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Researcher explores reasons for Eastern Kentucky’s high rates of lung disease

Eastern Kentucky has long been recognized as having greater incidences of lung disease than other parts of the state. Even taking into account elevated smoking rates and the presence of coal dust, these incidences are much higher than would be statistically expected.

Dr. Susanne Arnold, Associate Director for Clinical Translation at the University of Kentucky’s Markey Cancer Center, is doing research in this area, looking for a reason for these startling realities. As an eighth-generation Kentuckian, the statistics trouble Arnold. She has been researching lung cancer almost since she began her medical career.

“When I began as a fellow, I developed an interest in lung cancer and lung cancer research, the clinical/therapeutic end of it where we’re trying novel new drugs and cancer therapies and such,” she said. “But in my clinics, I was always surrounded by the tragedy of lung cancer, and all my patients seemed to be coming from the eastern part of the state.”

Arnold’s research targets the 5th Congressional district, which is Appalachian Kentucky. She and her fellow investigators felt a certain sense of obligation to delve into this enigma.

“It’s our responsibility as a cancer center to address the cancer disparities in our state, and this is one of the biggies,” she said.

The case-controlled study involves finding lung cancer patients who are willing to fill out a questionnaire and donate tissues from their bodies and samples from their homes to the researchers.

“We go into their homes and interview them at length,” Arnold said. “We collect their toenails to do trace-elements analysis to see if there’s a higher amount of arsenic, chromium or cadmium in their bodies or other things that are linked to cancer. We sample their water and their soil.”

The samples are matched with controls from people who don’t have cancer but live in the area.

“We look at the differences in occupation, lifestyle, residence and the environmental toxins that they may become exposed to in that region, along with smoking and family history,” Arnold said.

The study began in 2011 and will continue until 2014. Kentucky Home Place, which has a large database of potential subjects, has been instrumental in finding people to participate in the study.

“They’re from the community, they’re trusted and they help to facilitate opening a door for us to do the research project,” Arnold said. “We’re going to have an immediate effect on those people, but also in the long run, the work with Kentucky Home Place may actually help drive solutions to some of the exposures and help with prevention.”

Arnold said it is too early to release any findings from the research as yet.

“To date we haven’t analyzed all of the specimens so I can’t say definitely we’re seeing arsenic and cancers in some people and not in others, and I don’t know if we’ll find that,” she said. “But the data will create a database and registry that will be very useful to many, many different researchers.”

Arnold said she has been impressed with the openness and willingness of the subjects she has met. “People have been extraordinarily generous in opening their homes and their lives to us,” she said. “They are pretty excited about it. Kentuckians, especially from that region, recognize how terrible the blight of cancer is and are willing to do something about it. They want to be part of the solution and are energized by our research and things that we can do to help change the pattern. [They say], ‘This happened to my mom, this happened to my dad. We’ve got to do something to stop it.’”

Better screening protocols and treatment opportunities will be two of the positive outcomes of Arnold’s study. “I hope it will provide some meaningful information that will help us change the track we’re on with lung cancer,” she said. “This study can add to the body of knowledge.”

by Tanya Tyler, Staff Writer, KY Doc Magazine

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