“As a radiologist, I feel obliged to promote lung cancer screening (LCS) — to explain to patients, providers and colleagues what a radiologist’s role is and how building partnerships can only help to spread the word about a lifesaving procedure,” says Debra S. Dyer, MD, FACR, chair of the department of radiology at National Jewish Health in Denver and chair of the ACR’s LCS 2.0 Steering Committee.
Lung cancer remains the leading cause of cancer death in the U.S.1 It is more critical than ever for radiologists to connect with specialists and referring physicians to dispel misconceptions about LCS — and get patients into screening, and patients who have only had one exam back into screening (learn more at acr.org/LCS).
Collaboration is vital to this effort. “I have worked with our state health department and gotten involved with our state’s cancer coalition,” Dyer says. “I got involved in LCS efforts because LCS just seemed like a logical thing that we needed to be able to offer to our patients. We have a partnership with two federally qualified health centers in Denver and have been active in a research study as well.”
Dyer points out that the LCS 2.0 Steering Committee includes clinicians from all over the country, playing different roles. “It is not all radiologists. We have navigators, program coordinators, patient advocates, pulmonary specialists, and primary care physicians (PCPs) contributing,” she points out.
When it comes to LCS, one of the absolute most important things is getting involved — ideally with all healthcare players and patients. “It is a [fairly] new science — a shift in thinking,” says Michael R. Gieske, MD, a PCP and director of LCS at St. Elizabeth Medical Center in Edgewood, Ky., and east division physician director of primary care. “I didn’t know what a low-dose CT for LCS was in 2016. We, as providers, need to get the message out to patients who qualify.”
An effective approach, Gieske says, means overcoming the stigma and nihilism associated with lung cancer. “We take the approach that anyone with lungs can get lung cancer. You do not have to have a history of smoking to be diagnosed,” he says.
“We have flyers in the exam rooms on bulletin boards, wherever patients can see them,” Gieske says. “We are working very closely with our marketing department at St. Elizabeth Medical Center and trying to get the message out to the general public.” According to Gieske, there is a tremendous amount of hope now around diagnosing lung cancer early — and, if that doesn’t happen, curing the disease even in its late stages. “These days, radiation treatments, immunotherapy, and different therapeutic drugs are making a tremendous difference,” Gieske adds.
“One of the key components to our success has been getting the message out to our other PCPs — getting their buy-in and garnering their confidence,” Gieske says. “As we collaborate closely with radiologists and pulmonologists and thoracic surgeons, it has become clear that LCS is a team sport. Everyone needs to work together for better outcomes.”
Gieske and his team have gotten involved in a number of state-based initiatives they think will be pivotal in moving the dial with respect to increasing uptake for LCS. “We are working with the University of Kentucky, for instance. The university has worked with at least 10 different hospital systems to identify best practices and make improvements accordingly,” he explains.
As we collaborate closely with radiologists and pulmonologists and thoracic surgeons, it has become clear that LCS is a team sport. Everyone needs to work together for better outcomes.
The American Cancer Society National Lung Cancer Roundtable (NLCRT) is a consortium of public, private, and voluntary organizations working together to reduce the incidence and mortality of lung cancer by furthering the mission of its member organizations and taking on challenges that no one organization can take on alone.
“Since 2017, the NLCRT has galvanized more than 170 member organizations and 200 leading experts, as well as patient and caregiver advocate representatives, at the national, state, and local levels to collectively partner to achieve enduring systemic change to reduce deaths from lung cancer,” says Lauren S. Rosenthal, MPH, strategic director of the NLCRT.
“We believe that working collectively and collaboratively will drive progress faster to reduce lung cancer mortality,” Rosenthal says. “The ACR and the American Cancer Society have a long history of collaboration on imaging-based screening and have a mutual interest in identifying, gathering, and sharing data to measure and advance the quality of patient care — a central goal of the NLCRT.”
“The NLCRT engages experts in multidisciplinary, problem-solving collaborations to create innovative solutions and to develop and disseminate evidence-based interventions and best practices,” Rosenthal says. “We want to harness the collective power and expertise of the entire lung cancer community to close gaps in LCS by connecting people, communities, and systems to improve equity and access.”
“LCS can bridge disparities in lung cancer mortality through early detection,” says Efrén J. Flores, MD, officer of radiology community health improvement and equity at Massachusetts General Hospital. “Despite proven benefits and expanded coverage, LCS participation rates remain low, particularly among Latinx and other underserved communities.”2
Despite recent advancements in lung cancer treatments and early detection with LCS, disparities in lung cancer mortality persist among Latinx and other underserved communities.3 These communities experience disparities in lung cancer survival due to advanced stage at the time of presentation, Flores says.
“Anywhere there’s a gap or a need in your healthcare institution, that’s an opportunity for transdisciplinary collaboration with your colleagues, referral base, patients and community stakeholders to improve access and transform your LCS care delivery,” Flores emphasizes.
“Implementing LCS programs takes commitment, resources, and time. But radiologists are well-positioned to manage these programs and ensure patients are guided through appropriate care pathways,” Dyer says. “It is one more way we can leverage our expertise to ensure patients receive the care they need — and it gives us an opportunity to interact with patients.”
The whole idea behind the LCS 2.0 Steering Committee has been to empower radiologists — to get radiologists involved, Dyer says. “Now, how do you empower radiologists? Give them the information and the resources they need — and make the process easier to adopt,” she says.
Get involved too at the state level, Dyer recommends, with a state cancer coalition, for example. “In Colorado, as a result of a lot of advocacy for LCS, lung cancer will be the state’s cancer priority over the next five years,” Dyer says. “That has never happened — the state has never made lung cancer a priority. Now we are at the top of the list, and it’s amazing. Getting the word out will pay off.”
Radiologists have a role in being able to provide high-quality care and interpretation of these exams and follow structured reporting and guidelines, Dyer says. “We know the uptake of LCS just hasn’t been what it should be,” she says. “So I think, if nothing else, we have learned that we need to get outside of the reading room.”