Lauren K. Groner, DO, MS

The ACR is always encouraging College members to look at new and innovative ways to improve the specialty. Inspiration for such feats comes in many ways to ACR members, whether it be personal experiences or brainstorming with colleagues. 

For Lauren K. Groner, DO, MS, it came from a little of both. Using her passion for advancing lung cancer screening, along with hard work and an excellent team, Groner led the way to develop LungCheck.org, a new, easy-to-navigate tool that connects access to LCS resources to those who need it. Groner specializes in cardiothoracic radiology and is an assistant professor of radiology at Weill Cornell Medicine and an assisting attending radiologist at NewYork-Presbyterian/Weill Cornell Medical Center. She was awarded one of six inaugural 2022–2023 Dalio Center for Health Justice at NewYork-Presbyterian grants for her study targeting provider-level barriers to low-dose CT lung cancer screening. 

The ACR Bulletin sat down with Groner to discuss how LungCheck.org came to be and the impact the team hopes it makes.  

What started your interest in lung cancer screening care?

My grandmother died of lung cancer when I was a kid. She smoked for years, had late-stage disease at the time she was diagnosed and suffered terribly in the last year of her life. Fast-forward 20-plus years, and we now have a test (low-dose computed tomography) that is proven among individuals with a long-term tobacco history to reduce mortality rates from lung cancer by detecting it early when it’s easier to treat and cure. 

I never thought I’d hear the words “cure” and “lung cancer" in the same sentence in my lifetime. Unfortunately, only an average of 6% of those eligible for lung cancer screening in the U.S. get screened. I felt compelled to do something to increase lung cancer screening to give others a chance my grandmother didn’t have. 

A lot of the literature a few years ago focused on identifying rather than addressing barriers to lung cancer screening. This knowledge and evidence gap motivated me. In 2021, I enrolled in the clinical epidemiology and health services research master’s program at Weill Cornell Medicine and applied for and was selected to receive the Dalio Center for Health Justice research award, which funded my mixed-methods study, IBREATHE. The study focused on addressing barriers to lung cancer screening in the primary care setting using a theory-informed multicomponent behavior change intervention. 

I felt compelled to do something to increase lung cancer screening to give others a chance my grandmother didn't have.

I graduated from the master’s program in 2023, and now I split my time between clinical service as a cardiothoracic radiologist and health services research as head of the research arm of our lung cancer screening program. I feel lucky to be able to work in the field that I love while working toward the promise of a better tomorrow for our patients and their families. 

Many people have lost someone special to lung cancer. And although overall lung cancer incidence and mortality have declined over the past 60 years, these benefits are not shared equally by all subpopulations. Lung cancer remains a leading cause of racial and socioeconomic health disparities. Advancing health equity across the lung cancer continuum is top a priority for me.

How did you come up with the idea for LungCheck.org?

As part of our multicomponent behavior change intervention for the IBREATHE study, my team and I endeavored to create digital and hard-copy tools to address persistent barriers to lung cancer screening. It was critically important that this resource be grounded in data obtained from providers, patients and other relevant stakeholders, including navigators, billing experts, referral and practice managers, front-desk staff and other care providers who described and prioritized their top barriers to screening.

After conducting qualitative interviews with these stakeholders, I recruited a communications expert at Columbia University Irving Medical Center, Luis Blanco, who received his bachelor’s in fine arts from the Rhode Island School of Design and worked in advertising for many years before coming over to medicine and research. The two of us had an honest conversation about the messaging around smoking, lung cancer and lung cancer screening.

I shared a story about a brilliant friend of mine who sometimes smoked socially. She texted me a picture of lungs made up of cigarettes, and she told me, “This doesn’t make me want to quit smoking. This makes me feel like the damage is done.”  We also spoke about the fear and stigma that’s associated with smoking and lung cancer. There is a burden of blame and shame wrongly shouldered by people who smoke and then get lung cancer. Yet the same blame and shame are not borne by folks who get melanoma after tanning.

Luis and I wanted to reframe the narrative around lung cancer screening and shift the paradigm from one of shame, blame and fear — something that felt like a big deal for patients and providers — to a narrative that promotes optimism, transparency and something that just should be part of an annual checkup like blood pressure testing and lipid panels.

Early on, people often don’t know they have high blood pressure, high cholesterol or lung cancer until they check. That’s the idea behind LungCheck, and that’s why you’ll see the line on our website, “If your doctor recommends lung screening, they do NOT think you have lung cancer, they’re just checking!” Similarly, Luis came up with the “Breathe easy” tagline as a means of allaying fear.

How does Lungcheck.org work?

LungCheck.org is meant to be a clear, concise and high-yield resource for patients and providers. It was designed to be the definitive practical resource for lung cancer screening. It's set up in a wiki format with a table of contents that allows users to easily jump from one section to another. The title of each section explicitly tells users what that section is about and directly addresses barriers in such a way that is responsive to the feedback provided by primary care providers, patients and other relevant stakeholders

Every line of text and every image is intentional and intended to use a non-stigmatizing, transparent and practical approach that we believe promotes inclusivity and diversity. We spent months copywriting and editing. I brought in an expert to work with me, Kimberly Murdaugh, MD, MS, our site's technical director and a physician-scientist, writer, inventor and filmmaker with degrees from both Harvard University and the Yale School of Medicine

The website has two main pages. There's a patient page and there's a provider page. The patient page includes sections such as “What is LungCheck?” The provider page includes sections such as “Why lung screening (LungCheck)?”

We’ve received particularly positive feedback about our practical pack-year calculator, which allows patients and providers to calculate pack years over several time periods by entering multiple ages at which patients started and quit smoking, then restarted, followed by quitting again, and the number of packs smoked per day during those intervals. Accurately calculating pack-years in a real-world setting is critical for determining eligibility. Our calculator addresses what was cited as a major barrier to establishing eligibility.

How will this resource help improve screening and detection in diverse settings?

Our intention is to meet patients and practices where they are. I’m fortunate to work at an institution that is deeply committed to lung cancer screening. Our chairman has poured a lot of resources into the program, particularly our lung cancer screening navigation services. Unfortunately, resources such as time, money and personnel are not equitably distributed or available in health systems and practices across the U.S. Often, practices with the fewest resources serve communities that are the most at-risk — communities plagued by persistent poverty, high smoking rates and a heavy lung cancer burden. LungCheck.org is a free tool that gives providers knowledge and resources to implement lung cancer screening into their routine practice.  

The website is mobile friendly and available in English, Spanish, Bengali, conversational Chinese, Haitian Creole and Greek, and at a fifth-grade reading level. We plan to add languages such as Arabic and Russian. 

I’m excited to share that our team was just awarded a grant to support the next phase of our work. We will focus on building meaningful, enduring community partnerships and engaging community partners and patients to further tailor our site and resources to meet the needs of specific populations in the context of their daily lives and lived experiences. This formative work will allow us to design and test a multicomponent strategy to increase lung cancer screening knowledge and uptake in diverse clinical and community settings (such as barbershops, salons, community-based organizations and Federally Qualified Health Centers) in collaboration with our community partners.

Why is this such an important resource for the College and its members?

This resource builds on the already great resources available on the ACR website — in fact, we provide a link to the ACR website on our site. LungCheck.org adds value in several unique ways:

• The content on our site is grounded in information-rich qualitative data obtained from patients, providers, and other relevant stakeholders. It is directly responsive to their needs, concerns, priorities and preferences. 
• The website is set up as a wiki site that allows users to easily navigate from one section to another on a single page using hyperlinks. The site was intentionally designed as a practical, high-yield guide that is clear, concise, easy to navigate and comprehensible for providers and patients. 
• Our messaging is balanced. Transparent, non-stigmatizing and optimistic but pragmatic language and images were a priority for us.
• Our website is dynamic and up to date, and it links to the best available resources for lung cancer screening. 

How will this resource address barriers to LCS and improve uptake among patients and providers?

Using qualitative interviews, we identified the top persistent barriers to lung cancer screening in the primary care setting and used a theory-informed approach to define these barriers in behavioral terms. This helped us identify behavioral drivers of lung cancer screening and understand them in various contexts. Our multicomponent strategy, which includes LungCheck.org, is grounded in data and validated theoretical frameworks of behavior and behavior change. As I mentioned earlier, every line of text and every graphic is intentional in that they directly address barriers described by our stakeholders using a non-stigmatizing, transparent and practical approach.