Dr. Chaturvedi earned a degree in veterinary medicine (1999) from the Andhra Pradesh Agricultural University, India and an M.P.H. (2002) and Ph.D. (2004) in epidemiology from Tulane University. He joined IIB as a postdoctoral fellow in 2005, became a research fellow in 2007, was appointed as a tenure-track investigator in 2009, and was awarded scientific tenure and promoted to senior investigator in November 2016. He joined the Clinical Epidemiology Unit of the Clinical Genetics Branch in 2017.
Dr. Chaturvedi studies the molecular epidemiology of two common cancers—head and neck cancers and lung cancers. His work addresses research questions on etiology and natural history that have high potential for translation into efforts for screening and early detection of head and neck cancers and lung cancers.
Head and Neck Cancers
Head and neck cancers encompass cancers at several anatomic sites, including:
- Oral cavity (lip, oral tongue, gum, floor of mouth, hard palate, and buccal mucosa and other parts of the mouth)
- Oropharynx (base of tongue, tonsil, soft palate and uvula, pharyngeal wall, and Waldeyer ring)
- Other parts of the pharynx (nasopharynx and hypopharynx)
Head and neck cancer overall is the eighth most common cancer worldwide, with an estimated annual burden of 686,000 incident cases and 376,000 deaths. Tobacco in the form of smoking and chewing, betel-quid chewing, and alcohol use are established risk factors for all head and neck cancer subsites. Other emerging risk factors for head and neck cancer include poor oral hygiene and low fruit and vegetable consumption. Importantly, research over the past 15 years has identified HPV infection as an etiologic agent for oropharyngeal cancers. It is currently believed that oral cavity and larynx cancers are rarely (<5%) caused by HPV infection.
Given the recent recognition of HPV’s etiologic role in oropharyngeal cancer, Dr. Chaturvedi’s work addresses the epidemiology of HPV-positive oropharyngeal cancer as well as the epidemiology and natural history of oral HPV infections. He also studies the unique anatomic, histopathologic, and molecular characteristics of HPV-positive oropharyngeal cancers to understand the reasons underlying the vastly improved survival outcomes for these patients. He addresses these questions through population-based studies in the U.S.
Cancers of the oral cavity are ideal candidates for early detection and secondary prevention given the amenability for visual inspection and specimen collection and the availability of recognized precursor lesions, defined clinically and histologically. Yet, there are currently no guidelines for screening, treatment, or follow-up of patients with oral cancer precursor lesions due to several gaps in the current knowledge base. Dr. Chaturvedi is using a combination of retrospective and prospective cohort studies to address key questions pertaining to the natural history of oral cancer precursor lesions, epidemiologic and molecular predictors of progression of precursor lesions to cancer, methods for screening of oral cancer precursors, and the development of oral cancer risk stratification tools.
Lung cancer is the most common cancer, with an estimated 1.6 million annual incident cases worldwide and 230,000 cases in the United States. Cigarette smoking is the predominant risk factor for lung cancer, accounting for 80-90% of all lung cancers. Yet, smoking is neither necessary nor sufficient for lung cancer, underscoring the role of additional factors in lung carcinogenesis.
Dr. Chaturvedi studies the role of chronic inflammation in the etiology of lung cancer, through the identification of the inflammation mediators and pathways involved in lung carcinogenesis. He also studies the association of chronic inflammation with smoking, the primary lung cancer risk factor, to identify smoking-dependent and smoking-independent components of inflammation involved in lung carcinogenesis. Much of this work is conducted through the measurement of circulating immune/inflammation marker levels in case-control studies nested within large prospective cohorts.
Dr. Chaturvedi also conducts research on the development, validation, and application of lung cancer risk stratification tools, in collaboration with Dr. Hormuzd Katki. In 2011, the landmark National Lung Screening Trial (NLST) showed that, compared with chest radiography, three annual screens with low-dose computed tomography (LDCT) resulted in a 20% reduction in lung cancer mortality among 55-74 year-old smokers with at least 30 pack-years of smoking and no more than 15 years since quitting smoking. Based on these results, LDCT screening is currently recommended for smokers that meet the NLST entry criteria. In the U.S., there are currently 9 million smokers who meet the recommendations for LDCT screening, 20 million smokers in the recommended age range (55-80 years), and 94 million ever smokers of all ages. Given these numbers, as well as the costs and potential harms of LDCT screening, there is a growing recognition in the field to target screening to the highest risk smokers.
Dr. Chaturvedi conducts research on the potential utility of lung cancer risk prediction tools to improve the population-level effectiveness of LDCT screening in the United States. He specifically addresses questions regarding which smokers should be targeted for LDCT screening and how screen-positive individuals should be clinically managed. Additionally, he studies minimally invasive lung cancer biomarkers for improved risk stratification.
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