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Non small cell lung cancer (NSCLC) detection through a novel approach at Notre Dame

Author: Juan Cisneros

Rlac Esteem TeamPresenting at the 7th Annual Harper Cancer Research Day L to R: Daniel Hogan, Marissa Koscielski, Juan Cisneros, Claire Kleinschmidt, Brady Riesgraf, Cian O’Donnell

Lung cancer is the leading cause of cancer-related deaths in both the U.S. and the state of Indiana, killing more people per year than breast, prostate, and colon cancers combined. Most cases of lung cancer are currently diagnosed after a patient is symptomatic, in which case, the cancer is typically late-stage with a higher mortality rate.


Early diagnosis of non-small cell lung cancer (NSCLC) is critical to improving life expectancy, and thanks to the introduction of a novel low dose computed tomography (LDCT) scanning technology, there is great opportunity for lung cancer survival rates to rapidly improve. Researchers predict this new screen could save 15,000 lives per year if only half the eligible population obtain LDCT scans. Although this scan is covered under Medicare reimbursements and is offered for free or at a reduced cost, many people are not aware of the scan or do not have access to nearby screening centers. It is estimated that less than 2% of the eligible population is currently being scanned.


After researching lung cancer treatment disparities, Juan Cisneros (ESTEEM ’18), decided more needed to be done, especially in Northern Indiana where smoking and lung cancer rates are higher than national averages. To further explore existing issues with lung cancer awareness and screening throughput in Midwestern communities, Cisneros built out a team of Notre Dame ESTEEM graduate students, bringing on Cian O’Donnell, Claire Kleinschmidt, Marissa Koscielski, Brady Riesgraf, and Daniel Hogan. The team also received the guidance of pulmonary specialist Matthew Koscielski, M.D. (‘85), and Geographic Information Systems Librarian, Matthew Sisk, Ph.D.


Ultimately, the long-term goal of this study is to understand the obstacles leading to late-stage lung cancer diagnosis. The team aims to reduce treatment disparities and improve accessibility/awareness for lung cancer screening   opportunities for high-risk populations in neglected areas.


Instead of taking a laboratory approach, Cisneros and team opted to use their training in lean-startup methodology – driven by customer interviews and human-centered design – to understand the status of LDCT scanning, lung cancer detection, and generate sustainable solutions to current issues. After receiving the Research Like a Champion Grant in the Fall of 2018, this interdisciplinary team got to work.


Cisneros and team hypothesized that health disparity issues in rural Indiana contributed to both the lack of awareness and accessibility of the scan. The scan currently is being marketed in many areas of the U.S. but may not effectively reach rural regions. Furthermore, due to the necessary collaboration of referring physicians, screening centers, and radiologists, rural health systems may be unable to reach eligible smokers. Using global information systems (GIS) modeling and stakeholder interviews in rural Indiana communities, they sought to find possible breaks in the pipeline for awareness, detection, treatment, and post-care. Every week, the team traveled to rural areas determined by GIS analyses of data from the U.S. Census, the American College of Radiology, and the County Health Rankings & Roadmaps (CHRR) program. The team interacted with these communities in five counties in Indiana, accruing conversations with 265 potential “scanees” and visited local restaurants and stores to gather community health interviews.


After compiling and analyzing these interviews, the work revealed a number of issues in referring patients from their primary care physicians and generally educating rural smoking populations about the existence and availability of the scan. Kleinschmidt and Cisneros have continued work on a GIS model to select areas that have the largest populations of individuals eligible for the scan (smoking history and age). From there, counties are categorized as either (1) having a screening clinic but needing awareness or (2) out of range of a screening clinic and needing access. Thanks to a second round of funding through the Research Like a Champion program and the Harper Cancer Research Institute (HCRI), the team is working on de-risking a novel awareness strategy targeting rural Indiana communities in need of the scan. On July 26th, 2018, Cisneros presented this work at the 19th Annual International Lung Cancer Congress and the team will be attending the LUNG FORCE Expo in September to further evaluate awareness models with the community and disseminate current findings.


Mentorship from national lung cancer research institutes and local clinicians continues to shape this project advised by Dr. Matthew Koscielski and Dr. Matthew Sisk. Graeme White ‘19G, Odhran Reidy ‘19G, and Madison Heide ’20C will work on implementing this campaign Fall of 2018 – Spring 2019 and evaluating other options, such as mobile lung cancer screening.

Originally published by Juan Cisneros at on September 12, 2018.