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Crossing Medical Frontiers: Research Innovations Transforming Care
This podcast series features Mass General Brigham researchers whose work is redefining what's possible and how we care for patients. Our goal is to spotlight transformative discoveries, the people leading these transformations, and how they can improve patient outcomes, highlighting how today's research is shaping the future of medicine, including training the next generation of clinicians and scientists.
This podcast series is not accredited for CME/CE at this time.
Hello. Welcome to the new podcast series, Crossing Medical Frontiers, Research Innovations Transforming Care. My name is doctor John Co, and I'm the vice president for education at Mass General Brigham. This podcast series features Mass General Brigham researchers whose work is redefining what's possible and how we care for patients. Our goal is to spotlight transformative discoveries to people leading these transformations and how they can improve patient outcomes, highlighting how today's research is shaping the future of medicine, including training the next generation of clinicians and scientists.
John Co:Today, I'm delighted to be talking with doctor Chi Fu Jeffrey Yang, a thoracic surgeon at Mass General Brigham and associate professor at Harvard Medical School. Doctor Yang is the founding director of the Center for Artificial Intelligence and Innovation Research, advancing AI applications in surgery and cancer care. An area of focus is early detection in lung cancer screening. Doctor Yang, it's great to have you here. Thank you for being here with us today.
John Co:Can you tell us a little bit about how you got interested in this area of medicine that you're spending your career and devoting all your time towards?
Chi Fu Jeffrey Yang:Great. Well, thank you so much for having me. Really appreciate it. I've been interested in early detection probably ever since I was in college, and that's when my grandfather was found to have lung cancer. And unfortunately, he had small cell lung cancer and after a year and a half after his diagnosis, he passed away.
Chi Fu Jeffrey Yang:But it's his situation and I was part of his care team really haunted me because I felt that if we had found the lung cancer earlier, it probably would have been a different situation and I always regret that he wasn't able to see me graduate from medical school because we had talked about my aspirations and goals. And so that stuck with me for a long time. And, now as a thoracic surgeon, I get to work on early detection for lung cancer and other kinds of complications for surgery. And, but I think my original inspiration probably was through my grandfather's experience with lung cancer.
John Co:Wow. So this is this area that you've devoted your career to is so seems so meaningful and personal. Can you tell me what are some of the questions you're trying to answer answer with the research and all the work you're doing? I know you do advocacy as well. Yeah.
John Co:But tell me, what are some of these questions you're trying to answer? What are some of the maybe policies you're trying to impact? Mhmm. And if you're successful, how is it gonna transform how we, care for patients?
Chi Fu Jeffrey Yang:So one of the questions is on lung cancer screening eligibility. Just to give you an overview of the scope of the problem, in America, a hundred and thirty thousand Americans every year die from lung cancer. And the best way to save lives from lung cancer deaths is early detection. And, unfortunately, many Americans are not eligible to get early detection and screening, and that's because the criteria set are very strict. It is you have to be 50 to 80 years old.
Chi Fu Jeffrey Yang:You have to have smoked greater than twenty pack years, so a pack a day for twenty years. And you have to have stopped smoking or or be, you have to have stopped smoking with the past fifteen years or are currently smoking. Just to tell you that was a mouthful. And because of how strict the guidelines are, every year about a hundred and thirty thousand Americans who are diagnosed with lung cancer are not eligible to get screened. So that that is a key area of my research is how do you make the guidelines better so that more people who are at risk of developing lung cancer are able to get life saving lung cancer screening.
Chi Fu Jeffrey Yang:And one of the things we found was that many people who develop lung cancer actually don't smoke that much. They smoke fewer than twenty pack years. Maybe just smoke two or three cigarettes a day, but they do smoke quite a long time, so over twenty years. And through analyses of large still large scale epidemiologic cohorts, like the Southern Community cohort study, the Black Women's Health study, the multiethnic cohort study, our team has shown that if you change the guidelines to instead of asking people how many pack years you have smoked, just ask them how many years have you smoked. And if you make that one simple change and just set the guideline at twenty years duration, then many more people who are at risk of developing lung cancer can then get scraped.
Chi Fu Jeffrey Yang:And that that paper we published in JCO last year and it led to the change in guidelines for the NCCN, the National Comprehensive Cancer Network. But, ultimately, what we're hoping to do is build enough research to change the USPSTF guidelines because that is the committee that insurance companies listens to. And so we're hoping to do, continue to build the evidence for that, both from the retrospective side, but also through prospective clinical studies.
John Co:Wow. So that's amazing. Your work can impact populations well beyond here, you know, in Boston and Massachusetts. And having said that, a lot of what we focus on in Mass General Brigham is caring for our communities Yep. Right around here.
John Co:So can you tell us a little bit about the work you're doing right here in Boston, right here with patients here, to improve care for the patients in our communities?
Chi Fu Jeffrey Yang:Definitely. So I started a nonprofit called the American Lung Cancer Screening Initiative about eight years ago, and our sole focus is to increase lung cancer screening awareness and access for community members. Hence, one of the things we do in Boston is we go out there in the community and teach people about lung cancer screening either in the subway or health fairs or community events and try to raise awareness about lung cancer screening. And one thing I'm very excited about is we're also going out there anywhere there is a Mass General Brigham Community Care Van because the MGB Community Care Vans have been doing a great job of teaching people about diabetes management and other things, and we felt that it was important to also raise awareness about lung cancer screening. What what we found in the community is that everybody has heard about mammography for breast cancer, and everybody has heard about colonoscopies for colon cancer.
Chi Fu Jeffrey Yang:So and when I say everybody, I mean everybody. It's it's kinda surprising. Just we've talked to people from all walks of life, and there have been people who I have talked to who I don't think might not necessarily know about colon cancer screening or or breast cancer screening, but they all -- everybody's heard of it. And most everybody has not heard of lung cancer screening.
John Co:Yeah. Yeah. And it's incredible. I think the the vans you're talking about, community vans, are really well known here in the area, but I don't think they understand the many people don't understand the extent of what's done there, including the cancer screening work. Yeah. Yours in particular.
John Co:What are some other investigators or studies going on at Mass General Brigham related to this that you think people should know about? Because one of the great things about being here is being in this in this sort of place where there's so many people that you can collaborate with, make sure your work is connected to make sure it has the, you know, the most impact. So tell us more about who we should know about.
Chi Fu Jeffrey Yang:Right now at the Center for AI Research or CARE, we have faculty from Mass General Brigham working on early detection for lung cancer. And specifically, there's an algorithm that our faculty have designed, which is it's called Sybil for short. And, there's a paper publishing how accurate Sybil is in Journal of Clinical Oncology last year where what it does is it will read a chest CT scan and pick up on things that a human radiologist can't pick up. And it's been found to accurately predict lung cancer risk for patients, up to six years. And it goes through a process.
Chi Fu Jeffrey Yang:It's a 3-D convolutional neural network architecture, and AUROCs and the AC indexes are really high. And so what this means is that potentially in the future, AI can help us identify, lung cancer even before you could see it years in advance.
John Co:Wow. And, you know, I think a lot of people know there's a lot of research going on here, and they wonder how does it or does it ever reach the patient. Yeah. Right? And so I'm curious with a lot of these innovations you're talking about, how close are they, or are some of these already benefiting patients that we see at Mass Brigham?
Chi Fu Jeffrey Yang:That that's a great question. So and I should I should say that, the investigators who are leading this civil consortium, which I am privileged to be part of, are doctors Lecia Sequist and doctor Florian Fentlemen here at Mass General Brigham. And right now with civil, one thing we're really proud of is it's open source. So it's not like, some of the other commercial platforms where it's very limited. So anybody in any center can use it and different centers are starting to use it now to detect and predict lung cancer risk in patients.
Chi Fu Jeffrey Yang:It hasn't quite evolved into daily practice yet, but ultimately, I think one area that we hope, and it doesn't necessarily have to be through Sybil, it could be through any kind of platform or algorithm. But my hope is that one day everybody can get a baseline low dose CT screening exam. It doesn't matter if you smoke or if you've never smoked. Just everybody kinda like how, everybody gets a baseline colonoscopy exam.
Chi Fu Jeffrey Yang:And then to then use AI to figure out how often does this person need follow-up CT scans. And and then that way to personalize the lung cancer detection for people.
John Co:Yeah. So you're really trying to change the paradigm of how we care for the patients. So that's fantastic. As you know, one of the areas of interest I have, I spend a lot of my time, is in education. Mhmm.
John Co:And so as we know at Mass General Brigham, training the next generation is is part of our mission. So how do trainees now, you know, get involved or are involved in your work? And is it, you know, is it that trainees here can, you know, get involved with these things really easily? Because I think a lot of people say, wow. There's all this stuff going on, but am I gonna be able to to be part of that?
Chi Fu Jeffrey Yang:That that's a great question. Well, I'm very excited that we do have the opportunity to work with many residents, fellows, medical students, and college students on both raising awareness about lung cancer and through our lung cancer studies. So one of the studies we're working on, it's called the INSPIRE study, and this is a study where we are screening black women who are at risk of developing lung cancer, many of whom are not eligible to get screened. And through this study, many trainees are involved with different aspects, including talking to community members, talking to patients, visiting them when they're in the hospital, and analyzing the data and and trying to ask different kinds of clinical questions even beyond lung cancer screening. So for example, one question that we're trying to ask is, does lung cancer screening influence behaviors in smoking?
Chi Fu Jeffrey Yang:Sometimes people have, in my opinion, wrongly assumed that lung cancer screening somehow increases smoking because because it gives you some, artificial sense that if you have screening then you can keep smoking. But but what we're finding is that through this study, we're we're finding that lung cancer screening actually helps decrease smoking. And that's because probably, this is what we're hypothesizing is that, people who get screened, they they start realizing that, the good news of lung cancer screening, oftentimes when you have a normal exam, it's actually very motivating. To help people stop smoking. And then also when you bring folks into the Mass General Brigham family, I do think that people feel very supported and get, get some momentum.
Chi Fu Jeffrey Yang:We we make sure everybody we talk to gets, who would like to, gets referred to a wonderful smoking cessation counselor, and I think that definitely helps with reducing smoking and reducing lung cancer risk.
John Co:What other things you would you like the our audience to know about research in this area, maybe your aspirations for how care will be changed?
Chi Fu Jeffrey Yang:Thank you. That's that's a great question. So earlier, we talked about lung cancer screening eligibility and how about half of Americans with lung cancer would never have been eligible to get screened. That still means that every year, there's a hundred and twenty five thousand Americans who are eligible to get screened. But of that group, only a tiny fraction is getting screened.
Chi Fu Jeffrey Yang:So only about twenty percent of people here in Massachusetts who are eligible are getting screened. And so I'd love for to get the audience's help to help raise awareness if if you have a neighbor or a loved one who has smoked in the past to encourage them to go see their health care provider and talk about lung cancer screening because that could very well save your neighbor or loved one's life.
John Co:Great. Well, it's great to hear of all the great work you're doing and also how our audience and listeners can get involved and really help their peers and loved ones. I think those are all my questions for you today. I wanna thank you for being here on the podcast. Congratulate you on all the work that you're doing, and look forward to having you back in the future.
Chi Fu Jeffrey Yang:Great. Thank you so much. Really appreciate it.
John Co:Thank you.
Chi Fu Jeffrey Yang:Thank you.
John Co:Thank you. For the next episode of Research Frontiers in Medicine, Research Innovations Transforming Care, we will be speaking with Doctor. Roger Hadger, whose expertise is in cardiac gene therapy. We hope you will subscribe and join us.