Bill would start state program to screen for lung cancer, in which Ky. leads in cases and deaths, to catch it earlier and save lives

Updated Jan. 26, 2022 : House Bill 219 to create a lung cancer screening program passed 95-0 out of the House of Representatives on Jan. 26 and will now move to the Senate for consideration. During her floor speech, Moser spoke about how many Kentucky families have been affected by lung cancer, noting that her mother, Margaret "Margie" Poore had succumbed to the disease in 2017. 

By Melissa Patrick

Kentucky Health News

Kentucky leads the nation in lung cancer. In an effort to get more eligible Kentuckians screened for it, to catch it early and prevent death, the chair of the state House health committee wants to create a special program for it.

Rep. Kim Moser

Kentucky also leads the nation in lung-cancer deaths, and one reason is its "low level of early detection. This is why this bill is just so critical," Rep. Kim Moser, R-Taylor Mill, told the members of the House Health and Family Services committee before they approved it Jan. 20.

Dr. Timothy Mullett, a cardiothoracic surgeon at the University of Kentucky's Markey Cancer Center, told the committee that lung cancer screening is one of the most important things needed to save more Kentuckians from the disease and it's imperative that we accelerate the number of screenings.   

"While we are often successful with our operations on early-stage lung cancer, surgeons are universally frustrated by the fact that only 15 to 18 percent of lung cancer [is] discovered at that early phase," Mullett said. "And so, as mentioned, the opportunity to be able to have more success with treating patients at an earlier stage is optimal. It is also less expensive."

Kentucky ranks second in the nation in screening of people at high risk for lung cancer, but Mullett said it has the highest death rate because the screening isn't done early enough. "The majority of our patients, much more than the rest of the country, are seen with late-stage disease, over 80 percent of the time. We have a chance to change that. Lung cancer screening can be effective and can reduce mortality by as much as 20 to 50 percent." 

Dr. Michael Gieske, a family practitioner at St. Elizabeth Healthcare, said "If we find lung cancer in the earliest stages, Stage I, we have a greater than 90% chance of curing that cancer."

Mullett said the screenings only cover about 20% of eligible Kentuckians and are not evenly distributed across the state. The American Lung Association says the national rate for screening is 5.7%. "That's not enough, we can do better," Mullett said.

Moser's House Bill 219 could pass the House as early as Monday, Jan. 24. She said the program would be modeled after the state's Colon Cancer Screening Program, which has helped to move the state's colon cancer rates from 49th in the nation to 22nd. 

Moser said she would ask for funding if the screening program is approved, adding that she had already talked to the chair of the House budget committee "and he understands the importance" of this bill. 

The Colon Cancer Screening Program gets $500,000 per year from the state, Moser said. She said the program would be able to receive grants and private donations and could also get a small amount of funding from the sale of lung-cancer-awareness license plates. 

"The goal is to increase lung cancer screening and enable early detection of cancers when they're treatable, reducing the horrible morbidity and mortality that we have in Kentucky for lung cancer," Moser told Kentucky Health News. "We're number one in the nation, and that's a glaring, horrible statistic that we need to change."

The lung association's "State of Lung Cancer" report says that while Kentucky is second in lung-cancer screening, it's worse than average in the percentage of lung-cancer patients (19%) not receiving treatment, ranking 18th.

The only recommended screening for lung cancer is low-dose computed tomography, also called a low-dose CT scan, according to the Centers for disease Control and Prevention. Annual CT scans are recommended for adults between 50 and 80 who have smoked at least 20 "pack-years" (a pack-year amounting to one pack of cigarettes a day for a year, or an equivalent amount, such as half a pack a day for two years) and either still smokes or has quit within the last 15 years.

Mullett said lung cancer screening with low-dose CT scans has been recommended for less than 10 years, and "we've already seen a 10% reduction in late-stage diagnosis. . . . That's something that we haven't seen, ever. So it's beginning to take effect." 

Gieske said that before low-dose CT scans, it was difficult to diagnose lung cancer in its earliest stages, since symptoms that typically bring a patient to the doctor don't show up until late in the disease process. "We have patients with Stage III and Stage IV lung cancer now [who] might have been alive for 10 to 15 years with no evidence of disease," he said.

Since 2013, when St. Elizabeth's started screening patients for lung cancer, it has done 22,000 screens and is finding one case of cancer for every 64 screenings, with 55% of them in Stage I and 69% of them in either either Stage I or Stage II.

"We are making a tremendous difference," said Gieske, who joined the hospital's thoracic oncology disease management team in 2016.

Rep. Ryan Dotson, R-Winchester, asked what is the driving force behind the state's high lung cancer rates, Mullett offered several reasons, including a culture of fatalism around lung cancer that discourages people to seek care, a disease that is largely asymptomatic until its late stages, and the state's high rates of smoking. 

Smoking is the No. 1 cause of lung cancer, causing about 90% of cases, according to the lung association. Kentucky ranks second in the nation for smoking, at 23.4% of the population, behind West Virginia.

Mullett said he had intentionally not mentioned tobacco in his presentation because it's important to separate the diagnosis of lung cancer with tobacco use. 

"There's a tremendous amount of stigma associated with the diagnosis of lung cancer and a bit of guilt associated with the exposure to tobacco," he said. "So the opportunity to be able to dissect, separate a person who smokes, from a diagnosis of lung cancer is really important -- because the truth is the majority of patients, when they are diagnosed with lung cancer, are not smoking, and so it's difficult for us to burden them with a diagnosis of tobacco use when they've already made that choice to quit." 

The state Department for Public Health offers a service called Quit Now Kentucky to help Kentuckians of all ages quit smoking. To learn more go to QuitNowKentucky.org, text QUITKY to 797979 or call 1-800-QUIT-NOW.