Background: The Martini and Melamed criteria for diagnosing multiple primary lung cancers (MPLCs) have remained in use for half a century despite substantial changes in lung cancer epidemiology, risk factors, imaging technologies, and treatment approaches. Correspondingly, the landscape of MPLC has likely changed, necessitating revisions to their diagnostic guidelines. Research Question: What are the clinicopathologic profiles of modern-day MPLC patients, and can these features be used to identify a subset of patients classified as MPLC that may warrant additional investigation as intrapulmonary metastasis (IPM)? Study Design and Methods: We conducted a retrospective cohort study using electronic medical record data from patients who underwent multiple lung cancer resections at Mount Sinai Hospital. Patient demographics, tumor characteristics, and surgical treatments were compared with those reported in the original Martini and Melamed series. We then proposed a reclassification framework incorporating a CT-based assessment of synchronous versus metachronous tumors and contemporary clinicopathologic features documented in imaging and pathology reports. Results: Ninety-one patients underwent successive lung cancer resections. Among first nodules treated with surgical resection, 46% exhibited pathologic features suggestive of metastasis within the lung, including visceral pleural invasion (18%), vascular invasion (24%), lymphatic invasion (36%), and/or lymph node positivity (3%). In contrast, among second nodules (second temporal surgery), 45% demonstrated ground-glass opacity (GGO) supportive of a diagnosis of MPLC. Using the original criteria, 83 patients (91%) were classified as having MPLC; this proportion decreased to 53 patients (58%) under the reclassification criteria. Regardless of the criteria applied, contemporary MPLCs were more likely to occur in older patients, women, those with adenocarcinoma histology, and treated with sublobar resections compared with MPLCs described in the Martini and Melamed era. Conclusions: MPLCs are increasingly recognized, and their clinical presentation has changed substantially over time. Modern imaging and pathologic assessment may be useful tools for diagnosing MPLCs, but this requires future validation. This has important implications for staging and treatment decision-making, as patients may be undertreated by not being offered multimodal treatments or over-treated with systemic therapy when surgery alone may be sufficient.

Objectives: Risk reducing decisions impact previvors’ identity, family experiences, and relationships. These decisions are especially challenging for non-BRCA previvors, who face vague guidelines and limited evidence. This qualitative study explored non-BRCA previvors’ attitudes towards family planning, relationships, and the burden of previvor status. Methods:Previvors with non-BRCA mutations (Lynch-related, PALB2, RAD51C, BRIP1, CHEK2) were recruited from an urban gynecologic oncology clinic. We conducted semi-structured telephone interviews which were transcribed verbatim. Two investigators independently coded a subset of interviews, resolved discrepancies with a moderator blinded to study background, and then refined the codebook and applied across all transcripts to identify themes. Results: Twenty-one previvors completed interviews (median age 39). Three overarching themes emerged: impact of previvor status on mental health, on personal identity, and impact of medical experience on decision making.Those considering future fertility worried about ART cost and time pressure from risk reduction timelines; those not pursuing fertility worried about early menopause and mutation transmission to children. Previvor status impacted romantic relationships differently, with some describing strains caused by altered family planning and cancer prevention timelines, while others feeling no impact. Previvors emphasized the physician-patient relationship and shared decision-making. Many expressed frustrations regarding access to reliable data amid unclear guidelines. The lower penetrance of the non-BRCA did not lessen the psychosocial burden of previvor status in our cohort. Conclusions: Family planning, relationships, and previvor burden are central concerns for previvors. Ambiguity surrounding non-BRCA variants emerged as an independent source of distress shaping daily lives. Physicians can better partner with previvors by acknowledging these challenges to align medical and personal goals.