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This article was written by Dr. Michael Gieske , Family Medicine Specialist and Director of Lung Cancer Screening for St. Elizabeth.

Dr. Gieske is Director of Lung Cancer Screening for St. Elizabeth, a program that has completed 25,000 screenings in the past 10 years, helping Kentucky to achieve the second highest rate of screening in the nation. Video provided by St. Elizabeth.

Q: What is your area of specialization?

A: I have been a family medicine practitioner for 30 years. In 2016, I joined the Thoracic Oncology Disease Management team at St. Elizabeth Healthcare as the primary care representative. Today, I am the Director of Lung Cancer Screening.

Q: What’s something surprising about this area of medicine that people might not know?

A: Lung cancer is a devastating scourge on the lives of my patients and their families. Lung cancer kills more individuals than breast, colon and prostate cancer combined. It kills three times as many women as breast cancer.

Lung cancer is deadly for two reasons: it’s extremely aggressive and fast-moving, and it’s historically found too late only after symptoms appear. The good news is that low-dose CT scanning has made a big difference by finding lung cancer in the early stages when the chance of a cure is much greater.

St. Elizabeth began lung cancer screening with low-dose CT scanning in 2013. We assembled a passionate and energetic team that has worked collectively to build one of the strongest, most exemplary lung cancer screening programs in the country.

That first year, we performed seven screenings. This year alone, we’re on track to exceed 8,000. To date, we’ve completed more than 25,000 lung cancer screenings. We’re finding nearly 70% of lung cancers in the early stages when the chance of curing it can exceed 90%. Many patients now are alive 10 to 15 years later with no evidence of disease.

So far, we’ve found nearly 400 lung cancers through the St. Elizabeth screening program. That’s one lung cancer for every 62 screenings we’ve performed.

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Q: What is St. Elizabeth doing in this field that is innovative, unique or leading edge that is helping patients?

A: In addition to our screening efforts, St. Elizabeth offers the latest technologies and treatments that can cure lung cancer, even in the late stages. Endoscopic diagnostic evaluations, advanced robotic surgery, highly precise radiation treatments, as well as the latest in precision medicine targeted therapies and immunotherapy, are tremendously improving the outcomes and survival for patients with lung cancer in all stages.

St. Elizabeth has implemented routine biomarker testing for directed therapies for patients with lung cancer. Often lung cancer has genetic variants or mutations, called driver mutations, that prohibit the body from fighting cancer through normal immunologic pathways. Many drugs are now available for specific mutations that can restore the body’s ability to combat these cancers. New ones are coming to market nearly daily.

Our phenomenal team of nurse navigators guides patients through the screening process, the diagnosis and subsequent care of their lung cancer. They communicate with patients, as well as their healthcare providers. This service and innovative approach to continuity of care is being recognized nationally.

Kentucky has one of the highest lung cancer rates in the nation. Dr. Geiske leads the St. Elizabeth Lung Cancer Screening program, where we’re finding nearly 70% of lung cancers in the early stages when the chance of curing it can exceed 90%. Photo provided by St. Elizabeth.

We also work closely with numerous patient advocacy groups to raise awareness of lung cancer and promote lung cancer screening. Real-life experiences make an immeasurable impact, and many patients within and outside our health system are willing to share their stories through the White Ribbon Project, Home – Breath of Hope KY, Inc. and Lung Cancer Patient Stories published on the St. Elizabeth website.

Additionally, we work closely with LungCAN (Lung Cancer Action Network), a grassroots coalition of various lung cancer support groups, to promote lung cancer research and raise research funding dollars for the deadliest cancer in the country. Through this effort, we hope to see research dollars for lung cancer from the Department of Defense and Congressionally Directed Medical Research Program increased from $20 million to $60 million. Currently, breast cancer receives $150 million.

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We’re working at this locally, as well. We were instrumental in advocating for and testifying before the Kentucky State Congress to pass House Bill 219, which will dedicate $1 million over two years to promote lung cancer screening in our state. This bill was signed into law on July 15.

Q: What is currently on the horizon for your specialty? What advances might we expect in the next few years?

A: Presently, St. Elizabeth uses the United States Preventive Services Task Force (USPSTF) 2021 lung cancer screening guidelines. This includes screening people between ages 50 and 80 who have a 20-year history of smoking a pack of cigarettes a day and who have smoked within the last 15 years.

Our program recognizes that there are other risk factors for lung cancer, and we are involved in shaping the future of lung cancer screening. This will involve the consideration of multiple risk factors, including radon exposure, secondhand smoke exposure, industrial and environmental exposures, family history, the presence of chronic lung disease, educational level and other things. We have begun to shift an equal amount of focus to the 20% of lung cancers that are not due to smoking.

St. Elizabeth is involved with research in collaboration with the World Health Organization and an affiliate organization in Lyon, France, to validate a blood test that identifies predictive biomarkers that make an individual more prone to develop lung cancer. The future of lung cancer screening will involve recognition of all these risk factors and will utilize artificial intelligence (AI) and sophisticated computerized algorithms to determine who gets screened, at what age and at what intervals. We are at the forefront of this science.

We are also concentrating on a new detection strategy called Multi-Cancer Early Detection (MCED) and Single-Cancer Early Detection (SCED). This is a fascinating and quickly evolving area of medicine. When a cancer is present, it sheds tiny amounts of cell-free DNA (cfDNA) into the bloodstream. This can be detected in the tiniest amounts through a blood test or “liquid biopsy.” This cfDNA leaves a fingerprint that indicates which organ the cancer came from. Lung cancer is one of more than 50 cancers that can be detected by these tests. We offer this test. It’s not yet approved by the FDA or covered by insurance, but both aren’t far off. Currently, we’re also conducting research with a company in Tel Aviv, Israel, to validate a SCED test for lung cancer that will be affordable and easily accessible. Eventually, these types of tests will become part of routine wellness exams and cancer screenings.

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In a third area, St. Elizabeth has partnered with Eon, a company that uses AI and computational linguistics to read through reports for X-rays, CT scans and MRIs of the chest. This product looks for keywords or phrases that suggest a suspicious lung nodule or other finding is present. Those nodules, once identified, are assembled into reports that help us track and manage the patients with these findings to coordinate their care and make sure we don’t inadvertently miss anything or lose them to follow-up.

Low-dose CT scanning is a quick and painless test that makes a big difference by finding lung cancer in the early stages when the chance of a cure is much greater. New guidelines call for screening people between ages 50 and 80 who have a 20-year history of smoking a pack of cigarettes a day and who have smoked within the last 15 years. Photo provided by St. Elizabeth.

Q: From your perspective as a family practitioner focused on lung cancer, what should people be aware of to prevent disease or catch it early?

A: The most significant step to preventing lung cancer is to never start smoking or to quit if you do smoke. Between 80% and 90% of lung cancer deaths in the United States are caused by cigarette smoke. Even secondhand smoke from cigarettes, cigars and pipes increases your risk of developing the disease.

Next to smoking cessation, the importance of screening for and early detection of lung cancer can’t be overstated. Currently, Kentucky is No. 2 in the country for screening eligible patients for lung cancer, and we’re anticipated to be No. 1 by the end of 2022.

If someone is a current or former smoker, they should talk with their primary care provider about screening. It’s important that they have their first low-dose CT scan as soon they qualify. Our providers at St. Elizabeth are committed to extending screening to as many of our eligible patients as possible.

Learn more about our lung cancer screening program and take a quick assessment to learn if you qualify for a low-dose CT scan.

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