# A Targeted Approach to the Surveillance of Precursor Lesions for Gastric Cancer

> **NIH NIH K08** · SLOAN-KETTERING INST CAN RESEARCH · 2021 · $167,616

## Abstract

Project Summary/Abstract
The proposed research will characterize the prevalence and management strategies of gastric intestinal
metaplasia (GIM), a lesion of the digestive tract that affects about 12.1 million adults in the United States (US)
and is a precursor to gastric adenocarcinoma, or gastric cancer (GC). While mass surveillance of GIM is
unlikely to be effective in regions of low-prevalence for GC such as the US, we hypothesize that risk-
stratification for targeted screening and surveillance will be cost-effective and can improve outcomes.
Extensive GIM has been identified by gastrointestinal society guidelines as a major risk factor for progression
to GC, but there is currently a dearth of evidence in understanding the prevalence of GIM overall and by
subtype (limited and extensive) in the US population, or how it should be managed. Furthermore, the recently
proposed guidelines from the American Gastroenterological Association suggest surveillance of GIM should be
considered in racial/ethnic minorities, foreign-born individuals, or those with a history of Helicobacter pylori (H.
pylori) infection; however, evidence on the threshold to initiate such interventions and the intervals at which
they should be continued is lacking. The research proposed in this K08 application will accomplish three
interrelated Specific Aims. In Aim 1, we will utilize data from across the Veterans Affairs health care system to
characterize the prevalence of subtypes of GIM and risk factors for progression of GIM to dysplasia or
malignancy in the US context. These data will provide a platform for Aim 2, in which we will build a simulation
model of the natural history of progression from precancerous gastric lesions to GC to assess which individual-
level risk factor profiles could benefit most from screening and surveillance of GIM. The model will utilize 64
different phenotypic profiles, stratified by: gender (male/female), race/ethnicity (non-Hispanic white, Hispanic,
black, and Asian), extent of GIM (limited vs. extensive), foreign-born status (immigrant vs. US-born), and H.
pylori infection status (previous/current infection vs. no infection). Outcomes will be reported based on number
of cancers prevented, survival, and incremental cost-effectiveness ratios (ICERs). Once an optimal profile and
screening regimen is identified on the patient level, in Aim 3 we will assess the population-level impact of
implementing such a strategy on health care outcomes and costs in the US. The long window of progression
from GIM to malignancy and the low incidence of GC make sufficiently powered randomized controlled trials
difficult. Simulation modeling allows for the integration of available knowledge to test multiple surveillance
regimens of GIM across a broad range of risk factor combinations, which would not be feasible in clinical
studies. By award period end, the proposed research will utilize national pathology data coupled with
simulation modeling to identify a spec...

## Key facts

- **NIH application ID:** 10215082
- **Project number:** 1K08DK125876-01A1
- **Recipient organization:** SLOAN-KETTERING INST CAN RESEARCH
- **Principal Investigator:** Monika Laszkowska
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $167,616
- **Award type:** 1
- **Project period:** 2021-05-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10215082

## Citation

> US National Institutes of Health, RePORTER application 10215082, A Targeted Approach to the Surveillance of Precursor Lesions for Gastric Cancer (1K08DK125876-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10215082. Licensed CC0.

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