0:01

If we look at evidence on lung cancer screening in the

0:05

lung cancer screening registry,

0:06

we have over 5 million lung cancer screening events at the

0:10

American College of Radiology from nearly 4,000

0:13

participating facilities.

0:15

Participation in a registry was initially required

0:18

by the Medicare coverage decision,

0:21

but in having this information from radiology practices

0:24

that your practice may have been putting data into,

0:26

it gives us important information on the national rollout

0:29

of lung cancer screening in essentially a decentralized

0:33

health system implemented at the facility level.

0:36

I work with colleagues in countries in Europe, for example,

0:39

where their rollouts are happening both at local facilities

0:43

but through the oversight of a national health system.

0:46

So their rollout in terms of quality structure

0:49

and how lung cancer screening is done is using a centralized

0:54

healthcare system based approach

0:56

that sits at the national government level

0:58

through national health systems.

1:01

In looking at how we're doing, we have a lot

1:03

of information about who's being screened, whether it's age,

1:06

gender, race, ethnicity, education

1:08

or insurance status, and where there are gaps.

1:11

We know where people are being screened by geography

1:15

and how close people are

1:17

to lung cancer screening facilities.

1:19

We have good information that the evidence coming out

1:22

of the registry supports the early stage distribution

1:26

of cancers being diagnosed by screening, which is

1:29

after all what we're trying to do.

1:30

Early detection. It affirms the use

1:33

of lung RAs interpretation schema

1:36

and management of patients,

1:38

but sadly, it shows us information such as the lack

1:41

of adherence to annual screening in just over

1:44

one in five patients.

1:46

Some newer data since we looked at the first UH,

1:48

one plus million screens shows that this is getting better.

1:52

We're up to closer to 40% of people coming back

1:54

for annual screening, but we certainly need to do better.

1:58

The type of information out

1:59

of the registry informs provider community

2:02

and patient outreach and facility expansion.

2:05

We've developed some new educational tools

2:08

for your lung cancer screening program on the lung cancer

2:11

screening registry webpages.

2:14

When you log into your interactive dashboard

2:16

for lung cancer screening,

2:17

you can look at your data in an interactive way in many

2:20

different slices and dices as they say.

2:24

You can look at it by interpreting radiologist,

2:26

you can look at it by CT scanner, you can look at it

2:29

by facility within your healthcare system to see

2:32

how you're doing from a quality perspective.

2:35

The three key performance indicators that we chose

2:38

to develop some educational walkthrough templates using

2:42

A-P-D-S-A methodology are improving adherence

2:45

to annual screening, achieving appropriate radiation dose,

2:49

which is squarely in the house of radiology

2:51

and increasing non-smoking rates as a measure

2:54

of smoking cessation.

2:56

And what the team did in the ACRs quality improvement uh,

3:00

subcommittee of the registry is look to existing evidence

3:04

and best practices for

3:05

how you can do better on these three key performance

3:09

indicators, what you can put in place

3:11

and how you can use your own registry benchmarks from your

3:15

interactive dashboard to see improvements.

3:18

So we're trying to fast forward improvements in lung cancer

3:20

screening to making sure that we're doing it well.

3:23

And this largely sits in the squarely in the house

3:27

of radiology to perform.

3:29

Something that also radiology practices can take an active

3:33

interest in is by promoting lung cancer screening

3:37

amongst individuals who are coming

3:39

for screening mammography.

3:41

These women coming

3:42

for screening mammography are already demonstrating

3:45

screening behaviors.

3:46

They understand the importance

3:48

of screening in breast cancer,

3:50

and so it's easy to translate that information

3:53

to lung cancer and easy for them to understand, well,

3:57

if it works for breast cancer screening, it should work

4:00

for lung cancer screening too.

4:02

So the A CR has developed a customizable brochure

4:05

that sits on the ACRs lung cancer screening resource webpage

4:08

where you can put it information about your practice

4:11

and use it in your screening mammography program

4:14

to increase awareness about lung cancer screening.

4:17

It might be one of these women who comes

4:19

for screening mammography who is eligible for screening,

4:22

but it may also be somebody

4:24

that they know love work with or live with.

4:27

We know that just as women drive decisions about

4:31

what cars are purchased in family units,

4:33

they also drive decisions in how healthcare

4:37

and who comes for healthcare in their family units as well.

4:40

So this is an important way to increase the visibility

4:43

of lung cancer screening in your own radiology practice.

4:47

Importantly, we know by looking at the evidence

4:51

that eligibility for screening by guidelines

4:54

and insurance coverage

4:57

and access by being close enough

4:59

to reach a facility does not necessarily mean

5:01

that we're reaching the people at risk.

5:04

How much of a role does your radiology practice wanna take

5:07

in changing this in your own community?

5:10

When we look at the protected performance

5:13

of the U-S-P-S-T-F updated criteria for race

5:16

and ethnicity for lung cancer screening, we recognize

5:20

that we are increasing the number of preventable deaths

5:23

and life years gains extending into diverse populations.

5:28

It can be challenging,

5:29

however, to reach individuals who are at risk

5:32

for lung cancer screening, not because they're not eligible

5:35

and not because they don't have insurance coverage, but

5:38

because there are many things going on in the heads

5:40

of people who are at risk for lung cancer

5:43

and it's not always healthcare related.

5:46

When we explored the first million people screened

5:50

as reported to the ACRs registry,

5:52

we compared the screen eligible population

5:55

to the simulates general population.

5:58

We saw that individuals eligible

6:00

for screening are disproportionately poor, uninsured

6:04

and enrolled in Medicaid.

6:05

And I think we all recognize these are challenges

6:08

incoming for healthcare.

6:10

We talk about a high burden

6:12

of social determinants of health.

6:15

Individuals eligible for screening are more than twice

6:18

as likely to describe their health status as poor compared

6:21

to the rest of the population

6:23

who is not eligible for screening.

6:25

So this population is different than the average population

6:30

of the same age.

6:31

In the United States. Tactics

6:34

to reach this population are important to you

6:36

as a radiologist or radiology practice

6:38

to make sure the population in your community who's

6:41

eligible is screened.

6:43

When we looked at the first million people

6:46

with information in the a CR registry, we compared them

6:49

to the general population of the same age.

6:53

We know that more women are coming forward

6:55

for lung cancer screening than men.

6:58

We know that individuals who are 65 to 74 are more likely

7:02

to come in for screening than others.

7:05

And we know that people who currently smoke are more likely

7:07

to come in for lung cancer screening than

7:09

those who used to smoke.

7:11

So why might this be?

7:13

Well, females, as we've talked about,

7:15

demonstrate screening behaviors and screening mammography

7:18

and about 70% of women eligible

7:21

for breast cancer screening are getting

7:23

their screening mammograms.

7:25

65 to 74 makes sense

7:27

because this is when Medicare population

7:30

on coverage happens.

7:32

And so patients know they have no copays under Medicare

7:35

coverage where they may not be as aware about

7:38

that while they're getting private payer coverage

7:40

or perhaps don't have health insurance.

7:42

And then when we think about currently smoking versus those

7:45

who used to smoke, it's very common in our electronic health

7:48

records to know who currently smokes.

7:51

But when somebody no longer smokes

7:53

that information often disappears from medical notes

7:56

and problem lists, reaching people at risk for lung cancer

8:01

to bring them in

8:02

for lung cancer screening means understanding their

8:05

attitudes about screening and smoking and they're complex.

8:09

And so if you are going

8:10

to invite people in your practice area to come

8:13

for lung cancer screening, it's important to understand

8:16

what's in their minds and how you might better message them.

8:19

They tend to be supportive of screening and practice,

8:22

but doubtful about the ability of screenings

8:24

to deliver long-term benefit that this generation

8:27

of heavy smokers who have seen generations of people

8:31

die from advanced stage cancer.

8:34

That's what they've known and they've perceived lung cancer

8:37

as an uncontrollable disease.

8:39

There's fatalism and worry about the perceived risk.

8:42

It's high. They perceive blame

8:45

and stigma around lung cancer

8:47

as a self-inflicted smoker's disease

8:50

preventing them from coming in for screening.

8:53

And we know that the stigma an nihilism also prevents people

8:57

from sticking with lung cancer care when they're diagnosed.

9:00

There's even the belief that lungs are not a treatable organ

9:04

as a commonly explanation

9:06

for why people don't survive from lung cancer.

9:09

So we have a lot to do to help understand the population

9:13

and help overcome the misperceptions

9:16

that exist about lung cancer today

9:18

and the value of lung cancer screening.

9:21

This stigma around lung cancer

9:24

because of cigarette smoking is high across anywhere.

9:28

You look about the topic of lung cancer,

9:33

it's been perpetrated in the US by the CD C's super scary

9:37

anti-tobacco campaign with scary imagery

9:40

of deformed individuals

9:42

and how that as a scare technique used

9:44

to prevent people from smoking and it worked.

9:47

Fewer people have smoked

9:48

because of that campaign,

9:50

unfortunately has given a perception in the US

9:53

that we don't see across the world about what it means

9:57

to be somebody who smokes

9:58

and has led to this stigmatized population making it

10:03

difficult to get them in

10:04

for healthcare, including screening.

10:06

So we need to do a lot to overcome this

10:09

and using patient first language is something

10:12

that you can do and you can talk to your radiologist

10:15

and your radiology technologists

10:17

and your front desk staff about using terms like someone

10:21

who used to smoke as opposed to calling somebody a smoker

10:24

and labeling them by

10:27

a habit which has increased their lung cancer risk.

10:30

It seems so simple, but it's very meaningful to people

10:34

and there is new guidelines

10:36

and materials out there to help you understand this topic.

10:40

More from the International Association for the Study

10:42

of Lung Cancer with its language guide to asco,

10:45

the leading professional organization in the US

10:48

for oncology in the American Society of Clinical Oncology.

10:53

So smoker, a term that we really shouldn't be using anymore.

10:58

Try a person who smokes and a person who doesn't smoke

11:01

or a person with a history of smoking,

11:03

but don't label people as a behavior.

11:06

This simple change can make a difference in making people

11:10

feel comfortable at coming in for care.

11:13

It's a comment on radiologists

11:14

and radiology practices

11:16

to get engaged in accelerating lung cancer screening in your

11:19

community, both screening individuals

11:21

and bringing them back for needed follow-up.

11:25

Um, imaging care.

11:26

We know that there are many obstacles that make it difficult

11:30

to do lung cancer screening,

11:32

whether it's the way our electronic health records work

11:35

and identifying people who are eligible based on pack years,

11:38

something that is very hard to find the medical record

11:41

with over half of people not having this

11:44

information about papac years.

11:46

Fortunately, the NCQA is developing HEDIS measures

11:49

for lung cancer screening and not only adherence to

11:52

Lung cancer screening

11:53

among eligible individuals like they currently do

11:56

for breast cancer screening,

11:57

but they're also considering a tobacco history documentation

12:01

quality measure of PAC years,

12:04

which should help improve this

12:05

in our electronic health records.

12:07

There's a lot for us to do about increasing awareness

12:11

among our communities as well as our primary care physicians

12:15

and helping them understand how

12:17

to access your lung cancer screening program or practice.