As recent advances improve the prospects of detecting and catching lung cancer early, a new challenge arises: how to ensure people worldwide, regardless of their socioeconomic circumstances, benefit from new clinical tools.
This podcast was produced for the Lung Cancer Initiative at Johnson & Johnson by Scientific American Custom Media, a division separate from the magazine’s board of editors.
In this episode, Mark Lloyd Davies, Global Head of Strategic Initiatives at The Lung Cancer Initiative at Johnson & Johnson, will discuss the importance of promoting health equity through early screening and open conversations about racial and social injustices, along with improved disease education.
Megan Hall: If you want to prevent lung cancer deaths, there’s an important first step: catch the disease early.
Scientists at Johnson & Johnson are developing tools to improve lung cancer detection, with the hope of doing just that.
And that’s where Mark Lloyd Davies’ work comes in. He’s the Global Head of Strategic Initiatives at Johnson & Johnson, working directly with the Lung Cancer Initiative. And he’s devoted to changing public policy so people who are most likely to develop lung cancer can access the regular screenings they need.
Mark recently sat down with Scientific American Custom Media to talk about ways to reach those vulnerable populations earlier.
Hall: We know lung cancer is often lethal because it’s detected too late. So, you’d think there would be a big push to offer regular screenings, especially to smokers. Unfortunately, that’s not the case.
Mark Lloyd Davies: There are few or no policy mechanisms which incentivize health systems to catch lung cancer at an early stage.
Hall: Mark says that each year, only about five to seven percent of people who qualify receive a lung cancer screening.
Davies: And that’s in complete contrast, for example, for other cancers, such as cervical cancer, where you have 80% of patients having their annual cervical cancer check.
Hall: Why are lung cancer screenings so low if we know they’d save lives?
Davies: I’ve been in many summits, meetings, discussions of leading clinicians, pulmonologists, oncologists, policymakers, patient group advocates, and there isn’t necessarily a one single well-known answer as to why that is the case.
Hall: But Mark has a few ideas. Number one: the “stigma” associated with smoking.
Davies: There’s almost a sense of shame amongst people who are at risk of developing lung cancer, such as, for example, smokers. And, as a result of that, there isn’t that sort of proactive drive to look for that annual lung screen, and to check my health, etc., on a regular basis.
Hall: It’s almost as if the healthcare system has over-stigmatized smoking.
Davies: It is, of course, bad for people’s health — people shouldn’t be doing it. But if they are, that doesn’t suddenly mean that health support, the annual lung screen, shouldn’t be followed. These patients should still be receiving their annual lung check.
Hall: Reason number two? Health inequities. According to Mark’s research, heavy smokers or former heavy smokers who recently quit are also more likely to be Black, earn less money, and have less education. All of these factors reduce their access to quality healthcare.
Davies: So, essentially, lower income and lower education groups are not receiving the annual lung check that they should be doing.
Hall: How do you fix this problem? Mark says the answer lies not in the patients, but in the healthcare providers.
Davies: There is a concern in the policymaking community of, how do we know how much our patients really smoke? But that’s, in some respects, approaching it from the wrong angle and perspective.
Hall: Instead of getting patients to be honest about their smoking habits, why not motivate doctors to offer lung cancer screenings proactively?
Davies: I think the best starting point to begin to move the needle would be for policymakers and health system experts to develop a quality measure for lung cancer screening. Which will essentially incentivize providers to start providing more screening.
Hall: The plan would work this way: if doctors and healthcare systems were evaluated based on their rates of lung cancer screenings, they’d be more likely to identify eligible patients and get them those screenings every year. Plus, people advocating for lung cancer patients could hold those healthcare providers accountable.
Davies: Purchasers and consumers can start to compare provider plans and see, “Ah, this particular organization provides lung cancer screening, and these ones don’t.”
Hall: How close are we to this kind of quality measure? Mark says a group of public, private and volunteer organizations called the National Lung Cancer Roundtable is very interested in this approach.
Davies: I’m really excited and delighted that the National Lung Cancer Roundtable, who had a lung cancer screening summit in Washington DC in July this year, announced that it was looking to work and take forward in leadership a quality measure.
Hall: Even before this summit, the Lung Cancer Initiative at Johnson & Johnson and an organization called LUNGevity brought stakeholders together for a high-level roundtable to think through the problem.
Davies: And one key breakthrough was everyone kind of agreeing, yes, these screening rates are way too low. So let’s start thinking potential solutions. And then through that forum, through that dialogue, led to the proposal of what about a quality measure?
Hall: Mark is excited to support these efforts, and to evaluate providers on their rates of lung cancer screenings. And if that work is successful, it will also help those like the Lung Cancer Initiative at Johnson & Johnson, and others, that are working to develop better screening tools — like blood tests or nasal swabs — to one day detect lung cancer.
Davies: As those new products come available to patients, there is a health system design which is going to enable those technologies to get to patients faster and quicker.
Hall: Making that work means aligning policy, research and technology. It’s Mark’s hope that the Lung Cancer Initiative’s efforts will lead to a future where vulnerable populations are screened frequently, lung cancer is caught earlier, and the disease is easier to treat. All with the goal of giving cancer patients a better shot at survival.
Mark Lloyd Davies is the Global Head of Strategic Initiatives at Johnson & Johnson.
The Lung Cancer Initiative was formed in 2018 to unleash the full potential of science and technology to change the trajectory of this complex disease.
This podcast was produced by Scientific American Custom Media and made possible through the support of the Lung Cancer Initiative at Johnson & Johnson.
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