New study finds smoking and vaping dual use increases lung cancer risk; expert says it increases risk for other diseases too

By Melissa Patrick
Kentucky Health News

People who use electronic cigarettes and smoke traditional cigarettes are more likely to develop lung cancer than people who just smoke, according to a new study.

Centers for Disease Control and Prevention photo 

The Ohio State University study, published in the Journal of Oncology Research and Therapy, found that vaping combined with cigarette smoking was eight times more common in the cases with lung cancer than the control subjects, and the risk of developing lung cancer was four times higher among those who combined vaping and cigarette smoking than those who only smoked. These findings were consistent across genders and races and for all major cell types of lung cancer.

 

"This study presents clear evidence showing that vaping in addition to smoking can increase your risk for lung cancer," Marisa Bittoni, lead author and researcher at Ohio State's College of Medicine, said in a news release. "This is especially concerning given the rate of youth and young adults using these products." 

Dr. Randall Harris, co-author and professor of epidemiology at Ohio State's College of Public Health, added that while most people know that tobacco smoke contains cancer-causing chemicals, there is less known about the chemicals inhaled through vaping products. 

“Our findings provide the first evidence that smoking in combination with vaping significantly increases the risk of lung cancer compared to smoking alone," Harris said. 

Dual use and other chronic diseases

Amanda Bucher, director of tobacco policy research and outreach at the University of Kentucky College of Nursing, explained that because e-cigarettes contain a different mix of toxic chemicals than cigarettes do, including some new compounds that are formed when the chemicals are heated, people who are dual users are exposed to a broader range of toxins than they would be if they just used one device or the other. 

"Using both e-cigarettes and traditional cigarettes is associated with a higher risk of developing other diseases too, a higher risk than just smoking traditional cigarettes," Bucher said. "So not just a higher risk of developing lung cancer, but also cardiovascular disease, stroke, metabolic dysfunction, asthma, COPD and oral diseases."

Smoking cessation, prevention and lung cancer screening

Bucher said the good news is that Kentucky ranks second among states for lung cancer screening, but the bad news is that there is more work to be done because Kentucky continues to lead the nation in the rate of new lung cancer cases and deaths from it. 

Lung cancer screening with annual low-dose CT scans is recommended for people 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.

According to the Centers for Disease Control and Prevention, around 30% of adult smokers in the United States are dual users. In Kentucky, the Truth Initiative, a tobacco-control advocacy group,  reports that 10.5% of adults use e-cigarettes and 17.4% are smokers. Among the state's high-school students, 4.9% are smokers and 21.9% vape. All of these Kentucky rates are higher than the national averages.

Bucher encouraged anyone trying to quit smoking and/or vaping to reach out to the Kentucky Quit Line at 1-800-QUIT-NOW, go to QuitNowKentucky.org or text QUITKY to 797979. 

She said help can also be found with a primary care provider who can offer counseling support and access to U.S. Food and Drug Administration-approved medications to help with cessation. 

"Research definitely shows that using medicines to help with tobacco treatment can double your chances of successfully quitting," she said. 

In addition, she said 39 local health departments receive funds to support cessation and prevention programs. Asked why all of the state's 61 district and county health departments don't offer this service, she said they used to, but reductions in funding from the state tobacco program have led to fewer of them offering such programs. 

"We know that almost 50% of Kentucky adults who smoke have tried to quit in the last year," she said. "It's really important for us to do everything we can to support those individuals." 

Bucher said policy matters when it comes to decreasing lung cancer rates and deaths in Kentucky.  

"We know that individuals who live in a Kentucky community with a comprehensive smoke-free workplace law are 8% less likely to be diagnosed with lung cancer," she said. "So just living in a place that has a certain kind of law means that you're less likely to get lung cancer. It doesn't matter what behavioral choices you are making." 

She added that only 38.1% of the state's population is covered by a comprehensive smoke-free workplace law, which means there is a lot of opportunity for communities to pass such laws to provide protections for their citizens. 

Further, she said, "We know that smoke-free laws make it easier for people to quit because they aren't exposed to those triggers. And, we also know that when fewer people are smoking and vaping inside public places, youth are less likely to start using tobacco products. So a smoke-free policy can also be something that is protective." 

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.

Korean study finds former smokers who use e-cigarettes or vapes have higher risk for lung cancer than ex-smokers who don't

Photo by Steve Helber, The Associated Press

Kentucky Health News

Former cigarette smokers who use electronic cigarettes or vaping devices may be at higher risk for lung cancer than former smokers who don’t vape, according to new research in South Korea.

“This is the first large population-based study to demonstrate the increased risk of lung cancer in e-cigarette users after smoking cessation,” said Dr. Yeon Wook Kim of Seoul National University, corresponding author of the study published at the 2024 international conference of the American Thoracic Society (ATS).

E-cigarettes are promoted as an aid to smoking cessation, but "There is little knowledge about the long-term consequences of vaping, and epidemiological evidence for the association between e-cigarette use and lung cancer is lacking," said an ATS news release.

"Biological studies suggest the possible dangers of e-cigarettes, including pulmonary toxicity and lung cancer. E-cigarettes and heating elements have been shown to contain carbonyl compounds (such as formaldehyde, acetaldehyde, acrolein and diacetyl) and toxic metals (such as chromium, nickel and lead), which are known to be carcinogenic. These toxins are also present in conventional cigarettes."

Kim said, “Our results indicate that when integrating smoking cessation interventions to reduce lung cancer risk, the potential harms of using e-cigarettes as an alternative to smoking must be considered.”

To determine the risk to former smokers, the researchers looked at the records of more than 4.3 million Koreans with a history of conventional smoking who participated in the Republic of Korea’s National Health Screening Program in 2012-14 and 2018. They conducted follow-up in December 2021.

"They found that 53,354 individuals had developed lung cancer," or 1.24%, and 6,351 died from it, or 0.147%, the release says. "Ex-cigarette smokers who had quit five years or more and used e-cigarettes were at greater risk of lung cancer-related death than ex-smokers who had quit five years or more and hadn’t used e-cigarettes. For smokers who had quit less than five years, those who used e-cigarettes were found to have both a higher risk of both lung cancer and lung cancer mortality than non-e-cigarette users."

The researchers also looked at people aged 50 to 80 with a smoking history of 20 or more pack-years , because in the U.S. they would be likely be referred for lung cancer screening under American guidelines. "Ex-smokers in this group who had quit smoking for five years or more and used e-cigarettes reported a higher risk of both lung cancer and lung cancer-related death than those who didn’t use e-cigarettes," the release says. "In addition, ex-smokers who used e-cigarettes and had quit smoking less than five years before had a higher comparative risk of lung cancer.

The authors conclude, “Clinicians must highlight the potential harmful effects of alternative e-cigarettes use when integrating smoking-cessation interventions, to reduce lung-cancer risk.”

Biden administration indefinitely postpones ban on menthol cigarettes amid election-year pushback from Black voters, others

Menthol cigarettes and other tobacco products are displayed at a store in San Francisco on May 17, 2018. For the second time in recent months, President Joe Biden’s administration has delayed a plan to ban menthol cigarettes, a decision that is certain to infuriate anti-smoking advocates but could avoid angering Black voters ahead of November elections. (Associated Press file photo by Jeff Chiu)

By Matthew Perrone and Zeke Miller

Associated Press

President Joe Biden’s administration is indefinitely delaying a long-awaited menthol cigarette ban, a decision that infuriated anti-smoking advocates but could avoid a political backlash from Black voters in November.

In a statement Friday, Biden’s top health official gave no timeline for issuing the rule, saying only that the administration would take more time to consider feedback, including from civil rights groups.

“It’s clear that there are still more conversations to have, and that will take significantly more time,” Health and Human Services Secretary Xavier Becerra said in a statement.

The White House has held dozens of meetings in recent months with groups opposing the ban, including civil-rights organizers, law-enforcement officials and small business owners. Most of the groups have financial ties to cigarette companies.

The announcement is another setback for Food and Drug Administration officials, who drafted the ban and predicted it would prevent hundreds of thousands of smoking-related deaths over 40 years. The agency has worked toward banning menthol across multiple administrations without finalizing a rule.

“This decision prioritizes politics over lives, especially Black lives,” said Yolonda Richardson of the Campaign for Tobacco-Free Kids, in an emailed statement. “It is especially disturbing to see the administration parrot the false claims of the tobacco industry about support from the civil rights community.”

Richardson noted that the ban is supported by groups including the NAACP and the Congressional Black Caucus.

Previous FDA efforts on menthol have been derailed by tobacco industry pushback or competing political priorities. With both Biden and former President Donald Trump vying for the support of Black voters, the ban’s potential impact has been scrutinized by Republicans and Democrats heading into the fall election.

Anti-smoking advocates have been pushing the FDA to eliminate the flavor since the agency gained authority to regulate certain tobacco ingredients in 2009. Menthol is the only cigarette flavor that wasn’t banned under that law, a carveout negotiated by industry allies in Congress. But the law instructed the FDA to continue studying the issue.

More than 11% of U.S. adults smoke, with rates roughly even between white and Black people, but about 80% of Black smokers smoke menthol, which the FDA says masks the harshness of smoke, making it easier to start and harder to quit. Also, most teenagers who smoke cigarettes prefer menthols.

For decades, cigarette companies focused menthol advertising and promotions in Black communities, sponsoring music festivals and neighborhood events. Industry documents released in litigation show companies viewed menthol cigarettes as a good “starter product” because they were more palatable to teens.

The FDA released its draft of the proposed ban in 2022. Officials under Biden initially targeted last August to finalize the rule. Late last year, White House officials said they would take until March to review the measure. When that deadline passed last month, several anti-smoking groups filed a lawsuit to force its release.

“We are disappointed with the action of the Biden administration, which has caved in to the scare tactics of the tobacco industry,” said Dr. Mark Mitchell of the National Medical Association, an African American physician group that is suing the administration.

Separately, Rev. Al Sharpton and other civil rights leaders have warned that a menthol ban would create an illegal market for the cigarettes in Black communities and invite more confrontations with police.

The FDA and health advocates have long rejected such concerns, noting FDA’s enforcement of the rule would only apply to companies that make or sell cigarettes, not to individuals.

An FDA spokesperson said Friday the agency is still committed to banning menthol cigarettes. “As we’ve made clear, these product standards remain at the top of our priorities,” Jim McKinney said in a statement.

Smoking can cause cancer, strokes and heart attacks and is blamed for 480,000 deaths each year in the U.S., including 45,000 among Black Americans.

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.

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.

You can test your home for invisible radon gas, leading cause of lung cancer among never-smokers; Kentucky has many hotspots

By Stacy Stanifer
University of Kentucky

January is National Radon Action Month, making it a great time to prioritize the health of those in your household by testing for the presence of radon gas. Radon is the second leading cause of lung cancer in the U.S., and the leading cause of lung cancer among never-smokers.

Radon is a radioactive gas that comes from the natural decay of uranium found in rocks and dirt in the earth. When radon under a home leaks in through openings in the ground, it can build up to dangerous levels inside. The longer a person is exposed to high levels of radon, the greater the risk of developing lung cancer later in life. 

For this reason, it is important to act now to not only reduce your exposure, but also children’s exposure to radon.

State radon map shows cancer risk is based mainly on geology.

Radon may be present inside any building or home, without regard to its location or type of foundation (slab, crawl space, or basement). Radon risk potential across Kentucky is variable, yet it is recommended that all homes be tested for radon. 

Despite the risk, only 13 of every 10,000 homes in Kentucky test for radon annually. Radon can’t be seen, tasted, or smelled and causes no immediate symptoms — so it’s easy for radon to go unnoticed. The only way to know if you have a radon problem is to test your home. 

The good news: Radon tests are simple to use and inexpensive or often free.

The Kentucky Radon Program provides radon test kits free of charge to Kentucky residents. You can request a free test kit by completing the form on the Free Radon Test Kit Offer website. You can also request a free kit from your local health department if it is on the radon program list. 

In addition, those with library cards from the Christian, Logan, Pulaksi or Rowan county libraries can borrow a digital radon detector. The detector kits are being made available for checkout through the Radon on the RADAR project, which aims to increase access to affordable home radon testing by partnering with public libraries.

Follow the instructions that are included with the kit. Depending on the type of test, it may take just a few days or several months to finish the test. If your test results show a radon level of 4 picocuries per liter (pCi/L) or higher, it is recommended that you take action to lower radon inside your home.

Your home should be tested:

• if it’s never been tested or radon levels are unknown, and then every two years.
• if you are preparing to buy or sell.
• before and after any home renovations, including after making repairs to reduce radon levels.
• before making any lifestyle changes in the home that would cause someone to spend more time in the basement or lower level (like converting a basement to a bedroom).

Finding out that your home has high radon levels can be alarming, but you can make your home safer. Radon-reduction repairs can be done with the help of a certified radon mitigation contractor. The National Radon Proficiency Program offers an online resource to find a contractor near you. Planning to build a new home this year? Ask you contractor about using radon-resistant new construction techniques to minimize radon entry in the home.

Home radon testing is easy. Making the choice to test your home this January is a healthy resolution you can keep.

Stacy Stanifer is a member of BREATHE at the UK College of Nursing and a member of the UK Markey Cancer Center’s Cancer Prevention and Control Research Program. BREATHE is an acronym for Bridging Research Efforts and Advocacy Toward Healthy Environments. 

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.

Cancer survivors in Appalachian Kentucky have greater risk of 2nd cancer than those in non-Appalachian counties, study finds

Cancer ribbons (Photo by Panuway Dansungnoen,

iStock/Getty Images Plus)

By Elizabeth Chapin
University of Kentucky

While cancer survivors have an increased risk of developing cancer in the future, that risk is notably higher in Kentucky and Appalachian Kentucky, according to a new UK Markey Cancer Center study.

Published in Frontiers in Oncology, the study shows that cancer survivors in Kentcky's 54 Appalachian counties had a significantly increased risk of developing cancer again (either the same cancer or a new type of cancer) compared to those in non-Appalachian Kentucky.

Survivors of smoking-related cancers in both Appalachian and non-Appalachian Kentucky were more likely to get cancer again, with no ststistical difference between the two regions.

SOAR map, adapted by Kentucky Health News

Kentucky has the nation’s highest rates of cancer incidence and death from cancer, with Appalachian Kentucky bearing the greatest burden, driven by health behaviors such as smoking and lack of screening.

The study's findings highlight the necessity for, and will help to inform, ongoing prevention interventions among cancer survivors in Kentucky.

"The higher risk of subsequent cancers, especially in Appalachia, emphasizes the importance of targeted interventions to address the specific challenges faced by survivors in this region,” said the study’s lead author Jill Kolesar, a professor in UK’s College of Pharmacy, director of the Markey Cancer Center’s Precision Medicine Center and co-director of Markey’s Molecular Tumor Board.

The research team examined data from more than 148,000 adult-onset cancer survivors who were diagnosed with first primary cancers between 2000 and 2014 and followed them for at least five years post-diagnosis. More than 12% of the survivors developed cancer again.

Among both men and women, larynx and lung cancers had the highest risk of redeveloping. While survivors from Kentucky's Appalachian counties have an increased likelihood of subsequent cancers, compared to those in non-Appalachian counties, that was not the case for smoking-related primary cancers, the study found.

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."

Invisible radon gas is the No. 2 cause of lung cancer in Kentucky but only 0.13% of houses in the state have been tested for it

Radon potential is measured in becquerels per cubic meter; a becquerel is one radioactive decay per second. Generally, the rate depends on the geology of a location and how much uranium and thorium are in the rocks, but levels in individual buildings vary depending on construction and exact location.

Three of every seven buildings in Kentucky have elevated levels of a colorless, odorless gas that is a significant cause of lung cancer, reports Bill Estep of the Lexington Herald-Leader. That rate of 42% is six times the national rate of 7%, according to the Kentucky Association of Radon Professionals.

But only 13 of every 10,000 houses in Kentucky have been tested for radon, says Ellen Hahn, a professor in the University of Kentucky nursing professor who runs BREATHE, which stands for Bridging Research Efforts and Advocacy Toward Healthier Environments.

Kentucky has the nation's highest age-adjusted rate of lung cancer, mainly because it has the nation's second-highest smoking rate, but some people who have never smoked or have little exposure to indoor tobacco smoke get lung cancer. Radon is the No. 2 cause of lung cancer, and a combination of radon and smoking create an even higher risk of the disease, Estep reports.

Lindi Campbell (Breath of Hope KY photo)

"Lindi Campbell, 58, was fit, active and had never smoked, but had to have two lobes of her right lung removed in December 2017 as a result of developing lung cancer. Campbell said she grew up in Lexington in a house where she was exposed to secondhand cigarette smoke and radon," Estep reports. "After she was diagnosed with cancer, she had her childhood home tested. The results showed a radon level that was the equivalent of smoking 40 cigarettes a day, she said."

Campbell is president of Breath of Hope KY, which tries to raise awareness about lung cancer, reduce stigma surrounding it, and raise money for research.

Radon is a product of the natural decay of uranium and thorium, another radioactive element. "As it breaks down, it releases radioactive particles that can be inhaled and damage lung tissue over time," Estep notes. Newer homes are more likely to have a buildup because are more tightly sealed.

Estep offers ways to take action to protect yourself: "Radon information is available through several sources, including BREATHE; the Kentucky Geological Survey; the Kentucky Radon Program; the U.S. Environmental Protection Agency; and the American Lung Association. Health officials also recommend testing your home."

“Everyone needs to test,” Hahn said. “There’s no risk-free level of radon.”

"Free test kits are available at many county health departments, and people can also request a kit through the Kentucky Radon Program," Estep reports. "People in Pulaski, Rowan, Logan and Christian counties can check out test kits at public libraries, with a valid library card, as part of an on-going study by BREATHE. People can also buy test kits at home-improvement stores or online. Companies that install systems to pull radon out of homes can also test for the gas."

And how much do those systems cost? "Tracy Howard said it cost $1,300 to have Alpha Radon Remediation install an exhaust system in the basement of her house in Stanford on May 24," Estep writes. "Howard got a free test kit from the local health department and the results showed a radon level of 4.2, just over the limit at which the EPA recommends installing a system to reduce the radon level. Howard, a nurse who works from home to do remote patient monitoring, shares the house with her husband and their daughter and 4-year-old grandson. She wanted to reduce their risk of exposure to the cancer-causing substance. To her, it was worth $1,300 to accomplish that."

“I know how dangerous it is,” Howard told Estep. “Consider the cost of installing the system vs. the cost of getting lung cancer later in life.”

House panel advances bill to make insurers pay for testing that doctor says can lead to 'miraculous' treatment of certain cancers

American Cancer Society members were at the Kentucky State Capitol Feb. 16 for Cancer Action Days to support passage of House Bill 180, the biomarker testing bill, sponsored by Rep. Kim Moser, who is in the front row, sixth from the left. (KHN Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

A bill to require private and public insurance plans in Kentucky to cover biomarker testing for cancer and screenings for genetic-based reactions to drugs has been posted for passage Tuesday in the state House.

The House Health Services Committee unanimously approved House Bill 180 Feb. 16. It is sponsored by committee chair Kim Moser, who said "We know that these biomarker and pharmacogenetic tests are evidence-based. They are standards of care for many cancer patients and others and they must be medically necessary in order to be prescribed. But the insurance coverage is failing to keep pace."

Pharmacogenetic testing determines how a patient will respond to a medication. Biomarker testing “is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers,” says the National Cancer Institute.

Kentucky ranks among the bottom 10 states for biomarker testing coverage, with 42 states having better access to such testing, according to Moser.

"House Bill 180 is about getting the right medical treatment at the right time, saving precious time, saving healthcare costs and saving lives," Moser said. "This testing allows for precision or targeted treatment, less trial and error and of course less of the devastating side effects that we see and premature death." 

The American Cancer Society estimates that more than 10,000 Kentuckians will die from cancer this year and 30,000 will be diagnosed with it. "Having access to insurance-covered biomarker testing gives them the best chance of survival," the society said in a press release. 

Moser said the bill will require all private insurance plans, Medicaid and the state-employee health plan to cover the biomarker and pharmacogenetic tests when they are medically necessary.  

Moser said the lack of consistent insurance coverage "especially affects the minority populations, Medicaid-eligible populations, and rural populations, where there's less access to this care." 

Dr. Michael Gieske, a family practitioner at St. Elizabeth Healthcare in Northern Kentucky and the director of the hospital's lung-cancer screening program, said biomarker screenings for people with lung cancer can make a big difference. He said 55% of people with lung cancer don't meet the current screening criteria and many of this group would respond to precision medicine and targeted therapies, which first requires a biomarker test to determine. 

"This treatment can be miraculous," Gieske said. "We have patients that are 5, 10, 15, even 20 years out of their cancer diagnosis with late-stage lung cancer . . . . They have no evidence of disease and most of those patients are able to say that because of targeted therapies, because they had biomarker testing."

He added, "These are medical advances that need to be embraced, they need to be available for all individuals, they should not be available for some and not others." 

 
Lung-cancer screening with an annual low-dose CT scan is recommended for adults aged 50 to 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.

Biomarker success stories

Leah Phillips, a stage 4 lung-cancer survivor from Oldham County, told the committee that she was diagnosed with the disease in 2019 as a healthy nonsmoker at the age of 43, and told she had a life expectancy of six months to a year. 

On the recommendation of her oncologist, Phillips had a biomarker test that found one of her genes had stopped working, allowing the lung cancer to grow. There was a targeted therapy to treat that type of cancer. 

"Had I not had the biomarker testing done, I would have just been treated like a typical lung-cancer patient, most of which are smokers, and been put on chemotherapy and immunotherapy," Phillips said. "If I would have chosen that route of treatment my life expectancy and my quality of life would be much decreased. . . .  So not only is this important in guiding my treatment plan but it's also allowed me now to live for 38 months since diagnosis with now the life expectancy of five to seven years."

Boyd "Bo" and Brandy Rowe

After the meeting, Boyd "Bo" Rowe of McCreary County told Kentucky Health News that he was diagnosed with stage 4 lung cancer in 2020 as a nonsmoker at the age of 41. He said the cancer had spread to his liver, hips, spine, ribcage and brain and he had a life expectancy of six months.

He said his biomarker test found a rare form of cancer called ALK-positive that could only be treated with a targeted therapy. He added that doctors didn't even know about ALK-positive lung cancer 10 years ago and the medicine to treat it has only been around for five years. Rowe said he takes eight pills a day and will for the rest of his life, but his last scan showed 90% of the cancer that had been detected is no longer detected.

"Without the biomarker, you know, there would be a tombstone with my name on it," he said. "I wouldn't have been able to get the treatment that I've gotten, which insurance has paid for -- but they didn't pay for the [biomarker] test that allowed for the targeted treatment that I need." 

Pushback 

Tom Stephens, president of the Kentucky Association of Health Plans, said the lobbying group doesn't oppose the bill, but wants to "make sure that there are appropriate guardrails on the legislation so that it isn't misapplied." He said the group is concerned that the mandated coverage will "significantly increase" the number of tests that insurers are required to cover, including tests that have not been found to improve health outcomes. 

"Broad testing leads to unnecessary testing, raising costs and lowering affordability for all enrollees," Stephens said. 

He also noted that the bill's fiscal-impact statement did not include Medicaid or the state-employee health plan. The statement, from the Kentucky Department of Insurance, said it did not expect the bill to materially increase premium or administrative costs for fully insured health plans.

Stephens asked the committee to delay consideration of the bill to consider those estimated impacts and his group's proposed amendments. 

KAHP lobbyist Scott Brinkman said one amendment would limit testing to detecting signs of cancer or a cancer-related health condition. "We also want to make clear that there has to be a medical necessity for the test," he said, as well as a narrow definition of medical necessity and a later effective date: January 2025 instead of January 2024. 

Moser said after the meeting that resistance to her bill has largely been about the "guardrails" around when the testing is required.

"I've done a lot of work with the insurance companies to date and I'll continue working with them on their concerns," she said. "But you know, I think that we've tightened this down to their specifications."

In mid-February, Kentucky Health News asked Doug Hogan, the cancer society's state-government relations director, about the costs associated with biomarker testing. "The cost really depends on the test and who is paying for it," he wrote. "Single-gene tests will be far less expensive than more comprehensive testing, but could also require multiple biopsies and multiple tests. A recent actuarial analysis found that the average cost to insurers per biomarker test in the private market was $224, and the average cost in the Medicaid market was $78.71. However, a patient forced to pay out of pocket for a biomarker test that wasn’t covered would be much more than this."

Senate passes its version of state budget with many health items; $100 million would 'support a response to the nursing shortage'

By Melissa Patrick
Kentucky Health News

The state Senate passed its version of a two-year state budget by a 30-6 vote Wednesday, the same day it passed out of committee. The bill will soon head to a House-Senate conference committee that will write the final version.

The Senate-revised House Bill 1 has a number of health provisions, with some variations from the House version and Gov. Andy Beshear's proposals.

The Republican-controlled chambers and the Democratic governor have three different approaches to addressing the nursing shortage, which has been exacerbated by the coronavirus pandemic. 

Photo from American Nurses Association

The Senate allocated $100 million of federal relief money in the first year of the budget, starting July 1, "to support a response to the nursing shortage," without giving any details. The House included no money for the retention and recruitment of nurses.

Beshear, who said Thursday that the focus needs to be on retention, called for $6 million each year from the General Fund for nursing scholarships; and from relief funds, $5 million a year for five years to create a new student loan-forgiveness program and $2 million for a marketing and outreach campaign.

The House budget and Beshear's budget both include $17.7 million in the first fiscal year and $19 million in the second fiscal year to cover the costs of local health departments required services, but the Senate's budget only allocated money for the second fiscal year in the amount of $19 million. 

Randy Gooch, executive director of the Jessamine County Health Department, said the Kentucky Health Department Association isn't sure why the Senate would have left out an allocation for fiscal year 2023 and Sen. Chris McDaniel, R-Ryland Heights, who crafted the Senate budget has not yet returned a call for clarification. 

The Senate budget includes Beshear's wish for for 500 new Michelle P. waiver program slots for people with intellectual or developmental disabilities; the House provided for 100. The Senate added 200 slots to the Supports for community Living waiver program for similar beneficiaries, double what Beshear and the House proposed. Both programs have thousands of Kentuckians on their waiting lists.  

The Senate agreed with the House on extra funding for domestic-violence shelters, rape crisis centers and child-advocacy centers, allocating $500,000 more for each in each fiscal year. Beshear proposed a 36% increase each year for each type of organization: $2.5 million, $1.78 million and $1.3 million, respectively.

And while the Senate and House budgets both would fund 200 more social workers, Beshear's budget proposal would have funded an additional 350. 

To implement the new 988 suicide hotline, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024, the Senate budgeted $3.37 million in the first year and $9.9 million in the second, the amounts Beshear recommended. The House allocated much more: $12.4 million in the first year and $17.6 million in the second, but directed that the money also be used to create more mobile crisis units. 

The Senate allocated $500,000 in each year for the Lung Cancer Screening Program that would be established with the passage of HB 219. The bill passed the House in late January and in the Senate Appropriations and Revenue Committee, which wrote the revised budget. 

The Senate budget also says that each Medicaid managed-care organization that has a participating contract with Kentucky in the next contract renewal will cover lung-cancer screenings.  

Here are some other health-related provisions in the Senate budget. 

From the Tobacco Settlement Fund:

• $500,000 in each fiscal year to support the Kentucky Rural Mental Health, Suicide Prevention and Farm Safety Program, titled the "Raising Hope Initiative."
• $1.4 million each year for substance-abuse prevention and treatment for pregnant women with a history of substance-use disorders;
• $7 million each year for the Health Access Nurturing Development Services Program (HANDS) for poor families with young children;
• $900,000 per year for the Healthy Start initiatives;
• $900,000 a year for early-childhood mental health;
• $900,000 a year for early-childhood oral health;
• $2 million a year for smoking cessation. Advocates have long asked for more smoking cessation funding, asking recently on a Kentucky Educational Television lung-cancer forum that this amount, at minimum, go back to the pre-pandemic level of $3.3 million.
  

From the General Fund:

• $6.25 million in each fiscal year for cancer research and screening to be equally shared by the University of Kentucky and the University of Louisville;
• $500,000 in the first year and $493,500 in the second year for spinal-cord and head-injury research (an amount that was previously taken from the Tobacco Settlement Fund); 
• $93,700 in each year for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma;
• $500,000 each year for the Kentucky Colon Cancer Screening Program;
• $100,000 per year for The Hope Center of Lexington for addiction recovery;
• $900,000 a year for The Healing Place, a Louisville recovery program;
• $1,495,000 a year to support the Lee Specialty Clinic, which provides specialty medical services for individuals with moderate developmental and intellectual disabilities living in residential and community settings. 
• $7.2 million in the first year and $14.48 million in the second fiscal year to expand the senior citizens' meal program. The appropriation will come from federal relief funds. 
• $1 million in the first year to support external performance reviews of substance-use treatment programs administered or funded by the health cabinet. 
• $2.5 million in each year to the Kentucky Pediatric Cancer Research Trust Fund; Beshear's proposal provided $3.75 million in each fiscal year. 
• $750,000 per year for the Kentucky Poison Control Center, unless federal emergency relief funds become available;
• $1 million a year for the Ovarian Cancer Screening Outreach Program at the University of Kentucky; the House budget had $500,000 a year. 
• Federal and state funds are allocated in both years to maintain the pandemic-elevated reimbursement of $29 per day per Medicaid patient in nursing homes.
• Money is provided to support expansion of of a pilot program for Tim's Law to additional locations as a way to ensure statewide access. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door them going in and out of jails and state psychiatric hospitals.