Addressing the challenges in lung cancer screening

DomAIn Knowledge

Lung cancer is the leading cause of cancer deaths worldwide; more than colon, prostate, ovarian, and breast cancer deaths combined. It’s estimated that 235,760 people in the United States will be diagnosed with lung cancer in 2021. These statistics beg the question, as a healthcare community what can we do to change the outcome for these patients? In speaking with a radiologist at Sutter Health, he told me, “When you look at lung cancer, survival is all about early detection.”

November is lung cancer awareness month and a perfect time to focus on screening and early cancer detection. Recently I had the opportunity to sit down with Dr. Debra Dyer, Chair of the Department of Radiology at National Jewish Health and Chair of the American College of Radiology Lung Cancer Screening 2.0 Steering Committee. During our conversation, she and I discussed the importance of early detection, current guidelines on who should be screened, challenges in getting people screened, and the value of a centralized program for care management and follow-up.

Kathleen: Dr. Dyer, please tell us a little about yourself and your focus on lung cancer.

Dr. Dyer: I am a diagnostic radiologist. I did a fellowship in cardiothoracic radiology, my sub-specialty is cardiothoracic radiology, and I really love working on the thoracic side. And because I work at a facility, a hospital that has the main focus of chronic respiratory disease, it was kind of a natural fit when lung cancer screening became available, that we would embrace that. So many of our patients are eligible. It really made a lot of sense to offer that to our patients. And we started offering it as soon as the National Lung Screening Trial results were released in 2011.

Kathleen: What changes have you seen occur in lung cancer screening?

Dr. Dyer:  I think albeit it has been slow, there has been an increased acceptance of lung cancer screening. Lung cancer screening CT specifically. And when I started practicing back in the early ’90s, we really were only able to offer chest x-ray as a screening tool. And it was not a good screening tool. Because by the time we would find an abnormality on chest x-ray, it was usually too late.

As CT came into more and more prominence in our field, then of course the National Lung Screening Trial was funded, and it started in the early 2000s. And at that time, I was working at the University of Colorado. And we were one of the sites for the screening trial. So very early on, I was familiar with lung cancer screening. And then of course, when the results were released, it was just so exciting.

At that time, some of my oncology friends would say, “This is the best news we’ve ever had in lung cancer.” It was just a very natural thing for those of us in diagnostic radiology, and particularly in the field of thoracic radiology, to take on lung cancer screening.

And then what was very clear to me was it’s not something though that a radiologist can just do by themselves. It requires a team and I feel fortunate working here at National Jewish that we have a whole team of folks that are really engaged in lung cancer screening. We have pulmonologists, interventional pulmonologists, thoracic surgeons. We have advanced practice providers that are engaged with the patients from the very beginning in that they do the required shared decision-making. We have a centralized program, and we’re able to manage the whole care continuum from beginning to end.

Now, of course, we rely on referrals from primary care providers in our surrounding community. Our pulmonologist here at National Jewish can refer patients as well. But we try to reach out to the primary care community. And I think they appreciate our centralized program in that we’re able to provide them with the whole package. 

Kathleen: Are there many programs like yours?

Dr. Dyer: It is variable. There certainly are programs like mine around the country. They tend to be at academic centers, but it’s certainly possible to do in a community network of hospitals if they share resources, and they can set up multidisciplinary committees. I do think it’s possible, it may be more challenging, I haven’t tried to do it, but I think even if you at least have parts of a centralized program, you’re getting on the way. Absolutely though, critical from the very beginning is to have the navigator or the program coordinator that really is the one that gets the referrals and gets things going.

Kathleen: As we move forward in our discussion, what is the correct terminology? Is it lung screening or lung cancer screening?  

Dr. Dyer: Right now, in the U.S., what we say is lung cancer screening. Now that’s a really, really interesting question that you ask because some folks are saying maybe we should change the terminology so it’s less threatening and use something like lung screening. In the UK, they have had a project in place for some time where they call it the Lung Health Check. This approach has helped them get a lot of patients involved in lung cancer screening. They felt that was a more positive message, and they could really bring in more folks. I think that is something we should be considering here, to maybe put a little different angle on just how we present it. Particularly to patients and the community.

Kathleen: What are your thoughts on using the terminology low dose CT scan with the general healthcare consumer?

Dr. Dyer: I totally see where you’re going with this. And we’re kind of new at this really. Lung cancer screening has really only been around and more fully adopted I’d say in the past seven years. And if we compare that to something like breast cancer screening with mammography, they’ve got a lot more years behind them. And we can learn from their experience.

But I think what you’re suggesting is that actually, there are ways that we could make it more inviting and have that sort of positive message to it. And the low dose CT idea came about because it was felt early on that to do a regular full dose CT would not necessarily be something we would want to be doing every year on a patient. And lung cancer screening CT does require that it be done annually.

If we were going to propose this to a wide population, it really made sense to cut the dose down as low as possible. The low dose CT is almost more of a message to the providers or maybe the savvy patient that is worried about radiation dose. In my experience, I haven’t found patients to be that worried about it. But certainly, some of the referring providers have asked and they are reassured when we’re able to tell them, yes, this low dose CT is about a sixth of the dose of the usual chest CT. So that is important, but maybe we need a new term. It also sounds a little threatening.

Kathleen: Talk to me about the importance of early lung cancer detection.

Dr. Dyer: We need to be able to identify lung cancer at an early, treatable, and potentially curable stage. To do that, it has to be a small lesion. It can’t have spread into the mediastinum, into the center of the chest where the lymph nodes are, or elsewhere. What I’m describing is we want to identify the lung cancers at stage one as opposed to stage four. There are four stages.

Unfortunately, most of the lung cancers in our country and the world are found at a late stage because, by the time you have symptoms, the cancer has progressed. And if you’re coughing up blood, for example, that would be a symptom that we’d worry about. Then it’s usually a later stage.

What we found with the National Lung Screening Trial and having then evaluated the utility of CT is that we found a dramatic stage shift. We were able to identify these lung cancers early. And then when they did declare themselves, they would be a stage one.

Now, how would they declare themselves? If we find on the initial baseline scan that there is a small nodule, that nodule needs follow-up. Or if it’s really small, it at least needs the next annual. So then when we look at the follow-up scan, if that nodule has grown, that’s when we get worried. It’s still relatively small because we picked it up at a small stage. But when we can then say, “Oh my goodness, we have a growing nodule in the edge of the right lung. And we are now suspicious that it’s cancer.” We can do a biopsy, see that it is cancer from the biopsy. And then there are really two options as far as a cure. And that is to either have it resected. And the thoracic surgery community has so much more to offer now, as far as advanced robotic surgery. They can wedge out an abnormality. They don’t have to take out a whole lobe of the lung.

Or if a patient isn’t a candidate for surgery, there is also targeted radiation therapy. We’re now able to offer patients these kinds of curative measures that really are much less invasive than they used to be. And we’ve seen great results.

And then I can just say for example with my lung cancer screening program here at National Jewish, 85% of the cancers we identify are stage one. Not all go to surgery. And about two-thirds go to surgery, one-third to radiation therapy. It is so wonderful to be where we are at least in our stage of diagnosis and treatment options, that we can really offer the patient much more in the way of less invasive, but also curative measures.

Kathleen: It’s easy to see that lung cancer screening enables early diagnosis. What are the current lung cancer screening guidelines? What do you think of them? And would you make any changes?

Dr. Dyer: Fortunately, just last March, the U.S. Preventive Services Task Force released updated guidelines to their original guidelines. In 2013, the task force recommended lung cancer screening in high-risk patients. And at that time, they defined high risk as ages 55 to 80, being a current smoker, or quitting within the past 15 years. And you must have at least a 30 pack-year history of smoking, that’s a pack a day for 30 years, two packs a day for 15 years.

Those guidelines were in place. And then some research has been done over the past few years looking at whether those are indeed the best eligibility criteria. And in fact, is it not including all the patients that it should?

What happened in March is the task force was able to look at some research that had been done in the past four to five years. And they realized for instance that African Americans were getting lung cancer at lower ages and with less smoking history. We really were not addressing the African American population for instance, with the original eligibility criteria.

The task force looked at studies. In fact, they reviewed something like 223 studies. And what they came up with then was a recommendation to drop the age from 55 to 50, and then drop the pack years from 30 to 20.

Now they did keep in place the 15 years since quit. And they kept in place the upper age limit of 80. And I was involved with some groups where when the task force had originally released these guidelines, eligibility criteria as recommendations, we were given a chance to comment and respond.

A couple of things that we were hoping they would do, which they didn’t, is we were really hoping they would eliminate the 15 years since quit. Because even though there is some mild decline in lung cancer risk after quitting, it doesn’t go down to zero. And in fact, it’s an odd incentive that you could almost argue that it makes patients want to continue to smoke if they know they can continue to get screened. And that’s bizarre. We don’t want that, so we were hoping they would eliminate the 15 years since quitting smoking criteria.

The other criteria that we hoped they would eliminate was the upper age limit of 80. There’s nothing magic about 80 because there are really healthy 80, and 81, and 82-year-old people. And there are some not so healthy 60, 70-year-old people. It really should be based on the patient’s condition, their current comorbidities, and their appropriateness for screening as an individual. We had hoped that assessment could be made then by their doctor, but they did leave the 80 in place.

Now, we’re waiting for Medicare to release their recommended eligibility criteria. They do not have to follow the USPS Task Force recommendations. Medicare reopened their national coverage determinant, and they’ve been collecting comments, they’ve been reviewing the evidence. We are waiting now for Medicare to come up with some preliminary recommendations. Several of us at a national level have engaged with the Medicare Coverage Advisory Group and we’ve given them these suggestions. Certainly, we’re hoping they’ll at least align with the task force recommendations, but also that they would consider the elimination of the quitting time and the upper age limit.

Kathleen: Breast cancer screening is open to all women over a certain age. Do you think lung cancer screening guidelines will ever be like breast screening guidelines – open to everyone over a certain age?

Dr. Dyer: We need to figure out something to offer folks who have never smoked, but maybe a high risk for other reasons. Maybe it’s family history, maybe it’s radon exposure. It could be just exposures at work, or maybe it’s their genetics. And in my dreams, in five years’ time, what I would love to see is for us to have some sort of a blood or serum biomarker that doctors, advanced practice providers could offer to patients in their offices and say, “This is the initial step for lung cancer screening.” And maybe it would be a blood test, and it would look for a number of other cancers.

But if we were able to identify a few biomarkers that then indicated that a patient had a higher risk of lung cancer, then I think we’d feel much more comfortable enrolling them in lung cancer screening, and having them get a CT, and getting a yearly CT.

The issue around not just screening everybody right now is that we probably don’t have the capacity. But also, we want to make sure that we are being responsible. And there is a little risk. It’s not large, we don’t even have research to show exactly what it is. But getting a CT scan is just … putting someone into a CT scanner exposes them to radiation that they otherwise would not get, we want to make sure that we’re acting responsibly in exposing anybody to any level of radiation.

Now, a couple of things that are going on right now that I think are very exciting, there is a lot of work going on in that whole biomarker realm. But also, our CT scanners are getting better and better. And our technology is getting such that we can reduce that dose of a low dose CT even further, it may be a 10th of the dose of a usual CT. In some places they’ve suggested If we could get this down to the level of a chest x-ray then gosh, perhaps that is something we could offer more widely on a population level. We’re not there yet, but I do see us moving that way because there is so much support within the medical community for this idea that we can make a difference in lung cancer.

And of course, in parallel to all this that’s going on with the early detection side, the treatments for more advanced lung cancers have improved greatly. So even those folks who unfortunately are diagnosed with later-stage three or four lung cancers, there are treatment options for now. The survival rates are improving, but we do need to work on both in parallel. And we are. I think this is in a way, the best time to be working in the lung cancer world because I think we have so much more to offer.

It requires a team and I feel fortunate working here at National Jewish that we have a whole team of folks that are really engaged in lung cancer screening.

Dr. Debra S. Dyer, Chair, ACR Lung Cancer Screening 2.0 Steering Committee Tweet

Kathleen: What are some of the challenges in routine lung cancer screening? What can we do to address them? And how do they impact different patient groups?

Dr. Dyer:  A major challenge is referring provider awareness. In the primary care community, we know that there is a lot on their plate, the providers have to address so many issues with patients. They may not have fully been educated about lung cancer screening CT, or maybe there’s just no time. During their visits with patients, there might be other higher priority issues. I think we must work on two things. I think we need to try to educate them in the simplest, easiest way we can, so it’s not overwhelming for them. And then we need to make it easier for them to refer patients to lung cancer screening.

Another problem that we know we have is that patients are not adhering to annual screening. In the National Lung Screening Trial where we got such great results, a 20% reduction in mortality. The adherence, now this was a research study, the adherence of patients to annual screening was 95%.

In the real world, what we have learned from the data that’s been submitted to the national American College of Radiology Lung Cancer Screening Registry is that the adherence rate is about 22, 25%. And it is, I can say in my program, it’s better than that, but it’s still about 50%. And the issue is that, well there’s a number of things. Of course, the pandemic got in the way. But even before the pandemic, we were not seeing patients necessarily comply and getting back in for annual screening.

It’s probably multifactorial that there are so many barriers and there’s a stigma about smoking. And there’s a number of considerations that may make patients just hesitant or not just ready to step right up and make sure they get in like they would for their mammogram.

There’s also research going on to address these questions. Why is it? Why is the adherence rate so low? And what can we do as a lung cancer screening program to actually increase that? And one of the things that we could do is stay in touch with patients. Don’t just expect them to come once a year. Do something where you can check in on them, even mid-year, and say, “How are you doing? Anything new or different?” The one thing the research has shown is that if you stay in touch and if you make it easier on everybody, more people get routine lung scans.

And then you mentioned, I think another big area is that there really are disparities in the groups of patients that are getting screened and are not. And unfortunately, the groups that are not getting screened tend to be in the rural areas or in some of the underserved areas in big cities. And we also know that tends to be where smoking rates are higher. There’s this crazy disparity that in the metropolitan areas, there seems to be adequate lung cancer screening programs and access for patients. But we also see lower smoking rates in the major metropolitan areas. And then with other underserved communities or in the rural areas, we’re not seeing access as widely spread.

We know that’s something we also have to work on, and everybody’s trying to be creative.  For instance, would mobile units help? That did work in England, and the UK program was so successful because they kind of took the screening to the population and didn’t expect the patients to come to the facility.

There is some work being done there, and maybe that will take off. And I think though, there’s just a lot of other issues around just the stigma, and the hesitancy, and wanting to make sure that we make it inviting and comfortable for patients to get screened. And like we talked about at the very beginning, just the notion of maybe we need to change the terminology to a Lung Health Check. That maybe it’s not as threatening. I think we have work to do, those of us that practice in this area, to think outside the box and think about it from the patient perspective.

Kathleen: We have the initial screening, but what about incidental findings? How do we get patients back in when we do find something? How do we prevent losing patients to follow-up?

Dr. Dyer: Now that is a very good question. And I think for lung cancer screening to be successful, it absolutely requires at least a navigator, program coordinator, nurse manager. A human being that can make sure to get patients back into the care pathway. First of all, make sure they understand what the report says. If it’s an incidental finding and it’s something that needs follow-up, they need to have a personal conversation with the patient and also with the referring provider, the outside provider, so that everybody’s on the same page. And make sure there’s a plan in place.

And a classic example is we see lesions in the kidney. Now we don’t image the whole kidney when we’re doing a chest CT, but we do image the top of the kidney. We scan through the chest, and we get down just through the top, and we may see some abnormality in the top of the kidney. So the patient needs another exam to see what’s really going on in that kidney. It could be an ultrasound. It could be a CT scan. Maybe it would even be an MRI. But the important thing is that the navigator, the nurse, whoever is doing that care coordination needs to make sure that the patient and the referring provider understand that this next step is needed and that that is set up.

In my program, we’re centralized as I mentioned, we have navigators, but we also have six advanced practice providers. Now they’re not full-time doing lung cancer screening, but they all see lung cancer screening patients for the shared decision-making visit. In my program, they’re the ones that follow up with the patient and the referring provider. Especially if it’s something like a possible renal mass, again, we need to make sure that everybody understands that this next step needs to be done.

The other thing that’s helpful is that I’m very involved at a national level with the American College of Radiology Lung Cancer Screening. We just created a handout for navigators and nurse coordinators for how these incidental findings should be managed. Now we’re not expecting them to order the follow-up, that’s not it at all. But we know that they’re often in the middle trying to communicate to the patient and to the referring provider. This handout really was just released in the last couple of weeks. It’s on their website with the American College of Radiology.

It has been incredibly successful. We did a pilot of it last winter with navigators, and every single one of them loved it because it’s a really good synopsis. It tells them what they need to worry about and what you don’t have to worry about.

Kathleen: How do we keep the continuity in patient care when there are multiple tests and physicians involved in the process?

Dr. Dyer: The fragmentation in healthcare is certainly something that doesn’t help. I think that’s why at least our centralized program is so helpful because we don’t have lots and lots of people in the mix, we have two navigators and six advanced practice providers. And between those folks, we can manage, and we can communicate. And just keeping those lines of communication open and in a way tight just I think can make a huge difference. Because you’re right. I mean, things can get missed, dropped, fall through the cracks. And that’s what we don’t want. Bringing somebody in for screening, all of us are pretty much on board. Yeah. We know we’re looking for lung nodules and nodules that might be cancer. But there are going to be these other things that need to be addressed.

Kathleen: Looking forward, what technologies are you currently using and what do you see being used in the future?

Dr. Dyer: We do use our electronic health record, we’re able to query the record for smoking, either current or former. And we hope that nearly every electronic healthcare record will make sure in the years to come, if not currently, that they have some sort of information there that is easy to query and that is accurate. It’s really hard to keep the smoking information accurate. Because some patients stop and start, and it’s tricky, so we can’t rely 100% on the EHR, but it is at least a start.

What we’re hoping to see in the next five years let’s say, that every electronic health record provider, vendor out there will provide some sort of an alert to the primary care provider and indicate, based on what information we have here, your patient may be eligible for lung cancer screening. At least that alerts them and highlights the need to talk to the patient about getting screened.

And then also in the primary care offices, if the patient meets initially with a medical assistant, a medical assistant could probably do a little interview and drill down further on smoking and find out if they do meet the screening eligibility criteria.

I think technology has the potential to help us, I really do but it’s not the complete answer. I do think technology and a navigator or program coordinator are the keys to at least getting a foothold. And then as programs expand, you add people. We used to have one navigator and now, it looks like we’re going to end up with two and a half because we have so many patients. We’re still not anywhere near where we want to be and in Colorado, I’m embarrassed to say our uptake on a state level for lung cancer screening is only 3.3%. Nationally, it’s somewhere around 5%. Some states are up around 10, 12%. When I say uptake, I mean by that the eligible percent of eligible patients that are getting screened.

There are other ways that you can also use technology. For instance, many states have all-payer claims databases where a query can be done. And I’m part of our Cancer Coalition in Colorado, and our Lung Cancer Task Force did a query of our all-payer claims database and we were able to find out where in our state lung cancer screening is occurring by the billing. Then we know where it’s being performed, where it’s being billed. And these databases include Medicare, and Medicaid, and commercial insurance.

We could very quickly tell from that data the parts of Colorado that aren’t billing anything for lung cancer screening and now we know that’s where we need to start targeting. And again, that’s the underserved, the rural areas and it is using technology in a way to confirm what we knew, but that’s valuable to know and act upon.

Kathleen: Again, looking to the future, when do you think Medicare will come out with the guidelines you mentioned previously?

Dr. Dyer: We’re hoping by the first of the year. We are expecting any day now that they’ll release their draft recommendations, they told us they would have something in November. Then there will be a 30-day comment period, and then they will have to review the comments again. I’m hoping by the first of the year. It would make it a lot easier if everybody had the same guidelines for eligibility. I work very closely with a lot of program navigators in Colorado, and they get it, and they just have to explain to patients – you have Medicare, right now if you’re 50, we can’t screen you, let me put you on a list to call back in the future. With the updated guidelines we’re hoping that’s going to change.

Kathleen: If a patient doesn’t meet the screening criteria, does that mean their insurance doesn’t pay for the scan?

Dr. Dyer: Yes, and most lung cancer screening programs will have a self-pay option. The strict criteria are age and smoking history. But there is another way of looking at eligible patients which is through kind of elaborate risk prediction models and there are a number of them. There is one that we use here on all our patients, it’s called the Brock model. Basically, it looks at a lot of other things besides smoking history and age. It looks at exposures, and radon, and family history and it can calculate a percent risk for lung cancer. And in the calculation, if the patient has higher than a 1.5% risk, then we will screen on a self-paid basis, even if they don’t have that magic number of pack years. We don’t scan young people, but basically, we do if they have any of these other exposures that increase their risk. Our approach is to evaluate each individual patient. We do have the self-pay option, and some of our docs will refer patients here because they’re aware of it and they know this patient has some sort of a unique situation.

One thing that’s unique in Colorado is we have a lot of mining and people are exposed to radiation in uranium mining. Also, the work that they do, not just the uranium exposure, but other mining, can increase their risk of lung cancer as well. Here in Colorado, we are cognizant of that, and we try to be responsible, but offer screening where we think there are people that are at high risk.

Kathleen: Is self-pay at times a barrier as well? I would think not everybody can afford to pay out of pocket What is the cost for self-pay to get access to lung screening?

Dr. Dyer: At our institution, it’s $250, that’s for the CT scan and the interpretation and the care coordination. You get the advanced practice provider following up on you and all that comes with that. And I do know across the country, there are some programs that do it for $99. There are other programs that charge usually $300, $350, maybe up to 500, but it’s definitely at a lower cost than what the usual charge is for a CT.

Kathleen: You mentioned reading of the scan was included in the price.  Do you ever use AI in terms of doing a double read or as a tool that runs in the background?

Dr. Dyer: Well, there are some research studies going on right now to investigate that. At my institution, we are not using AI at the moment. But the idea, especially if lung cancer screening were to really take off. Let’s say we were getting 75% of all the eligible people in for screening under the new criteria. It would make sense to have some sort of an automated pre-read done through AI. And then it would be presented to the radiologist with flagged parts of the scan to look at. There are some research studies going on along that line. Nobody is quite ready I think for AI to do the whole thing.  I think it makes perfect sense. And that would be another great use of technology. I am excited to see where that goes. I think that there’s a lot of good tools out and they’re being tested. And I think many of them are quite good. I’ve seen some of them. So that’s something that probably in the next five years, we will see. There will be some way to help and enhance the radiologist’s interaction with the scan.

Kathleen: Looking forward, if you could change anything in the lung cancer screening and diagnosis, what would it be?

Dr. Dyer: My hope is that in the next five years, we will have certainly increased the uptake. It may not be the 80% that breast cancer screening and colorectal screening have been able to achieve. But even if we could get to 50% uptake, that would be terrific. The way we would have to do that is increased provider and patient awareness. What I’d like to see is a massive educational campaign. And we know we have to go be on TV and radio. We could also go through social media. We must embrace all these different ideas of how to reach people, and literally reach people where they are.

We can’t just stay in a hospital and expect people to come to us. I see us in the next five years being much more engaged in the community helping to educate providers and patients. And that includes all patients everywhere and trying to reach those underserved folks. And we know part of that is going to have to be addressing some of the hesitancy and maybe mistrust of medicine. We have to get savvier, and maybe more sensitive to where the patients are, and I think that we’ll get there. In five years, that would be fabulous if we could have increased our uptake to around 50%. That’s probably a lofty goal, but that would be a dream.

Kathleen: Why do you think breast and colon cancer screenings have had such good uptake?

Dr. Dyer:  Well certainly, they’ve been around longer, and there’s not the stigma associated with those cancers. With breast cancer, people feel sorry for the woman. Could be a man. But the patient who has breast cancer didn’t do anything wrong. Well with lung cancer, the first question that patients are asked when somebody finds out they have cancer is, “did you smoke?” Or, “I didn’t know you smoked.” People automatically leap to the assumption that someone has been a smoker. And in fact, if they have, okay. That’s okay too. There are a lot of reasons that people smoked. And certainly, we know back in the ’60s and ’70s, there was a lot of advertising that encouraged people to smoke. And even in the military, my father who was in World War II used to get two packs of cigarettes when he would go through the chow line.

There are a lot of reasons that people smoke cigarettes, and it shouldn’t be that we look at lung cancer as something they deserved. I mean, that is just outrageous if you think about it. We definitely have to help address the stigma. And if we’re going to increase the uptake, we must think about the stigma, and what the patient is feeling. And maybe there’s an underlying fear in the patient that they don’t want to know, then that’s a whole other part that we have to address.

It’s complex. I think one thing for sure about lung cancer screening is that it is much more complex than other screening tools that we have. We need to be aware of that and on every level, make it easier.

Kathleen: If you could change one thing in terms of lung cancer screening, what would you change?

Dr. Dyer: I think I would want to change people’s perception of lung cancer screening CT and have it recognized as a real opportunity and a positive thing to do. And I think we can do that.

There are a lot of things we can’t change, but I think we can work on our messaging. If we can wrap lung cancer screening CT in a package where we think that providers, and patients, and the community would see it as a real value and an opportunity for people to improve their being, their health all the way around. I think that would be a major step that would get us toward all the other stuff we’ve talked about.

And the only other thing that I guess I really want to emphasize is how much of a team effort it is. In my program, not only do we have the navigators and the advanced practice providers, but we have pulmonologists, interventional pulmonologists, radiologists, thoracic surgeons, and oncologists but they’re not as involved at least in the early detection part. Obviously, they get more involved later if it’s a later-stage cancer. But then also radiation oncologists, because they do get involved if it’s an early-stage cancer or someone isn’t a surgical candidate.

So that whole team of people, we meet once a month. And we really try to keep up with our statistics. We know we share annually with everybody how many cancers we’ve detected, what the stages are. And that’s reinforcing. And everybody is on the same page.

Nobody can do it by themselves, it takes that team. And then the other thing that I just have to say, our administration has been incredibly supportive. Hospital administrators need to recognize the value, and at my place they have. They have been extremely supportive just as an example of, as our program has grown, they’ve realized that we need to hire more and more navigators.

Lung Health Resources

The ACR is a wonderful resource for safe, effective lung cancer screening with the latest research, toolkits, and key patient information.

Lung Cancer Screening Resources for the Healthcare Professional

Interested in using AI as a second read to identify undocumented lung nodules at your hospital or radiology practice?

Case Study: AI Enhanced Peer Review Drives Quality Care Through the Identification of Undocumented Lung Nodules

American Lung Association has resources to help health consumers understand lung cancer screening.

Lung Cancer Screening Resources for the Patient

The Ferrum Health team would like to thank Dr. Dyer for sharing her knowledge and experience with us and the larger healthcare community. The work she is doing in educating and advocating for access to lung cancer screening is truly life-changing for patients and their families.

What are your thoughts on the current lung screening guidelines? Does your facility have a comprehensive lung cancer program in place or are you thinking of developing one?

We’d love to hear your thoughts and learn from your experience, please drop us a note in the comment section below. 

Kathleen Poulos

Kathleen Poulos

Kathleen is a registered nurse with a digital marketing background, a love for using technology to solve healthcare challenges and a passion for improving patient care.

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