Korean Americans (KAs) have by far the highest stomach cancer incidence, with 5 times higher incidence compared to non-Hispanic whites (NHWs). Resembling the development of esophageal adenocarcinoma from Barrett's esophagus, metaplastic changes in the stomach known as gastric intestinal metaplasia (GIM) and subsequent development of dysplasia are important pre-malignant stages in the multi-step carcinogenesis in the stomach. However, there are no clear surveillance guidelines for GIM in the US due to the scarcity of research on the rate of progression and determinants of progression of GIM in the diverse populations in the United States (US) as well as in the high-risk countries. Investigating lifestyle and molecular determinants and rate of progression of GIM will enable risk-stratification and personalized recommendations for surveillance.

This pilot study aims to build a multidisciplinary community-engaged collaboration to establish a longitudinal study of KA GIM in the Norris Comprehensive Cancer Center catchment area. First, we will start with a retrospective chart review project, which will likely highlight the importance of a larger prospective research, and help us plan further collaborative grant application. We also aim to test feasibility of molecular profiling (genomics and proteomics) utilizing archived paraffin embedded tissue (FFPE) of GIM biopsy samples.

Results from this pilot study will provide the team with additional data to gain insights in to the prevalence of GIM in this high risk population and design a larger study to investigate the rate of progression to malignant cancer. By identifying the rate of malignant progression and identifying a subgroup of GIM patients who are more likely to develop cancer, this investigation will inform clinicians and policy makers to develop a refined screening/surveillance guidelines for GIM patients, thus reducing the medical and financial burden in lower-risk GIM patients and the risk of rare but serious complications associated with endoscopy.

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