Pike County to be part of pilot project to improve lung-cancer screening rates in Central Appalachia, big hotspot for the disease

National Cancer Institute map shows Eastern Kentucky has a very high rate of death from lung cancer; other maps show its rate of lung-cancer cases is also very high. For larger version, click on it.

By Melissa Patrick
Kentucky Health News

The Appalachian Community Cancer Alliance has launched a pilot project to improve lung-cancer screenings in rural Appalachia, and Pike County is part of it. 

Dr. Michael Gieske, director of lung cancer screening at St. Elizabeth Healthcare in Northern Kentucky, told Kentucky Health News that he had been working with the regional alliance off and on for about four and a half years, most recently on projects that involve diversity, equity and inclusion. 

Dr. Michael Gieske

Gieske said the alliance is recognized by President Biden's Cancer Moonshot Initiative and has been charged with improving cervical, colon and lung cancer screenings in the 13-state Appalachian region. 

"They felt after some of their initial work that lung cancer screening was by far the greatest need and demonstrated the greatest disparities when you were looking at health care inequities," he said. 

This realization prompted the alliance to form the Rural Appalachian Lung Cancer Screening Initiative, a multidisciplinary group of which Gieske is the subject-matter expert. 

Gieske said St. Elizabeth, which has one of the most robust lung-cancer screening programs in the country, has done 33,000 screenings since 2013 and has found 525 cancers – 70 percent of which were in either Stage I or Stage II, which are considered the early stages of lung cancer, ans most treatable.

"We're finding it when the chance of cure can be greater than 90 percent," he said. 

And, he said, because of recent improvements in treatment in lung cancer, it's really important to emphasize that even people with late-stage lung cancers are surviving the disease.  

Pilot project

To decide the location of the pilot project, leaders of the initiative used geospatial mapping to find the intersection of the highest mortality rates and lowest access to care in Appalachia, Meg Barbor writes for the ASCO Post, published by the American Society of Clinical Oncology.

Pike County (Wikipedia map, adapted)

"It was very apparent that there was a glaring area where Kentucky, West Virginia and Virginia came together," Gieske said. "They had the highest incidence of lung cancer, the highest mortality from lung cancer, the worst five-year survival rates, the highest smoking rates, the worst access, the highest poverty rates, the lowest education rates, and all these came together in this region. So we thought, well, this is probably going to be a very difficult challenging area to work in, but at the same time, it would give us an opportunity for the greatest impact." 

The pilot will include 10 counties that Gieske said "really lit up the brightest" on that map. He said Pike County, Kentucky's largest in land area, is the only county in the state in the project. Five of the counties are in Virginia and four are in West Virginia.

Gieske said they would be working with Dr. Aasems Jacob, a pulmonologist at Pikeville Medical Center, on the project. 

Dr. Leigh Boehmer

Dr. Leigh Boehmer, chief medical officer and deputy executive director of the regional cancer alliance, told Barbor that the initiative aims to increase lung-cancer screening rates by identifying and addressing informational, literacy, and cultural barriers that inhibit rural Appalachians from seeking recommended preventive care.

“The alliance was designed to provide a platform to share promising, evidence-based, translatable practices and solutions to improve access and quality of care for patients in this part of the country," Boehmer said. 

Gieske said "education and communication" are key when it comes to reaching out to primary-care providers who are on the front line of care. 

Most electronic medical-record systems "will flag a patient if they meet the criteria, and then it's it's up to the provider to order the test," he said. "Lung cancer is just as important if not more important than breast cancer and colon cancer and cervical cancer screening. Lung cancer kills more patients or more individuals in our state, in our country than prostate, breast and colon cancer combined. Lung cancer kills three times more women than breast cancer, and a lot of women don't realize that." 

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. Medicare rules are a bit different. 

Bad news and good news

Gieske noted that Kentucky has a long history with lung cancer, largely because of its association with tobacco.

"We're by far the worst state in the country for the incidence of lung cancer, we're 55% above the national average, we have the highest mortality rate, we're fourth from the bottom for five years in lung-cancer survival," he said, "But the good news is . . . we're now number two in the country, if you go by the American Cancer Society data for lung cancer screening, and we are really starting to make a difference." 

Gieske said several state-based initiatives have helped increase screening rates, including the Kentucky Health Collaborative and the Kentucky LEADS Collaborative, for "Lung cancer education, awareness, detection and survivorship," and data from the University of Kentucky's Markey Cancer Center shows a decrease in late-stage lung cancer. 

"We have now seen a 19% reduction in late stage lung cancer – that's Stage 3 and Stage 4 lung cancer  –over the last six years," he said. "And that's strictly a result of screening. And that's two times faster than the national average, that decline." 

Gieske encouraged anyone who qualifies for lung-cancer screening to get tested, noting that it is a simple test that takes about three minutes and does not require any "needles, tubes or dye." 

He added, "It's a very simple screening test with incredible results."