Dr Michael Gieske on Addressing Lung Cancer Screening Disparities in Rural America

Michael Gieske, MD, director of lung cancer screening at St. Elizabeth Health Care, discusses disparities in lung cancer incidence and mortality that the Rural Appalachian Lung Cancer Screening Initiative aims to address.

Transcript

Can you provide an overview of the Rural Appalachian Lung Cancer Screening Initiative and why increased lung screenings are so important to this region and the people living there?

With the Rural Appalachian Lung Cancer Screening Initiative, we were looking at Appalachia, of course, in particular, and then we wanted to direct our focus to an area that had really the worst of all worlds. We looked at the areas that had the worst incidence for lung cancer, the worst mortality for lung cancer, and the same time, the poorest access. As it turned out, all those worst variables intersected where Kentucky, Virginia, and West Virginia come together; we picked a 10-county region there. This is recognized by the President's Cancer Panel and Moonshot Initiative, and it's a branch of the ACCA, which is the Appalachian Community Cancer Alliance. And that alliance looks at cervical cancer screening, colon cancer screening, and breast cancer screening. We, of course, directed our interest and our efforts toward lung cancer screening. And as an offshoot of that, we formed the Rural Appalachian Lung Cancer Screening Initiative.

How is the Appalachian Community Cancer Alliance helping to identify and address disparities in equitable access to cancer care in this region?

Well, we know there's poor access in this region, there's lower rates of education, there's higher rates of poverty, and it's a working-class, White type of poverty that we're directing our efforts towards. The area that we're piloting has particularly disparate health care, and we're in the process of assimilating some data presently to find out what their screening rates are. And once we have that benchmark, then we'll be able to go into these 3 pilot regions, introduce our efforts, and then be able to mark improvement based on where we started as a benchmark.

Can you share some insights and perspectives on why states such as Ohio, Kentucky, Pennsylvania, Virginia, and West Virginia have the highest lung incidence and mortality rates across the United States?

Well, Kentucky really is the bottom of almost every list when it comes to health care related to your lungs. We have the highest incidence of lung cancer in Kentucky in the nation. It’s 55% higher than national average, and a lot of that has to do with simply geographically being located in the Tobacco Belt. Kentucky, Ohio, Tennessee, North Carolina, a lot of these states, they've built a lot of their traditional wealth and cultural heritage around tobacco, and it's been a hard needle to move because tobacco and culture around smoking is so ingrained and woven into the fabric of these states.

We also have a lower rate of education in these regions, there is a higher rate of poverty in these regions, and the smoking rates are significantly higher in Kentucky. West Virginia and Kentucky battle for the bottom of that list—who has the highest smoking rate? The national average is about 14% of adults that smoke; in Kentucky, it's about 22%; in West Virginia, it's about 23%. West Virginia is presently ahead by about a nose, but that's a big factor. Eighty percent of lung cancer is due to smoking, so when you take the lack of education, the higher poverty levels, the higher smoking rates, there's areas in eastern Kentucky where 30% to 35% of adults smoke, and you really see a lot of tobacco-related disease—and in particular, lung cancer.