HJAR Nov/Dec 2022

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2022 51 SamMakhoul, MD Medical Director, Clinical Research CARTI than practical). Yet it can detect lung can- cer in the earliest stages, reducing deaths by 20%, according to a study by the National Institute of Health. That’s a significant win for any cancer and certainly for the world’s deadliest cancer. So, who qualifies for low- dose lung screenings? Here are the recom- mendations we follow: • Current or former smokers, age 50 to 77. • Smoking history of at least 20 pack years, an amount that refers to the number of packs of cigarettes smoked per day multiplied by the number of years smoked (i.e., smoking one pack a day for 20 years would equal 20 pack years). • Generally in good health with no his- tory of lung cancer. • No signs or symptoms of lung cancer. Smokers who have quit within the last 15 years are still eligible for low-dose lung screening. After 15 years of being smoke- free, the risk seems to go down significantly. Which brings us to smoking cessation pro- grams. As healthcare providers, we must continue to stress the importance of quitting to all patients. Smoking is actually linked to around 18 different types of cancer, lung be- ing the most famous, but also including head and neck, esophageal, and pancreatic can- cers. Other serious health concerns — chron- ic lung disease, cardiovascular disease, skin aging that makes healing difficult — only add to the mountain of reasons to stop smoking as soon as possible. It’s hard, but programs and medications can help patients succeed. Convenient, fast, and free In addition to geographic availability — thanks to CARTI’s facilities, as well as others Why are we not pushing harder for these critical lung screenings to detect cancer early and reduce mortality? Where we come in A study in the American Association for Cancer Research journal Cancer Epidemiol- ogy, Biomarkers &Prevention concluded that the low utilization of lung screenings is due in part to the fact that “only 4.3 percent of all adults and 8.7 percent of current smok- ers reported talking with their doctor about having a test to check for lung cancer in the past year.” Simply put, it all comes down to col- laboration. Family medicine doctors and PCPs are the gatekeepers, seeing patients before cancer strikes. Working together, we can get the right information and resources into the right hands, creating a shared deci- sion-making process with patients. So, let’s build the relationships, have the conversa- tions, and take on lung cancer in Arkansas. There are 255,000 lives at stake. n REFERENCES 1 Sorscher, S.; LoPiccolo, J.; Chen, E.; et al. “Land- scape of pathogenic germline variants in patients with lung cancer.” Journal of Clinical Oncology 40, no. 36 (Aug. 20, 2022): 388570-388570. DOI: 10.1200/JCO.2022.40.36_suppl.388570 Sam Makhoul, MD, is a hematologist/oncologist withmore than 20 years of experience and currently serves as themedical director of clinical research at CARTI, Arkansas’s largest community-based can- cer care provider. Under his direction, the clinical research teamseeks to build a network spanning the entire state and offers the newest life-saving treat- ment options available to all Arkansans. Before join- ing the CARTI team, he served at UAMS as the chief of hematology/oncology and the Laura Hutchins hematology/oncology chair. In addition, he helped develop the clinical research programat theWinthrop P.Rockefeller Cancer Institute and was the principal investigator of clinical trials. throughout the state — the screening process itself is convenient for patients. There’s no need for special prep, no changing into a hospital gown, and no challenging side ef- fects to manage. It only takes a minute or two to complete the scan, so our patients can expect to be out in about 30 minutes with quick turnaround on results. What could make it even better? There is no need to pay out-of-pocket expenses for a healthy lung screening for patients who qualify. Medicaid and Medicare cover 100% of the costs, and CARTI was recently approved for grant funding to cover the screening costs for uninsured patients. So, the only associated cost is getting to the fa- cility — and we can even provide gas vouch- ers for some patients, if needed. This is a great selling point for patients who are un- able or unwilling to pay for something that “hasn’t even happened” yet. The breast cancer role model As mentioned earlier, lung screening rec- ommendations apply to hundreds of thou- sands of Arkansans. The process is quick. Convenient. Free. Painless. So why are only 2.5% of at-risk individuals being screened? Breast cancer, thankfully, has an annual screening rate closer to 70%. In 1,000 breast screenings, we can expect to detect about 6 cancers. Compare that to lung screenings, where we find about 15 to 18 cancers per 1,000 screenings — 2.5 to 3 times the amount. According to the Lung Cancer Foundation of America, 2022, lung cancer is the most federally underfunded cancer per related death. The organization breaks down breast cancer funding at $19,050 per related death, while lung cancer garners just $3,580 per related death. The difference is awareness.