Each year, the New York State Department of Health’s Bureau of Tobacco Control tracks the prevalence of smoking among adults by county. County level estimates can be used to identify areas of concern, track progress for program interventions, and evaluate the effectiveness of tobacco control policies.
With high rates of smoking in counties like Chemung, Schuyler and Steuben, pulmonologists at Arnot Health and Cayuga Health treat many people for pre-cancer and symptoms of lung cancer. In 2024, Arnot Health’s physicians noticed a problematic delay between the time of a lung scan and the time a patient received treatment.
“People get a scan and then things are not coordinated in a streamlined fashion. I mapped out the entire process between getting the scan and what steps could delay care,” said Dr. Michelle Malnoske, pulmonary critical care physician, medical director of the intensive care unit and associate chief medical officer at Arnot Health, a member of Centralus Health.
According to Dr. Malnoske, a positron emission tomography, or PET, scan will delay diagnosis. This scan provides doctors with more information about the lungs’ condition, but scheduling time between a scan and a follow up appointment created a delay in treatment.
To offset the delays, the pulmonology team at Arnot Ogden Medical Center created a rapid lung nodule clinic, which uses CT scans. Dr. Malnoske says the goal is to get patients in for a scan and schedule a visit with a pulmonologist or thoracic surgeon quickly.
“Our goal is to rapidly diagnose the abnormalities found on CT scans. If someone was diagnosed with lung cancer, their abnormal CT scan to the time of diagnosis was about 73 days, which is a long time to sit with this unknown,” said Dr. Malnoske.
Lung nodules are small growths that can develop in the lungs. Research shows nodules appear in nearly one out of every three chest CT scans. Not all spots are cancerous but they can be concerning for the patient, and waiting weeks without an answer can increase already high levels of anxiety.
“For folks who have gone through our rapid nodule clinic, the average time to diagnosis is less than 18 days. It’s much faster getting their answer,” said Dr. Malnoske.
Doctors aim to expedite the process by getting necessary studies, consultations and follow-up appointments scheduled within the same day.
“Patients that come to the clinic get their breathing test done; they see a pulmonologist and, if needed, they see our thoracic surgeon,” said Dr. Malnoske.
Each patient’s case is assessed individually. Dr. Ahmed Khan, cardiothoracic surgeon at Arnot Health, says the pulmonologists will evaluate their lung function, determine whether they’re a surgical candidate, and move forward with the best plan of care.
“Once pulmonologists determine if someone will survive a lung resection, they hand them over to me and the candid discussion we have is, ‘hi, you likely have cancer and this is what needs to happen’,” said Dr. Khan.
Understanding what cancer patients need to know and from whom they receive information during care is essential to ensuring quality care. Dr. Khan spends time answering questions and alleviating any concerns people may have.
“My biggest role is knowledge delivery: what stage is the patient? Is this resectable? Can I cure you? What other options do I have? Those are all the things we discuss in that meeting,” said Dr. Khan.
Not every patient is the right fit for the rapid lung nodule clinic. People who qualify for a lung scan are those who have a 20 pack-year or more smoking history (an average of one pack a day over 20 years or two packs a day over 10 years), smoke now or have quit within the past 15 years, and are between 50 and 80 years old. Patients with concerns over a recent scan should talk to their doctor about a referral.
Arnot Health’s pulmonology department is located at 600 Roe Ave. in Elmira. To find out if you are eligible or to make an appointment, click here.
Cayuga Health offers pulmonary and sleep services at Cayuga Medical Center, 201 Dates Drive, Suite 301, Ithaca; at Schuyler Hospital, 220 Steuben Street, Montour Falls and at 260 Tompkins Street, Cortland. To request an appointment, click here.
