Hossein Borghaei, DO, MS: What percentage of patients have advanced disease? That number is a little variable, but unfortunately, the majority of patients with lung cancer at some point have recurrence of the disease and can progress into more advanced stages. I agree with you that the lung cancer screening programs have done a really good job overall in detecting smaller lesions and having an impact on the outcomes of the disease.

Just like your institution, we’re very happy with the way lung cancer screening is going in our area in terms of patients who come in. The unhappiness comes from the fact that only a minority of patients who are eligible are actually getting lung cancer screening. We have to have more effective efforts to make sure we get the patients who are at high risk evaluated, because that would make a huge difference in the treatment of the disease. I’d be curious to see how you’re using the lung cancer screening program and what you’ve seen from your program.

Charu Aggarwal, M.D., MPH: Yes. And even though we have active guidelines for lung cancer screening, I feel that due to the COVID-19 pandemic, we’re seeing a shift, so-called stage migration, where we’re seeing more patients with stage IV disease come in with new symptoms and a de novo diagnosis of metastatic disease. This will affect outcomes and how patients present, not just this year, but also over the next few years. Because, as you know, even including our area, many screening programs were halted for a while due to COVID-19 mitigation strategies. We’re going to see downstream impact, but hopefully we can pick right back up quickly.

Transcript edited for clarity.