Moving Upstream: Why My Research Had to Change
Dear Dr. Fancy Collective,
My research journey began in the lab, focused on cancer biology mechanisms, pathways, and the molecular drivers of disease. But as I advanced in my training, the data began telling a story that the science alone could not explain.
What the Data Made Impossible to Ignore
In my early work, I found that Black patients were 2.3 times more likely to be diagnosed with advanced non–small cell lung cancer. I also saw that Black patients and those who were uninsured were significantly less likely to receive guideline-concordant treatment.
These disparities weren’t random. They were historical. Predictable. Systemic.
And they revealed a painful truth: By the time many of my patients reached the point of diagnosis, the system had already failed them.
The Implementation Science Question
So I began asking a different set of questions. The kind that sit at the heart of implementation science:
Where are the breakdowns in the lung cancer care continuum?
What structural barriers prevent patients’ participation in lung cancer screening and early detection?
How do we improve uptake of evidence-based interventions like lung cancer screening?
How do we ensure that the right care reaches the right people at the right time?
I realized I was studying cancer downstream, at the point of diagnosis, while the real opportunity for impact lived upstream, long before cancer was ever identified.
Why I Shifted Upstream
If Black patients are more likely to be diagnosed late, then the intervention cannot start at diagnosis. It must start with:
Increasing screening awareness
Improving access to low-dose CT scans
Building trust in the healthcare system
Integrating navigation support
Removing structural barriers
Engaging community-health partners
This is where implementation science became my anchor. It gave me the tools to examine not just what works, but why it isn’t working for everyone, and designing ways to fix it.
What My Research Focuses on Now
Today, my work centers on intercepting late-stage lung cancer diagnosis through:
improving lung cancer screening uptake
identifying and addressing barriers to early detection
designing community-informed interventions
strengthening care pathways from screening to follow-up
ensuring equitable delivery of guideline-concordant care
My goal is simple: to move evidence into practice and practice into communities.
What This Shift Means to Me
Moving upstream didn’t make my research less scientific. It made it more impactful. More rigorous. More aligned with the realities my patients face.
I am still a scientist. But now my science is connected to systems, structures, and the lived experiences of the people most affected by inequities.
I’m not just studying cancer anymore. I’m studying the conditions that shape who gets to survive it.
Signed,
Your favorite doctor’s favorite doctor – Dr. Fancy