Addressing Barriers in Lung Cancer Screening



Philippa Cheetham, MD: Chris, we’ve heard a lot here about screening protocols and who we screen and how we screen. What are your thoughts on this knowing that you wife had, I believe, stage 4 cancer at diagnosis?

Chris Draft: Yes. Based on the screening protocol, she was a never-smoker. She’s 37 years old, in amazing shape, so she wouldn’t have fallen in that protocol. Early detection would have only happened randomly. We have some survivors who have been in car accidents who have had pain over on their side. It’s something else that ends up helping them diagnose that it’s lung cancer. It’s not because the symptoms were so bad. Usually when the symptoms get bad, it’s already at stage 3 or stage 4 in most cases. So, yes, unfortunately, she was diagnosed, she was stage 4. But when we look at screening and how it is right now, she wouldn’t have benefited from it, but there are people who can. And that’s what we have to do. We can’t worry that we can’t get everybody. I could easily say, “Well, if it doesn’t work for my wife, forget it.” And there are some people who will say that. But if I want to be an advocate, if I want to be out here in the front, I can’t do that.

Philippa Cheetham, MD: Do you think the problem for people in the community is lack of awareness or do you think that screening is that there are these obstacles we’ve heard about—the financial obstacles, the radiation concern obstacle, the age obstacle? What do you think is the issue?

Chris Draft: I think we need to love our people. We have smokers out there, right now, that because we’ve only talked about prevention, we’ve only made it where it’s individuals’ responsibility. We have not addressed the fact that the cigarette industry got indicted for predatory marketing and for putting additives in. It is absolutely difficult for them to stop smoking. We have to address that and then give them love to say, “Man, I know it’s hard. I know it’s going to be hard, but we have to help you stop. We know that in terms of health issues, that the best thing that we can do is to get you to stop smoking.”

Philippa Cheetham, MD: And that’s why it’s so important to address this whole issue, stigma, isn’t it?

Chris Draft: Yes.

Philippa Cheetham, MD: Because we’ve already heard that patients may not get the love that they need if it’s thought to have been a self-inflicted disease in the first place.

Chris Draft: Absolutely.

Philippa Cheetham, MD: That’s a big issue, isn’t it?

Chris Draft: It’s looking at somebody and caring enough to ask, “Well, how did you get started? How did that happen?” And it’s not that you’re making an excuse that says, “Well, then it’s OK because you got started a certain way.” It says, “No, that means we have to put that much more energy into it. We have got to help you. We’ve got walk with you. We can’t just blame you but say, ‘Hey, we’ve got to get you to stop and I know you need help.’”

Philippa Cheetham, MD: Move forward, not go back.

Chris Draft: That’s right.

Philippa Cheetham, MD: Carly, the American Lung Association, they have this initiative, “Saved by the Scan.” Can you give us some extra information on what does that mean? What’s the protocol?

Carly Ornstein: Sure. This initiative is aimed at raising awareness of the high-risk screening criteria and encouraging those who meet that criteria to talk to their doctor about getting screened. There is a specific focus on former smokers because that group sometimes gets lost and that happens for a couple reasons. One is that some people think that when they quit smoking, they’re no longer at risk for lung cancer. And certainly, quitting smoking can reduce your risk but it doesn’t erase it. Secondly, sometimes you go to the doctor and they ask, “Do you smoke?” and you say, “No.” Well, maybe you smoked up until two days ago or something like that or 14 years ago or something like that. Sometimes that’s not even recorded in their medical record, so their doctor doesn’t even know that they have a smoking history. So, that’s why this campaign focuses a little bit more on the former smokers. And we really show real people who smoke cigarettes, who meet the high-risk criteria and their lives were saved because they got a scan. And this is not about making anyone feel guilty at all for anything in their past. It’s about these are the criteria and guess what, this could save your life. That’s really the positive message: This could save your life.

Philippa Cheetham, MD: And the screening interval is quite short, isn’t it? One year for picking up changes on any imaging is a relatively short period of time, no?

Carly Ornstein: Yes, and I actually was just talking with my mom yesterday and I asked, “Where are you?” And she said, “Oh, I’m about to meet with the pulmonologist. He’s reading my one-year scan.” This is because I made sure that she got it. She met the criteria and she’s getting scanned. I can understand why patients might be reticent to add another screening into their protocol or maybe they don’t know about it or CT scanning might sound a little scary. But also, part of that campaign is just dispelling any of those myths. It’s painless, it’s quick, and it’s about the possibility of saving your life.

Philippa Cheetham, MD: We’ve already heard that the radiation exposure for one scan is actually pretty small, and you’ve talked about environmental radiation. But if you’re following a screening protocol and having one CT scan every year between ages 55 and 77, 22 CT scans of radiation, do you think there will be a better way, maybe considering MRI with no radiation? Is there any value in considering alternative imaging where there’s zero radiation exposure?

Kim L. Sandler, MD: So, MRI and CT imaging are very, very different, and an MRI does not do a good job on the lungs because of all the air. Now, there are some other protocols that people are trying to develop, so that we could do a type of screening in the chest and not have any radiation. Radiation is not all the same, so if you have a lot of radiation all at one time, that can be much more detrimental than having a small increment of radiation over several years. So, you can’t necessarily add up all the radiation that one person has received and say this is what’s going to happen. We use an ultra-low-dose protocol for our CT scans. We’re also regulated by groups that tell us you cannot be a screening center. You cannot offer these exams, and you cannot even apply for reimbursement from Medicare unless you adhere to these very low-dose regulations.

Philippa Cheetham, MD: Which is good to hear, but I think that a lot of people don’t realize that they are exposed to radiation just by living, breathing the air. Flying from the East Coast to the West Coast, we know that with the radiation dose, just doing that is higher than many of the scans that we do in medicine.

Kim L. Sandler, MD: Yes.

Philippa Cheetham, MD: Well, it’s wonderful to hear that there is a screening program for patients at high-risk. Hopefully, these will develop to become more sophisticated as imaging improves. I’m sure that we’re going to see molecular tests come into this screening arena. In the meantime, thank you so much, Chris, for all the work that you do to educate people in high-risk and low-risk categories. And thank you, just to bring lung cancer awareness to the table, Carly, for the work you do with the American Lung Association. And thank you for the very insightful information about screening for patients, Dr. Sandler. It’s fantastic information. Thank you so much.

Transcript Edited for Clarity

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