plus-AI reasoning.

“When we think of these AI clinical decision aids, they may not really help the true clinical expert, the thoracic radiologist or pulmonologist who sees 20 of these a day. Where the larger health care system impact occurs is when generalist physicians can rely on these tools to remove the easy, cancer and not cancer cases, so they can focus or get a consult on the most difficult,” said the study’s senior author, Stephen Deppen, PhD, associate professor of Thoracic Surgery and co-director of the Early Detection Research Network Lung Group’s National Clinical Validation Center.

Other Vanderbilt Health authors are Caroline Godfrey, MD, MPH, Ashley Leech, PhD, MS, Kevin McGann, MD, Jinyi Zhu, PhD, MPH, Hannah Marmor, MD, MPH, Sophia Pena, Fabien Maldonado, MD, MSc, Evan Osmundson, MD, PhD, and Stacie Dusetzina, PhD. The researchers received support from National Institutes of Health grants T32CA106183, K01DA050740, R01CA253923, P30CA068485, U01CA152662, R01CA252964 and U01CA152662.

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