# Project 2: Mitigating Lung Cancer Disparities in Native Hawaiians: A Population-Based Approach to Evaluate Prevention Barriers and Lung Tumor Biology

> **NIH NIH P20** · UNIVERSITY OF HAWAII AT MANOA · 2023 · $294,649

## Abstract

ABSTRACT
We have shown in the Multiethnic Cohort (MEC) that Native Hawaiians have a markedly higher risk of lung
cancer and a poorer survival from the disease compared to (non-Hispanic) Whites, even after accounting for
smoking history and other risk/prognostic factors. This excess risk was observed for the two most common
histologic cell-types: adenocarcinoma and squamous cell carcinoma as well as for small-cell lung cancer, a more
aggressive cell-type. The poorer survival is observed with early stage and not advanced disease. We have made
extensive efforts in the study of genetics, epigenetics and smoking and tobacco carcinogens-related biomarkers
to understand the differences in lung cancer risk across populations. While the high risk in African Americans
and low risk in Japanese Americans can be explained by higher and lower smoking intensity (carcinogens dose
per cigarette), due to smoking behavior and lower nicotine metabolism, respectively, reasons for the risk excess
in Native Hawaiians remain to be elucidated. Lung cancer screening using low-dose Computed Tomography
(LDCT) among adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke, or
have quit within the past 15 years, has been found to decrease mortality. However, the state of Hawaii ranks last
in the proportion of lung cancers diagnosed at an early stage (19% vs. the national average of 24%), with less
than 3% of high-risk smokers undergoing LDCT scan (national average is 6%). Studies have suggested that the
use of risk-based prediction models may be more effective than the U.S. Preventive Services Task Force
(USPSTF) criteria at identifying high-risk smokers for lung cancer screening. However, both the USPSTF
guidelines and these risk prediction models were derived from data collected in mostly European-descent
populations. We also found that there may be distinct biological processes related to tumorigenicity that
contribute to the excess risk and poor disease outcomes for Native Hawaiians. We observed differences in
epigenetic patterns in blood leukocyte DNA associated with smoking dose in Native Hawaiians when compared
to other racial/ethnic groups, with the differential methylation occurring in cancer-related genes. To reduce the
lung cancer burden of Native Hawaiians, we propose a multilevel translational study to identify the individual-
and provider-based barriers for lung cancer screening to develop an intervention strategy to be disseminated in
collaboration with the Hawaii Department of Health (Aim 1), to better identify those at greatest risk of developing
lung cancer by computing a Native Hawaiian-specific risk prediction model (Aim 2), and to characterize the tumor
pathobiology associated with the poor survival of Native Hawaiian lung cancer patients (Aim 3). Study findings
will provide critical information along the continuum of lung cancer healthcare for a high risk minority population.
During this grant cycle, we will develop collabor...

## Key facts

- **NIH application ID:** 10716155
- **Project number:** 1P20CA275734-01A1
- **Recipient organization:** UNIVERSITY OF HAWAII AT MANOA
- **Principal Investigator:** Sungshim Lani Park
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $294,649
- **Award type:** 1
- **Project period:** 2023-09-19 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10716155

## Citation

> US National Institutes of Health, RePORTER application 10716155, Project 2: Mitigating Lung Cancer Disparities in Native Hawaiians: A Population-Based Approach to Evaluate Prevention Barriers and Lung Tumor Biology (1P20CA275734-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10716155. Licensed CC0.

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