Tracing Lung Cancer in Appalachian Kentucky

In 2011, the Department of Defense awarded University of Kentucky Markey Cancer Center researcher Susanne Arnold a three-year grant to study potential environmental reasons for the high lung cancer rates in Eastern Kentucky. She is looking at exposure to trace elements (some of which are known carcinogens like arsenic, cadmium, chromium, nickel, and lead) through samples of water and soil, hair, blood, urine, and toenails.

As a native Kentuckian, the University of Kentucky Markey Cancer Center's Dr. Susanne Arnold understands many of the health issues our state faces — and focusing on the problems that hit hardest close to home has kept her motivated in her work. 

"I got into research in Appalachia because I'm an eighth-generation Kentuckian, and my father, who was also a doctor and researcher, was a seventh-generation Kentuckian," Arnold said. "I learned a very valuable lesson from him — that we can't make progress in the treatment of diseases without being invested in the research that we do." 

Since becoming a clinician at UK in 1998, Arnold has devoted much of her time and effort into studying one of Kentucky's deadliest diseases — lung cancer. Kentucky ranks top in the nation in rates of lung cancer incidence and mortality, and this problem is especially magnified in the eastern region of the state. 

In fact, lung cancer incidence and death rates are the highest in the nation in the Appalachian region of Kentucky. Tobacco use is the leading cause of lung cancer, and 25 percent of Kentuckians smoke, compared to the 21 percent of people nationally. But smoking on its own doesn't explain the discrepancy between southeastern Kentucky and the rest of the nation, says Arnold. 

"We know that tobacco is the number one cause of lung cancer, but that isn't the only factor causing the high cancer burden for southeastern Kentucky," Arnold said. "So we started to look for other possible reasons. Could environmental carcinogens play a role?"

In 2011, Arnold and her colleagues were awarded a $1.43 million grant by the Department of Defense to study potential environmental reasons — such as trace elements in soil or water — for the high lung cancer rates in Eastern Kentucky. 

Although trace amounts of metals (such as iron) are necessary for the body's normal functions, prolonged exposure to trace elements including arsenic, beryllium, cadmium, cobalt, chromium, nickel and vanadium has been linked to several types of cancer — including lung cancer. These trace elements are known to promote carcinogenesis by increasing oxidative stress, inflammation and DNA damage, and reduced DNA repair efficiency. 

Undertaking a project of this scope takes a major team effort by multiple communities at UK. Completing the study wouldn't be possible without the collaboration of UK's Center for Rural Health, particular the Kentucky Homeplace program run by Fran Feltner. Kentucky Homeplace is an advocacy organization known and trusted throughout southeastern Kentucky. The organization provides access to medical, social, and environmental services for the citizens of the Commonwealth. 

Kentucky Homeplace staff perform much of the data-gathering for Arnold's study, which involves going into the homes of both healthy volunteers and volunteers with cancer. Workers gather information about health-related issues, health practices, environmental exposures, and job history. They also collect water and soil samples from the home, as well as samples of hair, blood, urine, and even toenails from the residents themselves. 

The partnership with Kentucky Homeplace is crucial, says Arnold, because the people that actually go out and collect the information are natives to the area and know the community well. 

"They are an outstanding community partner that knows the area, they live here, they are trusted, and they know what works and what doesn't work," Arnold said. "Without them, we couldn't do this study. It wouldn't be possible."   

Additionally, The UK Center for Clinical and Translational Science has supported Arnold’s research by providing courier transport of the biospecimens from Hazard, Ky. beginning in January 2012.  Transport of these biospecimens in a timely manner facilitates the examination of the relationship of environmental conditions to lung cancer by UK’s top cancer biologists in the UK Graduate Center for Toxicology.  Plans are underway for CCTS study coordinators based at the Centers for Rural Health in Hazard and Morehead, Ky. to assist with recruitment of research participants to Arnold’s study. 

Arnold's study runs through 2014, and in the end, she says the findings will lead researchers in new directions to reach one goal: reducing the lung cancer burden on her fellow Kentuckians. 

"We will learn things from this study that will lead us to new discoveries and new questions," Arnold said. "And hopefully those new discoveries will impact the people of this region,  help to detect cancer earlier, or help figure out how to avoid cancer in the first place. That's the whole goal."