Rep. Cynthia Roe (R-Lindsay) hosted an interim study Thursday exploring policy solutions related to lung cancer prevention, treatment and health equity.
Roe, a nurse practitioner, said it is something that significantly impacts Oklahomans, with a rate of 63.7 new lung cancer cases per 100,000 people, according to the American Lung Association. That’s significantly higher than the national rate of 53.6 per 100,000 people.
“We see it a lot in primary care just doing routine chest X-rays or the low-dose CT scanning,” Roe said. “I do a lot of those in my smokers.”
Only 23.4% of Oklahoma’s cases are caught at an early stage, when treatment is more effective and chances of survival increase. That places Oklahoma at 44th in the nation among 47 states with data on diagnosis at an early stage. And only 22.2% of those diagnosed are alive five years after. The state ranks last in that category.
Roe said she wanted to cover ways to catch lung cancer sooner and prolong the lives of those impacted by it. Stakeholders gathered to discuss some potential solutions.
Raising awareness
Many of the speakers are a part of the recently launched Oklahoma Lung Cancer Roundtable, a statewide initiative focused on advancing lung cancer prevention, early detection and care coordination throughout the state.
“The roundtable looks forward to partnering with legislators and state leaders to advance policies that expand access and prevention,” said Valerie Moise, an outreach liaison with OU Health Stephenson Cancer Center and roundtable member.
Dr. Samid Farooqui, a pulmonologist, said there are various reasons why patients don't access lung cancer screenings. Primary care physicians are often overwhelmed with other screenings for things like breast and prostate cancer, he said. There is also a stigma surrounding lung cancer.
“It doesn't get the sympathy that breast cancer would get in the regular population,” Farooqui said. “People would find more sympathy for a 40-year-old young lady who is unfortunate to get breast cancer, but probably not for a 70-year-old gentleman who smoked for his life.”
And awareness regarding lung cancer is lacking. Take the story of Lauran Larson. Her mom, Teresa Glynn, had been experiencing pain in her pelvis and had trouble breathing, but thought it might be asthma. She was sent to the emergency room and, through a CT scan, it was discovered she had a large mass. It was lung cancer. She passed away 12 days later.
“She could hardly breathe. Watching her gasp for air was very traumatizing, and it looked very painful," Larson said. “And then she passed away before she could get treatment, before she even knew for sure that it was lung cancer.”
Larson said her mom lived in extreme poverty and started smoking at 13. Larson said she tried “everything under the sun” to try to get her to quit.
“But I wish I would have asked her to get a lung cancer screening because maybe we could have caught it earlier,” Larson said.
“I also don't know if she even knew about lung cancer screening,” Larson added.
Jordan Neil, an assistant professor at the Stephenson Cancer Center, said nationally, only 16% of current eligible smokers are aware that a lung cancer screening is available to them. He said it’s hard to get people motivated to get screened if very few are aware they can.
Neil stressed the importance of awareness campaigns, which can work to address stigma, increase understanding of what screenings are and improve outcomes.
“The long-term benefits of a campaign – particularly a digital campaign – we can track whether individuals are actually clicking on our ads, they're actually seeking information about lung cancer screening, and eventually whether or not lung cancer screening rates increase over time,” Neil said.
Shifting outcomes
Dr. Mark Doescher, associate director for community outreach and engagement at the Stephenson Cancer Center, discussed the recent launch of a mobile lung cancer screening bus in partnership with the Tobacco Settlement Endowment Trust.
Currently, they are in a pilot period determining their capacity, Doescher said. He estimates they can serve around 30 people a day.
“If you fast forward 12 months from now or so … my goal would be between 2,800 and 3,200 people screened per year through that unit,” Doescher said. “But most of it we would hope would be pre-scheduled because there is a shared decision-making requirement with patients."
Doescher also shared research comparing lung cancer outcomes in Kentucky and Oklahoma. He said they both are very rural states, with high rates of poverty, historically significant rates of tobacco use and an excessive burden of lung cancer.
But over time, some of Kentucky’s outcomes have started to shift, Doescher said, with screening rates rising above the national average of 16% of individuals who are up to date in only two years.
Kentucky established the Kentucky Lung Cancer Screening Program in 2022 through its Department for Public Health. The goals were to increase screenings, reduce lung cancer mortality and reduce the costs associated with late-stage treatment.
The program’s legislative foundation was House Bill 219, which established a committee for oversight and required outreach programs in each of the state’s area development districts. It also funded exams and rescreening for uninsured and underinsured people, and created restricted funds and income-based fee schedules.
Eligibility criteria for a low-dose CT lung cancer screening extend to those ages 50 through 80 with a 20 pack-year smoking history, who are either current smokers or have quit in the last 15 years.
The program started with an initial appropriation of $500,000. It also accepts federal and private grants.
Over the last five years, the early diagnosis rate in Kentucky improved by 14%, compared to Oklahoma, which hasn't seen a significant change during that period, according to the American Lung Association.
Matt Glanville is the Oklahoma and Arkansas government relations director at the American Cancer Society Cancer Action Network. He said this program is a great example of a state taking action to address its deficiencies in this area.
“I think [it] also falls into the category as something that is really viable and readily attainable in terms of … making progress on this area of cancer mortality in Oklahoma,” Glanville said.
Glanville said lung cancer is an urgent problem in Oklahoma.
“But by employing some of these effective policy models, we're confident that we can see improvement across all of these metrics and significantly reduce the impact of lung cancer in Oklahoma,” Glanville said.
StateImpact Oklahoma is a partnership of Oklahoma’s public radio stations which relies on contributions from readers and listeners to fulfill its mission of public service to Oklahoma and beyond. Donate online.
