ACR Bulletin

Covering topics relevant to the practice of radiology

Spreading the Word on Screening

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The specialty has seen numerous advancements in lifesaving screening. Despite this, patients have not been educated on these advancements and/or don't have proper access to them. How can we change this?

We as a specialty need to be cognizant of the social determinants of health and the disparities to access many patients face.

October 02, 2023

An ounce of prevention is worth a pound of cure. No truer words could be said with regards to the practice of medicine and, in particular, cancer care.  

Many practicing radiologists, including myself, spend countless hours caring for patients with cancer. In my own practice, my efforts span the gamut from interpreting diagnostic imaging exams identifying and longitudinally following cancer, to performing image-guided biopsies of tumors to facilitate targeted therapies, to participating in multidisciplinary tumor boards and working with other physicians to determine the ideal treatment plan for a patient with a malignancy. 

While this work is important and rewarding, I would rather spend most of my days identifying cancers before they arise or early in their course when the chance for complete cure is high. Fortunately, screening tools that identify cancer early exist and are effective.  

In the field of radiology, we have pioneered lifesaving procedures such as mammography, CT colonography and low-dose CT for lung cancer screening (LCS). Unfortunately, many patients are unaware of the value of these exams, lack access to them or simply don’t choose to pursue them. This results in too many unnecessary deaths as well as significant pain and suffering faced not only by patients, but also by their families and caregivers.

Since 2020, I have had the honor of serving as chair of the ACR’s Commission on Patient- and Family-Centered Care (PFCC). Through the work of our PFCC committees, we have developed numerous resources to assist patients, families, caregivers and practicing radiologists on how best to facilitate shared decision-making and deliver care that is more patient- and family-centered. 

One primary goal of our work is to help patients and their families understand how radiologic care plays a role in their overall health. To that end, encouraging and helping patients understand when, how and why to get screening exams is critically important. 

Radiologists can play a role in helping to close the gap between patients eligible for screening and those who choose to pursue screening by messaging and advocating for the importance and value of the various radiologic screening exams that are available. This work is most effective when collaborative — working with multiple patient advocacy organizations as well as leveraging all communication channels.

One primary goal of our work is to help patients and their families understand how radiologic care plays a role in their overall health.

One such effort is the work of the ACR PFCC’s LCS 2.0 Steering Committee. Through collaboration with the American Cancer Society, the National Lung Cancer Roundtable and the GO2 Foundation for Lung Cancer, our team helped establish the first-ever National Lung Cancer Screening Day in 2022. This year, National Lung Cancer Screening Day will fall on Veterans Day, Saturday, Nov. 11, 2023. 

This special event has many benefits to patients. First, it improves access by providing exams on a Saturday for those who cannot make an appointment during the typical work week. Second, the effort increases awareness of the screening exam via the White Ribbon Campaign and a nationwide marketing effort. I hope one day white ribbons will be as ubiquitous and recognizable a symbol to promote lung cancer screening as NFL players wearing pink gloves and shoes in October to promote Breast Cancer Awareness Month. 

Why has our group focused so much attention on outreach efforts to increase awareness of LCS exams? Of the three major radiologic screening exams, those for lung health trail well behind those for breast (about 70%) and colon (about 60%), with only approximately 5% of eligible patients receiving screening despite lung cancer being the leading cause of cancer-related death, according to the World Health Organization.

While therapies to treat lung cancer have improved dramatically, up to 79% of lung cancers are metastatic or locally advanced at the time of diagnosis. When lung cancer screening exams are pursued, most cancers identified are at stage 1, where the possibility of remission is high.   

In addition to raising awareness and educating individuals on the value of radiologic screening exams, we as a specialty need to be cognizant of the social determinants of health and the disparities to access many patients face. When I think of all the great innovations that our specialty has brought to bear, I am reminded of a quote by American-Canadian writer William Gibson: “The future is already here — it’s just not evenly distributed.” The work of the Radiology Health Equity Coalition, a collaborative effort of multiple national and state radiology societies, will be key to ensuring that our innovations reach as many patients as possible. 

Cancer, as Siddhartha Mukherjee has eloquently termed it in his Pulitzer Prize-winning book, is "The Emperor of all Maladies.” It will impact nearly everyone throughout their lives either personally or through a loved one. 

The specialty of radiology, via its innovation in the development of screening exams, can help lessen the burden of suffering wrought by this malady. However, it will take a concerted effort from all radiologists if we are to bring our lifesaving and life-extending technologies to as many individuals as possible. This month's special content of the ACR Bulletin highlights many of those efforts.

Author Arun Krishnaraj,  MD, MPH, FACR, chair of the ACR Commission on Patient- and Family-Centered Care

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