Advancements and Challenges in Lung Cancer Screening: A Conversation with Dr. Chi-Fu Jeffrey Yang and Alex Potter of ALCSI

Interview By Natalie Wing

HUHPR Senior Editor Natalie Wing interviewed Dr. Chi-Fu Jeffrey Yang, MD and Alex Potter. Dr. Yang is a thoracic surgeon at Massachusetts General Hospital and an assistant professor of surgery at Harvard Medical School. He received his B.A in biochemistry from Harvard College and his M.D at Harvard Medical School. He also started the American Lung Cancer Screening Initiative (ALCSI). Alex Potter is the co-founder and Executive Director of the ALCSI.

Natalie Wing (NW): Hi Dr. Yang and Ms. Potter, thank you so much for meeting with me. For our readers, please describe your current work both through ALCSI and in general.

Dr. Chi-Fu Jeffrey Yang (CJY): Thank you, Natalie, for the opportunity to share our experiences with you. I am a thoracic surgeon at Mass General, and I take care of people who have chest problems needing surgical treatments. A lot of what I do is take care of patients who have lung cancer, and one of my focuses is lung cancer screening and the early detection of lung cancer. That is why I started the American Lung Cancer Screening initiative back then: to help raise awareness about lung cancer screening and to increase access to lung cancer screening to people who are at high risk of developing lung cancer. I want to add that I’ve had the opportunity to start this nonprofit with other amazing individuals, such as Alex Potter who is with us here today, and that it’s just been a wonderful experience to work with people who really care about helping others and raising awareness about this important issue.

Alex Potter (AP): Thank you for the warm intro. I am the CEO of the American Lung Cancer Screening Initiative (ALCSI), so I lead our ALCSI team and all the initiatives we do to increase lung cancer screening awareness. I joined in 2018 when ALCSI was started. What really inspired me to join was the opportunity to teach people about lung cancer screening. Knowing that the lung cancer screening rate is so low, and that there was no one else in the US really dedicated to solely focusing on increasing lung cancer screening, it really motivated me to get involved and grow ALCSI to this wonderful team, which now includes so many students and doctors located across the US.

NW: Having focused for so many years on lung cancer screening, what do you consider to be the most important advances so far--since ALCSI was founded? And, in your experience, what advancements have there been in terms of screening and potentially also in treatment?

AP: So, in terms of screening, I think one of the key advances is the changes made in the 2021 United States Preventive Services Task Force criteria and people’s acknowledgement that the lung cancer screening guidelines in 2013 were not adequate and that a lot of people at high risk of lung cancer--who would then develop lung cancer--would not have qualified for screening. The expansion made from the 2013 to 2021 United States Preventive Services Task Force guidelines increased the number of people eligible for screening from about 8 million to 14.5 million in the US. We still have a lot of work to do, as many people who are at high risk of lung cancer still do not qualify, but since the time ALSCI was founded that’s been one of the big advancements in the field of lung cancer screening.

It's also important to know that there are a lot of advancements that have not been made. One thing to highlight is that the screening rate in 2018 nationally was 4.2%. In 2022, it’s 5.8%. So, the needle has not moved a lot yet. This really highlights the importance of ALCSI’s work.

NW: Speaking of screening rates, what are the current screening guidelines for lung cancer and the typical insurance policies that cover the screening?

AP: Right now, the United States Preventive Services Task Force recommends lung cancer screening with low dose Computed Tomography for people ages 50 to 80, who have at least a 20-pack year smoking history, and who either currently smoke or have quit smoking within the past 15 years—there’s an estimated 14.5 million people in the US who meet those criteria right now. And, because the United States Preventive Services Task Force gave lung cancer screening a Grade B recommendation, it means that most private insurers are required to cover the costs of lung cancer screening for people who meet those criteria.

Medicare also covers it up to age 77 and Medicaid, for states that have expanded their Medicaid coverage, covers lung cancer screening--but there’s still a small number of states that have not yet expanded their Medicaid coverage, so people who live in those states who have Medicaid are not eligible to get screening. But for the most part, people who are insured, either through private insurance or through Medicare, and who meet the United States Preventive Services Task Force criteria, should have their lung cancer screening covered by their insurance.

NW: What argument would you give to someone who meets the criteria to get screened for lung cancer but is still hesitant? And what does lung cancer look like in a typical individual?

CJY: I think that there are wide ranging symptoms for people who have lung cancer. For people who have later stages of lung cancer, they will often have some type of symptoms: chronic cough, coughing up blood, shortness of breath, wheezing, weight loss, fatigue. But, oftentimes, with early-stage lung cancer, people have no symptoms at all. That’s why we think lung cancer screening is so important: because if you can find lung cancer at its earliest stage, that leads to the best outcomes. Oftentimes, people aren’t going to have any symptoms. So, you need to rely on screening to initiate the discovery process. We urge everyone who fits the criteria to get screened.

NW: I know both of you do a lot of work with the American Lung Cancer Screening initiative. While we’re still on the topic of screening, can you both describe for our readers what exactly this is and what your goals are as an organization?

AP: We’re an all-volunteer team of students and doctors across the United States, and we have about 200 people working on our national initiatives team. Then, through our different chapters located at colleges across the US, we have a network of over 500 students all working to increase lung cancer screening awareness and access. And the two main goals of ALCSI are to teach people about the importance of early detection of lung cancer through lung cancer screening, and to help those who meet the USPSTF criteria get access to screening and get screened for lung cancer.

NW: So how is ALCSI different from other lung cancer-oriented organizations?

CJY: There are so many important issues affecting patients who have lung cancer, but we’ve decided to really focus on just lung cancer screening. That is because so few people who are eligible to get screened for lung cancer are getting screened. The estimates vary, but--to reiterate Alex’s earlier point--nationally less than 10% of people who are eligible to get screened for lung cancer are getting screened. So that’s why we’ve decided to really focus to put all our energy and all of our resources into lung cancer screening, especially because lung cancer screening is an incredibly powerful way to save lives.

The other thing that is different about our organization is that we are an all-volunteer organization, and I’m proud of the fact that everybody who is working on ALCSI is just volunteering their time. Any money from fundraising efforts, therefore, do not go to pay salaries. 100% goes straight to actual programs, and helping lung cancer patients, survivors, and those at risk for lung cancer.

NW: I know ALCSI had a recent initiative soliciting public service announcements and November’s Lung Cancer Awareness Month proclamations. What policy changes are you hoping will result from this?

AP: To describe a little bit more about these initiatives, we are working with different leaders within our communities at the local level, at the state level and at the national level, to speak about lung cancer screening in different forms, and speak about the importance of lung cancer screening.

There’s been two main ways we’ve done so far. One is through proclamations and having mayors and governors issue proclamations recognizing the importance of lung cancer screening and recognizing November as National Lung Cancer Awareness Month.

We’ve also done public service announcements where it’s a filmed video, and we have these leaders speak about the importance of lung cancer screening. I think the main goal of these PSAs and other proclamations is to just try to get more people involved in the conversation about the importance of early detection of lung cancer, and lung cancer screening and to think creatively about how we can get the message out about lung cancer screening.

We hope this will give us an opportunity to ask leaders to further enact change to promote lung cancer screening however they are able to. For example, if we can get legislation passed at the local level that allows people who live in that city to take paid time off work to go get screened, that would be helpful. That’s something that’s often done for breast cancer, and colon cancer, but not something we’ve seen yet for lung cancer screening.

So right now, it’s just about how can we get the message out. How can we engage all these different people and leaders in this effort to promote early detection through lung cancer screening? Once we answer these questions, we hope to then move towards something where there’s concrete changes being made.

NW: Can you tell us more about the House and Senate resolutions that have been introduced and passed to raise lung cancer screening awareness?

AP: So back in the summer of 2020, we were working on ways to increase lung cancer screening awareness and talking to people to get the message out. One of the things that I noticed was that the US House and the US Senate had never passed a resolution recognizing the importance of lung cancer screening. And the US House had never passed a resolution recognizing November as National Lung Cancer Awareness Month, which is shocking because when you look at other years, there seems to be one for breast cancer, colon cancer, cervical cancer, etc. It seemed so crazy that lung cancer wasn’t included--I couldn’t believe it.

So, I spoke with the health policy aide for a representative from my town, and I explained the situation: there has never been a US House or Senate resolution for lung cancer screening, and I wondered if this is something that my representative could introduce to the US House. They essentially told me that it could be introduced, but it’s not a great idea; and I don’t think it’s something we’re going to be willing to pursue or lead. That was frustrating. But it’s also just a testament to how people generally act towards lung cancer and lung cancer screening: they’re not willing to go out of their way to do something and enact change and pass or introduce a US House or Senate Resolution.__Eventually, we were able to get into contact with the Lung Cancer Caucus in the House, led by US Representative Brendan Boyle. We worked with his office, and US Senator Tina Smith and US Senator Ricky Rubio’s office to draft resolutions. These two resolutions were introduced in the US House and the US Senate in November 2020. The resolution was passed in the Senate, marking the first time the US Senate had ever recognized the importance of lung cancer screening. And I just want to emphasize that it not only passed, but it was passed by unanimous consent, meaning now we were able to get all 100 US senators to agree to a resolution recognizing November as National Lung Cancer Awareness Month and recognizing the importance of the early detection of lung cancer through screening. That was historic, because it had never been done before and, it really denotes a turning point where we’re able to engage these national leaders in these conversations about lung cancer and lung cancer screening and have their support. Since then, we’ve been able to work with the US Senate in 2021 and 2022, to pass--by unanimous consent--similar US Senate resolutions recognizing November as National Cancer Awareness Month and recognizing the importance of early detection.

The more recent resolutions have really been focused on disparities in lung cancer screening, especially among veterans and among women. And, of course, we’re going to work with the US Senate and US House again to introduce similar resolutions for 2023. But, this year, our goal is to get it passed in both the US Senate and the US House (which has never even recognized November as National Lung Cancer Awareness Month, so that would be a big step).

CJY: I just want to add to Alex’s answer. We are very grateful for the leadership of the senators and their offices without whom these resolutions would not have been passed. But I also wanted to point out that the drafts of these resolutions were written by Alex Potter, here. Obviously, we all helped but it really was just led by Alex and the final language looks actually very similar to the exact language that Alex had drafted out--obviously with the input and recommendations from the Congressional Research Service. Alex did this when she was a second-year college student. So, I wanted to highlight this to hopefully inspire our younger readers to know that you really can make a huge difference--regardless of how young or old you are.

And one more thing, the most recent resolutions have also highlighted that people who don’t smoke get lung cancer, as well.

NW: We’ve covered a lot of different initiatives so far, but what do you think is the most impactful difference ALCSI has made?

CJY: I think a lot of the things we touched upon earlier are important achievements that ALCSI has done. But I think the most impactful difference ALCSI has made is just our ability to teach people about lung cancer screening, and to get out there in the community and have these one-on-one conversations with people about what lung cancer screening is. Do they qualify? Do they know anyone who qualifies? At the end of the day, that’s really what makes ALCSI special. Our team of wonderful, passionate students are excited to go out there and really make a difference and help people. And as we continue to grow and continue to talk to people, that’s really what’s going to make the biggest difference in getting more people screened.

NW:What do you envision for ALCSI’s future? And similarly, what do you think ALCSI can do better going forward?

AP: I think just continuing to grow and engage more people to increase awareness of screening is important. And I think one of the things that ALCSI would like to do moving forward is not only getting the message out about screening, and teaching people about screening, but also helping the people who do qualify get screened. So, for 2023 and 2024 and beyond, that’ll be one of our main focuses: really figuring out how to best guide people in this lung cancer screening process and make sure that those who should be getting screened, have the resources to get screened.

NW: Lastly, and most important question so far, how can individuals get involved with ALCSI and lung cancer screening advocacy?

AP: We would love anyone who’s interested to join our team. If anyone is interested in joining, they can send an email to info@alcsi.org.

We’re just a community of passionate people, excited to make change and teach others. So, we would love anyone, including students, doctors, lung cancer survivors, and anyone else who’s interested, to come and join this effort and help us teach more people about lung cancer screening.