Lung cancer, the leading cause of cancer deaths worldwide, is often detected in late stages when treatments may not be as effective. Early in his career, Avrum Spira, M.D., M.Sc., dealt with this firsthand when treating a patient who came to Boston Medical Center with worsening shortness of breath. They found she had stage IV lung cancer, but all the team could do was offer her palliative care.
Dr. Spira has devoted decades to developing bioinformatic approaches to address the challenge of detecting and diagnosing lung cancer at early stages. His laboratory pioneered a technology to utilize the concept of “field of molecular injury” to detect lung cancer. Through the NCI’s Early Detection Research Network, the “brushing” technology was shown to be an effective means to enable the identification of biochemical changes that may be due to carcinogen exposure.
In 2015, Dr. Spira and his colleagues identified a molecular signature for lung cancer in current and former smokers using bronchoscopy, sampling the first airway passages that branch from the windpipe. These regions are more accessible than the small airways buried deep in the lungs, where pulmonary lesions can occur. The new method reduces the need for invasive, risky biopsies to identify potential cancers and resulted in a commercial test.
In a 2017 study, Dr. Spira’s team extended the field of injury even farther. They found that gene expression profiles of cells obtained by swabbing the nasal passages improved a predictor for current and former smokers with lung cancer. Dr. Spira also leads efforts to find new, noninvasive biomarkers, such as the Detection of Early lung Cancer Among Military Personnel (DECAMP) studies.
Dr. Spira is a professor of medicine, pathology, and bioinformatics at Boston University and global head of the Lung Cancer Initiative at Johnson & Johnson. He was elected a member of the American Society for Clinical Investigation in 2010 and a member of the Association of American Physicians in 2017.
To learn more about Dr. Spira, see his 2020 Annual Advances in Cancer Prevention Lecture, hosted by the NCI Cancer Prevention Fellowship Program.