New York City-based Montefiore Einstein Comprehensive Cancer Center is diagnosing more patients with stage 1 lung cancer than stage 4 for the first time in decades.
In 2024, stage 4 lung cancer diagnoses fell to 34% while stage 1 diagnoses increased to 45%, according to a Nov. 20 news release from the health system.
The shift follows efforts to detect cancer earlier through low-dose CT screening and the creation of the Follow-Up ASsessmenT of Lung Nodules Clinic, or FAST clinic. Montefiore Einstein collaborated with community members to co-create educational materials for the Bronx community and deployed nurse and peer navigators to boost patient engagement.
Launched in 2021, the FAST clinic uses artificial intelligence and clinical navigation to triage patients whose lung nodules were found incidentally during unrelated care. To date, the clinic has received more than 1,000 referrals that have led to more than 80 lung cancer diagnoses.
Brendon Stiles, MD, chief of thoracic surgery and surgical oncology at Montefiore Einstein and associate director of surgical services at Montefiore Einstein Comprehensive Cancer Center, said the system has been able to enroll about 20% of screen-detected lung cancer patients into clinical trials.
Dr. Stiles spoke with Becker’s about the steps Montefiore took to reach this shift in diagnoses and what other health systems can learn from its success.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What were the most critical operational or clinical changes your team made to drive this shift in lung cancer diagnosis in the Bronx community?
Dr. Brendon Stiles: Lung cancer screening, for us, used to live in radiology, which made sense because it’s a radiologic exam.
We’ve operationalized the process by moving it into the Cancer Center, applied extra resources and really focused on the end result. We focused not only on how many patients were getting screened, but what were the timelines after they had a nodule found? How many had cancer? What happens downstream from that?
But lung cancer screening can’t stand alone without an incidental nodule program.
[In] our FAST clinic, led by one of my partners, Dr. Neil Shutter, any patient in the hospital who comes to the ER, comes to the cardiac services or anywhere a primary care physician has found a lung nodule, [providers] can just click a button and send that patient right to the lung nodule clinic.
We make sure they get appropriate follow-up in a timely fashion. The clinic dramatically changed our timelines for care. It has kept more patients in the Bronx, led to more stage 1 diagnoses and really driven the falling rates stage 4 diagnoses.
Question: What lessons have emerged about follow-up procedures, patient navigation or clinical care coordination through the FAST clinic?
BS: It’s been a lot of work and elbow grease for our team. The heart and soul of the team is our lung cancer screening nurse practitioners, but also the nurse practitioners who work with all of us in the FAST clinic, our radiologists and medical oncologists. It really just is a huge team effort.
The biggest lesson for me is to put the providers together. For us, the FAST Nodule Clinic is thoracic surgeons and interventional pulmonologists, who are often the ones who do the diagnosis. If needed, our interventional pulmonary team can jump into action and perform navigational bronchoscopy.
By finding these nodules early, we’re curing early-stage lung cancers or diagnosing in the right way. For the nodules that aren’t cancer — because we’re biopsying beforehand — we’re not doing unnecessary surgeries.
Q: Outside of the incidental findings, how were you able to build trust within the Bronx community to increase participation in lung cancer screening?
BS: We were lucky to get a funded grant with our partners, Longevity, called Project Urbana. It focused on increasing screening access, but also building trust in the Latin American and Black communities. We really took that to heart.
We developed community panels and surveys. We asked our patients in our catchment area what they thought about lung cancer screening, what their reservations were and how we could better communicate it to them. They developed handouts in multiple different languages and went out into the communities to talk about the importance of cancer screening.
With lung cancer screening, there’s a lot of stigma and fear. It is still dramatically underutilized compared to other screening modalities.
But a CT scan is much easier than colonoscopy and mammography. It is important to address the smoking stigma while helping people understand what happens if you find a nodule, when you need to worry and when you don’t.
About 20% of our patients are never smokers. There are important implications there [related to] environmental exposures, family history and higher incidence in particular ethnic groups. We’re trying to educate and talk about all those factors.
If you think about it, there really is no screening option for patients who haven’t smoked, but we know there are lots of patients who haven’t smoked who get lung cancer. That’s where the importance of an incidental nodule program comes in.
Leave a Reply