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Early Onset Colorectal Cancer: Trends in Incidence and Screening

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Early Onset Colorectal Cancer: Trends in Incidence and Screening
Author(s)
Aasma Shaukat, MD, MPH, AGAF

Click to view more from Gastroenterology Data Trends 2022.

References
  1. Nfonsam VN, Jecius HC, Janda J, et al. Cartilage oligomeric matrix protein (COMP) promotes cell proliferation in early-onset colon cancer tumorigenesis. Surg Endosc. 2020;34(9):3992-3998. doi:10.1007/s00464-019-07185-z
  2. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. doi:10.1093/jnci/djw322
  3. Loomans-Kropp HA, Umar A. Increasing incidence of colorectal cancer in young adults. J Cancer Epidemiol. 2019;2019:9841295. doi:10.1155/2019/9841295
  4. Gausman V, Dornblaser D, Anand S, et al. Risk factors associated with early-onset colorectal cancer. Clin Gastroenterol Hepatol. 2020;18(12):2752-2759.e2. doi:10.1016/j.cgh.2019.10.009
  5. Use of colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated November 3, 2021. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/statistics/use-screening-tests-BRFSS.htm
  6. Lee JK, Lam AY, Jensen CD, et al. Impact of the COVID-19 pandemic on fecal immunochemical testing, colonoscopy services, and colorectal neoplasia detection in a large United States community-based population. Gastroenterology. 2022;S0016-5085(22)00503-0. doi:10.1053/j.gastro.2022.05.014
  7. Zhao G, Li H, Yang Z, et al. Multiplex methylated DNA testing in plasma with high sensitivity and specificity for colorectal cancer screening. Cancer Med. 2019;8:5619-5628. doi:10.1002/cam4.2475
  8. Abualkhair WH, Zhou M, Ahnen D, Yu Q, Wu XC, Karlitz JJ. Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age. JAMA Netw Open. 2020;3(1):e1920407. doi:10.1001/jamanetworkopen.2019.20407
  9. Burnett-Hartman AN, Lee JK, Demb J, Gupta S. An update on the epidemiology, molecular characterization, diagnosis, and screening strategies for early-onset colorectal cancer. Gastroenterology. 2021;160(4):1041-1049. doi:10.1053/j.gastro.2020.12.068
  10. Gu J, Li Y, Yu J, et al. A risk scoring system to predict the individual incidence of early-onset colorectal cancer. BMC Cancer. 2022;22(1):122. doi:10.1186/s12885-022-09238-4
  11. Lou S, Shaukat A. Noninvasive strategies for colorectal cancer screening: opportunities and limitations. Curr Opin Gastroenterol. 2021;37(1):44-51. doi:10.1097/MOG.0000000000000688
  12. Fecal immunochemical test (FIT). MedlinePlus. Updated July 1, 2021. Accessed July 7, 2022. https://medlineplus.gov/ency/patientinstructions/000704.htm
  13. Colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated February 17, 2022. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm
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Author(s)
Aasma Shaukat, MD, MPH, AGAF
Author(s)
Aasma Shaukat, MD, MPH, AGAF

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References
  1. Nfonsam VN, Jecius HC, Janda J, et al. Cartilage oligomeric matrix protein (COMP) promotes cell proliferation in early-onset colon cancer tumorigenesis. Surg Endosc. 2020;34(9):3992-3998. doi:10.1007/s00464-019-07185-z
  2. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. doi:10.1093/jnci/djw322
  3. Loomans-Kropp HA, Umar A. Increasing incidence of colorectal cancer in young adults. J Cancer Epidemiol. 2019;2019:9841295. doi:10.1155/2019/9841295
  4. Gausman V, Dornblaser D, Anand S, et al. Risk factors associated with early-onset colorectal cancer. Clin Gastroenterol Hepatol. 2020;18(12):2752-2759.e2. doi:10.1016/j.cgh.2019.10.009
  5. Use of colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated November 3, 2021. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/statistics/use-screening-tests-BRFSS.htm
  6. Lee JK, Lam AY, Jensen CD, et al. Impact of the COVID-19 pandemic on fecal immunochemical testing, colonoscopy services, and colorectal neoplasia detection in a large United States community-based population. Gastroenterology. 2022;S0016-5085(22)00503-0. doi:10.1053/j.gastro.2022.05.014
  7. Zhao G, Li H, Yang Z, et al. Multiplex methylated DNA testing in plasma with high sensitivity and specificity for colorectal cancer screening. Cancer Med. 2019;8:5619-5628. doi:10.1002/cam4.2475
  8. Abualkhair WH, Zhou M, Ahnen D, Yu Q, Wu XC, Karlitz JJ. Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age. JAMA Netw Open. 2020;3(1):e1920407. doi:10.1001/jamanetworkopen.2019.20407
  9. Burnett-Hartman AN, Lee JK, Demb J, Gupta S. An update on the epidemiology, molecular characterization, diagnosis, and screening strategies for early-onset colorectal cancer. Gastroenterology. 2021;160(4):1041-1049. doi:10.1053/j.gastro.2020.12.068
  10. Gu J, Li Y, Yu J, et al. A risk scoring system to predict the individual incidence of early-onset colorectal cancer. BMC Cancer. 2022;22(1):122. doi:10.1186/s12885-022-09238-4
  11. Lou S, Shaukat A. Noninvasive strategies for colorectal cancer screening: opportunities and limitations. Curr Opin Gastroenterol. 2021;37(1):44-51. doi:10.1097/MOG.0000000000000688
  12. Fecal immunochemical test (FIT). MedlinePlus. Updated July 1, 2021. Accessed July 7, 2022. https://medlineplus.gov/ency/patientinstructions/000704.htm
  13. Colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated February 17, 2022. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm
References
  1. Nfonsam VN, Jecius HC, Janda J, et al. Cartilage oligomeric matrix protein (COMP) promotes cell proliferation in early-onset colon cancer tumorigenesis. Surg Endosc. 2020;34(9):3992-3998. doi:10.1007/s00464-019-07185-z
  2. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. doi:10.1093/jnci/djw322
  3. Loomans-Kropp HA, Umar A. Increasing incidence of colorectal cancer in young adults. J Cancer Epidemiol. 2019;2019:9841295. doi:10.1155/2019/9841295
  4. Gausman V, Dornblaser D, Anand S, et al. Risk factors associated with early-onset colorectal cancer. Clin Gastroenterol Hepatol. 2020;18(12):2752-2759.e2. doi:10.1016/j.cgh.2019.10.009
  5. Use of colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated November 3, 2021. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/statistics/use-screening-tests-BRFSS.htm
  6. Lee JK, Lam AY, Jensen CD, et al. Impact of the COVID-19 pandemic on fecal immunochemical testing, colonoscopy services, and colorectal neoplasia detection in a large United States community-based population. Gastroenterology. 2022;S0016-5085(22)00503-0. doi:10.1053/j.gastro.2022.05.014
  7. Zhao G, Li H, Yang Z, et al. Multiplex methylated DNA testing in plasma with high sensitivity and specificity for colorectal cancer screening. Cancer Med. 2019;8:5619-5628. doi:10.1002/cam4.2475
  8. Abualkhair WH, Zhou M, Ahnen D, Yu Q, Wu XC, Karlitz JJ. Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age. JAMA Netw Open. 2020;3(1):e1920407. doi:10.1001/jamanetworkopen.2019.20407
  9. Burnett-Hartman AN, Lee JK, Demb J, Gupta S. An update on the epidemiology, molecular characterization, diagnosis, and screening strategies for early-onset colorectal cancer. Gastroenterology. 2021;160(4):1041-1049. doi:10.1053/j.gastro.2020.12.068
  10. Gu J, Li Y, Yu J, et al. A risk scoring system to predict the individual incidence of early-onset colorectal cancer. BMC Cancer. 2022;22(1):122. doi:10.1186/s12885-022-09238-4
  11. Lou S, Shaukat A. Noninvasive strategies for colorectal cancer screening: opportunities and limitations. Curr Opin Gastroenterol. 2021;37(1):44-51. doi:10.1097/MOG.0000000000000688
  12. Fecal immunochemical test (FIT). MedlinePlus. Updated July 1, 2021. Accessed July 7, 2022. https://medlineplus.gov/ency/patientinstructions/000704.htm
  13. Colorectal cancer screening tests. Centers for Disease Control and Prevention. Updated February 17, 2022. Accessed July 7, 2022. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm
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The literature calls early-onset CRC a “distinct disease,” because of its molecular characteristics, challenges in diagnosis, and often poor prognosis.1 Patients with early-onset CRC often have a close family member with colon cancer, yet often ignore symptoms like abdominal pain. Among individuals with a firstdegree relative with colon cancer, those younger than age 50 years are half as likely to have undergone a colonoscopy as those 50 years and older.2 When symptoms do appear, the average time to diagnosis is 128 days for those younger than 50 vs 79 days for those older than 50.3

What is important to consider is the life stage in which these patients find themselves. A cancer diagnosis in a patient’s 40s—accounting for about three-quarters of early-onset cases4—comes in the middle of a career, of raising a family, of living a full life. Therefore, noninvasive screening is so important for those at risk of early onset CRC: An easier screening procedure takes less time than a colonoscopy procedure can consume.

CRC screening rates remain suboptimal, even among persons aged 50 and older. As of 2020, approximately 30% to 35% of adults older than 50 in the United States had never been screened for colorectal cancer.5 Strategies to improve CRC screening rates include organized outreach programs and use of noninvasive CRC screening tests. These tests do not replace colonoscopy but complement them.

Acceptance of FIT is high and can reduce CRC incidence and mortality.6 Industry has been working on devising other noninvasive options, which in their newer iterations are starting to show diagnostic relevance.7 These options may help all individuals due or overdue for CRC screening.

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New Treatment Pathways for Cystic Fibrosis

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Wed, 11/09/2022 - 15:48
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New Treatment Pathways for Cystic Fibrosis
Author(s)
David Finklea, MD

Click to view more from Pulmonology Data Trends 2022.

References
  1. Cystic Fibrosis Foundation. What is cystic fibrosis? https://www. cff.org/intro-cf/about-cystic-fibrosis. Accessed June 17, 2022.
  2. Middleton PG, Mall MA, Dřevínek P, et al. Elexacaftor-tezacaftor-ivacaftor for cystic fibrosis with a single Phe508del allele. N Engl J Med. 2019;381(19):1809-1819. doi:10.1056/NEJMoa1908639
  3. McGarry ME, McColley SA. Cystic fibrosis patients of minority race and ethnicity less likely eligible for CFTR modulators based on CFTR genotype. Pediatr Pulmonol. 2021;56(6):1496-1503. doi:10.1002/ppul.25285
  4. O’Connor KE, Goodwin DL, NeSmith A, et al. Elexacaftor/ tezacaftor/ivacaftor resolves subfertility in females with CF: a two center case series. J Cyst Fibros. 2021;20(3):399-401. doi:10.1016/j.jcf.2020.12.011
  5. Shteinberg M, Taylor-Cousar JL, Durieu I, Cohen-Cymberknoh M. Fertility and Pregnancy in Cystic Fibrosis. Chest. 2021;160(6):2051-2060. doi:10.1016/j.chest.2021.07.024
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CHEST Physician
Topics
Pulmonology
Author(s)
David Finklea, MD
Author(s)
David Finklea, MD

Click to view more from Pulmonology Data Trends 2022.

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References
  1. Cystic Fibrosis Foundation. What is cystic fibrosis? https://www. cff.org/intro-cf/about-cystic-fibrosis. Accessed June 17, 2022.
  2. Middleton PG, Mall MA, Dřevínek P, et al. Elexacaftor-tezacaftor-ivacaftor for cystic fibrosis with a single Phe508del allele. N Engl J Med. 2019;381(19):1809-1819. doi:10.1056/NEJMoa1908639
  3. McGarry ME, McColley SA. Cystic fibrosis patients of minority race and ethnicity less likely eligible for CFTR modulators based on CFTR genotype. Pediatr Pulmonol. 2021;56(6):1496-1503. doi:10.1002/ppul.25285
  4. O’Connor KE, Goodwin DL, NeSmith A, et al. Elexacaftor/ tezacaftor/ivacaftor resolves subfertility in females with CF: a two center case series. J Cyst Fibros. 2021;20(3):399-401. doi:10.1016/j.jcf.2020.12.011
  5. Shteinberg M, Taylor-Cousar JL, Durieu I, Cohen-Cymberknoh M. Fertility and Pregnancy in Cystic Fibrosis. Chest. 2021;160(6):2051-2060. doi:10.1016/j.chest.2021.07.024
References
  1. Cystic Fibrosis Foundation. What is cystic fibrosis? https://www. cff.org/intro-cf/about-cystic-fibrosis. Accessed June 17, 2022.
  2. Middleton PG, Mall MA, Dřevínek P, et al. Elexacaftor-tezacaftor-ivacaftor for cystic fibrosis with a single Phe508del allele. N Engl J Med. 2019;381(19):1809-1819. doi:10.1056/NEJMoa1908639
  3. McGarry ME, McColley SA. Cystic fibrosis patients of minority race and ethnicity less likely eligible for CFTR modulators based on CFTR genotype. Pediatr Pulmonol. 2021;56(6):1496-1503. doi:10.1002/ppul.25285
  4. O’Connor KE, Goodwin DL, NeSmith A, et al. Elexacaftor/ tezacaftor/ivacaftor resolves subfertility in females with CF: a two center case series. J Cyst Fibros. 2021;20(3):399-401. doi:10.1016/j.jcf.2020.12.011
  5. Shteinberg M, Taylor-Cousar JL, Durieu I, Cohen-Cymberknoh M. Fertility and Pregnancy in Cystic Fibrosis. Chest. 2021;160(6):2051-2060. doi:10.1016/j.chest.2021.07.024
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Cystic fibrosis is a deadly genetic disorder, affecting 80,000 people worldwide.1,2 The disorder is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.2 This gene codes for a protein that creates epithelial channels in the respiratory track, along with other organs. Mutations in this gene can create improper ion balance, leading to thick and sticky mucus that blocks airways in the lungs and contributes to infections in people with CF (pwCF).1

Currently, there is no cure for cystic fibrosis, but newer research is looking into modulating the CFTR gene from multiple pathways by repairing, restoring, or replacing the CFTR protein.1,2 At this point, CFTR modulators are the most promising new treatments for cystic fibrosis.

CFTR modulators involve repairing the CFTR protein made from this gene. To qualify for treatment with this class of drugs, people with cystic fibrosis need to have certain CFTR mutations. Fortunately, approximately 90% of pwCF qualify for CFTR modulators.1,2 Due to this, the Cystic Fibrosis Foundation is working on finding alternative therapies that are listed below.1

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Risk Assessment in Pulmonary Arterial Hypertension

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Wed, 11/09/2022 - 15:50
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Risk Assessment in Pulmonary Arterial Hypertension
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Sandeep Sahay, MD, MSc, FCCP, ATSF

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References
  1. Sahay S, Balasubramanian V, Memon H, et al. Utilization of risk assessment tools in management of PAH: a PAH provider survey. Pulm Circ. 2022;12(2):e12057. doi:10.1002/pul2.12057
  2. Sahay S, Tonelli AR, Selej M, Watson Z, Benza RL. Risk assessment in patients with functional class II pulmonary arterial hypertension: comparison of physician gestalt with ESC/ERS and the REVEAL 2.0 risk score. PLoS One. 2020;15(11):e0241504. doi:10.1371/journal.pone.0241504
  3. Galiè N, Channick RN, Frantz RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J. 2019;53(1):1801889. doi:10.1183/13993003.01889-2018
  4. Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889. doi:10.1183/13993003.00889-2017
  5. Wilson M, Keeley J, Kingman M, Wang J, Rogers F. Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States. Pulm Circ. 2020;10(3):2045894020950186. doi:10.1177/2045894020950186
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CHEST Physician
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Pulmonary Arterial Hypertension
Author(s)
Sandeep Sahay, MD, MSc, FCCP, ATSF
Author(s)
Sandeep Sahay, MD, MSc, FCCP, ATSF

Click to view more from Pulmonology Data Trends 2022.

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References
  1. Sahay S, Balasubramanian V, Memon H, et al. Utilization of risk assessment tools in management of PAH: a PAH provider survey. Pulm Circ. 2022;12(2):e12057. doi:10.1002/pul2.12057
  2. Sahay S, Tonelli AR, Selej M, Watson Z, Benza RL. Risk assessment in patients with functional class II pulmonary arterial hypertension: comparison of physician gestalt with ESC/ERS and the REVEAL 2.0 risk score. PLoS One. 2020;15(11):e0241504. doi:10.1371/journal.pone.0241504
  3. Galiè N, Channick RN, Frantz RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J. 2019;53(1):1801889. doi:10.1183/13993003.01889-2018
  4. Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889. doi:10.1183/13993003.00889-2017
  5. Wilson M, Keeley J, Kingman M, Wang J, Rogers F. Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States. Pulm Circ. 2020;10(3):2045894020950186. doi:10.1177/2045894020950186
References
  1. Sahay S, Balasubramanian V, Memon H, et al. Utilization of risk assessment tools in management of PAH: a PAH provider survey. Pulm Circ. 2022;12(2):e12057. doi:10.1002/pul2.12057
  2. Sahay S, Tonelli AR, Selej M, Watson Z, Benza RL. Risk assessment in patients with functional class II pulmonary arterial hypertension: comparison of physician gestalt with ESC/ERS and the REVEAL 2.0 risk score. PLoS One. 2020;15(11):e0241504. doi:10.1371/journal.pone.0241504
  3. Galiè N, Channick RN, Frantz RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J. 2019;53(1):1801889. doi:10.1183/13993003.01889-2018
  4. Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889. doi:10.1183/13993003.00889-2017
  5. Wilson M, Keeley J, Kingman M, Wang J, Rogers F. Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States. Pulm Circ. 2020;10(3):2045894020950186. doi:10.1177/2045894020950186
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Properly assessing risk level at the time of diagnosis and follow up is crucial for understanding each patient’s case, identifying modifiable barriers and the most appropriate treatment options, and, ultimately, optimizing survival outcomes for pulmonary arterial hypertension (PAH). Despite the variety of risk assessment tools and electronic medical records at clinicians’ disposal, these resources remain underutilized.1

A survey, designed by CHEST’s Pulmonary Vascular Disease section of the Pulmonary Vascular and Cardiovascular Network, asked members to share insight into their use and perceptions of PAH risk assessment tools in clinical practice. Although the ability of proper risk assessment to greatly improve patient care has been demonstrated in the literature and is recommended by most clinical guidelines, the results of this survey revealed that more than one-third of specialists were not using guideline-recommended risk tools to assess PAH, and only 7% reported that risk assessment tools impacted their treatment decision in new patient care and evaluation.1-4

There is a lack of consensus in patterns of risk tool use among physicians, with 58% reporting that they use more than one tool. In addition to continued clinical research to support the use of available tools and the development of new ones, clinician education programs can help increase the positive impact that risk assessment has on patient survival and other outcomes.1,5

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Diversity in the Gastroenterology Workforce and its Implications for Patients

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Diversity in the Gastroenterology Workforce and its Implications for Patients
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Sandra Quezada, MD, MS, AGAF

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References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
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Sandra Quezada, MD, MS, AGAF
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Sandra Quezada, MD, MS, AGAF

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References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
References
  1. Welch M. Required curricula in diversity and cross-cultural medicine: the time is now. J Am Med Womens Assoc (1972). 1998;53(3 Suppl):121-3, 130. PMID:17598289. 
  2. Carethers JM. Toward realizing diversity in academic medicine. J Clin Invest. 2020;130(11):5626-5628. doi:10.1172/JCI144527 
  3. Guevara JP, Adanga E, Avakame E, Carthon MB. Minority faculty development programs and underrepresented minority faculty representation at US medical schools. JAMA. 2013;310(21):2297-2304. doi:10.1001/jama.2013.282116 
  4. Guevara JP, Wade R, Aysola J. Racial and ethnic diversity at medical schools – why aren’t we there yet? N Engl J Med. 2021;385(19):1732-1734. doi:10.1056/NEJMp2105578
  5. Dill J, Akosionu O, Karbeah JM, Henning-Smith C. Addressing systemic racial inequity in the health care workforce. Health Affairs. September 10, 2020. Accessed July 12, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20200908.133196/full/ 
  6. Carr RM, Quezada SM, Gangarosa LM, et al; Governing Board of the American Gastroenterological Association. From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology. Gastroenterology. 2020;159(5):1637-1647. doi:10.1053/j.gastro.2020.07.044 
  7. American Gastroenterological Association. AGA equity project. Accessed July 11, 2022. https://gastro.org/aga-leadership/initiatives-and-programs/aga-equity-project/ 
  8. Barnes EL, Loftus EV Jr, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology. 2021;160(3):677-689. doi:10.1053/j.gastro.2020.08.064 
  9. White PM, Iroku U, Carr RM, May FP; Association of Black Gastroenterologists and Hepatologists Board of Directors. Advancing health equity: The Association of Black Gastroenterologists and Hepatologists. Nat Rev Gastroenterol Hepatol. 2021;18(7):449-450. doi: 10.1038/s41575-021-00464-y 
  10. Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States medical school academic faculty workforce diversity, institutional characteristics, and geographical distributions from 2014-2018. Cureus. 2022;14(2):e22292. doi:10.7759/cureus.22292 
  11. Weiss J, Balasuriya L, Cramer LD, et al. Medical students’ demographic characteristics and their perceptions of faculty role modeling of respect for diversity. JAMA Netw Open. 2021;4(6):e2112795. doi:10.1001/jamanetworkopen.2021.12795 
  12. Association of American Medical Colleges (AAMC). Medical school enrollment more diverse in 2021. December 8, 2021. Accessed June 29, 2022. https://www.aamc.org/news-insights/press-releases/medical-school-enrollment-more-diverse-2021 
  13. Silvernale C, Kuo B, Staller K. Racial disparity in healthcare utilization among patients with irritable bowel syndrome: results from a multicenter cohort. Neurogastroenterol Motil. 2020;33(5):e14039. doi: 10.1111/nmo.14039 
  14. Robinett K, Kareem R, Reavis K, Quezada S. A multi-pronged, antiracist approach to optimize equity in medical school admissions. Med Educ. 2021;55(12):1376-1382. doi:10.1111/medu.14589 
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Diversity in the Gastroenterology Workforce and its Implications for Patients
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As the US population has become more diverse, the medical community has advocated for students, faculty, and curricula to reflect these changes. Understanding and addressing a patient’s culture and socioeconomic situation is vital to their well-being, and physicians who share in the cultural backgrounds and lived experiences of their patients are more likely to bring this insight and understanding to medicine.1 Yet over the last 2 decades, diversity among medical faculty is largely unchanged. One author recently wrote that students who are Black, Indigenous, and people of color (BIPOC) would be hard-pressed to find role models that look like them, as these populations are underrepresented among medical faculty.2-4

In 2020, the upsurge of the Black Lives Matter movement combined with the COVID-19 pandemic’s exposure of health disparities prompted society to better acknowledge socioeconomic inequalities and health organizations to revisit these issues.5,6 The AGA has introduced many crucial initiatives in collaboration with its Diversity Committee, including the AGA Equity  Project – a multiyear strategic plan designed to: eliminate health disparities and inequities in access, support GI research that aligns with the realities of multicultural patient populations, and educate AGA members and staff about unconscious bias.7

Further diversification of the gastroenterology workforce will ultimately benefit all patients – perhaps most notably patients from diverse backgrounds and lived experiences. Diagnosis and treatment outcomes in multiple digestive-tract diseases are disparate across different races and ethnicities. The literature has demonstrated that patients are more comfortable discussing sensitive health issues and undergoing procedures in the care of doctors with whom they share a similar  cultural background.8,9

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Increasing Surveillance Programs and Expanding Treatment Options in HCC

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Increasing Surveillance Programs and Expanding Treatment Options in HCC
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Amit Singal, MD, MS

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References
  1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6. doi:10.1038/s41572-020-00240-3
  2. Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global trends in incidence rates of primary adult liver cancers: a systematic review and meta-analysis. Front Oncol. 2020;10:171. doi:10.3389/fonc.2020.00171
  3. Lee YT, Wang JJ, Luu M, et al. The mortality and overall survival trends of primary liver cancer in the United States. J Natl Cancer Inst. 2021;113(11):1531-1541. doi:10.1093/jnci/djab079
  4. Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis. Hepatology. 2021;73(2):713-725. doi:10.1002/hep.31309
  5. Parikh ND, Mehta AS, Singal AG, Block T, Marrero JA, Lok AS. Biomarkers for the early detection of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev. 2020;29(12):2495-2503. doi:10.1158/1055-9965.EPI-20-0005
  6. Berhane S, Toyoda H, Tada T, et al. Role of the GALAD and BALAD-2 serologic models in diagnosis of hepatocellular carcinoma and prediction of survival in patients. Clin Gastroenterol Hepatol. 2016;14(6):875-886.e6. doi:10.1016/j.cgh.2015.12.042
  7. Lin N, Lin Y, Xu J, et al. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun. 2022;6(7):1753-1763. doi:10.1002/hep4.1918
  8. Del Poggio P, Mazzoleni M, Lazzaroni S, D'Alessio A. Surveillance for hepatocellular carcinoma at the community level: Easier said than done. World J Gastroenterol. 2021;27(37):6180-6190. doi:10.3748/wjg.v27.i37.6180
  9. Byrd K, Alqahtani S, Yopp AC, Singal AG. Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma. Semin Liver Dis. 2021;41(1):1-8. doi:10.1055/s-0040-1719178
  10. Mazzaferro V, Citterio D, Bhoori S, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial [published correction appears in Lancet Oncol. 2020;21(8):e373]. Lancet Oncol. 2020;21(7):947-956. doi:10.1016/S1470-2045(20)30224-2
  11. Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional therapy approaches for hepatocellular carcinoma: recent advances and management strategies. Cancers (Basel). 2020;12(7):1914. doi:10.3390/cancers12071914
  12. Salem R, Johnson GE, Kim E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology. 2021;74(5):2342-2352. doi:10.1002/hep.31819
  13. Cheng AL, Qin S, Ikeda M, et al. Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. J Hepatol. 2022;76(4):862-873. doi:10.1016/j.jhep.2021.11.030
  14. Tzartzeva K, Obi J, Rich NE, et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018;154(6):1706-1718.e1. doi:10.1053/j.gastro.2018.01.064
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GI and Hepatology News
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Hepatocellular Carcinoma
Author(s)
Amit Singal, MD, MS
Author(s)
Amit Singal, MD, MS

Click to view more from Gastroenterology Data Trends 2022.

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References
  1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6. doi:10.1038/s41572-020-00240-3
  2. Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global trends in incidence rates of primary adult liver cancers: a systematic review and meta-analysis. Front Oncol. 2020;10:171. doi:10.3389/fonc.2020.00171
  3. Lee YT, Wang JJ, Luu M, et al. The mortality and overall survival trends of primary liver cancer in the United States. J Natl Cancer Inst. 2021;113(11):1531-1541. doi:10.1093/jnci/djab079
  4. Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis. Hepatology. 2021;73(2):713-725. doi:10.1002/hep.31309
  5. Parikh ND, Mehta AS, Singal AG, Block T, Marrero JA, Lok AS. Biomarkers for the early detection of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev. 2020;29(12):2495-2503. doi:10.1158/1055-9965.EPI-20-0005
  6. Berhane S, Toyoda H, Tada T, et al. Role of the GALAD and BALAD-2 serologic models in diagnosis of hepatocellular carcinoma and prediction of survival in patients. Clin Gastroenterol Hepatol. 2016;14(6):875-886.e6. doi:10.1016/j.cgh.2015.12.042
  7. Lin N, Lin Y, Xu J, et al. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun. 2022;6(7):1753-1763. doi:10.1002/hep4.1918
  8. Del Poggio P, Mazzoleni M, Lazzaroni S, D'Alessio A. Surveillance for hepatocellular carcinoma at the community level: Easier said than done. World J Gastroenterol. 2021;27(37):6180-6190. doi:10.3748/wjg.v27.i37.6180
  9. Byrd K, Alqahtani S, Yopp AC, Singal AG. Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma. Semin Liver Dis. 2021;41(1):1-8. doi:10.1055/s-0040-1719178
  10. Mazzaferro V, Citterio D, Bhoori S, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial [published correction appears in Lancet Oncol. 2020;21(8):e373]. Lancet Oncol. 2020;21(7):947-956. doi:10.1016/S1470-2045(20)30224-2
  11. Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional therapy approaches for hepatocellular carcinoma: recent advances and management strategies. Cancers (Basel). 2020;12(7):1914. doi:10.3390/cancers12071914
  12. Salem R, Johnson GE, Kim E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology. 2021;74(5):2342-2352. doi:10.1002/hep.31819
  13. Cheng AL, Qin S, Ikeda M, et al. Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. J Hepatol. 2022;76(4):862-873. doi:10.1016/j.jhep.2021.11.030
  14. Tzartzeva K, Obi J, Rich NE, et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018;154(6):1706-1718.e1. doi:10.1053/j.gastro.2018.01.064
References
  1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6. doi:10.1038/s41572-020-00240-3
  2. Dasgupta P, Henshaw C, Youlden DR, Clark PJ, Aitken JF, Baade PD. Global trends in incidence rates of primary adult liver cancers: a systematic review and meta-analysis. Front Oncol. 2020;10:171. doi:10.3389/fonc.2020.00171
  3. Lee YT, Wang JJ, Luu M, et al. The mortality and overall survival trends of primary liver cancer in the United States. J Natl Cancer Inst. 2021;113(11):1531-1541. doi:10.1093/jnci/djab079
  4. Wolf E, Rich NE, Marrero JA, Parikh ND, Singal AG. Use of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis. Hepatology. 2021;73(2):713-725. doi:10.1002/hep.31309
  5. Parikh ND, Mehta AS, Singal AG, Block T, Marrero JA, Lok AS. Biomarkers for the early detection of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev. 2020;29(12):2495-2503. doi:10.1158/1055-9965.EPI-20-0005
  6. Berhane S, Toyoda H, Tada T, et al. Role of the GALAD and BALAD-2 serologic models in diagnosis of hepatocellular carcinoma and prediction of survival in patients. Clin Gastroenterol Hepatol. 2016;14(6):875-886.e6. doi:10.1016/j.cgh.2015.12.042
  7. Lin N, Lin Y, Xu J, et al. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun. 2022;6(7):1753-1763. doi:10.1002/hep4.1918
  8. Del Poggio P, Mazzoleni M, Lazzaroni S, D'Alessio A. Surveillance for hepatocellular carcinoma at the community level: Easier said than done. World J Gastroenterol. 2021;27(37):6180-6190. doi:10.3748/wjg.v27.i37.6180
  9. Byrd K, Alqahtani S, Yopp AC, Singal AG. Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma. Semin Liver Dis. 2021;41(1):1-8. doi:10.1055/s-0040-1719178
  10. Mazzaferro V, Citterio D, Bhoori S, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b/3 trial [published correction appears in Lancet Oncol. 2020;21(8):e373]. Lancet Oncol. 2020;21(7):947-956. doi:10.1016/S1470-2045(20)30224-2
  11. Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional therapy approaches for hepatocellular carcinoma: recent advances and management strategies. Cancers (Basel). 2020;12(7):1914. doi:10.3390/cancers12071914
  12. Salem R, Johnson GE, Kim E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology. 2021;74(5):2342-2352. doi:10.1002/hep.31819
  13. Cheng AL, Qin S, Ikeda M, et al. Updated efficacy and safety data from IMbrave150: atezolizumab plus bevacizumab vs. sorafenib for unresectable hepatocellular carcinoma. J Hepatol. 2022;76(4):862-873. doi:10.1016/j.jhep.2021.11.030
  14. Tzartzeva K, Obi J, Rich NE, et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018;154(6):1706-1718.e1. doi:10.1053/j.gastro.2018.01.064
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The incidence of HCC has increased over the last 10 years, with more than 1 million cases projected by 2025.1,2 Although mortality rates—which have risen over the past decade—appear to be leveling out, improved surveillance and screening efforts are still critical for decreasing mortality.3 More intensive, multifaceted interventions—such as increasing patient and provider education, which are currently underutilized in clinical care—are needed, as well as the start of earlier screening for HCC.4 The use of new imaging and biomarker, GALAD, and liquid biopsy techniques is also being explored, although these techniques still require validation prior to routine use in clinical practice.5-7 The  current ultrasound screening methods alone are not ideal, with sensitivity as low as 47% for detecting  early-stage HCC.8

Generally, multidisciplinary care has also been emphasized in the treatment process, using oncologists, radiologists, hepatologists, and surgeons working together to improve clinical outcomes.9 Recent treatment advances have been reported for early-, intermediate-, and late-stage disease. For early-stage HCC, surgical resection and transplant criteria have been expanded through downstaging techniques.10 For intermediate-stage HCC, radioembolization has been incorporated as another therapy, beyond transarterial chemoembolization.11,12 For late-stage HCC, treatment is moving toward immunotherapy, which has generated longer survival than older therapies.13 While HCC remains a cancer of concern, new interventions, tools, and treatments on the horizon can help expand screening and improve treatment outcomes.

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New Pathogens, COVID-19, and Antibiotic Resistance in the Field of Pneumonia

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New Pathogens, COVID-19, and Antibiotic Resistance in the Field of Pneumonia
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Marcos I. Restrepo, MD, MSc, PhD, FCCP

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References
  1. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415-427. doi:10.1056/NEJMoa1500245
  2. Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021;398(10303):906-919. doi:10.1016/S0140-6736(21)00630-9
  3. Pagliano P, Sellitto C, Conti V, Ascione T, Esposito S. Characteristics of viral pneumonia in the COVID-19 era: an update.  Infection. 2021;49(4):607-616. doi:10.1007/s15010-021-01603-y
  4.  Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19 [published correction appears in Crit Care. 2021 Apr 6;25(1):130]. Crit Care. 2021;25(1):25. doi:10.1186/s13054-021-03460-5
  5. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140- 6736(21)02724-0
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Marcos I. Restrepo, MD, MSc, PhD, FCCP
Author(s)
Marcos I. Restrepo, MD, MSc, PhD, FCCP

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References
  1. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415-427. doi:10.1056/NEJMoa1500245
  2. Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021;398(10303):906-919. doi:10.1016/S0140-6736(21)00630-9
  3. Pagliano P, Sellitto C, Conti V, Ascione T, Esposito S. Characteristics of viral pneumonia in the COVID-19 era: an update.  Infection. 2021;49(4):607-616. doi:10.1007/s15010-021-01603-y
  4.  Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19 [published correction appears in Crit Care. 2021 Apr 6;25(1):130]. Crit Care. 2021;25(1):25. doi:10.1186/s13054-021-03460-5
  5. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140- 6736(21)02724-0
References
  1. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373(5):415-427. doi:10.1056/NEJMoa1500245
  2. Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021;398(10303):906-919. doi:10.1016/S0140-6736(21)00630-9
  3. Pagliano P, Sellitto C, Conti V, Ascione T, Esposito S. Characteristics of viral pneumonia in the COVID-19 era: an update.  Infection. 2021;49(4):607-616. doi:10.1007/s15010-021-01603-y
  4.  Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19 [published correction appears in Crit Care. 2021 Apr 6;25(1):130]. Crit Care. 2021;25(1):25. doi:10.1186/s13054-021-03460-5
  5. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140- 6736(21)02724-0
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 Before the onset of the COVID-19 pandemic, researchers in the feld of pneumonia were grappling with the increase in the number of pathogens, antimicrobial-resistant strains causing pneumonia, and high mortality in short-term and long-term cases in those with comorbidites and with severe pneumonia.1,2 In 2015, a landmark study identified that the most common pathogens causing community-acquired pneumonia (CAP) were viruses such as rhinovirus and influenza virus, and that the most common bacterial pathogen remained Streptococcus pneumoniae.1 Just as the rest of world was forced to shift their focus in 2020 because of the pandemic, those of us in the pulmonary space were challenged to understand the impact that COVID-19 would have on treating our patients, particularly those with pneumonia. SARS-CoV-2, the virus that causes COVID-19, in a short time became the leading pathogen causing pneumonia. In addition, severely ill patients with COVID-19 were found to have a higher risk of developing hospital-acquired pneumonia and ventilator-associated pneumonia (VAP). The rate of VAP increased during the pandemic due to several factors, one of them being the time patients with COVID-19 spent on ventilators.3,4

Now that the pandemic has passed its peak, the field of pneumonia is revisiting earlier concerns—assessment of new pathogens and antibiotic resistance—as well as addressing issues brought to light by the COVID-19 pandemic.

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Comorbidities, Racial Disparities, and Geographic Differences in Asthma

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Comorbidities, Racial Disparities, and Geographic Differences in Asthma
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Navitha Ramesh, MD, FCCP

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References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
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Navitha Ramesh, MD, FCCP
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Navitha Ramesh, MD, FCCP

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References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
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Asthma management is becoming increasingly personalized, making it crucial to evaluate the various comorbidities and socioeconomic factors affecting patient care. Asthma is no longer simply understood as the typical allergic asthma requiring treatment with corticosteroids. There is an evolving distinction between allergen-specific T helper 2 (Th2) and non-Th2 asthma.1 In Th2 asthma, eosinophilic inflammation plays a key role, whereas in non-Th2 asthma, neutrophils are the primary inflammatory cells involved.1 Asthma masqueraders, such as vocal cord dysfunction, chronic obstructive pulmonary disease, eosinophilic granulomatosis with polyangiitis, etc, must be considered in the differential diagnosis, and asthma comorbidities, such as upper airway cough syndrome, gastroesophageal reflux, depression, and anxiety, have to be actively sought out and managed appropriately.2

Racial, socioeconomic, and geographic characteristics are also key patient factors that affect asthma symptoms and control, quality of life, and asthma-related morbidity and mortality. Assessing and understanding the multiple factors that affect each patient is crucial in the optimal management of asthma symptoms, and also preventing exacerbations, which in turn lead to accelerated loss of lung function.

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Rising Incidence of Bronchiectasis and Associated Burdens

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Rising Incidence of Bronchiectasis and Associated Burdens
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Anne E. O'Donnell, MD, FCCP

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References
  1. Goeminne PC, Hernandez F, Diel R, et al. The economic burden of bronchiectasis – known and unknown: a systematic review. BMC Pulm Med. 2019;19(1):54. doi:10.1186/s12890-019-0818-6 
  2. Cohen R, Shteinberg M. Diagnosis and evaluation of bronchiectasis. Clin Chest Med. 2022;43(1):7-22. doi:10.1016/j.ccm.2021.11.001
  3. Emmons EE. Bronchiectasis. Medscape. Updated September 15, 2020. Accessed June 24, 2022. https://emedicine.medscape.com/article/296961-overview
  4. World Populating Ageing 2019: highlights (ST/ESA/SER.A/430). United Nations Department of Economic and Social Affairs, Population Division. Published 2019. Accessed July 28, 2022. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
  5. O’Donnell AE. Bronchiectasis update. Curr Opin Infect Dis. 2018;31(2):194-198. doi:10.1097/QCO.0000000000000445
  6. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629. doi:10.1183/13993003.00629-2017
  7. Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis. 2017;14(4):377-384. doi:10.1177/1479972317709649
  8. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among Medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142(2):432-439. doi:10.1378/chest.11-2209
  9. Bronchiectasis statistics. British Lung Foundation. Accessed June 24, 2022. https://statistics.blf.org.uk/bronchiectasis
  10. Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J. 2019;54(6):1900499. doi:10.1183/13993003.00499-2019
  11. Aliberti S, Sotigiu G, Lapi F, Gramegna A, Cricelli C, Blasi F. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med. 2020;20(1):15. doi:10.1186/s12890-020-1050-0
  12. Park DI, Kang S, Choi S. Evaluating the prevalence and incidence of bronchiectasis and nontuberculous mycobacteria in South Korea using the nationwide population data. Int J Environ Res Public Health. 2021;18(17):9029. doi:10.3390/ijerph18179029
  13. Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res. 2022;23:111. doi:10.1186/s12931-022-02023-8
  14. Hayoung Choi, H, Yang, B, N. Hyewon et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J. Aug 2019, 54 (2) 1900194; doi:10.1183/13993003.00194-2019.
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Author(s)
Anne E. O'Donnell, MD, FCCP
Author(s)
Anne E. O'Donnell, MD, FCCP

Click to view more from Pulmonology Data Trends 2022.

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References
  1. Goeminne PC, Hernandez F, Diel R, et al. The economic burden of bronchiectasis – known and unknown: a systematic review. BMC Pulm Med. 2019;19(1):54. doi:10.1186/s12890-019-0818-6 
  2. Cohen R, Shteinberg M. Diagnosis and evaluation of bronchiectasis. Clin Chest Med. 2022;43(1):7-22. doi:10.1016/j.ccm.2021.11.001
  3. Emmons EE. Bronchiectasis. Medscape. Updated September 15, 2020. Accessed June 24, 2022. https://emedicine.medscape.com/article/296961-overview
  4. World Populating Ageing 2019: highlights (ST/ESA/SER.A/430). United Nations Department of Economic and Social Affairs, Population Division. Published 2019. Accessed July 28, 2022. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
  5. O’Donnell AE. Bronchiectasis update. Curr Opin Infect Dis. 2018;31(2):194-198. doi:10.1097/QCO.0000000000000445
  6. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629. doi:10.1183/13993003.00629-2017
  7. Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis. 2017;14(4):377-384. doi:10.1177/1479972317709649
  8. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among Medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142(2):432-439. doi:10.1378/chest.11-2209
  9. Bronchiectasis statistics. British Lung Foundation. Accessed June 24, 2022. https://statistics.blf.org.uk/bronchiectasis
  10. Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J. 2019;54(6):1900499. doi:10.1183/13993003.00499-2019
  11. Aliberti S, Sotigiu G, Lapi F, Gramegna A, Cricelli C, Blasi F. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med. 2020;20(1):15. doi:10.1186/s12890-020-1050-0
  12. Park DI, Kang S, Choi S. Evaluating the prevalence and incidence of bronchiectasis and nontuberculous mycobacteria in South Korea using the nationwide population data. Int J Environ Res Public Health. 2021;18(17):9029. doi:10.3390/ijerph18179029
  13. Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res. 2022;23:111. doi:10.1186/s12931-022-02023-8
  14. Hayoung Choi, H, Yang, B, N. Hyewon et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J. Aug 2019, 54 (2) 1900194; doi:10.1183/13993003.00194-2019.
References
  1. Goeminne PC, Hernandez F, Diel R, et al. The economic burden of bronchiectasis – known and unknown: a systematic review. BMC Pulm Med. 2019;19(1):54. doi:10.1186/s12890-019-0818-6 
  2. Cohen R, Shteinberg M. Diagnosis and evaluation of bronchiectasis. Clin Chest Med. 2022;43(1):7-22. doi:10.1016/j.ccm.2021.11.001
  3. Emmons EE. Bronchiectasis. Medscape. Updated September 15, 2020. Accessed June 24, 2022. https://emedicine.medscape.com/article/296961-overview
  4. World Populating Ageing 2019: highlights (ST/ESA/SER.A/430). United Nations Department of Economic and Social Affairs, Population Division. Published 2019. Accessed July 28, 2022. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
  5. O’Donnell AE. Bronchiectasis update. Curr Opin Infect Dis. 2018;31(2):194-198. doi:10.1097/QCO.0000000000000445
  6. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629. doi:10.1183/13993003.00629-2017
  7. Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis. 2017;14(4):377-384. doi:10.1177/1479972317709649
  8. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among Medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142(2):432-439. doi:10.1378/chest.11-2209
  9. Bronchiectasis statistics. British Lung Foundation. Accessed June 24, 2022. https://statistics.blf.org.uk/bronchiectasis
  10. Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J. 2019;54(6):1900499. doi:10.1183/13993003.00499-2019
  11. Aliberti S, Sotigiu G, Lapi F, Gramegna A, Cricelli C, Blasi F. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med. 2020;20(1):15. doi:10.1186/s12890-020-1050-0
  12. Park DI, Kang S, Choi S. Evaluating the prevalence and incidence of bronchiectasis and nontuberculous mycobacteria in South Korea using the nationwide population data. Int J Environ Res Public Health. 2021;18(17):9029. doi:10.3390/ijerph18179029
  13. Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res. 2022;23:111. doi:10.1186/s12931-022-02023-8
  14. Hayoung Choi, H, Yang, B, N. Hyewon et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J. Aug 2019, 54 (2) 1900194; doi:10.1183/13993003.00194-2019.
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Rising Incidence of Bronchiectasis and Associated Burdens
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Bronchiectasis has historically been considered an uncommon and ofen neglected disease in respiratory medicine.1-3 Although bronchiectasis was previously thought to be an orphan disease, its incidence and prevalence have been on the rise since the early 2000s, and the disease is now estimated to affect between 0.25% and 0.5% of adults.2 This observed increase can be attributed at least partially to two key factors: growing use of CT scanning has allowed for higher detection of abnormal airways, and the global population is aging.2,4 Bronchiectasis is more common in elderly people, and the number of persons aged 65 and older is estimated to double by 2050.2,4

As bronchiectasis has become more widely recognized as a serious and prevalent condition, the need for clinical research and consensus in this area has also increased.2,5,6 In 2017, the European Respiratory Society released the frst international guidelines that provide recommendations for reducing exacerbations, symptoms, and risk for future complications, while improving quality of life.6

In 2022, clinicians are more equipped than ever to identify and treat bronchiectasis. However, the immense comorbidity and economic burdens that accompany this disease will continue to present challenges. Using a shared decision-making approach is important to understand and address each patient’s unique goals and concerns and, thus, optimize their health outcomes.

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ILD: Diagnostic Considerations and Socioeconomic Barriers

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ILD: Diagnostic Considerations and Socioeconomic Barriers
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Daniel Dilling, MD, FCCP, FACP, FAST

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References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

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Author(s)
Daniel Dilling, MD, FCCP, FACP, FAST

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References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

References

1. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2022;205(9):e18-e47. doi:10.1164/ rccm.202202-0399ST

2. Diagnosis and evaluation of hypersensitivity pneumonitis: CHEST guideline and expert panel report (podcast). Chest. 2021;160(2). Published August 5, 2021. Accessed July 11, 2022. https://www.podbean.com/ew/pb-jgzb7-10980b0

3. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc. 2022;19(7):1193-1202. doi:10.1513/ AnnalsATS.202102-198OC

4. Goobie GC, Ryerson CJ, Johannson KA, et al. Neighborhoodlevel disadvantage impacts on patients with fibrotic interstitial lung disease. Am J Respir Crit Care Med. 2022;205(4):459-467. doi:10.1164/rccm.202109-2065OC

5. Gaffney AW, Podolanczuk AJ. Inequity and the interstitium: pushing back on disparities in fibrosing lung disease in the United States and Canada. Am J Respir Crit Care Med. 2022;205(4):385-387. doi:10.1164/rccm.202111-2652ED

6. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta-analysis. Respirology. 2016;21(5):834-841. doi:10.1111/resp.12770

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ILD: Diagnostic Considerations and Socioeconomic Barriers
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When navigating the multiple layers of interstitial lung disease (ILD), new American Thoracic Society (ATS) guidelines recommend a diagnostic approach through the lenses of radiologic progression, worsening symptoms, and physiologic progression. An interdisciplinary approach to diagnosis and treatment of patients with ILDs is key for informed decision-making and for optimizing outcomes.1 Also, guidelines presented by CHEST on ILD dive deeper, addressing diagnostic decision-making, evaluation, gaps, challenges, and risk management failures, as they specifically pertain to hypersensitivity pneumonitis.2

Radiologists, pathologists, and pulmonologists look at newer methods of ILD diagnosis–such as transbronchial lung cryobiopsy and genomic classifiers–from a systemic point of view and utilize artificial intelligence to explore new techniques that may be beneficial to patients.3 Additionally, characteristics associated with health disparities, inequities, social determinants, and neighborhood-level disadvantages all affect patients and show clear differences in access to care in the United States.4

Given the nature of ILD, patients may experience disease progression culminating in the need for lung transplantation or in death from their disease.1,4 Ensuring proper care for patients with ILD is an urgent priority for pulmonologists. With further research and, hopefully, with changes to how we approach ILD care in society, our goal is to eradicate these socioeconomic disparities, so patients receive proper diagnosis and care.

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Key Presentations in Lung Cancer From CHEST 2022

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Key Presentations in Lung Cancer From CHEST 2022
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Douglas Arenberg, MD, FCCP

The 2022 CHEST Annual Meeting had several important studies on lung cancer.

Douglas Arenberg, MD, FCCP from the University of Michigan Northville Health Center, reports on content from two papers that focus on the first million persons to have been screened for lung cancer after the initial launch of the American College of Radiology Lung Cancer Screening Registry. The research showed that the medical community is, in fact, doing well in some areas of lung cancer screening but that improvements need to be made in order to reach former tobacco users, who would greatly benefit from these screenings. 

He also highlights a series of studies that were discussed regarding smoking cessation at lung evaluations known as the SCALE Collaboration. Effective smoking interventions could enhance the benefits of lung cancer screening by reducing mortality and morbidity resulting from lung cancer.

Finally, Dr Arenberg shares a series of presentations that highlight how the surgical treatment of early-stage lung cancer is creating significant changes in the standard of care.

 

--

 

Douglas Arenberg, MD, FCCP Professor of Medicine, Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan; Director of Bronchoscopy and Medical Director for the Lung Cancer Screening and Lung Nodule Clinics, University of Michigan, Ann Arbor, Michigan 

Douglas Arenberg, MD, FCCP has disclosed no relevant financial relationships. 

 

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Douglas Arenberg, MD, FCCP
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Douglas Arenberg, MD, FCCP

The 2022 CHEST Annual Meeting had several important studies on lung cancer.

Douglas Arenberg, MD, FCCP from the University of Michigan Northville Health Center, reports on content from two papers that focus on the first million persons to have been screened for lung cancer after the initial launch of the American College of Radiology Lung Cancer Screening Registry. The research showed that the medical community is, in fact, doing well in some areas of lung cancer screening but that improvements need to be made in order to reach former tobacco users, who would greatly benefit from these screenings. 

He also highlights a series of studies that were discussed regarding smoking cessation at lung evaluations known as the SCALE Collaboration. Effective smoking interventions could enhance the benefits of lung cancer screening by reducing mortality and morbidity resulting from lung cancer.

Finally, Dr Arenberg shares a series of presentations that highlight how the surgical treatment of early-stage lung cancer is creating significant changes in the standard of care.

 

--

 

Douglas Arenberg, MD, FCCP Professor of Medicine, Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan; Director of Bronchoscopy and Medical Director for the Lung Cancer Screening and Lung Nodule Clinics, University of Michigan, Ann Arbor, Michigan 

Douglas Arenberg, MD, FCCP has disclosed no relevant financial relationships. 

 

The 2022 CHEST Annual Meeting had several important studies on lung cancer.

Douglas Arenberg, MD, FCCP from the University of Michigan Northville Health Center, reports on content from two papers that focus on the first million persons to have been screened for lung cancer after the initial launch of the American College of Radiology Lung Cancer Screening Registry. The research showed that the medical community is, in fact, doing well in some areas of lung cancer screening but that improvements need to be made in order to reach former tobacco users, who would greatly benefit from these screenings. 

He also highlights a series of studies that were discussed regarding smoking cessation at lung evaluations known as the SCALE Collaboration. Effective smoking interventions could enhance the benefits of lung cancer screening by reducing mortality and morbidity resulting from lung cancer.

Finally, Dr Arenberg shares a series of presentations that highlight how the surgical treatment of early-stage lung cancer is creating significant changes in the standard of care.

 

--

 

Douglas Arenberg, MD, FCCP Professor of Medicine, Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan; Director of Bronchoscopy and Medical Director for the Lung Cancer Screening and Lung Nodule Clinics, University of Michigan, Ann Arbor, Michigan 

Douglas Arenberg, MD, FCCP has disclosed no relevant financial relationships. 

 

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