Gabriella Oprea-Ilies - Academia.edu (original) (raw)
Papers by Gabriella Oprea-Ilies
Cancer, 2008
BACKGROUND. A disparate proportion of breast cancer deaths occur among young women, those of Afri... more BACKGROUND. A disparate proportion of breast cancer deaths occur among young women, those of African-American (AA) ancestry, and particularly young AA women. Estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor-2 (HER-2) are key clinically informative biomarkers. The triple-negative (ER-/PR-/HER-2-) tumor subgroup is intrinsically resistant to treatment and portends a poor prognosis. Age, race, and socioeconomic status have been associated with triple-negative tumors (TNT). In the current study, the authors investigated breast cancer subgroups among patients in an urban cancer center serving a multiracial, low socioeconomic population. METHODS. This case series analyzed female invasive breast cancers diagnosed and/or treated between 2003 and 2004 in the AVON Comprehensive Breast Center at Grady Hospital in Atlanta, Georgia. Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, and augmented by the hospital registry and pathology reports. Statistical analyses utilized frequency distributions and logistic regression. RESULTS. Of 190 breast cancers; 167 (88%) were diagnosed among AA and 23 (12%) were diagnosed among non-AA women. The median age at diagnosis in the 2 groups was 58 years and 57 years, respectively. TNT prevalence was found to differ by race (29.3% among AA women and 13.0% among non-AA women; P 5 .010). Differences persisted after adjustment for age and stage (odds ratio [OR] of 3.1; 95% confidence interval [95% CI], 0.8-11.6). The majority of recurrences (40.0%) occurred among women with TNT, who were also most likely to experience a fatal event (OR of 3.7; 95% CI, 1.1-13.0). CONCLUSIONS. Despite a similarity in their age at diagnosis, AA women in our urban cancer center presented with a higher prevalence of TNT and TNT was found to predict the poorest outcomes. Institutional interactive breast conferences and intervention/navigation programs could help to dispel breast cancer disparities and improve outcomes.
Cancer Epidemiology, Biomarkers & Prevention
INTRODUCTION The advent of deep molecular analysis using next generation sequencing (NGS) leads t... more INTRODUCTION The advent of deep molecular analysis using next generation sequencing (NGS) leads to a better understanding of carcinogenesis and the ability to identify and target specific mutations. METHOD After obtaining IRB approval, patients were approached in several oncology clinics in Grady Health System and explained the risk and benefit of being tested for molecular testing to better guide clinical management of their disease. After informed consent, we carried out Clinical Laboratory Improvement Amendments of 1988 (CLIA) NGS for a large number of targetable genes, tumor mutation burden (TMB), microsatellite instability (MSI), and the somatic transcriptome. We identified germline mutations, actionable genes, biologically significant genes, pertinent negative, variants of unknown significance, tumor profile-matched clinical trials and the recommended therapies based on CLIA NGS findings. All data and medical reports were made available to treating physicians. RESULTS We teste...
Cancer Research
African Americans (AA) have higher incidence and mortality rates for several cancer types in comp... more African Americans (AA) have higher incidence and mortality rates for several cancer types in comparison to their European American (EA) counterparts. Increasing participation in clinical research and patient registries, related to precision cancer medicine, will significantly improve cancer health equity. Many AA cancer patients are treated in community oncology clinics. Unfortunately, these health systems have limited access to Clinical Laboratory Improvement Amendments (CLIA) next generation sequence (NGS) germline and somatic DNA and RNA testing that are used to inform oncologists on the best treatment and/or clinical trial options for cancer patients. Indeed, AA CLIA NGS sample sets are poorly represented, which could presumably result in incomplete knowledge of genomic variants that could affect their treatment and overall outcomes. Hence, it is crucial to implement CLIA NGS efforts for all cancer patients. To address these disparities, Morehouse School of Medicine has formed t...
Journal of the American Society of Cytopathology, 2021
B75 Background Since year 2000, standard medical care guidelines have recommended characterizing... more B75 Background Since year 2000, standard medical care guidelines have recommended characterizing breast cancer, a non-homogeneous disease that demonstrates marked racial diversity in biology and outcome, by three protein biomarkers (estrogen receptors [ER], progesterone receptors [PR], and human epidermal growth factor receptor2 [HER2]). As of 2007, HER2 data is not collected by U.S. national cancer registries, rendering the population-based understanding of HER2 and associated ‘triple subtypes’ (combined ER/PR/HER2 expression) largely unknown. This study documents the population-based prevalence of HER2 testing, HER2 status, and ER/PR/HER2 subtpes and compares distributions across racial/ethnic and other subgroups. Methods Medical records and cancer registry abstracts were searched for ER, PR, and HER2 on 1842 females residents of two large metropolitan Atlanta counties diagnosed with breast cancer during 2003-2004 (52.5% White, 44.2% Black, 1.6% Hispanic, and 1.7% ‘Other’). We analyzed HER2 testing status, test results and triple subtypes; overall, and by age, race/ethnicity, other tumor prognostic factors, socio-economic status and vital status. The four triple subtypes were based on whether expression of ER, PR, and HER2 was positive (+) or negative (-): ER-PR-HER2- (Triple negative), ER-PR-HER2+, ER+/PR+HER2-, and ER+/PR+HER2+. Frequency distributions, χ2 tests of independence,T-tests, and multivariate logistic regression were employed in analyses. Results Evidence of HER2 testing was found for over 90% of diagnosed cases; 12.6% positive, 71.7% negative, and 15.7% indeterminable/not assayed. Recommended fluorescent in situ hybridization (FISH) assay for confirmation of the 13.5% scored 2+ by immunohistochemistry (IHC) was documented for nearly 77%, 12.5% of which were positive. HER2 testing and profiles did not differ between Black and White women or by poverty index, but HER2+ tumors were most likely among women under age 50. The most prevalent triple subtype was ER+/PR+HER2- (66.6%), followed by triple negative tumors (TNTs), 19.0%. HER2+ tumors were least prevalent, and fairly equally divided among ER-PR-HER2+ (6.0%) and ER+/PR+HER2+ (8.5%) subtypes. TNTs were most prevalent among Black women (26.8%) and least among White women (12.4%); adjusted Odds Ratio = 2.42, 95% Confidence Interval 1.69-3.49. TNTs also conferred the highest mortality (25.6%). Moreover, TNT mortality significantly differed between Black women (28.2%) and White women (19.8%), (P
Cureus, 2021
Lung cancer is the most common cause of death in both men and women. The United States Preventive... more Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers were included in the survey. The majority of the providers were aware of the USPSTF guidelines and believed that patients with multiple comorbidities and insurance issues were barriers in initiating LDCT screening. Lung cancer screening is an important component in cancer preventive strategies. Widespread awareness among the primary care providers and the public is extremely necessary for improving the use of LDCT.
American journal of clinical pathology, 2014
Survival as it relates to p16 overexpression and MIB-1 (Ki-67) proliferation in primary squamous ... more Survival as it relates to p16 overexpression and MIB-1 (Ki-67) proliferation in primary squamous cell vaginal carcinoma was studied. Retrospective chart review from 1997 to 2006 revealed 43 patients who were treated for primary vaginal cancer at Emory University hospitals. Tissue was evaluated by immunohistochemical staining for the presence of p16 and MIB-1 markers, and survival data were examined. Patients who had primary squamous cell vaginal cancers (n = 31) with a positive diffuse staining of p16 had significantly (P = .003) improved survival (~49.5 months) compared with p16-negative patients (~25.3 months). Stage-specific analysis with 30 additional reported cases showed a significant survival benefit for p16-positive vaginal cancers compared with p16-negative cancers for stages I and II (P = .017; hazard ratio [HR] 0.400; 95% confidence interval [CI], 0.189-0.850) and stages III and IV (P = .001; HR, 0.176; 95% CI, 0.066-0.479). No difference was observed in survival for MIB-...
Cancer, 2010
Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal gro... more Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal growth factor receptor 2 (HER2), national cancer registries do not collect HER2, rendering a population-based understanding of HER2 and clinical ''triple subtypes'' (estrogen receptor [ER] / progesterone receptor [PR] / HER2) largely unknown. We document the population-based prevalence of HER2 testing / status, triple subtypes and present the first report of subtype incidence rates. METHODS: Medical records were searched for HER2 on 1842 metropolitan Atlanta females diagnosed with breast cancer during 2003-2004. HER2 testing/status and triple subtypes were analyzed by age, race/ethnicity, tumor factors, socioeconomic status, and treatment. Age-adjusted incidence rates were calculated. RESULTS: Over 90% of cases received HER2 testing: 12.6% were positive, 71.7% negative, and 15.7% unknown. HER2 testing compliance was significantly better for women who were younger, of Caucasian or African-American descent, or diagnosed with early stage disease. Incidence rates (per 100,000) were 21.1 for HER2þ tumors and 27.8 for triple-negative tumors, the latter differing by race (36.3 and 19.4 for black and white women, respectively). CONCLUSIONS: HER2 recommendations are not uniformly adhered to. Incidence rates for breast cancer triple subtypes differ by age/race. As biologic knowledge is translated into the clinical setting eg, HER2 as a biomarker, it will be incumbent upon national cancer registries to report this information. Incidence rates cautiously extrapolate to an annual burden of 3000 and 17,000 HER2þ tumors for black and white women, respectively, and triple-negative tumors among 5000 and 16,000 respectively. Testing, rate, and burden variations warrant population-based in-depth exploration and clinical translation.
Cancer, 2008
A disparate proportion of breast cancer deaths occur among young women, those of African-American... more A disparate proportion of breast cancer deaths occur among young women, those of African-American (AA) ancestry, and particularly young AA women. Estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor-2 (HER-2) are key clinically informative biomarkers. The triple-negative (ER-/PR-/HER-2-) tumor subgroup is intrinsically resistant to treatment and portends a poor prognosis. Age, race, and socioeconomic status have been associated with triple-negative tumors (TNT). In the current study, the authors investigated breast cancer subgroups among patients in an urban cancer center serving a multiracial, low socioeconomic population.
BMC Cancer, 2013
Background Triple Negative subset of (TN) Breast Cancers (BC), a close associate of the basal-lik... more Background Triple Negative subset of (TN) Breast Cancers (BC), a close associate of the basal-like subtype (with limited discordance) is an aggressive form of the disease which convey unpredictable, and poor prognosis due to limited treatment options and lack of proven effective targeted therapies. Methods We conducted an expression study of 240 formalin-fixed, paraffin-embedded (FFPE) primary biopsies from two cohorts, including 130 TN tumors, to identify molecular mechanisms of TN disease. Results The annotation of differentially expressed genes in TN tumors contained an overrepresentation of canonical Wnt signaling components in our cohort and others. These observations were supported by upregulation of experimentally induced oncogenic Wnt/β-catenin genes in TN tumors, recapitulated using targets induced by Wnt3A. A functional blockade of Wnt/β-catenin pathway by either a pharmacological Wnt-antagonist, WntC59, sulidac sulfide, or β-catenin (functional read out of Wnt/β-catenin p...
Cureus, 2021
Lung cancer is the most common cause of death in both men and women. The United States Preventive... more Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers w...
Cancer, 2008
BACKGROUND. A disparate proportion of breast cancer deaths occur among young women, those of Afri... more BACKGROUND. A disparate proportion of breast cancer deaths occur among young women, those of African-American (AA) ancestry, and particularly young AA women. Estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor-2 (HER-2) are key clinically informative biomarkers. The triple-negative (ER-/PR-/HER-2-) tumor subgroup is intrinsically resistant to treatment and portends a poor prognosis. Age, race, and socioeconomic status have been associated with triple-negative tumors (TNT). In the current study, the authors investigated breast cancer subgroups among patients in an urban cancer center serving a multiracial, low socioeconomic population. METHODS. This case series analyzed female invasive breast cancers diagnosed and/or treated between 2003 and 2004 in the AVON Comprehensive Breast Center at Grady Hospital in Atlanta, Georgia. Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, and augmented by the hospital registry and pathology reports. Statistical analyses utilized frequency distributions and logistic regression. RESULTS. Of 190 breast cancers; 167 (88%) were diagnosed among AA and 23 (12%) were diagnosed among non-AA women. The median age at diagnosis in the 2 groups was 58 years and 57 years, respectively. TNT prevalence was found to differ by race (29.3% among AA women and 13.0% among non-AA women; P 5 .010). Differences persisted after adjustment for age and stage (odds ratio [OR] of 3.1; 95% confidence interval [95% CI], 0.8-11.6). The majority of recurrences (40.0%) occurred among women with TNT, who were also most likely to experience a fatal event (OR of 3.7; 95% CI, 1.1-13.0). CONCLUSIONS. Despite a similarity in their age at diagnosis, AA women in our urban cancer center presented with a higher prevalence of TNT and TNT was found to predict the poorest outcomes. Institutional interactive breast conferences and intervention/navigation programs could help to dispel breast cancer disparities and improve outcomes.
Cancer Epidemiology, Biomarkers & Prevention
INTRODUCTION The advent of deep molecular analysis using next generation sequencing (NGS) leads t... more INTRODUCTION The advent of deep molecular analysis using next generation sequencing (NGS) leads to a better understanding of carcinogenesis and the ability to identify and target specific mutations. METHOD After obtaining IRB approval, patients were approached in several oncology clinics in Grady Health System and explained the risk and benefit of being tested for molecular testing to better guide clinical management of their disease. After informed consent, we carried out Clinical Laboratory Improvement Amendments of 1988 (CLIA) NGS for a large number of targetable genes, tumor mutation burden (TMB), microsatellite instability (MSI), and the somatic transcriptome. We identified germline mutations, actionable genes, biologically significant genes, pertinent negative, variants of unknown significance, tumor profile-matched clinical trials and the recommended therapies based on CLIA NGS findings. All data and medical reports were made available to treating physicians. RESULTS We teste...
Cancer Research
African Americans (AA) have higher incidence and mortality rates for several cancer types in comp... more African Americans (AA) have higher incidence and mortality rates for several cancer types in comparison to their European American (EA) counterparts. Increasing participation in clinical research and patient registries, related to precision cancer medicine, will significantly improve cancer health equity. Many AA cancer patients are treated in community oncology clinics. Unfortunately, these health systems have limited access to Clinical Laboratory Improvement Amendments (CLIA) next generation sequence (NGS) germline and somatic DNA and RNA testing that are used to inform oncologists on the best treatment and/or clinical trial options for cancer patients. Indeed, AA CLIA NGS sample sets are poorly represented, which could presumably result in incomplete knowledge of genomic variants that could affect their treatment and overall outcomes. Hence, it is crucial to implement CLIA NGS efforts for all cancer patients. To address these disparities, Morehouse School of Medicine has formed t...
Journal of the American Society of Cytopathology, 2021
B75 Background Since year 2000, standard medical care guidelines have recommended characterizing... more B75 Background Since year 2000, standard medical care guidelines have recommended characterizing breast cancer, a non-homogeneous disease that demonstrates marked racial diversity in biology and outcome, by three protein biomarkers (estrogen receptors [ER], progesterone receptors [PR], and human epidermal growth factor receptor2 [HER2]). As of 2007, HER2 data is not collected by U.S. national cancer registries, rendering the population-based understanding of HER2 and associated ‘triple subtypes’ (combined ER/PR/HER2 expression) largely unknown. This study documents the population-based prevalence of HER2 testing, HER2 status, and ER/PR/HER2 subtpes and compares distributions across racial/ethnic and other subgroups. Methods Medical records and cancer registry abstracts were searched for ER, PR, and HER2 on 1842 females residents of two large metropolitan Atlanta counties diagnosed with breast cancer during 2003-2004 (52.5% White, 44.2% Black, 1.6% Hispanic, and 1.7% ‘Other’). We analyzed HER2 testing status, test results and triple subtypes; overall, and by age, race/ethnicity, other tumor prognostic factors, socio-economic status and vital status. The four triple subtypes were based on whether expression of ER, PR, and HER2 was positive (+) or negative (-): ER-PR-HER2- (Triple negative), ER-PR-HER2+, ER+/PR+HER2-, and ER+/PR+HER2+. Frequency distributions, χ2 tests of independence,T-tests, and multivariate logistic regression were employed in analyses. Results Evidence of HER2 testing was found for over 90% of diagnosed cases; 12.6% positive, 71.7% negative, and 15.7% indeterminable/not assayed. Recommended fluorescent in situ hybridization (FISH) assay for confirmation of the 13.5% scored 2+ by immunohistochemistry (IHC) was documented for nearly 77%, 12.5% of which were positive. HER2 testing and profiles did not differ between Black and White women or by poverty index, but HER2+ tumors were most likely among women under age 50. The most prevalent triple subtype was ER+/PR+HER2- (66.6%), followed by triple negative tumors (TNTs), 19.0%. HER2+ tumors were least prevalent, and fairly equally divided among ER-PR-HER2+ (6.0%) and ER+/PR+HER2+ (8.5%) subtypes. TNTs were most prevalent among Black women (26.8%) and least among White women (12.4%); adjusted Odds Ratio = 2.42, 95% Confidence Interval 1.69-3.49. TNTs also conferred the highest mortality (25.6%). Moreover, TNT mortality significantly differed between Black women (28.2%) and White women (19.8%), (P
Cureus, 2021
Lung cancer is the most common cause of death in both men and women. The United States Preventive... more Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers were included in the survey. The majority of the providers were aware of the USPSTF guidelines and believed that patients with multiple comorbidities and insurance issues were barriers in initiating LDCT screening. Lung cancer screening is an important component in cancer preventive strategies. Widespread awareness among the primary care providers and the public is extremely necessary for improving the use of LDCT.
American journal of clinical pathology, 2014
Survival as it relates to p16 overexpression and MIB-1 (Ki-67) proliferation in primary squamous ... more Survival as it relates to p16 overexpression and MIB-1 (Ki-67) proliferation in primary squamous cell vaginal carcinoma was studied. Retrospective chart review from 1997 to 2006 revealed 43 patients who were treated for primary vaginal cancer at Emory University hospitals. Tissue was evaluated by immunohistochemical staining for the presence of p16 and MIB-1 markers, and survival data were examined. Patients who had primary squamous cell vaginal cancers (n = 31) with a positive diffuse staining of p16 had significantly (P = .003) improved survival (~49.5 months) compared with p16-negative patients (~25.3 months). Stage-specific analysis with 30 additional reported cases showed a significant survival benefit for p16-positive vaginal cancers compared with p16-negative cancers for stages I and II (P = .017; hazard ratio [HR] 0.400; 95% confidence interval [CI], 0.189-0.850) and stages III and IV (P = .001; HR, 0.176; 95% CI, 0.066-0.479). No difference was observed in survival for MIB-...
Cancer, 2010
Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal gro... more Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal growth factor receptor 2 (HER2), national cancer registries do not collect HER2, rendering a population-based understanding of HER2 and clinical ''triple subtypes'' (estrogen receptor [ER] / progesterone receptor [PR] / HER2) largely unknown. We document the population-based prevalence of HER2 testing / status, triple subtypes and present the first report of subtype incidence rates. METHODS: Medical records were searched for HER2 on 1842 metropolitan Atlanta females diagnosed with breast cancer during 2003-2004. HER2 testing/status and triple subtypes were analyzed by age, race/ethnicity, tumor factors, socioeconomic status, and treatment. Age-adjusted incidence rates were calculated. RESULTS: Over 90% of cases received HER2 testing: 12.6% were positive, 71.7% negative, and 15.7% unknown. HER2 testing compliance was significantly better for women who were younger, of Caucasian or African-American descent, or diagnosed with early stage disease. Incidence rates (per 100,000) were 21.1 for HER2þ tumors and 27.8 for triple-negative tumors, the latter differing by race (36.3 and 19.4 for black and white women, respectively). CONCLUSIONS: HER2 recommendations are not uniformly adhered to. Incidence rates for breast cancer triple subtypes differ by age/race. As biologic knowledge is translated into the clinical setting eg, HER2 as a biomarker, it will be incumbent upon national cancer registries to report this information. Incidence rates cautiously extrapolate to an annual burden of 3000 and 17,000 HER2þ tumors for black and white women, respectively, and triple-negative tumors among 5000 and 16,000 respectively. Testing, rate, and burden variations warrant population-based in-depth exploration and clinical translation.
Cancer, 2008
A disparate proportion of breast cancer deaths occur among young women, those of African-American... more A disparate proportion of breast cancer deaths occur among young women, those of African-American (AA) ancestry, and particularly young AA women. Estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor-2 (HER-2) are key clinically informative biomarkers. The triple-negative (ER-/PR-/HER-2-) tumor subgroup is intrinsically resistant to treatment and portends a poor prognosis. Age, race, and socioeconomic status have been associated with triple-negative tumors (TNT). In the current study, the authors investigated breast cancer subgroups among patients in an urban cancer center serving a multiracial, low socioeconomic population.
BMC Cancer, 2013
Background Triple Negative subset of (TN) Breast Cancers (BC), a close associate of the basal-lik... more Background Triple Negative subset of (TN) Breast Cancers (BC), a close associate of the basal-like subtype (with limited discordance) is an aggressive form of the disease which convey unpredictable, and poor prognosis due to limited treatment options and lack of proven effective targeted therapies. Methods We conducted an expression study of 240 formalin-fixed, paraffin-embedded (FFPE) primary biopsies from two cohorts, including 130 TN tumors, to identify molecular mechanisms of TN disease. Results The annotation of differentially expressed genes in TN tumors contained an overrepresentation of canonical Wnt signaling components in our cohort and others. These observations were supported by upregulation of experimentally induced oncogenic Wnt/β-catenin genes in TN tumors, recapitulated using targets induced by Wnt3A. A functional blockade of Wnt/β-catenin pathway by either a pharmacological Wnt-antagonist, WntC59, sulidac sulfide, or β-catenin (functional read out of Wnt/β-catenin p...
Cureus, 2021
Lung cancer is the most common cause of death in both men and women. The United States Preventive... more Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers w...