Lung Cancer | Image Credit: 
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MJH Life Sciences Using AI

In a new study of nearly 1,000 consecutive patients treated for lung cancer at 

, researchers discovered only 35% would have qualified for screening according to the U.S. Preventive Services Task Force (USPSTF) screening criteria. The two-thirds of patients who would have been excluded were disproportionately women and never-smokers. Currently, 

 annual lung cancer screenings for adults ages 50-80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years – a narrow window that excludes many vulnerable individuals. 

In the new study, published on November 21 in 

, Northwestern Medicine researchers recommend expanding the universal age-based screening to 40-85. They estimate this would detect 94% of lung cancers, preventing more than 26,000 extra deaths annually. The research also demonstrates that such screening would be remarkably cost-effective, with the minimal risks from radiation exposure or biopsies far outweighed by the potential to save lives.

“We moved to universal age-based screening for breast and colon cancer with tremendous success, and we need to move to the same approach for lung cancer. Chest screening offers something unique – with one low-dose scan, we can assess lungs, heart and bones comprehensively. This baseline scan becomes invaluable for monitoring their health over time,” said 

, chief of thoracic surgery and executive director of the 

Northwestern Medicine Canning Thoracic Institute

Lung cancer remains America’s deadliest cancer, claiming more lives than breast, colon and prostate cancers combined, accounting for one in every five cancer deaths among both men and women. The disease is particularly insidious: nearly 80% of cases aren’t discovered until they’ve reached advanced stages, largely because symptoms rarely appear until it’s too late. The widespread misconception that only smokers develop lung cancer, combined with limited screening access for those without tobacco history, contributes to these devastating statistics. Researchers at the Canning Thoracic Institute predict that a universal age-based screening (40-85) could enhance detection, improve cost-effectiveness and address health inequities.

Providing low-dose CT screening to all eligible adults

In response to these findings, Northwestern Medicine has launched the 

 at the Canning Thoracic Institute to detect lung, heart and bone conditions earlier. The center, supported by a generous gift from John and Rita Canning, will encourage lung cancer screening for Northwestern Medicine patients and conduct studies to evaluate low-dose CT screening with necessary assessments in patients who might not qualify for lung cancer screening. In addition, scans from all patients will be evaluated for their ability to detect early pulmonary fibrosis, post- COVID lung damage, cardiovascular disease, osteoporosis and other conditions affecting millions of Americans. The results of these screenings will be studied and published to inform changes to existing guidelines. 

The scan that takes less than 10 seconds and doesn’t need any intravenous dyes provides a complete picture of the chest cavity, creating a baseline image patients can keep for life. This approach also addresses critical gaps in preventive care, particularly for the growing number of patients experiencing lasting respiratory effects from COVID-19 and other environmental exposures.

"Nearly six years after the pandemic's start, we're seeing increasing numbers of patients with lung scarring and fibrosis from COVID-19, especially those who get reinfected with respiratory viruses," said Dr. Bharat. “The damage compounds with each infection. Early detection through comprehensive screening can help us intervene before these conditions progress to requiring transplantation.”

The Lung Health Center addresses multiple health concerns simultaneously. Beyond respiratory conditions, the screening can detect coronary calcium deposits that indicate cardiovascular risk and can identify early signs of osteoporosis, which is particularly important for women's health. Currently, cardiovascular disease remains the leading cause of non-cancer deaths nationally, while lung disease, including cancer, represents the top cancer-related mortality for both men and women.

"This initiative transforms how we approach chest health comprehensively," said 

, interventional pulmonologist and medical director of the Canning Thoracic Institute. "Instead of waiting for symptoms to appear, we're giving patients and physicians a complete picture of chest health that can guide preventive care across multiple specialties."

The center particularly encourages screening for individuals who may have sustained lung damage from various sources:

· COVID-19 survivors experiencing ongoing respiratory issues

· People exposed to wildfire smoke, industrial pollution, or high radon levels

· Individuals with family history of lung disease or pulmonary fibrosis

· Those exposed to secondhand smoke, vaping, or marijuana use

· Asian women and other demographics at elevated risk for lung conditions

· Anyone seeking baseline chest health assessment

“We're seeing younger patients with respiratory problems from vaping, environmental exposures, and COVID-19 who would never qualify for traditional screening,” said 

, chief of pulmonary and critical care at the Canning Thoracic Institute. “This lung screening approach allows us to catch interstitial lung disease, pulmonary fibrosis, lung cancer, and other conditions years before they'd typically be diagnosed.”

Danielle Hoeg, a 45-year-old mother of three from Chicago, knows the importance of comprehensive screenings. In March 2023, Hoeg had finished breastfeeding her son and felt like something was “off” in her body. She scheduled appointments for a mammogram, colonoscopy, skin check and bloodwork, but everything came back normal – still, Hoeg couldn’t help but feel like something was wrong.

In March 2024, Hoeg underwent a full body MRI scan and the findings revealed something was happening on her lung. She was urged to see Dr. Bharat who ordered a CT and PET scan and the results came back showing the spot on Hoeg’s lung was 99.9% cancerous. Hoeg was in disbelief as she had never smoked and was in picture perfect health. Soon after, she underwent a minimally invasive lung conserving surgery at 

 where Dr. Bharat removed the spot on her lung and confirmed the non-smoker had an aggressive stage 1 lung cancer. Today, Hoeg is cancer-free but still carries the experience with her.

“Every young person I see, I immediately think, ‘do they have lung cancer? How do I convince them to get checked out?’” said Hoeg. “With more women, never-smokers and young people being diagnosed with lung cancer, I’m a huge advocate for the Lung Health Center and encourage adults to get screened.”

Carla Tapia, a mother of three from Beltsville, Md., was shocked to learn about her stage 4 lung cancer diagnosis at the age of 33. Tapia had some smoking exposure during her teenage years but quit when she was 18 and currently doesn’t meet the USPSTF screening criteria for lung cancer.

In December 2019, Tapia developed a fever and was diagnosed with pneumonia. Her symptoms progressed to a bad cough with mucus, but as the COVID pandemic hit, Tapia remained focused on her three kids and put her own health on the backburner.

By July 2020, she could no longer catch her breath and that’s when she was diagnosed with stage 4 lung cancer, which had spread to both lungs and was inoperable. For the next four years, Tapia underwent chemotherapy treatments, but the cancer kept growing. Out of options, she heard about the 

 at Northwestern Medicine, which provides double-lung transplants to select patients with advanced lung cancers.

By the summer of 2024, Tapia’s health was quickly declining, and she flew to Chicago on supplemental oxygen for a transplant evaluation. On September 12, 2024, Tapia received a life-saving double-lung transplant at Northwestern Memorial, and the 38-year-old is now back home in Maryland.

“When I was diagnosed with stage 4 lung cancer, I was told there was no cure, but thanks to Northwestern Medicine, I’m alive today and no longer having to go to the hospital for weekly chemotherapy treatments. Instead, I just finished by bachelor’s degree and am hoping to go to law school,” said Tapia. “I keep hearing stories about young people being diagnosed with lung cancer, and if we could expand the screening guidelines, I believe more lung cancers could be caught at earlier stages, and more lives would be saved.”

 through a simple process beginning with a phone consultation. Marisol Munoz, nurse practitioner for the program, guides patients through each step.

“We make this as seamless as possible for patients,” said Munoz. “From the initial call through receiving results in 24-48 hours, our team coordinates everything. We work with insurance when covered and ensure eligible patients have access regardless of coverage through the Canning's philanthropic support.”

The Lung Health Center also includes a research component where participants contribute de-identified data to help establish new screening guidelines. The center incorporates artificial intelligence to provide rapid, highly sensitive analysis of results, with the goal of delivering comprehensive health insights within seconds of scanning.

The Lung Health Center has already launched at 

 and is expanding systemwide by the end of the year. Anyone over the age of 21 is eligible, with particular emphasis on those over 40 or with risk factors.

For more information or to schedule a screening consultation, call 312.695.1800 and mention the Lung Health Center, or email lunghealthcenter@nm.org.

The pulmonology and lung surgery program at 

 in Illinois for 14 straight years and No. 7 in the U.S. For more information, visit 

Articles

A recent study at Northwestern Medicine found that only 35% of lung cancer patients met the current USPSTF screening criteria, which excludes many at-risk individuals, particularly women and never-smokers. Researchers advocate for expanding screening to ages 40-85, potentially preventing over 26,000 deaths annually. The Lung Health Center at Northwestern Medicine aims to enhance early detection of lung, heart, and bone conditions through low-dose CT scans. This comprehensive approach addresses health inequities and provides critical preventive care, especially for those with respiratory issues from COVID-19 and environmental exposures.

Northwestern Medicine researchers discovered only 35% of patients would have qualified for lung cancer screening according to the U.S. Preventive Services Task Force (USPSTF) criteria.

New Study Shows Lung Cancer Surveillance in the United States Misses Most Patients; Northwestern Medicine Researchers Urge Universal Age-Based Screening

For the first time at Northwestern Medicine, surgeons have successfully performed a combined lung-liver transplant on a patient with advanced lung cancer who had limited time to live. The patient, 69-year-old 

, a pulmonologist, allergist and immunologist from Santa Monica, Cali., was diagnosed with stage 3 lung cancer in March 2023. After undergoing chemotherapy, radiation and immunotherapy at a California hospital, Dr. Gibbon was admitted to the intensive care unit, where he learned the immunotherapy had not only permanently destroyed his lungs, but also caused irreparable damage to his liver. His only option for survival would be traveling to Chicago for a combined lung-liver transplant, where a first-of-its-kind clinical program called 

Double Lung Replacement and Multidisciplinary Care (DREAM)

 was established for select patients with advanced lung cancers that do not respond to conventional treatments. In September 2023, Dr. Gibbon received his new lungs and liver from the same donor, and six months after surgery, Dr. Gibbon still has no signs of cancer in his body and doesn’t require any further cancer therapy.

“To our knowledge, this is the first known case in the nation where a patient with advanced lung cancer has successfully received a combined lung-liver transplant,” said 

, chief of thoracic surgery and director of the 

 who performed Dr. Gibbon’s lung transplant. “The purpose of DREAM is to help patients with some forms of late-stage cancers that are only limited to the lungs through double-lung transplantation if conventional or experimental treatments have failed. In Dr. Gibbon’s case, he received all possible treatments for his aggressive lung cancer. Unfortunately, not only did his cancer not get treated, but he also developed severe damage to his lungs and liver that was unsustainable with life. He was running out of time, and the DREAM program was his only option for survival.” 

“Even though a combined lung-liver transplant for advanced lung cancer had never been done before, our team was confident we could do this, and more importantly, Dr. Gibbon had full confidence in us,” said 

, transplant surgeon and director of the 

Northwestern Medicine Comprehensive Transplant Center

 who performed Dr. Gibbon’s liver transplant. “We’re not just here to do transplant – we’re here to change the world of transplantation by innovating and moving the field forward. Out-of-the-box thinking is exactly what we hang our hat on at Northwestern Medicine, and without this procedure, I can confidently say that Dr. Gibbon would not be here today, cancer-free, breathing on his own, celebrating his 69th birthday.”

Originally from Cape Town, South Africa, Dr. Gibbon moved to Santa Monica where he was in 

 for 33 years until his recent hospitalization. He’s also an associate professor at 

. In March 2023, Dr. Gibbon started coughing and losing weight; a chest X-ray confirmed a mass with a diagnosis of stage 3 lung cancer. He proceeded with chemotherapy, immunotherapy and radiation, and by mid-July he was hospitalized with septic shock, pneumonia and multiple organ failure. His lungs had become fibrotic due to the cancer treatment, and he was fighting for his life in a Los Angeles intensive care unit.

“As a pulmonologist, I never imagined I’d ever need a lung transplant – let alone for lung cancer,” said Dr. Gibbon. “While my doctors in California had done everything they could, we knew there was only one place in the entire country that could give me a fighting chance, and after speaking with Dr. Bharat, I could see the light at the end of the tunnel.”

“Dr. Gibbon met the criteria to receive a double-lung transplant through our DREAM program, but as the preliminary evaluation was performed prior to his acceptance to Northwestern Medicine, our team discovered that he had also developed liver cirrhosis from the immunotherapy. We had to modify our DREAM program and work with Dr. Nadig’s team to formulate a pathway for Dr. Gibbon to receive not only a double-lung transplant, but a concurrent liver transplant. Fortunately, we were able to do it just in time for Dr. Gibbon to receive this first-of-its-kind procedure,” said Dr. Bharat.

On Sept. 10, the then 68-year-old was transported to Chicago via a four-hour medical flight and waited for new organs from his ICU bed at 

. After spending 12 days on the transplant waitlist, Dr. Gibbon received his new lungs shortly before midnight on Sept. 26, and his new liver in the early hours on Sept. 27.

Drs. Bharat and Nadig worked together during the 10-hour procedure. While the new lungs were put in first, the donor liver was kept alive outside the body thanks to new technology called 

 – or “liver in a box.” The liver was attached to a machine that pumps warm, oxygenated and nutrient-enriched blood through the organ. With the liver was on the pump, the team could assess its function to ensure the liver was ideal for transplantation.

“Transplantation is ever evolving and we’re embarking upon the era of technology. Dr. Bharat anticipated that the lung transplant would be extremely challenging due to the size of Dr. Gibbon’s tumor and the different types of treatments, including radiation, to the lungs and chest which would result in the lungs getting fused to the surrounding structures. To give Dr. Bharat sufficient time to meticulously remove the damaged lungs and all the cancer, we used the new liver perfusion technology through which we were able to keep the liver alive outside the body for an extended duration,” said Dr. Nadig. “Dr. Gibbon’s transplant took so many resources and teams across multiple departments at multiple health systems. To leave his ICU bed in California, travel to Chicago, get him listed, then transplanted, while using technologies and techniques that aren’t common, took extreme efforts. Northwestern Medicine handles complicated cases very well.”

To date, the Canning Thoracic Institute (CTI) has performed more than 30 lung transplants for patients under the DREAM program, including several with terminal stage IV lung cancer and one in which cancer from another organ had spread to the lungs. Using lessons learned from 

 in the United States, CTI surgeons developed the novel surgical technique to clear the cancer during surgery while minimizing the risk of spread that has plagued prior such attempts at other hospitals.

“Unlike the conventional technique of sequential transplants, this innovative technique involves putting the patient on full heart and lung bypass, delicately taking both cancer-ridden lungs out at the same time along with the lymph nodes, washing the airways and the chest cavity to clear the cancer, and then putting new lungs in,” said Dr. Bharat. “These patients can have billions of cancer cells in the lungs, so we must be extremely meticulous to not let a single cell spill into the patient’s chest cavity or blood stream. We believe this technique can help reduce the risk of recurrence, which we learned through our experience with pioneering COVID-19 lung transplants.”

The outcomes of the program’s patients are being tracked in a research registry also called 

. Dr. Gibbon is grateful to have his name added to the list and is even more appreciative to celebrate his birthday (March 27) and National Doctors’ Day (March 30) with two of the physicians who helped save his life. To date, the Northwestern Medicine Canning Thoracic Institute is the only place in the nation offering this treatment for patients without any other hope.

“I’ve been a physician for decades, and we tend to be conservative at times with our treatment plans, which is why the enormity of the science that went into this procedure is awe-inspiring to me,” said Dr. Gibbon. “As a physician, I knew I was in the right place. I wasn’t just stepping on the moon by myself. It took surgeons, oncologists, transplant specialists, nurses, respiratory therapists and most importantly, my donor, to help me get my ‘Triple L’ – two lungs and a liver. This DREAM program is new territory for transplantation and the fact that I could experience it and have a wonderful outcome makes me feel so blessed. I wouldn’t be here today without Northwestern Medicine.”

“Because Dr. Gibbon is a pulmonologist and allergy specialist, he’s familiar with lung diseases, which made this case even more special,” said Dr. Bharat. “As physicians helping another physician, we feel very proud that we were able to do something that hopefully opens the doors for future patients who would otherwise not survive.”

Cancers of the lung are the leading cause of cancer-related deaths in the United States with more people dying of lung cancer than colon, breast and prostate cancers combined. Lung cancer patients interested in being evaluated for a lung transplant can contact the 

 at 844.639.5864. For more information about Northwestern Medicine’s transplant programs, as well as advanced therapies, visit 

Gary Gibbon, MD, pulmonologist and allergist, visited Chicago for a first-of-its-kind transplant procedure, becoming the first person in the U.S. to receive a double-lung and liver transplant for advanced lung cancer.



California Doctor Receives Northwestern Medicine’s First Combined Lung-Liver Transplant for Advanced Lung Cancer

A new artificial intelligence (AI) tool may make it possible to spare breast cancer patients unnecessary chemotherapy treatments by using a more precise method of predicting their outcomes, reports a new Northwestern Medicine study.

AI evaluations of patient tissues were better at predicting the future course of a patient’s disease than evaluations performed by expert pathologists.

The AI tool was able to identify breast cancer patients who are currently classified as high or intermediate risk but who become long-term survivors. That means the duration or intensity of their chemotherapy could be reduced. This is important since chemotherapy is associated with unpleasant and harmful side effects such as nausea, or more rarely, damage to the heart.

Currently, pathologists evaluate cancerous cells in a patient’s tissue to determine treatment. But patterns of non-cancerous cells are very important in predicting outcomes, the study showed.

This is the first study to use AI for comprehensive evaluation of both the cancerous and non-cancerous elements of invasive breast cancer.

“Our study demonstrates the importance of non-cancer components in determining a patient’s outcome,” said corresponding study author Lee Cooper, PhD, associate professor of pathology at Northwestern University Feinberg School of Medicine. “The importance of these elements was known from biological studies, but this knowledge has not been effectively translated to clinical use.”

In 2023, about 300,000 U.S. women will receive a diagnosis of invasive breast cancer. 

About one in eight US women will receive a breast cancer diagnosis in their lifetime

During diagnosis, a pathologist reviews the cancerous tissue to determine how abnormal the tissue appears. This process, known as grading, focuses on the appearance of cancer cells and has remained largely unchanged for decades. The grade, determined by the pathologist, is used to help determine what treatment a patient will receive.

Many studies of breast cancer biology have shown that the non-cancerous cells, including cells from the immune system and cells that provide form and structure for the tissue, can play an important role in sustaining or inhibiting cancer growth.

Cooper and colleagues built an AI model to evaluate breast cancer tissue from digital images that measure the appearance of both cancerous and non-cancerous cells, as well as interactions between them.

“These patterns are challenging for a pathologist to evaluate as they can be difficult for the human eye to categorize reliably,” said Cooper, also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “The AI model measures these patterns and presents information to the pathologist in a way that makes the AI decision-making process clear to the pathologist.”

The AI system analyzes 26 different properties of a patient’s breast tissue to generate an overall prognostic score. The system also generates individual scores for the cancer, immune and stromal cells to explain the overall score to the pathologist. For example, in some patients, a favorable prognosis score may be due to properties of their immune cells, where for others it may be due to properties of their cancer cells. This information could be used by a patient’s care team in creating an individualized treatment plan.

Adoption of the new model could provide patients diagnosed with breast cancer with a more accurate estimate of the risk associated with their disease, empowering them to make informed decisions about their clinical care, Cooper said.

Additionally, this model may help in assessing therapeutic response, allowing treatment to be escalated or de-escalated depending on how the microscopic appearance of the tissue changes over time. For example, the tool may be able to recognize the effectiveness of a patient’s immune system in targeting the cancer during chemotherapy, which could be used to reduce the duration or intensity of chemotherapy.

“We also hope that this model could reduce disparities for patients who are diagnosed in community settings,” Cooper said. “These patients may not have access to a pathologist who specializes in breast cancer, and our AI model could help a generalist pathologist when evaluating breast cancers.”

The study was conducted in collaboration with the American Cancer Society (ACS) which created a unique dataset of breast cancer patients through their Cancer Prevention Studies. This dataset has representation of patients from over 423 U.S. counties, many whom received a diagnosis or care at community medical centers. This is important because most studies typically use data from large academic medical centers which represent only a portion of the U.S. population. In this collaboration, Northwestern developed the AI software while scientists at the ACS and National Cancer Institute provided expertise on breast cancer epidemiology and clinical outcomes.

To train the AI model, scientists required hundreds of thousands of human-generated annotations of cells and tissue structures within digital images of patient tissues. To achieve this, they created an international network of medical students and pathologists across several continents. These volunteers provided this data through a website over several years to make it possible for the AI model to reliably interpret images of breast cancer tissue.

Next, the scientists will evaluate this model prospectively to validate it for clinical use. This coincides with the transition to using digital images for diagnosis at Northwestern Medicine, which will happen over the next three years.

The scientists also are working to develop models for more specific types of breast cancers like triple-negative or HER2-positive. Invasive breast cancer encompasses several different categories, and the important tissue patterns may vary across these categories.

“This will improve our ability to predict outcomes and will provide further insights into the biology of breast cancers,” Cooper said.

Other Northwestern authors include Mohamed Amgad Tageldin, Kalliopi Siziopikou, and Jeffery Goldstein.

A new artificial intelligence tool may make it possible to spare breast cancer patients unnecessary chemotherapy treatments by using a more precise method of predicting their outcomes.

Robert H. Lurie Comprehensive Cancer Center of Northwestern University Northwestern Medicine

Articles

New Study Shows Lung Cancer Surveillance in the United States Misses Most Patients; Northwestern Medicine Researchers Urge Universal Age-Based Screening

California Doctor Receives Northwestern Medicine’s First Combined Lung-Liver Transplant for Advanced Lung Cancer

AI May Spare Breast Cancer Patients Unnecessary Treatments