New Lung Cancer Screening Guidelines With Brian Whang, MD, FACS
Recently, the American Cancer Society recommended new lung cancer screening guidelines to shift the focus from quitting smoking, to helping all individuals who have smoked despite quitting 20 to 30 years prior. In this interview, Dr. Brian Whang, Medical Director of Lung Cancer Screening for Hartford Healthcare, discusses these new guidelines, what they mean, and why we should continue advocating for better lung cancer screening guidelines and awareness of this issue.
Oncology Data Advisor: Thank you so much, Dr. Whang, for meeting with me today to talk about the new lung cancer screening guidelines. To start out, would you like to introduce yourself and your research interest?
Brian Whang, MD, FACS: My name's Brian Whang. I'm a Thoracic Surgeon. I'm also the Medical Director of Lung Cancer Screening for Hartford Healthcare. My research interests are mainly in thoracic oncology. Thank you very much.
Oncology Data Advisor: Great. Thank you again for joining us today. To get started, what are the new lung cancer screening guidelines and why are these changes important?
Dr. Whang: Well, the new lung cancer screening guidelines eliminate the quit date for people who have smoked. Just for some background, lung cancer screening really came into the forefront with the National Lung Screening Trial that, in 2013, established our previous criteria of ages 55 to 74, a 30 pack-year smoking history, and either current smokers or people who have quit within 15 years. More recently in 2021, that criteria was expanded, which was aimed at capturing more people. So, it includes more people who are younger, people who are 50 to up to 80, and people who have smoked 20 pack-years or more. Now with the new guidelines recommended by the American Cancer Society (ACS), it doesn't really matter when you've quit as long as you've had the burden of 20 pack-years, meaning the equivalent of smoking a pack per day for 20 years. That could be a half pack per day for 40 years, or two packs per day for 11 years, et cetera, et cetera.
Oncology Data Advisor: To continue on this thought, I noticed that the American Cancer Society Journal wrote an article regarding these new guidelines titled, "Lung Cancer Screening Guidelines: Smoking Matters, Not Quitting," and you begin to mention this. So, I wanted to ask, why is it vital that we're shifting our focus from quitting smoking to all individuals who have smoked even if they've quit 20 to 30 years prior?
Dr. Whang: Well, we recognize that there's a smoking-related risk for up to 80% of lung cancer, and we have people in different ethnic groups that have various dispositions toward mortality and new diagnoses. We're trying to eliminate some of the disparities that are apparent in the way we treat lung cancer amongst the whole population. There are variations in how much people smoke, the intensity of smoking, despite there being a higher mortality and higher number of cases, especially among Black men. Black men also are less likely to be diagnosed early compared to the White population. They are less likely to have things like surgery and other very successful curative measures when lung cancer is detected early.
Oncology Data Advisor: I'd like to ask you, what challenges do you and other clinicians face with screening? And how do these changes potentially alleviate those challenges or future challenges?
Dr. Whang: Well, believe it or not, there is a lack of awareness. We're trying to change that, and thank you for this opportunity. About 70% of people don't know about this. People who are eligible and see their primary care physician are not having this conversation—they don't know. Primary care physicians are not uniformly on board with embracing this measure. In various socioeconomic areas that are more depressed, we have a health care system that is under more stress from volume of patients. They're understaffed, basically, and resources are lower. So, we really need to have things aimed at not just more awareness, but also helping places that need more help in terms of resources.
And fortunately, there are a couple of things that have recently happened that address that. Here in Connecticut, for example, a measure was passed in our state legislature that will pay for more support staff directed at lung cancer screening. Also, the Centers for Medicare and Medicaid Services (CMS) basically has eliminated the guideline or the requirement for a shared decision-making conversation to be performed by the physician or non-physician practitioner. Now, a health care educator or other ancillary staff can have that conversation, which frees up the physician, and it all should open up the bottleneck a little bit.
Oncology Data Advisor: Final question that I wanted to ask you is, are you hopeful for any additional changes in the future that you think should also be implemented?
Dr. Whang: I am. I'm glad you asked that because as much as we recognize that smoking's a problem, there are other things that impact a person's risk for lung cancer, and there is, as I alluded to 80% being smoking-related, the other 20% of people who have not smoked and gotten lung cancer who also deserve some attention. Also, we know that the women are starting to outpace men. Actually, they haven't started, they've been so for over 10 years at the younger age groups. And as they get older, they're also going to start dominating all age groups. Basically, family history should be taken into account—a personal history of cancer should be taken into account. We should have other risk factors that are being recognized in recent studies. There's one from JAMA Oncology recently that showed a risk model approach when looking at the ratio of people eligible to the incidence of lung cancer and how that varies across different ethnicities.
We're finding that using these models helps to increase that eligibility to incidence ratio. It's actually quite striking when comparing the White population to the other ethnic population. When using this model, they demonstrated a narrowing of that gap between eligibility and incidents. So, I think that's going to be coming down the line. I also think we're going to have more quality metrics incorporated into the efficacy of our lung cancer screening programs, so that we have more uniformity, we better know what works, and maybe can direct resources toward the places that are underperforming, where we still have a population that is relatively underserved and have worsening numbers, so we'll see.
Oncology Data Advisor: Yes, there's definitely a lot of things to look forward to, a lot of things to stay hopeful for. So, thank you so much for your passion on this topic. And thank you so much for your research and meeting with us today to help spread the word of this. Thank you so much, Dr. Whang.
Dr. Whang: Absolutely. Thank you very much.
About Dr. Whang
Brian Whang, MD, FACS, is the Medical Director of Lung Cancer Screening and Director of Thoracic Surgery for Hartford Healthcare's Fairfield Region. He is a Thoracic Surgeon at St. Vincent's Medical Center in Bridgeport, Connecticut where he specializes in treating diseases affecting the chest, lungs, esophagus, and heart. Dr. Whang's research interest revolves around thoracic oncology, where he is passionate about developing and offering new surgical solutions and advocacy for better lung cancer screening guidelines.
Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.