United States

Abstract Title
Topological Characterization of the Glioblastoma Microenvironment Reveals Perivascular Niche Interactions

Background
Differential response to treatment in many tumors can be attributed to intratumoral heterogeneity. This describes diversity of features on the molecular, cellular, and tissue levels that contribute to driving tumor dynamics and fueling disease. In glioblastoma (GBM), a deadly and aggressive brain tumor, extensive cellular and genetic intratumoral heterogeneity play a major role in the inevitable resistance to treatment. Routine histopathological analysis of GBM reveals an extremely diverse cancer ecosystem inclusive of marked nuclear atypia, microvascular proliferation, and foci of necrosis while large-scale genomic analyses have demonstrated an accumulation of genetic changes within cancer cells. However, interactions between genetically distinct GBM cells and the surrounding tumor microenvironment (TME) are incompletely understood. Considering the dynamic GBM microenvironment and heterogeneous clonal populations that arise within, the high degree of both molecular and cellular diversity may be reflecting a level of cooperation. Wherein, genetic heterogeneity confers an evolutionary advantage to tumor cells in the face of fluctuating microenvironmental selective pressures.

Methods
In a cohort of matched primary and recurrent GBM samples, we integrated immunofluorescent staining, fluorescence-in-situ-hybridization techniques, reflectance imaging, species distribution modeling, and computational image analysis methods alongside spatial RNA sequencing to achieve multiplexed single cell spatial profiling. With this method, we have evaluated the TMEs for various histopathological niches, extracellular matrix (ECM) organization, hot-spot mutations, and oncogenic amplifications in the same tissue and at the same histological coordinates. 

Results
Our study found that specific textures of the ECM were linked to specific genetic and phenotypic characteristics of tumor cells. We observed that “string-like” ECM textures, possibly representing neuron-rich environments, serve as selective niches for tumor cells with TERT promoter mutations and EGFR amplifications. Additionally, reflectance imaging of the ECM revealed structured organization of perivascular niches in recurrent GBM which were enriched in collagen and immunosuppressive macrophages. Results from the single-cell spatial transcriptomics further confirmed the presence of the niche-specific macrophage populations and identified interactions between endothelial cells, immunosuppressive macrophages, and perivascular fibroblasts. 

Conclusion
Our findings demonstrate how TME elements may serve as markers indicative of spatial heterogeneity and how combined analysis of spatial diversity can be used to uncover novel niche interactions. Understanding the molecular and cellular dependencies within the GBM microenvironment is crucial for devising targeted therapeutic strategies. In this work we expand the knowledge base of spatially resolved GBM characterization by evaluating the interplay among tumor cell populations, TME members, and ecological features that impact GBM pathophysiology.


AMA Research Challenge 2025 

Topological Characterization of the Glioblastoma Microenvironment Reveals Perivascular Niche Interactions

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Molsamp 2021

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Background
Neurons decentralize translation to generate, maintain, and rapidly remodel distal cellular sub-compartments. Neurodevelopment, synaptic plasticity, and axonal repair all depend vitally on this process, with disruptions resulting in neurological disease. Local protein synthesis is a ubiquitous feature of neuronal processes. However, how neurons intrinsically regulate local translation is poorly understood. Given our recent discovery of mRNAs that hitchhike on lysosomes for long-distance transport in neurons, we sought to probe the capacity of lysosomes to support local protein synthesis.

Methods
To study local translation, we used iPSC-derived neurons to recapitulate human neuronal biology. Using a derivative of puromycin, we labeled translation sites in neurites, co-localizing these sites to lysosomes. We developed and used a novel spatially-resolved transcriptomics method and a lysosome-targeted genetically-encoded protein synthesis inhibitor, mapping the landscape of mRNA transcripts and nascent protein made on the surface of the lysosome. We fed isotope-labeled peptide to neurons and traced their incorporation into new proteins, quantifying the contribution of lysosome-derived amino acids to local protein synthesis. We then conducted proteomics of the lysosome-ribosome interface, identifying potential regulatory complexes for lysosome-associated translation. Finally, we used bio-orthogonal nascent protein and lysosome co-detection along with live cell nascent protein imaging to characterize the regulatory dynamics of local protein synthesis at the lysosome surface.

Results
We find that lysosomes are the primary sites of protein synthesis in neuronal processes. Lysosome-associated ribosomes support the translation of a wide variety of neurite-enriched transcripts, including those encoding ribosomal subunits, mitochondrial proteins, and synaptic proteins. Lysosome-derived amino acids are important fuel sources for translating lysosome-localized transcripts, and deacidification of the lysosome impairs their recycling into new proteins at the lysosome surface. The mTORC1 pathway is enriched at the lysosome-ribosome interface, and mTOR inhibition mirrors the translational effects of a lysosome-targeted protein synthesis inhibitor. Finally, lysosomes associated with active translation co-localize with mTORC1 in neuronal processes.

Conclusion
Our data unravel a functional model linking lysosomal signaling and metabolism with RNA co-trafficking, revealing a new layer of spatiotemporal translational control by mTORC1. These findings also implicate deficient local translation as a potential pathomechanism in neurological diseases with prominent lysosomal dysfunction, such as Alzheimer’s, Parkinson’s, FTD, and ALS. More broadly, the spatial coincidence of anabolism and catabolism presented here provides a new platform for exploring diverse modes of subcellular metabolic regulation.


A lysosome-associated ribosome-mTORC1 assembly regulates local protein synthesis in neurons

Abstract Title: Bidirectional Risks and Immune Dysregulation in TB and Type 2 Diabetes

Background:
Pulmonary Tuberculosis (TB) and Type 2 Diabetes Mellitus (T2DM) are major global health burdens that independently impair immune function. When present concurrently, they exacerbate disease severity, reduce treatment effectiveness, and increase mortality. Recent literature suggests a growing bidirectional relationship between these conditions.

Methods:
A literature review was conducted using PubMed, focusing on articles related to cytokine signaling, immune modulation, T2DM, and tuberculosis.

Results: 
T2DM contributes to impaired immunity primarily through hyperglycemia-induced suppression of cytokines such as tumor necrosis factor-alpha (TNF-α) and various interleukins (IL-1β, IL-6, IL-12). This dysregulation compromises macrophage and T-cell responses, increasing the risk of TB activation and reducing treatment efficacy. The rising incidence of both diseases in the United States highlights the urgent need to understand this mechanistic overlap to improve therapeutic strategies.

Conclusion:
T2DM serves as an independent risk factor for TB due to its immunosuppressive metabolic environment. Recognizing these mechanisms can inform clinical decisions and improve management of co-affected patients.


Bidirectional Risks and Immune Dysregulation in TB and Type 2 Diabetes​

TITLE: Histotripsy for the Treatment of Oral Tumors: A Canine Ex-Vivo Feasibility Study

AUTHORS: Dana Wang (2), Victor A. Lopez (1), Jessica Gannon (1), Sheryl Coutermarsh-Ott (3), Jeremy A. Brown (4), Adam Maxwell (1), Joanne Tuohy (5), Eli Vlaisavljevich (1)

(1 )Biomedical Engineering and Mechanics, Virginia Tech 
(2) Virginia Tech Carilion School of Medicine, Virginia Tech 
(3) Biological Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine 
(4) School of Biomedical Engineering, Dalhousie University
(5) Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine 

BACKGROUND: Oral tumors are frequently diagnosed in both humans and dogs and have potential for malignancy. Current standard of care treatments like surgery, radiation, and chemotherapy are invasive, often leading to facial disfigurements and other adverse effects that decrease quality of life. There is a pressing need for less invasive treatments that preserve oral function and appearance.

Histotripsy is a non-invasive, non-thermal, and non-ionizing image-guided focused ultrasound technique. It utilizes acoustic cavitation to break down tissue into acellular debris by producing high-pressure ultrasound pulses that converge at the transducer focus to generate a cavitation bubble cloud for mechanical tissue ablation. While current clinical histotripsy systems are large, cart-based devices operating at low frequencies for deep tissue treatments like the liver, this study aims to develop miniaturized high-frequency histotripsy transducers for targeting smaller, superficial structures like oral tumors.

METHODS: CT images from ten canines with oral tumors were segmented and analyzed in MATLAB to identify accessible acoustic windows with histotripsy treatment. This guided the design of 2MHz and 6.3MHz single-element transducers which were tested on excised canine oral tumors, producing bubble cloud diameters of approximately 2mm and 0.25 mm, respectively. Excised tumors were degassed, embedded in 1% agarose gel, treated with a pulse repetition frequency of 1kHz and 2,000 pulses per point. Real-time ultrasound imaging was used for treatment monitoring and post-treatment ablation was confirmed histologically with hematoxylin and eosin staining.

RESULTS: Acoustic window analysis visualized accessible ultrasound paths to the tumor without impedance by bony structures such as the skull. The tumor volumes varied in size and ranged from 2.2 cm3 to 223.8 cm3, informing the need for a flexible and versatile device to target tumors in the oral cavity. Both transducers produced well-confined cavitation bubble clouds during treatment. After treatment, hypoechoic regions observed via ultrasound correlated to tissue ablation, which was confirmed histologically with sharply demarcated, decolorized ablation zones. Notably, the 2MHz transducer achieved ablation approximately 7.4 times faster than the 6.3MHz transducer. 

CONCLUSIONS: Acoustic window analysis informed optimal transducer positioning and device design for targeting oral tumors effectively with a miniaturized transducer system. Both 2MHz and 6.3 MHz transducers successfully ablated excised canine oral tumors, demonstrating feasibility. Future work will include analysis of additional canine and human tumors and development of an electronically steerable transducer to reduce treatment time. Overall, this study is the first to demonstrate the feasibility of histotripsy for ablating oral tumors and offers key insights for optimizing transducer design for oral tumor treatment.

Histotripsy for the Treatment of Oral Tumors: A Canine Ex-Vivo Feasibility Study

Background
Raoultella planticola is a gram-negative, encapsulated bacillus, commonly isolated from environmental sources such as soil and water, as well as the human gastrointestinal tract. Formerly classified under Klebsiella, improved microbiologic identification methods—such as MALDI-TOF MS and VITEK 2—have refined its classification and led to increased recognition in clinical settings. Historically, it is rarely associated with clinical infection, but there has been an increase in the number of case reports attributed to R .planticola infections in the past decade. This calls the need for establishing guidelines to manage infections due to this emerging pathogen.

Case Presentation
A 46-year-old woman with a past medical history of anxiety disorder and depression presented with concerns of recurrent urinary symptoms (dysuria and frequency). She was previously treated empirically with Amoxicillin-Clavulanate without improvement. She has a remote history of vulvovaginal candidiasis resolved with a single Fluconazole dose. Repeat urine culture done on this visit grew Raoultella planticola (50,000–100,000 CFU/mL), resistant to ampicillin but sensitive to multiple other antibiotics including Cephalexin with which the patient was treated for 7 days. The patient has no other comorbidities and neither is immunocompromised.

Discussion
R. planticola infection was first reported in 1984. Since then it has been implicated in various infections including urinary tract infections (UTIs), bacteremia, pneumonia, cholangitis, and soft-tissue infections. This pathogen primarily infects patients who are immunocompromised, critically ill, have undergone invasive surgical procedures, or individuals with underlying malignancies. Infections in immunocompetent individuals are exceedingly rare, with fewer than 10 documented cases in the literature. We report an unusual case of R. planticola UTI in an immunocompetent patient which was treated to resolution with Cephalexin 500mg BID for 7 days. The majority of reported R.planticola UTIs occurred in older adults with underlying conditions such as diabetes mellitus, chronic kidney disease, or neurogenic bladder manifesting as asymptomatic bacteriuria to severe urosepsis that have responded well to antibiotic therapy when guided by susceptibility results. Notably, R. planticola is intrinsically resistant to ampicillin but generally remains susceptible to β-lactam/β-lactamase inhibitors, cephalosporins, fluoroquinolones, and aminoglycosides. Rare cases of extended-spectrum beta-lactamase production and carbapenem resistance have been reported, underscoring the need for precise identification and targeted treatment. Given its emerging clinical relevance, particularly in recurrent or treatment-resistant UTIs, recognition of R. planticola as a potential uropathogen is important. This case adds to the limited but growing literature and highlights the importance of accurate microbiological diagnosis in managing atypical urinary pathogens.


Rare case of Raoultella planticola UTI in an immunocompetent patient

Background:
Mycoplasma pneumoniae (MP) is a common respiratory pathogen that may cause extrapulmonary manifestations, including mucocutaneous involvement. Reactive infectious mucocutaneous eruption (RIME) is one such manifestation, with skin involvement occurring in approximately 25% of the pediatric cases. MP has also been associated with immune dysfunction and autoimmune disease development. We present a case of a previously healthy child who developed RIME following MP infection, and was subsequently diagnosed with new-onset type 1 diabetes mellitus (T1D). 

Case Presentation: 
A previously healthy 9-year-old male presented with ten days of decreased oral intake due to painful oral mucosa, along with dysuria, penile blisters, and weight loss. Two days prior to symptoms onset, he developed fever and respiratory symptoms, testing positive for MP by PCR. He was initially treated at a community hospital for eight days with presumptive pneumonia and herpes, but was referred to our tertiary center due to persistent mucocutaneous lesions. 

On arrival, he was afebrile with stable vital signs, but presented marked hyperglycemia (glucose 431 mg/dL). Physical examination revealed oral mucositis with hemorrhagic crusting at the lip commissures, erosions on the glans penis, and erythematous plaques on lower extremities and lateral neck. Nikolsky sign was negative. Laboratory workup revealed elevated HbA1c (7.2%), hyponatremia, hyperkalemia, and glucosuria. 

During prior hospitalization, the patient received methylprednisolone for four days. However, glucosuria was documented before steroid initiation. His family denied diabetes symptoms or abnormal glucose levels, and there was no family history. He was started on azithromycin, mucocutaneous supportive care, and insulin therapy. At three week follow-up, skin lesions had resolved, but glycemic control required ongoing endocrinologic follow-up.

Discussion: 
RIME is a clinical diagnosis that may be underrecognized due to overlap with other mucocutaneous conditions. Diagnostic criteria include evidence of an infectious trigger, mucosal involvement at ≥2 sites, or cutaneous involvement affecting <10% of body surface. Drug-induced etiologies must be excluded. In this case, RIME was diagnosed after referral to a supra-tertiary pediatric center, where dermatologists evaluated the patient.

Although autoimmune diseases associated with MP have been documented within the first two years post-infection, the concurrent presentation of T1D raises the possibility of infection-triggered autoimmune disease. While the elevated HbA1c suggests a more prolonged course, the absence of glucose data limits definitive conclusions. Although the timing of both diagnosis could be coincidental, the possibility of a primary autoimmune process cannot be excluded. Clinicians should remain alert to this rare but notable association.

A Pediatric Case of Mycoplasma Pneumoniae presenting with Reactive Infectious Mucocutaneous Eruption with concurrent Type 1 Diabetes Mellitus

Background
Pancreatic Leiomyosarcoma (PLS), a rare malignancy (0.1% of pancreatic cancers), is seldom Estrogen Receptor(ER)-positive (<3%). This case involves a 55-year-old woman, post-hysterectomy, with ER-positive pulmonary Benign Metastasizing Leiomyomatosis (BML) and ER-positive PLS with identical markers, suggesting pancreatic spread. This first-reported dual presentation highlights diagnostic challenges and multidisciplinary approach for Uterine Leiomyoma spreading to lungs and pancreas.
Case Presentation
A 55-year-old woman with a history of Uterine Leiomyoma with s/p hysterectomy (2015), type 2 diabetes mellitus, hypertension, hyperlipidemia, asthma, knee osteoarthritis, and mild thalassemia underwent preoperative chest X-ray in 2022 which revealed bilateral pulmonary nodules up to 2 cm, suspicious for metastatic lung cancer. PET-CT showed well-defined pulmonary nodules in the right upper lobe (RUL- 1.9x1.9 cm), left upper lobe (LUL- 1.1x0.9 cm), and left lower lobe (LLL- 1.5x1.3 cm) without hypermetabolic activity. Endobronchial ultrasound-guided biopsy confirmed smooth muscle cells, positive for desmin, ER, Progesterone Receptor and smooth muscle actin(SMA), consistent with Pulmonary BML. 
Follow-up PET-CT after 4 months showed increased nodule sizes (RUL: 2.4x2.1 cm, LUL: 1.9x1.5 cm, LLL: 1.8x1.5 cm) with mild hypermetabolism. The patient was started on daily oral Anastrozole 1 mg.
Surveillance CT with contrast done in August 2023 revealed reduced nodule size but identified a 0.7cm pancreatic tail lesion. MRCP revealed a 2.3x1.8x1.6 cm lesion within the tail of pancreas and cytology indicated a Pancreatic Cyst with atypical epithelioid cells with mild spindling. In October 2024, the patient underwent a distal pancreatectomy and splenectomy and histopathology confirmed a 3.4 cm ER-positive PLS (pT1, pN0, pMx; Ki67 50%), positivity for ER, desmin, SMA and hCaldesmin, with negative EBER in situ hybridisation showing no association of EBV induced leiomyomas.The patient remains asymptomatic and stable on anastrozole.
Discussion
This case of ER-positive pulmonary BML and PLS post-hysterectomy raises intriguing questions about metastatic spread versus new primary tumors. Anastrozole reduced pulmonary BML, confirming hormonal responsiveness, yet aggressive PLS (high Ki67) emerged, requiring surgery. Could CDK inhibitors (palbociclib or ribociclib) or Selective Estrogen Receptor Degrader (SERD) such as fulvestrant, effective in ER-positive breast cancer, provide better control of hormonal spread in such rare tumors? The rarity of ER-positive PLS highlights the need for molecular profiling to clarify origins and optimize therapies like CDK inhibitors or SERD, opening avenues for future research.


Estrogen Receptor positive Leiomyoma with Metastatic Leap to Pancreas Over a Decade

Background
Peripheral artery disease (PAD) is a leading cause of functional limitation in older adults, with revascularization often required in advanced cases. Coexisting venous disorders, such as May-Thurner syndrome (MTS), can further complicate hemodynamics and outcomes. The combination of bilateral MTS and recurrent claudication following prior vascular reconstruction is rare and poses diagnostic and therapeutic challenges.

Case Presentation
A 66-year-old woman with coronary artery disease (status post-CABG), COPD, diabetes mellitus, and a history of extensive PAD presented with recurrent left calf claudication. Her vascular history included bilateral iliac vein stenting for MTS, bilateral common femoral endarterectomy, and a left CFA-to-above-knee popliteal bypass using a PTFE graft. Despite these interventions, she experienced exertional calf pain after walking two blocks. On exam, distal pulses were diminished. ABI was 0.73 on the left. Arterial duplex revealed 70% inflow stenosis at the bypass origin and 50% outflow stenosis. A revascularization attempt via CFA and radial access failed due to inability to cross the lesion. She is currently under multidisciplinary
evaluation for further intervention.

Discussion
This case underscores the complexity of managing PAD in the context of bilateral MTS and prior prosthetic bypass. Persistent claudication despite anatomically successful interventions suggests that both inflow and outflow disease can recur and affect graft patency. Bilateral MTS, though rare, may exacerbate venous congestion, impairing perfusion and masking arterial insufficiency. The case also highlights the limitations of prosthetic conduits like PTFE in maintaining long-term durability, especially in high-risk patients. Comprehensive vascular imaging, hemodynamic assessment, and individualized care planning are crucial in such
complex cases to optimize outcomes and prevent limb-threatening complications.

Recurrent Claudication Due to Bypass Inflow and Outflow Stenosis in a Patient with Bilateral May-Thurner Syndrome and a Complex Vascular History

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency that is characterized by elevated serum IgE levels, recurrent sinopulmonary infections, and chronic eczema, among other symptoms. Though reports on patients with HIES exist, they primarily focus on the clinical features, diagnosis, and management of HIES without detailing surgical interventions.

Here, we present the surgical management of an extensive cellulitic infection that developed into skin necrosis in a HIES patient with a history of polysubstance abuse. The patient had a diagnosis of Job’s Syndrome, the autosomal dominant form of HIES. In this case, severe infection resulting from immunodeficiency led to cellulitis and full thickness tissue loss in the left upper limb. Due to the extent of infection and necrosis, multiple debridements and upper extremity reconstruction were necessary for limb preservation.

The 625 cm2 wound, which involved the left upper extremity and crossed the elbow joint, was managed with initial debridement followed by a period of local wound care to allow for clearance of infection. We then performed reconstruction in a staged fashion with dermal substitute (Integra) placement and split thickness skin grafting. In this case, we demonstrate that the extensive soft tissue infections that may be found in HIES patients can be successfully managed with skin grafting and dermal substitute.

The Surgical Management of Extensive Cellulitic Infection and Tissue Necrosis in Rare Immunodeficiency: Hyper-IgE Syndrome

Background
Corona mortis (CM), meaning “crown of death,” is a vascular anatomical variation involving an anastomosis between the obturator artery and either the external iliac or inferior epigastric artery. This variation, present in a significant portion of individuals, is located near the superior pubic ramus, placing it at risk during pelvic or abdominal surgeries and trauma cases. Historical anatomical studies have documented CM as a key vascular hazard, given its propensity for severe hemorrhage if injured. This case highlights the implications of CM injury, emphasizing preoperative planning, intraoperative vigilance, and understanding of vascular variations among surgeons and radiologists.
Case Presentation
A 42-year-old male with end-stage cirrhosis presented to the emergency department with acute right lower quadrant abdominal pain and hypotension, two weeks post-robotic assisted bilateral inguinal and umbilical hernia repair. He was transferred from an outside hospital after imaging revealed intra-abdominal bleeding.
Upon arrival at the outside facility, the patient exhibited hypotension (90/58 mm Hg), tachycardia (128 bpm), and labs revealed a hemoglobin of 11.1 g/dL and hematocrit of 31.4%. Initial stabilization involved transfusion with 7 units of packed red blood cells before transfer.
Interventional radiology was consulted, and angiography identified bleeding from a right-sided CM variant arising from the inferior epigastric artery. Coil embolization was performed.
Following embolization, the patient was admitted to the ICU. His condition deteriorated, with worsening hemodynamic instability requiring intubation and pressor support. Despite consultations with general surgery and nephrology and aggressive resuscitative efforts, the patient ultimately experienced a pulseless electrical activity arrest. At the family’s request, further resuscitative measures were withheld.
Discussion
This anatomical variation poses a heightened risk for cirrhotic patients who are prone to coagulopathy and impaired hemostasis, complicating surgical outcomes and increasing the risk of severe hemorrhage, as demonstrated in our patient post-hernia repair. Preoperative imaging with CT angiography can help identify CM, aiding in surgical planning to minimize intraoperative risks. Surgeons should exercise caution with retractors and dissection near the superior pubic ramus, and in the event of an unexpected CM injury, direct pressure, hemostatic agents, or embolization may be necessary.
This case illustrates the critical need for heightened awareness of anatomical variations, particularly when operating on high-risk patients. Key takeaways include the value of preoperative imaging, cautious dissection near the pubic rami, and an interdisciplinary approach. Awareness of CM, combined with prompt identification and management, can prevent fatal outcomes.

Life-threatening Hemorrhage Due to Corona Mortis Injury: A Case Report

Background: Lung cancer screening with LDCT can lead to early detection and reduced lung cancer mortality. Sadly, uptake remains suboptimal with an estimated 5% of those eligible receiving LDCT. Cancer survivors require surveillance and preventive care but may face barriers to recommended screenings. Evidence also suggests survivors have higher lung cancer rates after LDCT than those without a cancer history, magnifying its benefit. This study examines smoking status and whether or not LDCT screening were discussed based on survivorship status.

Methods: Data from the nationally representative Health Information National Trends Survey 2022 were used to assess discussions of LDCT, comparing those with a prior cancer diagnosis (survivors) and those w/o cancer. Sample was limited to prior or current smokers aged 50-80 (pack year history not available); lung cancer survivors were excluded given expected surveillance with diagnostic CT scans. Demographics included age, race/ethnicity, gender, education, income, employment, and sexual orientation. Univariate analyses and logistic regression focused on predictors of LDCT discussion.

Results: Overall, 3,585 with current or prior smoking history were included of which 560 (15.6%) were cancer survivors. Survivors were older (median 69 vs. 65), less likely employed (26.2% vs. 40.4%), more commonly White (89.8% vs. 84.4%), and less often Black race (23.1% vs. 27.3%) (p < 0.05 for all) than those w/o a cancer history.

Among the cohort, 59 (10.5%) survivors vs. 346 (11.4%) non-survivors are current smokers (p=0.54). Actively smoking survivors were younger than survivors who had quit smoking (median age 63 vs. 68, p= 0.04).

More cancer survivors reported having a LDCT discussion with their provider in the last year than those w/o a cancer history (10.5% vs. 4.8%, p<0.001). Logistic regression confirmed this association, survivors were less likely to have not had a LDCT discussion (OR = 0.43, 95% CI [0.32, 0.59], p < 0.001). Further evaluation limited to survivors showed no significant differences in reported LDCT discussion by age, gender, race, ethnicity, sexual orientation, income, education, or current smoking status.

Conclusion: In this national study, cancer survivors with a smoking history report low rates of discussion of LDCT, despite one in ten being active smokers. While more common in survivors, only a tenth of eligible survivors and one in twenty without cancer are having this important screening discussion. Future interventions should focus on standardizing provider communication, improving survivorship care, and ensuring equitable LDCT screenings among all eligible individuals.


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