Lung Cancer Screening for the Poor and Underserved: Should Routine Screening be Performed?

Background: Lung cancer is a leading cause of death in United States. A recent study using low dose CT scans for screening long term smokers for lung cancer has, for the first time, demonstrated reduction in mortality, although it is not a standard of care in the community yet. Methods: We analyzed lung cancer data for stages 0 through 4 for 1,412 individuals from, a public hospital, Nassau University Medical Center (NUMC) with patients of lower income, two private hospitals, North Shore University Hospital (NSUH) and Long Island Jewish Hospital (LIJ), with patients of higher income, with average household income per year of 83,795 $, 152,777$ and 93,234 $ respectively. Results: Significantly smaller percentages of patients were diagnosed with stages 0 and 1 lung cancer at NUMC (8.55%) versus either NSUH (36.18%, P \u3c 0.001) or LIJ (35.70%, (P \u3c 0.001). Conclusions: At this point there is evidence that Lung Cancer Screening reduces mortality in long term smokers, but there is debate over, if it should be made into a recommendation. In light of the above study we suggest, that screening for lower socioeconomic class, could be recommended, if not for general population

Immunotherapy in extensive small cell lung cancer

Abstract Small cell lung cancer which constitutes about 15% of lung cancers is pathobiologically and clinically distinct from non small cell cancer. Histologically it is characterized by small cells with scant cytoplasm, absent or inconspicuous nucleoli, extensive necrosis, and expresses neuroendocrine markers. It is on a spectrum of neuroendocrine cancer that extend from typical carcinoids to large cell to small cell cancer. Clinically it behaves in a more malignant fashion with a rapid doubling time, early metastasis. They respond rapidly to cytotoxic treatment however tend to develop resistance soon. Immunotherapy with checkpoint inhibitors take advantage of PD 1 ligand-receptor axis between the tumor and T cells or CTLA4 on T cells which when engaged lead to inhibition of T cells. This inhibition helps tumors to evade immune surveillance. Checkpoint inhibitors break this axis by either binding to PD 1 ligands or PD 1 to CTLA4, thereby preventing tumors to evade the immune systems. This has led to remarkable responses in tumors. The immune related adverse effects can be severe however are experienced at much lower rates as compared to cytotoxic chemotherapy. Recently, CheckMate 032 has shown impressive response rates with Nivolumab and Nivolumab/Ipilimumab in relapsed small cell cancer. IMpower 133, a phase 3 trial showed that addition of Atezolizumab to Carbo/Etoposide led to a significant survival benefit in treatment naive extensive small cell cancer. This review will summarize recent developments and ongoing studies of immune therapy in extensive small cell cancer in addition to a brief summary of immune therapy landscape of Non small cell lung cancer. Investigational approaches to immune therapy have also been delineated

Mother India: the role of the maternal figure in establishing legal subjectivity

Psychoanalytic jurisprudence attempts to understand the images used by law to attract and capture the subject. In keeping with the larger psychoanalytic tradition, such theories tend to overemphasise the paternal principle. The image of law is said to be the image of the paterfamilias—the biological father, the sovereign, or God. In contrast to such theories, I would like to introduce the image of the mother and analyse its impact on the subject’s relation to law. For this purpose, I examine the history and use of the figure of Bharat Mata or Mother India and how it influences the Indian subject’s relation to law. When the subject is torn between his loyalties to the lawmaker–as–father and the nation–as–mother, who does he side with? Eschewing Greek myths and the Oedipus complex, I focus instead on Hindu mythology and the notion of an oedipal alliance to understand legal subjectivity in India. Lastly, I analyse a defining Indian political trial, the Gandhi murder trial, in which all these notions come to play and the accused justifies his decision to murder the father of the nation in the name of the motherland