Duke University is one of three sites that have been awarded a total of $4.4 million National Institutes of Health/National Cancer Institute Cancer Intervention and Surveillance Modeling Network (CISNET) comparative modeling funding. Duke will receive $1.2 million in funding.
The CISNET grant will be used to study ways of reducing uterine cancer mortality through primary prevention, screening and treatment approaches. In addition to Duke, the other research sites that are part of the study cohort are Columbia University (lead site) and Mt. Sinai Medical Center. CISNET is a consortium of National Cancer Institute (NCI)-sponsored investigators who use simulation modeling to improve the understanding of cancer control interventions in prevention, screening and treatment and their effects on population trends in incidence and mortality. These models can be used to guide public health research and priorities, and they can aid in the development of optimal cancer control strategies (more information at https://cisnet.cancer.gov/).
Duke’s CISNET investigators are Laura Havrilesky, MD, MHSc (Gynecologic Oncology); Evan Myers, MD, MPH (Women’s Community & Population Health, Obstetrics and Gynecology); Haley Moss, MD, MBA (Gynecologic Oncology); and Marc Ryser, PhD (Dept. of Population Health Sciences and Dept. of Mathematics).
“Uterine cancer is the fourth most common cancer and the sixth leading cause of cancer mortality among women, but this cancer ranks only 17th in annual NCI funding,” notes Duke Cancer Institute’s Dr. Laura Havrilesky. “Of even greater concern, both the incidence and mortality rate of uterine cancer are increasing. The average annual increase in mortality from uterine cancer is greater than from any other malignancy in either males or females. Despite a well understood natural history and the availability of diagnostic tests to detect uterine cancer, screening is not routine and evidence-based recommendations for screening and prevention are lacking. Finally, for those women diagnosed with uterine cancer, optimal treatment strategies and precision therapeutics are often uncertain.”
In this five-year, multi-site incubator project, the CISNET researchers will develop and apply three independent population-level, natural history models of uterine cancer. They will apply these models to clinical scenarios in which decision making is uncertain, explore how changes in epidemiologic risk factors including the rising obesity rate and declining hysterectomy rate influence current and future incidence and mortality, and develop tools for policymakers to facilitate cancer control and prevention activities.
“We anticipate that this work will be imminently actionable for patients, providers and policy makers. The findings of this work can be quickly utilized to develop strategies for screening and prevention using widely available and emerging tests and therapies,” says Dr. Havrilesky. “These data will provide estimates of the effectiveness and cost-effectiveness for these strategies for populations at varying risk. Similarly, this work will help inform treatment decision making for women with newly diagnosed, metastatic uterine cancer, for adjuvant therapy, and for treatment of recurrent disease. Our models will provide precision estimates weighing harms, benefits, and costs for patients based on disease characteristics as well as underlying individual characteristics such as age and co-morbidities. And importantly, these models will be leveraged to examine racial disparities including the influence of social determinants of health as well as population-level changes in obesity and the rate of hysterectomy. We will then utilize this work to develop strategies as well as an interactive web-based tool to help guide state and local cancer control and prevention activities.”