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Markey receives NCI grant to expand tobacco cessation treatment

The UK Markey Cancer Center is one of 22 cancer centers nationwide to receive funding to build and implement tobacco cessation treatment programs via the National Cancer Institute’s Cancer Center Cessation Initiative.

In 2017, NCI launched the Cancer Center Cessation Initiative as part of the NCI Cancer Moonshot℠ program. Through this initiative, Markey will receive $253,000 over the next year to help enhance the delivery of tobacco cessation treatments through four major efforts:

  • Refining electronic medical records and clinical workflows to ensure the systematic identification and documentation of smokers and the routine delivery of evidence-based tobacco cessation treatment services.
  • Overcoming patient, clinician, clinic and health system barriers to providing tobacco cessation treatment services.
  • Achieving institutional buy-in that treating tobacco use is a component of organizational “Standard of Care.”
  • Creating mechanisms to sustain tobacco cessation treatment services so that they continue beyond the funding period of the initiative.

Kentucky has more cases of lung cancer than any other state, and its mortality rate is 50 percent higher than the national average. Though other environmental factors play a part in the development of lung cancer, smoking and other uses of tobacco are the root cause of the disease.

“This grant award provides the means for Markey to embark on a clinically important, two-pronged approach to tobacco treatment, one that includes both provider education and patient care,” said Jessica Burris, assistant professor of psychology in the UK College of Arts & Sciences and member of the Markey Cancer Prevention and Control program.

“The goal is to quickly and reliably assess the tobacco use status of each and every patient, and to deliver evidence-based cessation treatment to all tobacco users. With this initiative, the promise of a marked, positive impact on the lives of Markey patients is clear because tobacco treatment is cancer treatment.”


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Dr. Jonathan Kiev answers questions about lung cancer.

Got questions about lung cancer? Dr. Jonathan Kiev has answers.

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

November is Lung Cancer Awareness Month, so now’s a great time for me to answer some common questions about the disease.

Lung cancer is a major problem in Kentucky. Unfortunately, our state leads the nation in both lung cancer incidence and deaths.

The good news is people who are at high risk for lung cancer – specifically, those who have a history of smoking – are eligible to undergo low-dose CT screening for the disease. This diagnostic test allows us to find lung cancer at a much earlier stage, giving us more time to potentially provide life-saving treatments. Even better news? The UK Markey Cancer Center has a Lung Cancer Screen Program for patients at high risk.

So, who’s at risk for lung cancer and what causes the disease?

First and foremost, if you smoke, seek help to quit.

Smoking is by far the No. 1 cause of lung cancer, and it causes head and neck cancers, too. It’s responsible for a variety of health problems not seen in non-smokers. In addition, hypertension and peripheral vascular disease are directly related to smoking, which is why getting on a nicotine cessation program is the first step.

(Related: Check out our tips for conquering a smoking addiction.)

Your doctor will take into account your current health and health history to decide if you are at risk for lung cancer. They will then order the appropriate blood tests and imaging (chest X-ray and CT scan) to see if you have developed early signs of the disease.

Can working in a coal mine or around asbestos cause lung cancer?

Any inhaled substance or chemical can cause lung cancer over repeated exposure, so the short answer is yes.

More importantly, exposure to these types of substances in high-risk professions can lead to other chronic lung illnesses as well. Patients in these professions need to be followed by specialists who understand their occupational risks and hazards.

What is lung cancer staging?

Staging is a way for your physician to determine the type of lung cancer that you have, and whether it has spread to your lymph nodes or to other organs.

Lung cancer can spread to the brain, bones and the adrenal gland. These are all treatable areas, but we like to catch the tumor as early as possible. Staging allows physicians to determine which therapy is best for you: surgery, radiation, chemotherapy or a combination of those. Additionally, your prognosis and risk of recurrence are linked to cancer stage.

How is lung cancer treated?

There are different options to treat lung cancer, so it’s important for you and your family to seek second opinions and find a physician who understands your priorities.

Surgery is best used for early-stage tumors that are smaller, but we can also perform successful operations for larger tumors that have spread to the chest wall. Radiation is available to patients that are not interested in or are not healthy enough to recover from a major chest surgery.

How is lung cancer surgery performed?

Thoracic surgeons specialize in the latest oncology techniques to successfully perform lung cancer surgery.

Typically, surgeons use small incisions and a camera to remove the diseased segments of the lung and its surrounding lymph nodes. Occasionally, a larger incision between the ribs is necessary (this is called a thoracotomy) if the tumor is large or centrally located.

Is robotic surgery available for lung cancer?

Yes, robotic surgery has been available for about 10 years, and it allows your surgeon to remove the affected lung or areas of the lung.

Robotic surgery provides a three-dimensional view, allowing surgeons to better see the areas they’re operating on.


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UK collaboration working to provide more effective treatment for lung cancer

Newly published findings from UK faculty reveal a novel cell signaling interaction that may prevent a key step in lung cancer progression.

Kentucky continues to lead the nation in incidence and death rates from lung cancer, and the UK College of Pharmacy is committed to reducing these numbers.

Lung cancers are often diagnosed in later stages, with very few treatment options available. Patients often develop a resistance to a targeted therapy, resulting in a need for a variety of therapies that can be administered in stages or coupled together.

A collaboration between the UK College of Pharmacy and the Department of Statistics in the UK College of Arts and Sciences is working to address this problem. The project is the work of Madeline Krentz Gober, a recent graduate of the UK College of Pharmacy’s graduate program in the lab of pharmacy faculty member Penni Black. Staff scientist James Collard and UK College of Arts and Sciences faculty member Katherine Thompson also contributed to the findings.

Previous work from the group established that a collection of microRNAs – small RNA that plays a role in regulating biological process like growth and proliferation – could predict sensitivity of non-small cell lung cancer cells to erlotinib, a drug that is effective in treating lung cancer in certain patients.

Further investigation into this collection of microRNA genes revealed a previously unknown relationship between the role of transforming growth factor TGFβ in initiating metastasis and epidermal growth factor receptor (EGFR) signaling non-small cell lung cancers.

Essentially, microRNA molecules that alter TGFβ activity may prevent a key step in metastasis for cancer progression known as epithelial-mesenchymal transition, and this interaction may also require the activity of EGFR, perhaps unappreciated in the initiation of metastasis.

“Getting the right drugs in the right patients is critical to improving cancer outcomes,” said Jill Kolesar, co-director of the Molecular Tumor Board at the UK Markey Cancer Center. “Dr. Black’s work is an important step in predicting which patients benefit most from erlotinib treatment.”

Ongoing work in Professor Black’s lab seeks to uncover biomarkers of response and toxicity to new immunotherapeutic agents used in the fight against lung cancer.


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lung cancer

5 things you should know about lung cancer even if you don’t smoke

Lung cancer is the deadliest type of cancer, taking more lives every year than breast, colon and prostate cancers combined.

November is Lung Cancer Awareness Month and the perfect time to learn more about the disease. Here are five things that everyone should know:

1. You don’t have to smoke to get lung cancer.

Although smoking is far and away the leading cause of lung cancer, non-smokers get the disease, too.

In fact, close to 20 percent of people who die from the disease didn’t smoke or use tobacco. Other factors, including radon exposure, exposure to secondhand smoke and genetic mutations, can all cause non-smokers to get lung cancer.

2. Lung cancer often has no symptoms …

Part of what makes lung cancer so deadly is its lack of symptoms. In many cases, symptoms don’t appear until the disease has advanced, often to an incurable stage.

Unfortunately, many common symptoms of lung cancer – such as a persistent cough, hoarseness, shortness of breath and chest pain – can be mistaken for other health problems, which further delays diagnosis.

3. … Which is why screening is so important.

When early-stage lung cancer is detected, a patient’s chance of survival can be as high as 70 percent.

That’s why the UK Markey Cancer Center created the Lung Cancer Screening Program, which offers low-dose CT screenings for patients who are at a high risk of developing lung cancer. Screenings are recommended for patients who:

  • Are ages 55-80.
  • Currently smoke or have quit within the past 15 years.
  • Have a 30 pack-year smoking history, meaning the patient smokes one pack of cigarettes per day for 30 years, or two packs per day for 15 years.
  • Have no current symptoms of lung cancer.

A lung cancer screening CT scan can detect cancer before symptoms are noticeable and at an early stage. When we find cancer at an early stage, many treatment options are available, which greatly improves the likelihood of survival.

Lung cancer screening does carry risks, including low-dose exposure to radiation and the possibility of more invasive follow-up tests. For that reason, only patients at a high risk for the disease who meet the criteria above should be screened.

4. Lung cancer hits hardest in Kentucky.

It’s a No. 1 ranking we’re not proud of in Kentucky: Our state leads the nation in lung cancer incidence and mortality.

Unsurprisingly, Kentucky also has the highest percentage of smokers in the country, with more than a quarter of residents age 18 or older reporting a smoking habit.

If you’re a smoker, you probably already know it’s a good idea to quit. Here are some tips for finally conquering your addiction.

5. Lung cancer treatment is getting better

One of the most promising recent developments in lung cancer treatment is the use of precision medicine to treat the disease. Precision medicine targets specific mutations in a person’s tumor, which leads to more effective treatment with fewer side effects.

Precision medicine treatments are available at the nation’s top cancer centers, where teams of cancer experts can come together to assess individuals’ genetic attributes and make treatment recommendations tailored to each person.

The UK Markey Cancer Center recently launched its own Molecular Tumor Board, which brings these precision medicine options to patients across Kentucky. Even better for patients with lung cancer is that they can be seen by the tumor board right after their initial diagnosis.


Next steps:

  • Learn more about Markey’s Multidisciplinary Lung Cancer Program, which provides expert care for conditions including small cell lung cancer and non-small cell lung cancer, mesothelioma, and other cancers of the chest and lungs.
  • Markey is Kentucky’s only National Cancer Institute-designated cancer center, providing world-class cancer care right here in the Commonwealth. Learn more about why patients choose Markey for their cancer treatment.
lung nodule

Your doctor says you have a lung nodule. Now what?

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

Your doctor tells you that a chest X-ray shows a spot on your lung. It might sound scary at first, but these spots, or lung nodules, are not an uncommon occurrence.

What are lung nodules and what causes them?

Lung nodules are small masses of tissue in the lung that can be cancerous, although the majority are non-cancerous.

Dust and chemical exposure, infection or other tumors can all cause a lung nodule to form. Most people have no symptoms at all and lung nodules are accidentally discovered during the evaluation of something else.

Conversely, people who smoke or who have smoked in the past may also have nodules, which sometimes progress to an invasive cancer. That’s why it’s so important for a specialist to look at your X-rays for further evaluation.

Do lung nodules cause pain?

Pain is rare, especially if the nodule is very small. A CT scan will reveal even the tiniest of nodules, and your doctor can then correlate it with your symptoms. Rarely, if the nodule is near a rib, there could be associated pain.

Why does my doctor want me to get my old records?

An X-ray or CT scan is a snapshot in time; it shows what is happening now.

For comparison, a doctor may ask you to get old hospital records or X-rays to see if your nodule was there in the past, if it’s grown or if it’s stayed the same size. Benign nodules usually don’t change in size, while nodules that are associated with cancer can grow or spread.

If I have a family history of lung cancer, should I be concerned?

Secondhand smoke increases the risk of lung cancer, so most physicians will screen family members of lung cancer patients more frequently. Cancerous nodules that are discovered earlier are more easily treated.

Unfortunately, that the vast majority of lung cancer patients have no symptoms at all, which is why only 15 percent of people who have lung cancer are diagnosed early.

My radiology report said that my nodule was suspicious. What does this mean?

Nodules that are deemed suspicious have certain characteristics, and your care team may want to do additional testing to find out whether your nodule is cancerous.

If your nodule is large enough, your doctor can do a needle biopsy, which involves placing a small needle in the nodule to remove some of the tissue for further testing. In some cases, a surgeon will need to do a surgical biopsy, which involves making a tiny incision to remove the questionable tissue for testing.

Why was I referred to a pulmonologist?

Pulmonologists specialize in lung disease. Through a procedure called a bronchoscopy, they are able to access different areas of the lung and perform biopsies of abnormal areas.

Additionally, they can assess your breathing function and make useful recommendations for inhalers and other medicines as well. They work in close collaboration with thoracic surgeons to form a multidisciplinary lung care team.

Should I consider lung cancer screening?

Lung cancer screening was developed several years ago to detect lung cancer in people who are at a higher risk of developing the disease.

Lung cancer screening is recommended for patients who are at high risk for lung cancer. Low-dose CT screenings are recommended for patients who:

  • Are ages 55-80.
  • Currently smoke or have quit within the past 15 years.
  • Have a 30 pack-year smoking history, meaning the patient smokes one pack of cigarettes per day for 30 years, or two packs per day for 15 years.
  • Have no current symptoms of lung cancer.

The low-dose CT scan takes about 30 seconds to perform, and there is very little radiation exposure to be concerned about. Most insurances will pay for the scan, and many hospitals have programs to help offset the cost as well.


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A new study, done in part at the UK Markey Cancer Center, shed light on why lung cancer cells can resist therapeutic cancer treatment.

Markey research sheds light on lung cancer formation and treatment

A new study co-authored by a researcher starting her laboratory at the UK Markey Cancer Center shows that in certain genetic situations, one non-small cell lung cancer subtype can change into another subtype.

This lung cancer “lineage switching” could explain why some cancers are resistant to therapeutics, and this research examines exactly how the lineage switch can happen. The work was a collaborative effort between laboratories in Kentucky, New York and Boston.

“Now that we have a glimpse into the molecular mechanism of lineage switching, we can begin to learn how to manipulate this phenomenon for better therapeutic outcomes,” said study co-author Christine Fillmore Brainson, assistant professor in the UK Toxicology and Cancer Biology department.

Previously, it was unclear which cells in the adult lung can be the “cells-of-origin” of the two major subtypes of non-small cell lung cancer, namely adenocarcinoma and squamous cell carcinoma. Likewise, it was unclear what differences in DNA organization define the two distinct lung cancer subtypes. The existence of adenosquamous lung tumors, clinically defined by the presence of both glandular adenocarcinoma lesions and fully stratified squamous lesions within the same tumor, suggested that both adenocarcinomas and squamous cell carcinomas could come from the same cells in the lung, but clear evidence for this theory was lacking.

Published in Nature Communications, the study showed that adenocarcinoma cells can change to squamous cells due to reorganization of their DNA in specific ways. Beginning with a mouse model of adenosquamous lung tumors, researchers validated the genetics by comparing it to human adenosquamous lung tumor – the genetics are often the same, including activation of the oncogene KRAS and the deletion of the tumor suppressor Lkb1. The team then used transplant assays to demonstrate that established adenocarcinoma tumors could transition to squamous cell carcinomas in the mouse lung.

Lastly, the group isolated different lung cells, and demonstrated that only certain lung cells could give rise to tumors capable of undergoing the lineage switch.

“This data is exciting because it shows which cells in the lung can give rise to adenosquamous tumors,” Brainson said.  “And the technique we used to transform the isolated cells can be applied to many lung cancer models.”

Oncologists have observed this “lineage switching” after the failure of EGFR tyrosine kinase inhibitor treatment, when it is clinically justifiable to take a second biopsy. However, second biopsies are not normally done after chemotherapy, a practice that Brainson thinks could be revised to understand the exact mechanisms of therapy resistance.

In addition to Brainson, the manuscript was co-authored by Haikuo Zhang of the Dana-Farber Cancer Institute in Boston. The research was a collaborative effort between the laboratories of Carla Kim at Boston Children’s Hospital, where Brainson was based for her post-doctoral studies; Hideo Watanabe at Icahn School of Medicine in New York; and Dr. Kwok-Kin Wong at Pearlmutter Cancer Center in New York.

This work was funded in part by the American Cancer Society, the Lung Cancer Research Foundation, the V Foundation for Cancer Research, the March of Dimes, the National Cancer Institute, the Gross-Loh Family Fund for Lung Cancer Research and Susan Spooner Family Lung Cancer Research Fund at the Dana-Farber Cancer Institute


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Dr. Timothy Mullett accepting the Lane W. Adams Quality of Life Award at the ACS summit in January.

Markey’s Dr. Timothy Mullett honored for exceptional patient care

The American Cancer Society (ACS) recently honored UK Markey Cancer Center surgeon Dr. Timothy Mullett with the Lane W. Adams Quality of Life Award. He was one of six recipients chosen for the national honor for his leadership in serving the complex needs of cancer patients and their families.

The ACS Quality of Life Award honors providers who routinely excel in providing care to their patients experiencing cancer, going beyond the bounds of their duties. Lane W. Adams emphasized the importance of a “warm hand of service” during his vice presidency of the American Cancer Society. This award represents Adams’ credence to serve and enhance others’ well-being.

Mullett has committed his time to lung screening and education by chartering the Lung Screening Excellence Project in Kentucky and serving as co-investigator at Kentucky Lung Cancer Education, Awareness, Detection and Survivorship, or LEADS. As a stage-4 liver cancer survivor, Mullett has a unique and personal perspective in providing care to his patients. He is known for his devotion to providing high-quality care for underrepresented citizens in Kentucky by working with nonprofit, government and medical groups.

Mullett currently serves as medical director for the Markey Cancer Center Research Network. He has also served as a colonel in the Army Reserves, with deployments in 2004 and 2012.


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Making the Rounds with Dr. Timothy Mullett

Meet Dr. Timothy Mullett, cancer surgeon – and cancer survivor

Making the RoundsGet to know Dr. Timothy Mullett, a cardiothoracic surgeon at the UK Markey Cancer Center, in our latest installment of Making the Rounds, a blog series where you’ll meet the providers at UK HealthCare.

Dr. Mullett specializes in surgical treatment for patients with lung cancer. He’s also the medical director of Markey’s Research and Affiliate networks. In addition to treating patients with cancer, Dr. Mullett is a cancer survivor himself. In 2014, he was diagnosed with liver cancer and was successfully treated at Markey.

When did you know you wanted to be a doctor?

It was one of those decisions I had made early on. I got sick when I was around 14 and I got used to being around doctors. I ended up getting better, but that left me with something that said, ‘This looks like a pretty cool place to spend some time.’

Who’s your favorite musical artist?

I’m a fan of country music. I’ve been listening to that for a long time. I’m a fan of modern country music: Tim McGraw, Faith Hill and now into Chris Stapleton.

My favorite part about music is that I put together this playlist. We have some friends that gather at the lake and I started to put together a playlist for when we’re on our boat. We’ve got my kids, some others folks and several families that are our age. Everyone contributes to this playlist that has now grown to about 780 songs. Everything from Meghan Trainor back to Eric Clapton. I love to put it on shuffle and let it go.

Describe your ideal weekend. Would it involve being on the lake?

Yeah, something on the water. Any time that I can gather with family and friends on a lake and get some water skiing in in the morning and some conversation and relaxation in in the evening. And I enjoy grilling something on the house boat.

What excites you most about working at UK HealthCare?

It’s the people we work with. The friends and contacts I’ve made here at UK are like a family, and we’re taking care of other people. We come together as a team and work together to say, ‘This is how we want to attack this problem.’ It’s great.


Check out our video interview with Dr. Mullett below. He tells us more about his work at Markey and how his own cancer diagnosis has impacted the way he cares for his patients.


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This one test could save your life

It’s a sad fact that Kentucky leads the U.S. in lung cancer incidence and mortality. If you smoke, live with a smoker or have smoked in the past, consider getting screened. Early detection is your strongest weapon against the disease.

What is lung cancer screening?

At the UK Markey Cancer Center, we use a low-dose CT scan to take many images of your chest and lungs. This allows a radiologist to look inside your lungs and identify suspicious spots that may be potential cancers.

Only low-dose CT scans – not chest X-rays – are recommended for lung cancer screening.

A suspicious or positive result means that the CT scan shows something that is abnormal. Additional tests will be done to determine whether this is cancer.

A negative result means that there were no abnormal findings at the time of the CT scan. It does not mean that you will never get lung cancer.

Who is qualified for lung cancer screening?

Lung cancer screening is recommended for patients who are at high risk for lung cancer, including those who:

  • Are ages 55-80, and
  • Currently smoke or have quit within the past 15 years, and
  • Have a 30 pack-year smoking history, which means smoking one pack a day for 30 years or two packs a day for 15 years, and
  • Have no current symptoms of lung cancer.

A lung cancer screening does not prevent lung cancer, but it can detect cancer at an early stage, before you develop symptoms of the disease.

Lung cancer screening has been shown to decrease the risk of lung cancer death in patients who are high risk for developing cancer. When lung cancer is found early, many treatment options are available, which greatly improves the likelihood of survival.


Next steps:

  • To make an appointment with the UK Lung Cancer Screening Program, call us at 844-SCN-LUNG (844-726-5864). You must have a primary care physician to participate in a lung cancer screening.
  • If you’re a smoker, you probably already know it’s not a healthy habit. Check out our “Take action to stop smoking” blog post with tips to help you quit.
Lung cancer in Kentucky

We’re fighting back against lung cancer in Kentucky

There’s a No. 1 ranking we’re not proud of in Kentucky: leading the nation in lung cancer incidence and mortality. November is Lung Cancer Awareness Month and the perfect time to learn more about the disease and what UK HealthCare is doing to fight back.

At the UK Markey Cancer Center, we’re working hard to reduce the burden of lung cancer in Kentucky through screening and prevention, state-of-the-art treatment and research, and compassion for patients and their families.

Markey’s Multidisciplinary Lung Cancer Program  brings together a team of health care providers with expertise in all areas of lung cancer. We treat small cell lung cancer, non-small cell lung cancer, mesothelioma and other cancers of the chest and lungs.

Screening and diagnosis

Survival rates for lung cancer are much lower than other common types of cancer, with less than 18 percent of people with lung cancer surviving five years. That’s why it’s so important to catch the disease at its earliest. When we detect early-stage lung cancer, a patient’s chances of survival can be as high as 70 percent.

The UK Lung Cancer Screening Program is available for patients who might be at risk for lung cancer, including smokers and former smokers, and can help identify lung cancer early on, before symptoms are noticeable.

Treating lung cancer

When a patient is diagnosed with lung cancer, we act fast to find a course of treatment that’s best for that person. Each treatment plan is based on the individual’s unique needs and the specifics of their cancer.

Surgery, radiation and chemotherapy treatments at Markey are state-of-the-art and are supplemented by national research studies as well as treatments with promising new drugs.

To make an appointment at the Multidisciplinary Lung Cancer Program, call 859-257-4488 or use our secure online appointment form.


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