CORE Posters Fall 2025

Group G

Cancer Long-Term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Hisham Zahid, MS, Mahad Alam, BS, Yen Ha, BS, Ayeshah Qureshi, MS, Mallory Duggan, BS, Elijah Akinade, MPH, Jessica Nicholson, MAT, Bernard Kadio, MD, PhD, MPH Edward Via College of Osteopathic Medicine, Preventative Medicine, Blacksburg, VA

Abstract

Results

Discussion

Lung cancer remains a leading cause of cancer-related death, with rural and underserved populations facing higher risk due to tobacco use, occupational exposures, and environmental factors. To improve screening, we developed the Cancer Long-term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Lung Cancer Risk Screening Tool, an evidence-based model designed for community health centers. Risk factors identified through a targeted literature review included age, smoking history, COPD severity, radon, asbestos, air pollution, family history, and secondhand smoke. Weighted scores (0 – 26) were assigned based on relative contribution and synergistic effects, with patients stratified into low (0 – 6), moderate (7 –13), and high (≥14) risk categories. An initial feasibility assessment studied clarity, applicability, and integration into clinical practice. By combining traditional and environmental risk factors, the C.L.A.I.R.E. tool offers a practical, multivariable approach to guide low-dose CT screening and reduce disparities in lung cancer prevention. Future studies will refine thresholds and validate its predictive accuracy. Community health centers play a vital role in addressing health needs, especially for those who are uninsured or underinsured. Many of these centers, clinics, and mobile units are run by smaller organizations, and volunteer efforts are crucial to meet the needs of these communities. According to the 2024 New River Community Health Assessment (NRCHA), malignant neoplasms rank as the second leading cause of death. The assessment particularly highlights a high prevalence of lung disease in the area, with tobacco use identified as a significant contributing factor to the development of these diseases. At the Community Health Center of the New River Valley (CHCNRV), there are currently over 400 patients documented as active smokers who have not received a lung cancer risk assessment or undergone informed decision making to determine the necessity of screening. This study aims to identify risk factors and develop a screening tool for identifying those who qualify for low-dose computed tomography (LDCT). The findings from this research will help decrease the prevalence and mortality of lung cancer, especially in at-risk populations of rural communities like Montgomery County. Evidence Review and Risk Factor Selection A targeted literature review of recent meta-analyses, clinical guidelines, and validated prediction models was conducted to identify the most significant contributors to lung cancer risk. The final set of factors included age, smoking history, COPD severity, residential radon exposure, occupational asbestos exposure, outdoor air pollution, family history of lung cancer, and secondhand smoke exposure. Weight Assignment and Scoring Framework Each risk factor was assigned a weighted point value proportional to its relative impact on lung cancer development. The framework emphasized dose – response relationships and recognized synergistic effects. Smoking history carried the highest weight, while interaction bonuses were applied when multiple exposures were present (e.g., smoking combined with asbestos or elevated radon exposure). Risk Stratification and Tool Design The resulting Cancer Long-term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Lung Cancer Risk Screening Tool calculates a cumulative score on a Moderate Risk (7 – 13 points): Shared decision-making regarding LDCT screening. High Risk (≥14 points): Strong recommendation for LDCT screening, with expedited referral if interaction bonuses are present. This structured approach ensures that lung cancer risk is evaluated holistically, while remaining practical for use in rural and resource-limited health settings. Introduction Methods 0 – 26 point scale. Patients are stratified into three categories: Low Risk (0 – 6 points): Routine care and preventive counseling.

The C.L.A.I.R.E. tool was developed to address lung cancer screening gaps in rural and underserved populations. It integrates both traditional factors, like age and smoking, and additional risks such as COPD, radon, asbestos, air pollution, family history, and secondhand smoke. By assigning weighted scores, it captures dose – response effects and combined exposures, stratifying patients into low risk (counseling and prevention), moderate risk (shared decision-making for LDCT), and high risk (strong LDCT recommendation). Pilot testing will assess feasibility, clarity, and smooth integration into community clinic workflows.

Conclusions

The C.L.A.I.R.E. scoring criteria offer a comprehensive and evidence-based method for lung cancer risk stratification by integrating age, smoking history, COPD severity, environmental exposures, air pollution, family history, and secondhand smoke. By categorizing patients into low, moderate, or high risk, the tool aligns clinical recommendations with appropriate low-dose CT screening strategies. As a multivariable model, C.L.A.I.R.E. supports informed, patient-centered decision making in lung cancer prevention and early detection. Future implementation studies across diverse and underserved populations will be essential to validate its sensitivity and specificity, refine thresholds, and strengthen its role as a standardized screening tool in community health settings.

• OR = Odds Ratio (relative risk compared to baseline). • 95% CI = 95% Confidence Interval. • Pack -years = (packs smoked per day) × (years smoked). • yr = years. • Bq/m³ = Becquerels per cubic meter (radon concentration unit).

• GOLD = Global Initiative for Chronic Obstructive Lung Disease staging for COPD. • LDCT = Low -Dose Computed Tomography (lung cancer screening modality).

Acknowledgements

We would like to thank the Community Health Center of the New River Valley for their support and commitment to improving rural health outcomes. Special thanks to our faculty mentors and colleagues at the Edward Via College of Osteopathic Medicine (VCOM – Virginia) for their guidance throughout this project. Finally, we are grateful to the patients and community members whose needs inspired the development of the C.L.A.I.R.E. Lung Cancer Risk Screening Tool.

References

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Risk Stratification: • Low Risk (0–6 points): Routine care; prevention and monitoring.• Moderate Risk (7 – 13 points): Shared decision-making for LDCT; consider mitigation. • High Risk (≥ 14 points): Recommend LDCT promptly; expedite if interaction bonuses apply.