After numerous trials proved that low-dose CT lung cancer screening could reduce mortality rates, diagnostic radiologist Samir J. Parikh, M.D., MBA, spearheaded a dedicated lung cancer screening clinic in Jackson, Michigan. The goal of the clinic is to detect lung cancer early, when there is still time for life-saving treatment — and it’s working. At a national level, 44 percent of lung cancers go undetected until stage four. In Jackson County, the late-stage cancer rate is just 36 percent.

HealthCare Business News recently spoke to Dr. Parikh about developing a life-saving lung cancer screening clinic to enable earlier detection and treatment of this deadly disease.

HCB News: Why is lung cancer screening more important than ever before, and what are the life-saving opportunities it presents?
Dr. Samir. J. Parikh: Lung cancer is a leading cause of death in both men and women. In fact, more people die of lung cancer than any other cancer, including breast, prostate and colon cancers. The disease’s mortality rate is high because it often goes undiagnosed until the later stages, when treatment is difficult. But it doesn’t have to be that way — and we can change it with low-dose CT (LDCT) lung cancer screening. The National Cancer Institute demonstrated this with the National Lung Screening Trial (NLST), which revealed that participants screened with LDCT were at least 20 percent less likely to die from lung cancer.

HCB News: What is the importance of early detection of lung cancer?
SJP: Screening for lung cancer saves lives! In general, by the time a patient comes to seek medical attention related to lung cancer, it is usually Stage 3 or Stage 4. At that stage, the five-year survival rate is dismal — only 5 percent. By offering screening, we can detect the cancers at an early stage, before the patient is even experiencing symptoms. However, when we detect lung cancer at an earlier stage, the five-year survival rate can reach upwards of 90 percent. In addition, the patient’s overall quality of life can improve as well.

HCB News: Why did you and your health system decide to implement a lung cancer screening clinic for the patients you serve in Jackson, Mich.?
SJP: There is a very high association of lung cancer in smokers, and in Jackson County, 30 percent of our population smokes. The numbers are even higher in Jackson city, where 35 percent of residents are smokers — compared with 23 percent of residents throughout the state of Michigan. Because we have a significantly higher number of smokers in our community than in the rest of the state, we realized that lung cancer screening could make a positive impact on our population health.

HCB News: How did you go about starting your lung cancer screening program?
SJP: We got all of the stakeholders at the table and explained why it is important to offer screening. In 2015, we brought together caregivers and administrators from Henry Ford Allegiance Health, a medium-sized community hospital in Jackson County, to form our lung cancer screening program, including finding space for the clinic and securing dedicated time to use the CT equipment. I met with my radiology group partners and proposed scheduling one morning a week, from 7 a.m. to noon, for lung cancer screening patients. And I asked our hospital administrators for the same dedicated time slot to use the LDCT scanner for the clinic. When they looked at the NLST trial data and our demographics, our administrators quickly recognized it was the right thing to do for our patients.

HCB News: How does the clinic work? What is the process when a patient comes in for lung cancer screening?
SJP: Each week, we offer a clinical day for lung cancer screening patients. When a patient comes in to the clinic, a trained technologist conducts the scan. While I am reading the scan, the patient goes to see a tobacco cessation counselor who is part of the team. A few minutes later, the patient joins me and a nurse navigator in the reading room, where I review the images with the patient, describe the findings, and answer any questions. Depending on the results of the scan, the nurse navigator schedules follow-up appointments — including the next annual screening for patients who are negative for lung cancer, a consultation with a pulmonologist or thoracic surgeon, or a PET/CT appointment for additional imaging. Our nurse navigator also communicates the findings and follow-ups with the patient’s referring clinician. And we also track and remind patients of their future appointments to ensure they are getting the care they need.

HCB News: How do patients typically respond to seeing their exams and talking with you?
SJP: Our patients love it. Nowadays, patients are often seen by nurse practitioners and physician assistants rather than doctors. While they are excellent caregivers, they may not be well trained to discuss lung cancer screening and its impact. What’s more, patients seem to understand the findings and take them more seriously when we show them a suspicious spot in their lung, rather than reading about it from a report. The picture immediately hits home. Also, we talk about smoking and what their lungs look like after a long time of smoking. The idea is to encourage patients to take the conversation from my reading room to their living room, dining room, and social gatherings to spread the message that lung cancer screening really is helpful. Flyers, billboards, and TV ads might have very short memory life. But if you show patients a picture of their own lungs, it leaves a lasting impression.

HCB News: How do you recruit eligible patients and collaborate with PCPs and other referring physicians to refer patients for the program?
SJP: The team regularly visits medical practices and referring physicians whose patient populations include a high number of smokers, to provide education and promote the screening program. We present at local meetings like the Rotary or Lions Club; we conduct outreach at events like the county fair and festivals; and we exhibit at health fairs and industrial parks. Our goal is to get out into the community to reach the highest risk patients, including those in lower socioeconomic groups.

HCB News: How many patients have you served through the program, how many lung cancers have you found, and what stages are they? What impact are you making in terms of earlier detection of lung cancer?
SJP: Since we opened the clinic, we’ve screened nearly 2,500 patients and found 53 cases with pathologically proven lung cancer. Thanks to the screenings, we also discovered nine other potentially deadly cancers, including esophageal, kidney, adrenal, transverse colon, abdominal, and lymphoma. In 2018, the cancer detection rate for our lung cancer screening program was nearly three percent. And the incidence of stage four cancer was just 36 percent in 2018 as compared to the national average of 44 percent. Many times, our patients think that when we catch cancer, it’s too late. But if we catch it when it’s small, it's not too late. We can make a difference.

WHERE TO LEARN MORE
Read Early Detection Matters on the ACR website for a complete profile of Dr. Parikh’s lung cancer screening clinic in Jackson, Michigan. And gain further actionable insights from other Imaging 3.0 lung cancer screening case studies about lung cancer screening.

In addition, the ACR offers a wealth of resources for safe, effective lung cancer screening, including the latest research, toolkits, webinars, and key patient information.