Kentucky is a national leader in lung-cancer screening, but still has a long way to go to get all eligible people screened

American Cancer Society photo illustration

By Melissa Patrick
Kentucky Health News

Kentucky ranks second among states for lung-cancer screening, but experts say many more Kentuckians need to be screened. Only 10.6% of those at high risk have received screening; the national rate is 4.5%.

A recent study led by American Cancer Society researchers, published in the Journal of the American Medical Association Internal Medicine, shows fewer than one in five eligible individuals in the United States were up-to-date with recommended lung-cancer screening. 

"This research does show an improvement over screening rates reported for previous years. But we clearly, still have a long way to go. We must push harder to move the needle in the right direction,” Dr. Priti Bandi, ACS's scientific director for risk factors and screening-surveillance research, said in a news release.

The U.S. Preventive Services Task Force and ACS recommend annual low-dose CT scans for lung-cancer screening for individuals who:

• are 50 to 80 years old
• smoke or have quit smoking within the past 15 years
• have at least a 20 pack-year smoking history, which means a pack a day for 20 years or two packs a day for 10 years, and so on. A pack year is the number of packs smoked per day multiplied by the number of years the person smoked. 

Jennifer Redmond Knight, who serves as co-principal investigator for the lung-cancer screening project under the Kentucky Lung Cancer, Education, Awareness, Detection, Survivorship Collaborative, said one reasons lung-cancer screening remains low is because it is a relatively new cancer screening. The first recommendations for annual screenings were issued in 2013 and the eligibility for screenings expanded in 2021. 

"What that means is more people are now eligible for screening, which means the percentage of people who have been screened has gone down because there are more people eligible," Knight said. 

Another challenge is stigma, said Knight, who is also an assistant professor in the University of Kentucky's College of Public Health and a member of the UK Markey Cancer Center's Prevention and Control Research Program.

For years, Knight said people with a "significant smoking history" have felt shamed when their health-care providers ask them if they've quit smoking and they haven't, so when their provider encourages this new screening, there are often trust issues.

Knight said much work is being done in Kentucky to reduce stigma associated with lung cancer, largely through the Lung Cancer Screening Program the legislature created in 2022. Knight is on the program's advisory board.

"Kentucky is actually leading the way in many ways with quality lung-cancer screening and addressing the stigmas and helping lung-cancer screening programs throughout the state work in that space," Knight said.

She also talked about the value of early detection, which lets cancer be treated more effectively. Early screening is also important because it can often identify cancer before it spreads or causes symptoms. 

"We have hope now with lung cancer that we never had before," Knight said. "The story used to be if you get lung cancer, you're not going to make it very long. But now there's a story of hope that has to be changed. . . . So there's a lot of cultural shifts around this." 

The cancer society's research found that screening was much less common in persons without health insurance or a usual source of care, and in Southern states, which have the highest lung-cancer burden. Lung cancer is the leading cause of cancer deaths in Kentucky.

Most Kentuckians can pay for lung-cancer screenings through insurance or a program that offers low-cost screenings. Most Kentuckians have access to health insurance because the state expanded Medicaid in 2014, under the Patient Protection and Affordable Care Act, to include people making up to 138% of the federal poverty level. 

"If you meet the eligibility criteria, lung-cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost," Dr. Timothy Mullett of UK wrote in an article to debunk myths about such screenings.

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.

Cervical-cancer screening declined in pandemic, UK study finds

A Pap test (Photo by Rabizo, iStock/Getty Images Plus)

By Elizabeth Chapin

University of Kentucky

New research at the University of Kentucky reveals concerning declines in cervical cancer screening rates among women in the U.S. during the Covid-19 pandemic, especially in rural areas.

The study, led by UK Markey Cancer Center researcher Ty Borders, analyzed nationally representative survey data from the National Cancer Institute to examine Pap test screening rates before and during the pandemic. A Pap test (or Pap smear) is a screening method that can detect cervical cancer or cell changes that may lead to cervical cancer, allowing for early detection and treatment.

The analysis showed that the odds of a woman receiving a Pap test in the past year were 30% lower in 2022 compared to 2019, before the pandemic began.
research published in JAMA Network Open 

The substantial decline is concerning, given that cervical cancer is largely preventable with regular screening and early intervention says Borders, a professor in the UK College of Nursing and director of the Rural and Underserved Health Research Center.

The study also found increased disparities in screening rates between rural and urban women. In 2022, only 48.6% of rural women reported receiving a Pap test in the past year, compared to 64% of urban women.

Women from rural areas have historically had higher rates of cervical cancer incidence and mortality, so a widening urban-rural gap in screening during the pandemic is particularly troubling, Borders says.

“The findings point to a need to expand access to cervical cancer screenings among all women, but especially those residing in rural areas, to prevent a possible uptick in future cervical cancer incidence and mortality,” said Borders.

Disruptions to health care services during Covid-19 lockdowns likely contributed to the declines in screening, as many clinics temporarily suspended or scaled back routine procedures like Pap tests.

Based on the results, health care providers may want to consider extra measures to ensure patients are up to date with recommended screenings, including expanding the availability of appointments for cervical cancer screenings and reminding patients of screening due dates.

The research was published in JAMA Network Open, a publication of the American Medical Association. 

Men's Health Month a reminder to schedule preventive screenings

By Melissa Patrick
Kentucky Health News

Men's Health Month in June is a reminder for men to think about their health and consider making some screening appointments that could lengthen, or even save, their lives. 

Why is it so important for men to take care of themselves? For one thing, on average in the United States, men die nearly six years earlier than women. 

That is a wider gap than before the pandemic, which took a disproportionate toll on men. Researchers also note that men are more prone to unintentional injuries, such as drug overdoses and  accidents. Homicides, heart disease and suicides also contribute to the worsening life expectancy for men. 

Men's Health Month is a time for men to take charge of their health and to schedule their preventive  health screenings, especially for the conditions that if caught and treated early could save their life. 

Some recommended screenings include: 

 

Heart disease is the leading cause of death in men, according to the Centers for Disease Control and Prevention.  The American Heart Association says the key screenings for heart health involve an annual physical that include test for blood pressure, cholesterol, body weight and diabetes. Smoking is also a major cause of heart disease, and a health-care provider can help with a cessation plan. 

Skin cancer: Increased sun exposure and fewer trips to the doctor put men at a higher risk of developing skin cancer, so it's important to not only protect your skin when outdoors, but to see a dermatologist if you notice any change in a mole's color or appearance, or if they bleed, ooze, itch, appear scaly or become tender or painful. A dermatologist can also do a full-body skin cancer screening. 

Lung cancer: Kentucky still has one of the highest smoking rates in the nation and leads the nation in lung-cancer cases and deaths. Lung-cancer screening via low-dose computed tomography (a low-dose CT scan) is recommended for anyone 50 to 80 who smokes or has quit in the past 15 years and has at least a 20 pack-year smoking history (a pack per day for 20 years or two packs per day for 10 years). 

Prostate cancer: On average, one in eight men will be diagnosed with prostate cancer and it is the second leading cause of death among men, according to the American Cancer Society. It is recommended that prostate cancer screenings for men who are at average risk begin at age 50. 

Colon cancer: Routine screening for colorectal cancer is recommended to start at age 45. Men with a family history of the cancer may be advised to get screened earlier.

Diabetes: In Kentucky, about 100,000 people have diabetes and don't know it. That's why it's important to get screened with a blood test even when you don't think you have any symptoms.

Mental health: A primary-care provider is a good place to start if you are seeking help with a mental-health concern. Mental Health America of Kentucky also offers a free, online mental-health screening. The new, national 988 suicide/crisis hotline is available 24/7.

"While men are diagnosed with depression half as often as women and are less likely to attempt suicide, men die by suicide three to four times more frequently," says a peer-reviewed article in the American Medical Association Journal of Ethics by Nathan Swetlitz. "Although there is no one-to-one correspondence between depression and suicide, depression is one of suicide’s most significant risk factors."

Deaths from colorectal cancer in Appalachian Kentucky have declined, but far less than in the rest of the nation, UK study says

County rates per 100,000 are seen in five ranges or quintiles.(Map adapted by Kentucky Health News)

Kentucky Health News

Deaths from colorectal cancer in Appalachian Kentucky declined from 1999 to 2020, but far less than the rate of decline in the rest of the nation.

That's the upshot of a University of Kentucky study analyzing death data.

It found that in the 54 Kentucky counties served by the Appalachian Regional Commission, the mortality rate fell from 31.24 deaths per 100,000 residents in 1999 to 24.46 per 100,000 in 2020. But the national rate dropped by almost half, from 27 deaths per 100,000 Americans in 1999 to 14.81 in 2020. In non-Appalachian Kentucky, the rate dropped from 27.6 to 17.1.

During the entire 21 years covered by the study, the colorectal-cancer death rate in Appalachian Kentucky was 25.8 per 100,000 residents. In the 66 non-Appalachian counties, the rate was about 22 per 100,000. The national rate was 19.43 deaths per 100,000. Kentucky has the fourth highest death rate. 

The Kentucky county with the highest age-adjusted rate from 1999 through 2020 was Fleming, at 39.6 deaths per 100,000 residents. The next highest were Harlan, 34.4; Bath, 33.2; Pike, 32.1; Breckinridge, 31.6; Henry, 31.5; Todd, 31.1; Carter, 30.7; Lewis, 30.7; Cumberland, 30.6; Mason, 30.5; Lawrence, 30.4; Morgan, 30.4; Clay, 30.2; Letcher, 29.7; Washington, 29.4; Nicholas, 28.6; Breathitt, 28.5; Perry, 28.5; Floyd, 28.3; Monroe, 28.3; Powell, 28.2; and Nelson, 27.9 (all in dark blue on the map).

The counties with the 10 lowesr rates were Lyon, 14.9 per 100,000; Trimble, 16.97; McCracken, 17.7; Jessamine, 18.2; Shelby, 18.3; Madison, 18.4; Bullitt, 18.7; Trigg, 18.8; and Owen, 18.8.  Rates for Hickman and Robertson counties were not reported due to small case numbers.

The study, in the journal Gastroenterology, used data from the Centers for Disease Control and Prevention on the causes of death for Americans 15 or older. Its lead author is Dr. Syed Hassan, a research coordinator and clinical research scientist in UK's Department of Internal Medicine.

Hassan "said efforts to enhance screening rates should be improved and more education on colorectal cancer is needed," according to a UK news release.

He noted that In Appalachian Kentucky, nearly 41% of the colorectal cancer deaths occurred at home, suggesting that many victims might not have been seen by a doctor until the cancer had significantly advanced.

“That’s concerning, in my opinion,” Hassan said. “Access to health care, lifestyle related modifiable risk factors and education are important factors we should further work upon.”

Hassan also said anxiety about colonoscopies and other cancer screenings, and lack of education about the disease, may also play a role: “Many of these patients might’ve believed that they probably wouldn’t be able to afford as much care due to their socioeconomic status.”

Screening for colon cancer is recomended to start at age 45, because cancers of the colon and rectum tend to occur after age 40, but recent studies have shown increases in younger people, especially those with risk factors.

These cancers tend to run in families; studies show that if a close relative has had colorectal cancer, you can be predisposed to polyps — pre-cancerous lesions that can lead to the development of the cancer,

Other risk factors include age and lifestyle factors such as smoking, sedentary living, obesity, a diet rich in red meat, salt and saturated fats or a low-fiber diet.

New official recommendation: Women should start every-other-year mammograms at age 40; some groups favor annual scans

Photo illustration from Medical News Today

By Carla K. Johnson
Associated Press

Regular mammograms to screen for breast cancer should start younger, at age 40, according to an influential U.S. task force. Women ages 40 to 74 should get screened every other year, the group said.

Previously, the task force had said women could choose to start breast cancer screening as young as 40, with a stronger recommendation that they get the exams every two years from age 50 through 74.

Tuesday's announcement by the U.S. Preventive Services Task Force makes official a draft recommendation announced last year. It was published in the Journal of the American Medical Association.

“It’s a win that they are now recognizing the benefits of screening women in their 40s,” said Dr. Therese Bevers of MD Anderson Cancer Center in Houston. She was not involved in the guidance.

Other medical groups, including the American College of Radiology and the American Cancer Society, suggest mammograms every year — instead of every other year — starting at age 40 or 45, which may cause confusion, Bevers said, but “now the starting age will align with what many other organizations are saying.”

Breast-cancer death rates have fallen as treatment continues to improve. But breast cancer is still the second most common cause of cancer death for U.S. women. About 240,000 cases are diagnosed annually and nearly 43,000 women die from breast cancer.

The nudge toward earlier screening is meant to address two vexing issues: the increasing incidence of breast cancer among women in their 40s — it’s risen 2% annually since 2015 — and the higher breast cancer death rate among Black women compared to white women, said task force vice chair Dr. John Wong of Tufts Medical Center in Boston.

“Sadly, we know all too well that Black women are 40% more likely to die from breast cancer than white women,” Wong said. Modeling studies predict that earlier screening may help all women, and have “even more benefit for women who are Black,” he said.

Here are more details on what’s changed, why it’s important and who should pay attention.

When should I get my first mammogram? Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk. They should have the X-ray exam every other year, according to the new guidance. Other groups recommend annual mammograms, starting at 40 or 45.

The advice does not apply to women who’ve had breast cancer or those at very high risk of breast cancer because of genetic markers. It also does not apply to women who had high-dose radiation therapy to the chest when they were young, or to women who’ve had a lesion on previous biopsies.

What about women 75 and older? It’s not clear whether older women should continue getting regular mammograms. Studies rarely include women 75 and older, so the task force is calling for more research.

Bevers suggests that older women talk with their doctors about the benefits of screening, as well as harms like false alarms and unnecessary biopsies.

What about women with dense breasts? Mammograms don’t work as well for women with dense breasts, but they should still get the exams.

The task force would like to see more evidence about additional tests such as ultrasounds or MRIs for women with dense breasts. It’s not yet clear whether those types of tests would help detect cancer at an earlier, more treatable stage, Wong said.

Does this affect insurance coverage? Congress already passed legislation requiring insurers to pay for mammograms for women 40 and older without copays or deductibles. In addition, the Affordable Care Act requires insurers to cover task-force recommendations with an “A” or “B” letter grade. The mammography recommendation has a “B” grade, meaning it has moderate net benefit.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Kentucky is No. 4 in smoking, down from No. 2, but at 17.4% of adults, experts say the state's smoking rate is still way too high

By Melissa Patrick
Kentucky Health News

Kentucky still has one of the nation's highest adult smoking rates, but has fallen to fourth among the states, after many years of either ranking first or second. The rate for 2022, the last year for which a rate has been calculated, is 17.4%.

Asked why Kentucky might have seen a drop in its ranking, Amanda Fallin-Bennett, director of the Kentucky Center for Smokefree Policy, said it could be because Kentuckians have good access to treatment programs. 

"Compared to other states, it does have pretty good access to tobacco-treatment services for most all Kentuckians," she said, adding later, "The majority of people who smoke cigarettes would like to quit. So we know that making cessation services available and accessible is a big help."

Kentucky passed a law in 2017 to require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration. This also includes Medicaid, which covers one in three Kentuckians. The law also removed many of the barriers to such treatment, such as co-payments and limits on length of treatment.

Kentucky offers a program called Quit Now Kentucky. The quit line can be reached at 1-800-QUIT-NOW(784-8669); through text QUITKY to 797979; or online at www.quitnowkentucky.org. The services are free and confidential. 

Fallin-Bennett added that it's important to consider that another reason that Kentucky's smoking rate has dropped could be because of increases in the uses of alternative tobacco products, like vapes. or heat-not-burn devices.

1 in 4 in Ky. smoked five years ago; now 1 in 6

With 17.4% of Kentucky adults reporting they smoke every day or some days, Kentucky ties with Mississippi for the fourth highest smoking rate in the nation, behind West Virginia (21%); Arkansas (18.7%); and Tennessee (18.5%). The figures are from the Behavioral Risk Factor Surveillance System, a continuing national survey by the Centers for Disease Control and Prevention.

Kentucky's smoking rate has been on a steady decline since 2011, even though it was nearly 20% in 2021 and nearly 25% just five years ago, according to America's Health Rankings, using CDC data.

This means that instead of more than one in four people smoking in Kentucky just five years ago and one in five in 2021, now just over one in six Kentucky adults are considered "current smokers."

Fallin-Bennett said any decrease in smoking is to be celebrated: "Smoking is the leading cause of preventable death and disease and so anytime someone stops smoking, they are dramatically reducing their risk for cancer, heart disease, stroke, preterm birth, just a myriad of adverse health outcomes that are associated with smoking."

Shannon Baker, advocacy director for the American Lung Association for Kentucky and Tennessee, said she had no data to analyze why Kentucky now ranks fourth among states instead of second, and cautioned that the focus should remain on the fact that Kentucky's smoking rate is still among the worst in the nation.

"I can tell you that 17.4% of Kentucky adults smoke compared to the national average rate of 14%. So still, it's still a terrible statistic, right? . . .  So I guess I would caution us to look at that, instead of how we rank," she said. 

Baker said any drop in the state's smoking rate is great news, but noted that Kentucky continues to have the nation's highest rates of lung cancer and lung-cancer deaths: "We still have miles to go." 

What next? 

Asked what needs to happen to bring this rate down further, Fallin-Bennett said increasing tobacco taxes would help, as would more Kentucky counties and cities passing  comprehensive smoke-free policies.

"So only 38% of Kentuckians are covered by comprehensive smoke-free policies where smoking is not allowed in restaurants, bars and workplaces," she said. "So that is an area that Kentucky continues to struggle with and that would likely further reduce smoking rates." 

Baker praised the efforts of the state's Lung Cancer Screening Advisory Committee, but said more Kentuckians and providers need to be educated about the availability of low-dose CT screening for smokers and former smokers who qualify for it.

She said she thinks the committee is the first in the nation "that's really focusing on what we can do to increase the number of eligible individuals actually getting the low-dose CT scan done, and making making it more accessible and affordable statewide," she said. "That's a huge opportunity for us."

A missed opportunity, she said, was in the recent legislative session, when legislators removed strict enforcement measures from House Bill 11, aimed at decreasing youth vaping. She said that the current laws that prohibit retailers from selling nicotine products to youth is "not effectively enforced." 

Baker added, "We need three things: We need licensing, and we need regular compliance checks, and we need penalties for violations that escalate for repeat violations all the way up to the point of suspension and revocation of your license for the worst actors, the scofflaw, and we know that they're out there. And those things together represent a tremendous opportunity to address youth e-cigarette use and nicotine addiction, and we missed the boat."

Gov. Andy Beshear signed HB 11 into law on April 5. It limits legal sale of vape products to those approved by the FDA. It will create a database of retailers that sell the products and set fines for retailers, manufacturers and wholesalers who violate the law, but penalties for retailers are much less than in the bill's original version.

March is Colorectal Cancer Awareness Month; Kentucky has the nation's fourth highest rate of death from colon cancer

Photo illustration by OnTheRunPhoto, iStock/Getty Images Plus

By Natalie Pitman
University of Kentucky

In March, we wear blue to recognize Colorectal Cancer Awareness Month, first observed in March 2000. Since then, it has become an opportunity to spread awareness about the importance of screening and honor those diagnosed with colorectal cancer.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women. It’s estimated that 106,590 new cases of colon cancer and 46,220 new cases of rectal cancer will be diagnosed in 2024. Kentucky has the fourth highest rate of death from colon cancer in the nation.

“The good news is colorectal cancer is easier to prevent than most other cancers and is highly treatable. It is often curable when caught early, and we could dramatically reduce complications from this disease by getting more people screened,” says Darwin Conwell, M.D., UK HealthCare medical pancreatologist and Jack M. Gill Endowed Chair in Internal Medicine at the UK College of Medicine.

Let's talk about the importance of colorectal cancer screenings and why they should be a priority for everyone.

What is colon cancer? The colon and rectum are parts of the digestive system. Colorectal cancer begins when cells that are not normal grow inside the colon or rectum. Early symptoms may be subtle, making regular screenings crucial for early detection.

Who should get screened? Most people should begin getting screened at age 45. You may need to begin screening earlier. Talk with your provider if you or a close relative has had colon polyps or colon cancer, or if you have an inflammatory bowel disease.

What are the different screenings? Screenings play a pivotal role in catching abnormalities before they turn cancerous. Detecting and removing polyps during screenings significantly reduces the risk of colorectal cancer.

There are different tests to detect colorectal cancer. For most people, the best test is the one they can complete. Talk with your primary-care provider about which test is right for you. More information is provided below or click on this link for a flyer.

UK HealthCare offers three types of colorectal cancer screening tests:

• Colonoscopy: The provider performing the screening can see and remove growths (polyps) in the colon and rectum during this test to prevent or detect colorectal cancer. You will need to take off work the day of the procedure. Some patients who take off the day before the procedure as well to complete bowel preparation. If a polyp is detected, it can be removed during the procedure. Screening is conducted every 10 years if results are normal.
• Cologuard: Your healthcare provider will order the Cologuard test to screen for colorectal cancer. Cologuard can be completed at home and is designed to detect abnormal cells in your stool. After you collect the sample, follow the Cologuard instructions to mail the sample to a lab. Results are sent to you and your provider. Screening is conducted every three years if results are normal.
• FIT Tests: The provider will test your stool sample for blood, by ordering a FIT test. You can complete the FIT test at home. Screening should be completed every year if results are normal.

A positive Cologuard or FIT test result is not the same as a cancer diagnosis, so please talk to your health care or telehealth provider for next steps.

“Colonoscopies are considered the gold standard for colorectal cancer screening, but stool-based tests like Cologuard or FIT tests can be a more accessible option if work, transportation, or family obligations are preventing you from getting a colonoscopy,” said Dr. Avinash Bhakta, a UK Markey Cancer Center colorectal surgeon. “Regardless of the test you choose, the most important thing you can do is get screened regularly.”

If you have a primary-care provider, or if you are in for a checkup or treatment, ask them if you’re due for your routine colorectal cancer screening. Based on your health history, they will be able to tell you which screening option is best for you.

Screening can help detect early signs and help monitor situations that can increase your risk of developing colorectal cancer. Getting screened for colorectal cancer is one of the most important ways you can take charge of your health.

Bowling Green hospital uses new technology to find lung cancer

Jennifer Finch, director of clinical intergration at Med Center
Health in Bowling Green, directs discussion of cases in the
hospital's new lung-cancer screening program. (Photo provided)

Kentucky Health News

The Medical Center at Bowling Green has established "a fast-track clinic that will help in the fight against lung cancer and give patients a better chance of surviving it," Ann Marie Dotson reports for the Bowling Green Daily News.

"The goal of the program is to detect lung nodules at the earliest stages to either prevent serious issues before they occur or to treat concerns quickly by offering a variety of options tailored to a specific diagnosis," Dotson writes, noting the it uses "a new technology that allows pulmonologists to biopsy smaller nodules."

Jennifer Finch, director of clinical integration at Med Center Health, said the program can detect cancer at stage 1, where there is a survival rate of 70 to 80%. “Historically, on small lesions, we had to wait and watch to see if they grew, but this computer-assisted robotic guided program guides the doctors to the small nodule, allowing them to get it,” she told Dotson.

The hospital said it started the program because Kentucky has the highest rate of new lung-cancer cases across the country, Dotson reports. It's a collaboration between its cardiothoracic surgeons, oncologists and Western Kentucky Heart and Lung board-certified pulmonologists.

"The team meets each Friday to view and discuss patients who may need further examination and review reports of patients who have incidental lung nodules and those detected through low-dose CT scans, working directly with the patient’s primary care providers," Dotson reports. "Eligible patients are then scheduled for consultations with the program’s team of physicians."

Finch told Dotson, “As a team, we review the patient’s history, whether the patient is a smoker, family history and cancer risk to see if the nodule could be benign or cancerous.”

Then the team devises a treatment plan "based on the patient’s needs, including further testing, surgery, diagnostic imaging, chemotherapy, radiation therapy or a biopsy." Finch said since the program opened Dec. 8, “we have had fantastic outcomes already.”

She added, “This program is really personal for me, and I have such a passion for it because my father died of lung cancer.” Kentucky leads the nation in lung cancer and deaths from it.

Kentucky rises to No. 2 in the nation in screening for lung cancer, which lowers the chances that the disease will be fatal

Tony Stumbo (Photo by Veronica Turner for KFF Health News)

By Charlotte Huff
KFF Health News

Dr. Tony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.

“I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in Eastern Kentucky near his childhood home in Floyd County shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”

Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate.

For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.

The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which launched in 2014 to improve screening and prevention in order to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia.

However, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested: the fear and stigma that swirl around cancer.

Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to the Centers for Disease Control and Prevention.

It’s a bit early to see an impact on lung-cancer deaths, because people may live for years with a malignancy, LEADS researchers said. Plus, other factor such as improvements in treatments may also help reduce death rates. Still, data already shows that more cancers in Kentucky are being detected before they become advanced and thus more difficult to treat.

Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to the Kentucky Cancer Registry. By 2020, that number had declined to 72%, according to the most recent data available.

“We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.

Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health.

“A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.

The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, the state legislature established a statewide lung cancer screening program based in part on the group’s work.

Jacob Sands, a lung-cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and is a volunteer spokesperson for the American Lung Association.

In 2014, Kentucky expanded Medicaid under the 2010 Patiemt Protection and Affordable Care Act. That increased the number of lower-income people who qualified for lung-cancer screening and related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.

Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%. Regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.

Some adults, like Lisa Ayers, didn’t realize lung-cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at University of Kentucky King’s Daughters Hospital in Ashland. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.

She was diagnosed with a type of lung tumor that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely. That type of cancer isn’t typically linked to smoking, but Ayers quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer: “It was a big wake-up call for me.”

Kentucky is second only to West Virginia in the percentage of adults who smoke. Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start.

Studts said the goal should ne to avoid stigmatizing people and instead to build rapport, meeting them where they are that day: “If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help. You know what? You actually develop a relationship with an individual by accepting ‘No’.”

Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.

In hospitals of Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, the chief medical officer in ARH's Big Sandy Region.

The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said. “Just how sad is that?”

KFF Health News is a national newsroom producing in-depth journalism about health issues. It is a core operating program of the Kaiser Family Foundation, an independent source of health policy research, polling and journalism.

Bill to ban cost-sharing fees on cancer screenings clears panel

By Melissa Patrick
Kentucky Health News

A bill aimed to ban cost-sharing for preventive cancer screenings in certain types of health-insurance plans passed unanimously out of a House committee and awaits a vote in the full chamber. 

Asked why the bill was important, its sponsor, Rep. Deanna Frazier Gordon, said cost is often a barrier for people when it comes to preventive screenings, especially if they don't have any symptoms.

Rep. Deanna Frazier Gordon

"I think the cost is a barrier for people," said Frazier Gordon, R-Richmond. "You know, a lot of health-care plans have $1,000, $2,000 deductibles. And so when you're asking asymptomatic people to go get screening for a condition that they might not have,  I think . . . a fear of that cost is a factor" in deciding to do it or not. 

House Bill 52 says cancer screenings, test or procedures performed for the purpose of detecting cancer "shall not be subject to . . .  any deductible, coinsurance, copayment or other cost-sharing requirement." 

The House Health Services Committee approved the bill 16-0 on Feb. 8. The bill has had two of its three required readings and is in the House Rules Committee. 

Frazier Gordon said the bill would only impact certain insurance plans. The bill's summary says it will "require limited health service benefit plans, Medicaid, self-insured employer group plans provided by the governing board of a state postsecondary education institution and the state employee health plan to comply with the cancer coverage requirement." 

The state Department of Insurance financial-impact statement for the bill says it is "not expected to materially increase premiums," nor is it expected to increase administrative costs. Further, it notes there is a potential for long-term savings due to early detection of cancer.

Bill would make diagnostic breast examinations more affordable

Reps. Lisa Willner, left, and Kim Moser present HB 115 to the
House Health Services Committee. (Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

The General Assembly is advancing a bill to remove out-of-pocket charges for follow-up diagnostic breast examinations and supplemental breast examinations when they're medically necessary.

A scientific study has found that one in five women don't get recommended follow-up breast exams  because of cost.

The House Health Services Committee approved House Bill 115 Feb. 1, and the measure was posted for passage in the full House on Monday, Feb. 5. 

"This bill really is about early detection of breast cancer," said Rep. Kim Moser of Taylor Mill, the bill's primary sponsor and the committee chair. "It'll ensure that individuals at high risk for breast cancer have access to diagnostic mammograms or follow up imaging. This is obviously needed to rule out breast cancer or the need for further testing."

Rep. Lisa Willner, a Democrat from Louisville, presented the bill with Moser.  Willner filed a similar bill last year that did not get any traction.
 

"The good news is that overall, our overall cancer numbers are declining," Willner said. "But breast cancer is one of the areas that's actually on the rise in Kentucky, really emphasizing the importance of this bill." 

Indeed, Kentucky's breast-cancer rate showed a steady rise between 2005 and 2019, when it reached a high of 132 women with breast cancer per 100,000, according to the National Cancer Institute.

In 2020, the rate declined to 127 cases per 100,000 women, but that was a "temporary, anomalous year" because of the pandemic, according to NIC. The pandemic caused reduced cancer screenings and diagnosis, which resulted in a decline in the 2020 incidence rates for most cancer sites, the agency said.  

The American Cancer Society estimates that one in every eight women will be diagnosed with breast cancer in her lifetime.

In 2023, more than 4,030 Kentuckians will be diagnosed with breast cancer and more than 790 will die of the disease, according to a letter from philanthropist Susan G. Komen supporting Willner's 2023 bill. 

Dana Carter, regional manager for state policy and advocacy for Komen's breast-cancer foundation, explained to the committee members why the follow-up testing is needed and how it would remove financial barriers to medically necessary diagnostic and supplemental breast examinations. 

"Mammography is only the initial step in the early detection process and it is not able to diagnose cancer alone," she said. "Early detection of breast cancer is not possible without medically necessary follow up imaging or additional supplemental imaging which is required to rule out breast cancer or confirm the need for a biopsy." 

She said an estimated 12% of women screened with "modern digital mammography" will require follow-up diagnostic imaging.

Further, she noted that a Komen-commissioned study recently found that out-of-pocket costs for patients varied widely and are often high, adding to the stress and confusion for patients who need such tests.  

"For example, the average patient cost for a mammogram is around $250, and for a breast MRI over $1000," she said. 

Carter also pointed to a study published in the scientific journal Radiology that found "one in five patients would not go in for the recommended follow up because they had to pay a deductible." 

"Unfortunately, we received many calls and emails from individuals who are unable to pay the out-of-pocket costs for the recommended follow up breast imaging," she said.

"Without assistance, many simply will delay or forego these medically necessary tests. This can mean that patients will not seek care until the cancer is potentially spread, making it much more costly or in deadlier to treat." 

Carter added, "Breast cancer can be up to five times more expensive when it is spread beyond the breast to other parts of the body."

The state Department of Insurance estimates that the bill would increase the cost of health insurance a as much as 57 cents per member per month, or not at all. "This represents an increase of approximately 0.0% to 0.1% or approximately $0 to $2.5 million for all fully insured policies in Kentucky, excluding Medicaid and state employees, due to the increased costs for health plans," the department says. 

The agency "acknowledges that there is a potential for long-term savings due to increased affordability and accessibility to cancer diagnostic testing which could lead to earlier detection of cancer."

Lt. Gov. Coleman reflects on her preventive double mastectomy

Lt.Gov. Jacqueline Coleman (KL photo by Sarah Ladd)

By Sarah Ladd
Kentucky Lantern

Kentucky Lt. Gov. Jacqueline Coleman knew for a long time that one day she might learn cancer was at her door.

Her family history put her on heightened alert; her mother, aunt and cousin all had breast cancer. So she “wasn’t shocked” when, in September, a routine mammogram — her first — concerned her health-care provider.

She went for more tests, including magnetic resonance imaging and biopsy. After the biopsy she learned she needed surgery, either way. Her doctors were concerned about several areas in her breasts, and she was facing “biopsy and remove, biopsy and remove, times four.”

She knew immediately: “I don’t want to live like that.” Without the mastectomy, she faced “scans and screens and biopsies every six months for the rest of my life.”

“In a way, it was almost like I was waiting for this news,” she told the Kentucky Lantern during a sit-down interview in her Capitol office on Jan. 23. She would eventually undergo a double mastectomy on Dec. 18.

But as she wrapped up the last leg of a statewide re-election campaign with Gov. Andy Beshear, Coleman found herself in medical limbo. Screenings and tests defined her personal October and November, even as she debated her opponent on KET, traveled the state meeting voters and celebrating on election night.

“I’m going through the end of a campaign, which is … the most intense time, and I have all these questions,” she said. “And it was really hard to not know what was going to happen.”

The tests “just kind of get a little bit more invasive each time,” said Coleman, 41. “And of course, it takes time to … do the test, to have them read, to schedule the next one. It’s a frustrating process because you have more questions than answers, it seems, the entire time. But you’re also grateful that your doctors are being so thorough, and making sure to cover all the bases.”

In early December, Coleman was “relieved” to learn she could get a double mastectomy at Baptist Health in Lexington.

“I felt it would be irresponsible to have a three-year-old, and to not be as aggressive as I could be,” she said.

Coleman did not have cancer, but she didn’t know that until after her surgery, when her pathology results came back clean. “The one place that was a great concern came back benign, but had malignant potential,” she said. “And so I felt like I got ahead of it. And I feel like I made the right decision.”

At the mercy of disease

Coleman says she's “not the best person about going to the doctor,” but “I also know that being preventative gives you a chance.”

“When you’re reactive, you’re at the mercy of … It could be a disease,” she said.

Still, medical issues wait for no one.

“You’re fighting for your life, and you still have to pick the kids up, and you still have to go to the grocery, and you still have to go to work,” Coleman said. “The world doesn’t stop.”

If anything, she said, the whole experience left her with less patience for what she called “petty politics.”

“There are real problems in the world,” she said. “I think about the importance of women being empowered to protect their own health, to be trusted.”

 
Not alone 

After her surgery, Coleman got cards and letters from people all over the state telling her their stories about going through similar health challenges.

“It was a message of: ‘You’re not alone’,” she said. “But it was also a message of reassurance. And it was remarkable.”

Coleman said she finally feels like herself again, and is looking forward to getting back out in communities across Kentucky. And she plans to keep using her story to encourage others to seek preventive care — and to know there is a community of Kentuckians who relate to their journeys.

“I know how alone I felt when I got the news and when I tried to find my way and what was the right path for me,” she said. “And I don’t want other women to feel that way.”

Women from 40 to 49 should get mammograms every two years, and from 50 to 74, they should get the exam every year, according to the state Department for Public Health. To find out how to get a free or low-cost mammogram or cervical cancer screening, call 844-249-0708. Click here for more information.

Cancer is a leading cause of death in Kentucky, which has high rates of breast cancer. In 2021, Kentucky lost more than 10,000 people to cancer, according to the Centers for Disease Control and Prevention. Breast cancer is second only to lung cancer in its mortality nationwide, according to the American Cancer Society.

UK doctor debunks myths about lung-cancer screening, which can find cancer before it spreads or causes symptoms, and save lives

Photo illustration by dragana991, iStock/Getty Images Plus

By Dr. Timothy Mullett

University of Kentucky

Lung cancer is the leading cause of cancer deaths in the U.S., claiming more lives than prostate cancer, breast cancer, and colorectal cancer combined. However, it can be a curable disease if detected early through screening, which can often identify cancer before it spreads or causes symptoms.

The U.S. Preventive Services Task Force recommends annual low-dose CT scans for lung-cancer screening for individuals who meet the following criteria:

• Are 50 to 80 years old
• Currently smoke or have quit smoking within the past 15 years
• Have at least a 20 pack-year smoking history, which is determined by multiplying the number of packs a person smoked per day by the number of years the person has smoked

Despite the benefits of screening, only a fraction of eligible people get screened due to public unawareness, stigma, and prevalent myths and misconceptions about the procedure. Here I address some of the most common myths:

Myth: “Lung cancer screening is not covered by my insurance or is too expensive.”
Fact: If you meet the eligibility criteria, lung cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost.

Myth: “I quit smoking years ago, so I don't need to be screened.”
Fact: Even individuals who have quit are at high risk for lung cancer and should get screened. While screening is primarily recommended for those who quit within the past 15 years, the American Cancer Society recently expanded its guidelines to encourage screening for people with a smoking history outlined above regardless of the number of years since quitting.

Myth: “I currently smoke, so I will get screened after I quit.”
Fact: If you currently smoke, you are at the highest risk. Everyone deserves empathetic health care, and you should not feel judged or ashamed for smoking. In addition to screening, your doctor can help connect you to smoking cessation resources. Quitting smoking at any time, even after a lung cancer diagnosis, reduces the risk of dying from other diseases besides cancer, including heart and lung disease.

Myth: “Lung cancer diagnosis is a death sentence. I’d rather not know.”
Fact: A lung cancer diagnosis today is not the same as it was even 10 years ago. Surgery for lung cancer is becoming much less invasive, and improved treatment options include targeted therapy and immunotherapy. Getting screened is your best defense against lung cancer — if it’s caught early, outcomes are greatly improved, and in some cases, the cancer can be cured.

Myth: “Lung cancer screening is time-consuming and invasive.”
Fact: Lung cancer screening is less invasive than procedures like mammograms or colonoscopies. It is a painless, quick process that involves a low-dose CT scan of the chest, taking only a few minutes to complete. Minimal preparation is required, and no needles or contrast dye are used.

Myth: “Lung cancer screening has a high rate of false positives.”
Fact: While cancer screenings provide valuable tools for early detection, they also carry a potential for false positives. These results may appear as abnormalities on imaging tests but don't necessarily translate to a need for invasive procedures.

Timothy Mullett, M.D., is a UK Markey Cancer Center surgeon and the medical director of the UK Markey Cancer Center Affiliate and Research Networks.

September is Prostate Cancer Awareness Month; American Cancer Society provides info on prevention, risk and treatment

By Melissa Patrick

Kentucky Health News

When prostate cancer is detected early, the odds of survival are high. That is the message being spread far and wide in September, which is Prostate Cancer Awareness Month. 

Prostate cancer is the second leading cause of cancer death among men in the United Statesm and Black men are two times more likely to die from it than white men. Black men having the highest death rate for prostate cancer of any racial or ethnic group.

According to the American Cancer Society, more than 288,000 men will be diagnosed with the disease this year, with close to 35,000 deaths. 

The good news is that more than 3.5 million men diagnosed with the disease in the U.S. are still alive today, the ACS reports.

The incidence rate for prostate cancer in Kentucky is 108 cases per 100,000 people, with 28 counties having the highest rates of  between 112.6 and 153.3 cases per 100,000 people. The statewide rate is  below the national rate of 109.9 cases per 100,000 people. 

The death rate for prostate cancer in Kentucky is 18.1 per 100,000, with 24 counties having the highest rates of between 22.5 and 44.9 deaths per 100,000 people. This is about the same as the national rate of 18.8 deaths per 100,000 people. 

For Prostate Cancer Awareness Month, Dr. Lorelei Mucci, director of strategic research partnerships at the ACS, provided information in an ACS news release about the signs and symptoms of prostate cancer,  risk factors, screenings and more.

Prevention: Mucci stressed the importance of Prostate Cancer Awareness Month as a way to promote prevention, early detection and treatment to improve survivorship. In addition, she said it's important to set aside time to reflect on those who have been impacted by prostate cancer and those who have lost their lives to it. Further, she said increased awareness of the disease can prompt officials to invest in more prevention and treatment opportunities. 

Warning signs of prostate cancer: "For some men, prostate cancer may lead to urinary problems, such as having difficulty starting urination or urinating frequently, or pain during ejaculation. This is because of the location of the prostate close to the bladder and urethra. These symptoms and signs also occur with non-cancer conditions, so it is important to follow up with a physician to find out what might be causing these symptoms.

"If a cancer has already grown beyond the prostate, there may be pain in the hips, back, or other areas that does not go away. For most people, however, there are no signs or symptoms indicating prostate cancer and the cancer is diagnosed with a biopsy following an abnormal blood test," she writes. 

Who is at risk: Anyone with a prostate is at risk of prostate cancer. 

However,  she writes that ACS research shows that Black men and those of African ancestry are 70% more likely to be diagnosed with prostate cancer. And, the risk of prostate cancer gets higher with age. In addition, people with a family history of prostate cancer (such as in their brother or father) as well as a family history of breast cancer in a sister or mother, are at higher risk of prostate cancer. 

That said, Mucci notes that "maintaining a healthy body weight, not smoking, and being physically active can help to offset this higher risk." 

Treatment and advancements: "There are effective treatments for prostate cancer," she writes. "When the cancer is still confined to the prostate (localized), surgery (radical prostatectomy) and certain forms of radiation are useful to treat and cure prostate cancer. For men who have a low risk of their prostate cancer metastasizing, active surveillance - in which a patient is closely monitored for signs of cancer progression - can also be an important treatment to consider. When the cancer is more aggressive, there are additional therapies that are used, including therapies that target hormonal pathways, chemotherapy, immunotherapy, and radiopharmaceutical therapies. "

"In fact, this is an exciting time in prostate cancer with substantial progress in the discovery and approval of new therapies over the past 5-10 years, as well as several other therapies being developed," she writes. 

Screening test: The main screening test for prostate cancer involves taking a blood sample and testing it for the level of a marker called prostate-specific antigen (PSA). Higher levels of PSA in the blood can indicate prostate cancer, but also may be higher in benign conditions such as an enlarged prostate, so it is important to follow up with a doctor to discuss the results and the next steps. 

She adds that while there is good evidence showing that regular PSA screening can reduce prostate cancer mortality, there is some controversy with screening for prostate cancer since the test can pick up slower-growing cancers that will never lead to harm. She said researchers are working on more effective screening approaches. 

When should you get screened? The ACS recommends that men at average risk for prostate cancer discuss the benefits and limitations of screening with their healthcare provider at age 50.

Men at high risk (which includes Black men in general and any man with a first-degree relative who had prostate cancer before age 65) should have the conversation at age 45. 

Black men with a family history of breast, ovarian, or prostate cancer, and men with more than one first-degree relative who had prostate cancer at an early age should discuss screening at age 40.

"Detecting prostate cancer early can lead to more effective treatment and improved outcomes," she writes. 

In response to the question, "What is the ACS doing to combat prostate cancer?" Mucci said they have established the "Improving Mortality Toward Prostate Cancer Together" (IMPACT) initiative, which she leads. 

She writes, "This cross-institution initiative will address urgent unmet needs with the goals of significantly improving outcomes for all men including survivorship and survival; reducing disparities; improving diversity in prostate cancer clinical trials; accelerating engagement and awareness and accelerating the implementation of known prevention strategies into at-risk communities." 

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."